Term
| what are 2 different ways to say coronary artery disease |
|
Definition
ischemic heart disease
athlerosclerosis of epicardial vessels |
|
|
Term
| when does coronary artery disease begin |
|
Definition
| begins early in life, manifests middle aged and beyond |
|
|
Term
| what are 5 manigestations of coronary artery disease |
|
Definition
heart failure
arrhythmia
stroke
peripherial vascular disease
acute coronary artery disease |
|
|
Term
| what are the 4 types of coronary artery disease |
|
Definition
angina syndrome
stable (exercise induced) angina
prinzmetal (vasospastic) angina
unstable angina |
|
|
Term
|
Definition
| describes variation in manigestation of agonia and its symptoms |
|
|
Term
| what are the symptoms of angina due to |
|
Definition
| ischemic pain (angina equlivaents) and accumulation of metabolites in striated muscle |
|
|
Term
| where is the pain in angina from most to least common 4 |
|
Definition
anterior chest
left upper arm
left lower arm
neck pain |
|
|
Term
| what causes vasospasm in CAD |
|
Definition
| imbalance of oxygen use and delivery |
|
|
Term
|
Definition
| when myocardial requirement increases (like exercise0 coronary flow does not increase proportionally causing ischemia and pain |
|
|
Term
| what is prinzmetal angina |
|
Definition
oxygen delivery decreased due to reversible coronary vasospasm
not brought on by exertion or emotional stress not relieved by rest |
|
|
Term
| EKG signs of prinzmetal angina |
|
Definition
| ST elevation (injury marker) |
|
|
Term
| cause of prinzmetal angina |
|
Definition
| altered vasodilators (NO, prostacyclin) or vasoconstrictors (entothelial, ANG II) |
|
|
Term
|
Definition
| change in stable angina or angina at rest |
|
|
Term
|
Definition
| increased coronary tone or platelet clots on athlerosclerosis |
|
|
Term
| what is the general approach to angina treatment |
|
Definition
| tissue ischemia is thwarted using vasodilator or anti-vasoconstrictor drugs |
|
|
Term
| what is the order of treatment and theory behind each in treatment/prevention of stable angina |
|
Definition
1. BB: decrease myocardial O2 demand
2. CCB: vasodilation decreases coronary/peripherial resistance and heart O2 demand
3. nitrates: venodilation decreases proload and myocardial O2 demand |
|
|
Term
| what are the tx of variant angina |
|
Definition
nitrates: relax coronary vessels, reduces spasm
CCB: relax coronary vessels, reducing spasm |
|
|
Term
|
Definition
aspirin, heparin
DOC: nitroglycerin
BB
CCB |
|
|
Term
| what is the tx of angina post MI |
|
Definition
|
|
Term
| what is the tx of angina with DM |
|
Definition
|
|
Term
| what is the tx of angina with LV dysfunction |
|
Definition
|
|
Term
| what is the tx of angina with CAD or LDL>130 |
|
Definition
|
|
Term
| what is the tx of angina with increased platelets |
|
Definition
aspirin
clopidogerl
pasugrel |
|
|
Term
|
Definition
converte nitrate ions to NO
activates guanylyl cyclase
increases cAMP
increases protein kinase G
activates phosphatases
dephosphyorlyate myosin light chain
vasodilation |
|
|
Term
| how is notroglycerin different at different doses |
|
Definition
moderate: dilates large veins > pooling of blood > decreases proload
all doses: dilate coronary vessels > increased blood to heart muscle |
|
|
Term
| administration and time of onset of nitroglycerin |
|
Definition
sublingual 2 min
transdermal 12h on 12h off prophylaxis |
|
|
Term
|
Definition
headache: migraine caused by vasodilation
orthostatic hypotension
reflex tachycardia
rolerance/tachyphylaxis (avoid with 6-8h nitrate free interval) |
|
|
Term
| how is isorbide mononitrate and isorbide dinitrate different from nitroglycerin |
|
Definition
oral administration
longer onset and duration |
|
|
Term
| interactions with nitro drugs |
|
Definition
NEVER COMBINE WITH PHOSPHODIESTERASE INHIBITORS (slidenafil, vardenafil, tadalafil)
causes extreme hypotension and death
erectile dysfunction is common in people with CAD |
|
|
Term
| what 3 BB are used for angina |
|
Definition
propranolol
metoprolol
atenolol |
|
|
Term
| what BB are not good for angina, why |
|
Definition
| partial agonists (sympathomimetric) are less efective (pindolol, acebutolol) |
|
|
Term
|
Definition
decrease sympathetic tone, HR, contractability
block B1 receptors
reduce frequency and severity of angina |
|
|
Term
| what are the CCB that work on angina and how |
|
Definition
dihydropyridines: work on vessels, causes reflex tachycardia
verapmil and diltiazem: work on heart (preferred) |
|
|
Term
|
Definition
stop influx of Ca via L-Ca channels which stops calmodulin from turning Ca into Ca-calmoulin so it cannot activate myosin LC kinase and thus cannot cause contraction
