Term
| 3 determinates of myocardial O2 demand |
|
Definition
HR
Myocardial contractility
Intra-myocardial wall tension |
|
|
Term
| Drug of choice for chronic stable angina? |
|
Definition
|
|
Term
| What drugs increase coronary blood flow? |
|
Definition
|
|
Term
| What drugs improve regional blood flow distribution? |
|
Definition
| Nitrates, CCBs & B-blockers |
|
|
Term
| What drugs decrease HR & cardiac contractility? |
|
Definition
|
|
Term
| What drugs decrease myocardial wall tension? How? |
|
Definition
Nitrates- decrease preload
CCBs- decrease afterload |
|
|
Term
| What is nitric oxide physiologically identical to? |
|
Definition
| EDRF- endothelium-derived relaxation factor |
|
|
Term
|
Definition
| Venodilation and coronary artery dilation |
|
|
Term
| Important pharmacokinetics of NTG |
|
Definition
| 1st pass effect & low bioavailability |
|
|
Term
| Major drug interactions of NTG |
|
Definition
| Erectile dysfunction drugs |
|
|
Term
| Usual dose of sublingual NTG? |
|
Definition
|
|
Term
| This drug has the same pharmacological activity, SE and drug interactions as NTG, but has a slower onset and longer duration. Active metabolite? |
|
Definition
Isosorbide dinitrate (Isordil)
AM: Isosorbide mononitrate |
|
|
Term
| Active metabolite of isosorbide dinitrate, has 100% bioavailability |
|
Definition
| Isosorbide mononitrate (Imdur, Monoket) |
|
|
Term
| Non-DHP CCBs work on which type of calcium channels? |
|
Definition
|
|
Term
| Physiological effects of non-DP CCBs |
|
Definition
| Vascular smooth muscle relaxation: reduces BP, wall tension & CA vasospasm |
|
|
Term
| What is the "prototype" DHP-CCB? |
|
Definition
|
|
Term
| DHP-CCB with the longest T1/2? |
|
Definition
|
|
Term
| SE and contraindications of DHP-CCB use. |
|
Definition
SE: Peripheral edema, flushing, headache
C: Heart failure |
|
|
Term
| SE & contraindications of verapamil |
|
Definition
SE: Same as DHP-CCBs + bradycardia & constipation
C: LV dysfunction & heart failure
*Dilitazem does not cause constipation |
|
|
Term
| Which B-blockers are commonly used for chronic stable angina? |
|
Definition
Cardioselective: Atenolol & Metoprolol
Non-cardioselective: Nadolol & Propanolol |
|
|
Term
| 10-Point plan for Chronic Stable Angina (ABCDE) |
|
Definition
A: Aspirin & antiplatelets
B: B-blockers and BP
C: Cholesterol & cigarettes
D: Diet & diabetes
E: Education & exercise |
|
|
Term
| What type of anti-ischemic drug should be administered w/in 24h if a patient presents with Class I unstable angina? |
|
Definition
|
|
Term
| What type of anti-ischemic drug should be administered w/in 24h if a patient presents with Class III unstable angina? |
|
Definition
|
|
Term
| In preparation for a CABG, what drug must be withheld for 7 days prior? |
|
Definition
|
|
Term
| What anti-platelet drug should be administered asap if a pt presents with Class I unstable angina? |
|
Definition
|
|
Term
| Which two classes of anti-arrhythmic agents slow ventricular response? |
|
Definition
|
|
Term
| Which class of anti-arrhythmic agents is not effective against supraventricular arrhythmias? |
|
Definition
|
|
Term
| What are the common types of supraventricular arrhythmias? |
|
Definition
| Asystole, PEA, sinus bradycardia, paroxysmal supraventricular tachycardia, atrial flutter, a-fib |
|
|
Term
| Management strategies of A-fib |
|
Definition
1. Ventricular rate control
OR
2. Conversion to and maintenance of normal sinus rhythm
PLUS
3. Thromboembolism prevention |
|
|
Term
| According to the RACE trial results, does rate control or electrical cardioversion result in less side effects? |
|
Definition
| "Adverse effects less with rate control agents" |
|
|
Term
| What are some agents for heart rate control in A-fib? |
|
Definition
- B-blockers: Metoprolol, propanolol, esmolol
- Non-DHP CCBs: diltiazem, verapamil
- Digoxin |
|
|
Term
| Most effective drug class for rate control of A-fib? |
|
Definition
|
|
Term
| Major drug interactions of CCBs |
|
Definition
Digoxin: Inc concentrations
CYP-3A4 inhibitors |
|
|
Term
| Contraindications of CCB use |
|
Definition
|
|
Term
| Preferred A-fib rate control drug if the patient is in heart failure or has LV dysfunction? |
|
Definition
|
|
Term
|
Definition
| AV block & ventricular tachyarrhythmias |
|
|
Term
| Major contraindication of digoxin? |
|
Definition
|
|
Term
First-line agent for most A-fib pts requiring rhythm control and the anti-arrhythmic agent of choice in heart failure.
EKG changes associated with this drug? |
|
Definition
Amiodarone
Prolonged QT interval |
|
|
Term
| Class III agents for sinus rhythm control in A-fib |
|
Definition
| Amiodarone, sotalol, dofetilide (Tikosyn) |
|
|
Term
| Class Ic agents for sinus rhythm control in A-fib |
|
Definition
Flecainide (Tambocor)
Propafenone (Rhythmol) |
|
|
Term
| Amiodarone is used in patients with _______________, ____________ and to _______________________________. |
|
Definition
Sustained V-tach
V-fib
Maintain sinus rhythm in A-fib |
|
|
Term
|
Definition
Pulmonary toxicity
Hyper/hypothyriod: b/c of iodine
Liver toxicity
GI: nausea, constipation
Ocular: deposits, neuritis
Derm: photosensitivity, bluish discoloration
Neurologic: ataxia, parasthesias, tremor
CV: bradycardia, heart block, torsades |
|
|
Term
| Drug interactions of Amiodarone |
|
Definition
Warfarin- dec warfarin dose
Digoxin- doubles Ami levels
B-blockers, CCBs, anti-arrhythmics |
|
|
Term
| Structurally related to Amiodarone, this drug is FDA approved for patients with a-fib/flutter who do not have heart failure. |
|
Definition
Dronedarone
*Doesn't contain iodine, shorter T1/2, less drug interactions |
|
|
Term
| The only Class III agent for both conversion and maintenance of sinus rhythm in A-fib. SE? |
|
Definition
Dofetilide (Tikosyn) [Class III]
SE: QT prolongation, torsades |
|
|
Term
| Drug interactions of Dofetilide (Tikosyn) |
|
Definition
| Verapamil, cimetidine, ketoconazole, trimethoprim, prochlorperazine & megestrol all increase serum levels of Dofetilide (Tikosyn) |
|
|
Term
| Major benefit of using Class Ic anti-arrhythmics for a-fib |
|
Definition
| Class Ic anti-arrhythmics have a great effect of the conduction rate throughout the heart |
|
|
Term
| SE of Flecainide (Tambocor)? [Class Ic] |
|
Definition
Flecainide (Tambocor) can cause:
Inc ventricular rate, dizziness (30%), visual changes, dyspnea |
|
|
Term
| SE of Propafenone (Rhythmol) [Class Ic] |
|
Definition
Propafenone (Rhythmol) can cause:
Bradycardia, heart block, heart failure, nausea, taste changes, bronchospasm, constipation |
|
|
Term
| This drug exhibits non-linear kinetics, and serum levels may increase 10x as the dose is slowly increased. |
|
Definition
|
|
Term
What is the "pill-in-the-pocket" dose of:
Flecainide (Tambocor)?
Propafenone (Rhythmol)? |
|
Definition
Flecainide (Tambocor): 300mg after onset of palpitations
Propafenone (Rhythmol): 600mg after onset of palpitations
|
|
|
Term
| In what patients should rate control be the first line of treatment for persistent A-fib? |
|
Definition
>65 yo
CAD
Anti-arrhythmic drug contraindications
Unsuitable for cardioversion
Pts w/o heart failure |
|
|
Term
| In what pts should rhythm control be the first line of treatment for persistent A-fib? |
|
Definition
Pts asymptomatic after rate control
< 65 yo
1st presentation w/ lone a-fib
Hypotension or worsening heart failure |
|
|
Term
| What is the CHADS scoring? |
|
Definition
C: CHF
H: HTN
A: Age >75 yo
D: DM
S: Stroke/TIA
Score >2: high risk |
|
|
Term
| This drug is used for paroxysmal supraventricular tachcardia |
|
Definition
Adenosine
*T1/2 = 5 seconds |
|
|
Term
| Class Ia anti-arrhythmic with the SEs of diarrhea and cinchonism w/ high doses. |
|
Definition
|
|
Term
| Class Ia anti-arrhythmic with the SE of SLE, hypotension & torsades |
|
Definition
|
|
Term
| Class Ia anti-arrhythmic with the SE of urinary retention, blurred vision and torsades |
|
Definition
|
|
Term
| 3 Class Ia anti-arrhythmic agents |
|
Definition
| Quinidine, procinamide, disopyramide |
|
|
Term
| 2 Class Ib anti-arrhythmic agents |
|
Definition
| Lidocaine, Mexiletine (Mexitil) |
|
|
Term
This anti-arrhythmic agent is only available IV for treating ventricular arrhythmias.
Major SE? |
|
Definition
Lidocaine
SE: Tremor, hallucinations, & parasthesias (w/ high serum levels)
*Mexiletine is oral |
|
|
Term
| What type of anti-arrhythmic drugs may result in Torsade de Pointes? |
|
Definition
| Drugs that prolong the QT interval |
|
|
Term
| How is Torsade de Pointes treated? |
|
Definition
| IV magnesium sulfate or isoproterenol |
|
|
Term
| Drug tx of mild to moderate migraine attacks? |
|
Definition
| NSAIDs, analgesics w/ caffeine |
|
|
Term
| 4 Therapeutic strategies for migraine headache treatment |
|
Definition
Abortive
Analgesic
Anti-emetic
Prophylactic |
|
|
Term
| Most prescribed -triptan for migranes |
|
Definition
|
|
Term
| SE of sumatriptan (Imitrex) |
|
Definition
Coronary vasocontstriction
(contraindicated in CAD or uncontrolled HTN)
Tingling, flushing, dizziness |
|
|
Term
| These two -triptans have a longer T1/2 an duration of action than sumatriptan. |
|
Definition
Naratriptan (T1/2: 6h)
Frovatriptan (T1/2: 26h) |
|
|
Term
| Preferred ergot alkaloid for tx of migraines? |
|
Definition
| Dihydroergotamine mesylate (DHE) |
|
|
Term
|
Definition
Nausea & vomiting (give anti-emetic, ie metoclopramide)
Ergotism (gangrene)
Uterine contractions: pregnancy X |
|
|
Term
| How does a pt prevent medication overuse headache? |
|
Definition
| Limit use of ergots, triptans and analgesics to 10 days per month |
|
|
Term
| What are the first line drugs for migraine prophylaxis? |
|
Definition
Beta-blockers: propanolol & timolol
Tricyclic antidepressants: amitriptyline, nortriptyline
Valproic acid derivatives: depakote & depakene
Topiramate
|
|
|
Term
| Tx of migraines in children? |
|
Definition
NSAIDs, nasal spray sumatriptan
Prophylactic: propanolol |
|
|
Term
| Most common type of primary headache? |
|
Definition
|
|
Term
| Antiepileptic drugs block which type of calcium channels? |
|
Definition
|
|
Term
| What are some basic principles of anti-epileptic therapy? |
|
Definition
- Drug choice is based on seizure classification
-Monotherapy preferred
-Least-sedating agents
-Least drug interactions |
|
|
Term
| Which anti-epileptic drugs are most sedating? |
|
Definition
Phenobarbital
Primidone
Benoziadepines |
|
|
Term
| Drugs of choice for partial seizures? |
|
Definition
|
Carbamazepine
Phenytoin
Oxacarbazepine
Gabapentin*
Lamotrigine*
Topiramate*
|
|
|
Term
| Drugs of choice for generalized tonic-clonic seizures? |
|
Definition
|
Valproate
Phenytoin
Carbamazepine
Lamotrigine*
Topiramate*
|
|
|
Term
| Drugs of choice for generalized absence seizures? |
|
Definition
|
Ethosuximide
Valproate
Lamotrigine*
|
|
|
Term
| Drugs of choice for myclonic, atonic & atypical absence seizures? |
|
Definition
|
|
Term
| This anti-epileptic drug undergoes autoinduction, resulting in a decreased T1/2 over the first month of use. |
|
Definition
|
|
Term
|
Definition
Leukopenia (monitor WBCs every 2wks for 1st month)
Rash
SLE
Aplastic anemia
SIADH |
|
|
Term
| What CYP enzymes are affected by carbamazepine? How? |
|
Definition
| Carbamazepine induces 2C9, 2C19 and 3A4 |
|
|
Term
| What seizure types are treated with carbamazepine? |
|
Definition
Partial and generalized T-C
* Aggravates absence & myclonic |
|
|
Term
| What seizure types are treated with Phenytoin (Dilantin) and Fosphenytoin (Cerebyx)? |
|
Definition
Partial and secondarily generalized seizures
*Aggravates absence seizures |
|
|
Term
| What are the notable kinetics of phenytoin? |
|
Definition
Zero-order kinetics at higher doses b/c of saturation
Narrow therapeutic range
Must adjust dosage for low albumin levels |
|
|
Term
| SE of phenytoin & fosphenytoin? |
|
Definition
| Nystagmus, dyskinesias, gingival hyperplasia |
|
|
Term
| These drugs are used in all types of seizures. |
|
Definition
| Valproate: Depakene & depakote |
|
|
Term
SE of valproate?
Drug interactions? |
|
Definition
SE: Weight gain, alopecia, hepatotoxicity, thrombocytopenia
DI: Warfarin, phenytoin, carbamazepine |
|
|
Term
|
Definition
| Liver fxn tests & platelet count every month for 1st 2 months |
|
|
Term
| What seizure types are treated with phenobarbital? |
|
Definition
| Partial and generalized T-C |
|
|
Term
| Half life and SE of phenobarbital? |
|
Definition
T1/2 = 100h (need loading dose)
SE: Sedation, rash, nystagmus, dizziness
Very CHEAP, $4/mo |
|
|
Term
What seizure types are treated with Ethosuximide (Zarontin)?
Effect on CYP-450? |
|
Definition
Ethosuximide (Zarontin):
Absence seizures
NO EFFECT on CYP-450 |
|
|
Term
What seizure types are treated with Topiramate (Topamax)?
SE? |
|
Definition
Topiramate (Topamax):
Partial and generalized T-C seizures
SE: Paresthesias, decreased sweating, hyperthermia, kidney stones, metabolic acidosis |
|
|
Term
| Drug interactions, monitoring, and other uses of Topiramate (Topamax). |
|
Definition
Topiramate (Topamax):
DI: Phenytoin, oral contraceptives
M: serum bicarb
Other uses: migraine prophylaxis, neuropathic pain |
|
|
Term
| A carbamazepine analog used to treat partial seizures that does not undergo auto-induction. |
|
Definition
| Oxcarbazepine (Trileptal) does not undergo auto-induction |
|
|
Term
| SE of Oxcarbazepine (Trileptal)? |
|
Definition
Oxcarbazepine (Trileptal):
Rash, hyponatremia |
|
|
Term
What seizure types are treated with Lamotrigine (Lamictal)?
SE? DI? |
|
Definition
Lamotrigine (Lamictal):
Partial and generalized seizures
SE: Severe rash which may progress to Stevens-Johnson Syndrome
DI: Valproate
*Expensive |
|
|
Term
| SE: Non-convulsive status epilepticus |
|
Definition
|
|
Term
| Similar to Topiramate, SE: Stevens-Johnson Syndrome |
|
Definition
|
|
Term
| This drug is used as adjunct therapy for drug-resistant seizures only. |
|
Definition
|
|
Term
| SE: Aplastic anemia, acute hepatic failure |
|
Definition
|
|
Term
| Types of benzodiazepines used for the tx of seizures. |
|
Definition
Diazepam (Valium)
Clonazepam (Klonopin)
Clorazepate (Tranxene) |
|
|
Term
| Ideally, how long before pregnancy should AEDs be stopped? |
|
Definition
|
|
Term
| What supplements should a pregnant woman take if she continues her AEDs during pregnancy? |
|
Definition
|
|
Term
| Drugs of choice for the tx of status epilepticus? |
|
Definition
|
|
Term
| Why is dopamine not an effective drug for the tx of Parkinson's? |
|
Definition
| Dopamine cannot cross the BBB |
|
|
Term
| What drug must be given with levodopa? Why? |
|
Definition
| Carbidopa b/c it blocks levodopa activity in the peripheral tissues, allowing more levodopa to act on the brain. Also prevents nausea. |
|
|
Term
| Why must levodopa be given on an empty stomach? |
|
Definition
| Levodopa must be given on an empty stomach to avoid absorption inhibition by proteins. |
|
|
Term
| Most effective treatment for Parkinson's disease? |
|
Definition
Levodopa
is the most effective treatment for Parkinson's disease |
|
|
Term
|
Definition
GI: Nausea, anorexia, body fluid darkening
CV: orthostatic hypotension, inc homocystine
Neuro: sedation, hallucinations, pathologic gambling
Motor: fluctuations in motor activity, dyskinesias |
|
|
Term
|
Definition
| Vitamin B6, ferrous sulfate, TCAs, metoclopramide |
|
|
Term
These drugs help to metabolize levodopa in the GI tract, and increase its T1/2 by 50%.
SE? |
|
Definition
COMT inhibitor: Entacapone
SE: Nausea, diarrhea, urine discoloration |
|
|
Term
2 non-ergot dopamine agonists for the tx of Parkinson's.
SE? |
|
Definition
Pramipexole (Mirapex)
Ropinirole (Requip)
SE: othostatic hypotension, sleep attacks, hallucinations, psychosis |
|
|
Term
| This drug is the only injectable drug for Parkinson's, the most potent dopamine agonist, and must be given with an anti-emetic. |
|
Definition
|
|
Term
This MAOBI is metabolized to L-methamphetamine
and L-amphetamine. |
|
Definition
|
|
Term
| Preferred MAOBI for the tx of Parkinson's? Why? |
|
Definition
Rasagiline
*Similar to selegiline but not metabolized to amphetamines (less stimulating) |
|
|
Term
| SE: Livedo reticulatis (purple, mottled, fishnet-like rash) |
|
Definition
|
|
Term
| Anticholinergic drugs used for the tx of Parkinson's? Action? |
|
Definition
Benztropine (Cogentin) and Trihexyphenidyl (Artane)
Balances cholinergic & dopaminergic neurotransmitters |
|
|
Term
| Drug therapy for essential tremor? |
|
Definition
|
|
Term
| First-line pharmacologic agents for the tx of restless legs syndrome? |
|
Definition
Ropinirole (Requip)
Levodopa
Pramipexole |
|
|
Term
| 4 Cholinesterase inhibitor drugs used for the tx of Alzheimer's? |
|
Definition
Tacrine (Cognex)
Donepezil (Aricept)
Rivastigmine (Exelon)
Galantamine (Razadyne) |
|
|
Term
| SE of cholinesterase inhibitors |
|
Definition
| nausea, diarrhea, incontinence, insomnia, headache |
|
|
Term
| Most hepatotoxic cholinesterase inhibitor? |
|
Definition
Tacrine (Cognex)
*Inconvenient: must take 4x day b/w meals |
|
|
Term
| Why is Riviastigmine (Exelon) an inconvenient tx for Alzheimer's? |
|
Definition
| Dose must be titrated up every 2 weeks. If a dose is missed, one must gradually taper back up to the necessary dose. |
|
|