vasodilation reduces coronary vasospasm and myocardial O2 demand
also used in raynaud's (vasospasm in cold) |
|
|
Term
|
Definition
| who knows, dosent reduce HR and BP |
|
|
Term
|
Definition
| adjunct therapy to BB, CCB, nitrates |
|
|
Term
|
Definition
| prolonged QT syndrome (causes torsades) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| increase in renal Na excretion and thus water excretion (diuretic) |
|
|
Term
| define diuretic and function |
|
Definition
inhibits ion transport and decreases Na transport in nephron
manage fluid retention (edema), tx HTN |
|
|
Term
|
Definition
filtered in glomerulus and not reabsorbed
causes osmotic attraction of water (not Na) to tubular lumen |
|
|
Term
| mannitol location of action 3 |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
maintain urine flow during toxic ingestion of substances causing renal failure
reduce increased ICP
lower pressure in acute glaucome
rhabdomyolysis: severe muscle injury to eliminate myoglobin |
|
|
Term
| what are the 6 types of K supplements and their adlministration |
|
Definition
K-DUR: KCl tablets
K-LOR: KCl powder
K-LYTE/CL: KCl tablets
K-TAB: KCl tablets
KLOTRIX: KCl tablets
KAO lectrolyte: fluid and electrolyte replacement |
|
|
Term
| what is KAO lectrolyte made of 6, when is it used |
|
Definition
dextrose, Na, K, citrate, calories, phenylalanine
mild/moderate diarrhea/vomiting |
|
|
Term
|
Definition
hepatic ascites: accumulation of fluid in abdomen
hyperALD: primary, secondary, decreased ability of liver to inactivate
nephrotic syndrome: glomerular membrane damaged and allows protein through decreasing colloid osmotic pressure
premenstural edema: increased estrogen causes loss of fluid into ECF |
|
|
Term
| causes of hepatic ascites |
|
Definition
| cirrhosis causes portal system obstruction and decreased colloid osmotic pressure |
|
|
Term
| what are the drugs that work on the PCT 4 |
|
Definition
acetazolamide
brinzelamide
dorzolamide
methazelamide |
|
|
Term
| what are the drugs that work on the loop of henle |
|
Definition
loop diruetics-
bumetanide
furosemide
torsemide
etharcynic acid |
|
|
Term
| thiazide diuretics and analogs 4 |
|
Definition
hydrochlorathiazide
chlorthalidone
metazone
indapamide |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| describe the cells of the PCT |
|
Definition
tall
microvili
basla invaginations
interdigitated borders |
|
|
Term
| explain how the PCT regulates acid/base |
|
Definition
CA changes bicarbonate+H from urine into CO2+H2O which can diffuse into the cell
CA turns it back into bicarbonate+H
H is sent back to urine with Na/H antiporter
bicarbonate uses facillitated transport to enter the blood |
|
|
Term
| other than the pumps for acid base regulation, what other transport is happening in the urine |
|
Definition
Na/glucose, AA, lactate, HPO4 symporter from lumen to blood
Na/K ATPase on blood side
60% of H2O diffuses into blood
organic anions and cations diffuse into urine |
|
|
Term
| what organic anions 3 and cations 3 diffuse into urine in PCT |
|
Definition
diuretics
antibiotics
uric acid
creatinine
procanamide
choline |
|
|
Term
|
Definition
carbonic anhydrase inhibitior makes it so bicarbonate cannot form CO2+H2O and diffuse into the cell causing metabolic acidosis
there isnt enough H to run the Na/H pump so Na also stays in the urine and draws water (Weak diuretic)
Cl is retained in the blood causing hyperchloremia |
|
|
Term
|
Definition
DOC chronic glaucoma
acute mountain sickness prophylaxis
seizure adjunct medicing |
|
|
Term
| how is acute mountain sickness treated, what are the symptoms |
|
Definition
5d prior to ascent
prevents weakness, SOB, dizziness, nausea, cerebral and pulmonary edema |
|
|
Term
|
Definition
hyperchloremic metabolic acidosis
renal stones (basic urine favors CaP)
sulfonamide allergies
hypokalemia |
|
|
Term
| what exchange happens in the thin limbs of the loop of henle |
|
Definition
thin limbs do not participate in reabsorption of Na
they are permeable to water which is impaired by mannitol and glucose |
|
|
Term
| what drugs interact with loop diuretics |
|
Definition
aminoglycocides
digoxin (decreases) |
|
|
Term
| what are the channels of the thick loops |
|
Definition
K/Na/2Cl symporter from urine to cell
K leak channel from cell to urine
Na/K antitiporter from cell to blood
K/Cl symporter from cell to blood
Mg+Ca charge driven transport paracellular from urine to blood |
|
|
Term
|
Definition
stop Na/L/Cl channel causing ion and water retention in ascending loop
increase Ca in urine because when Na/K/Cl transport is stopped there is no K build up and no leak which stops positive charge and Mg/Ca dont diffuse into blood |
|
|
Term
|
Definition
acute pulmonary edema (IV rapid onset, powerful)
CHF
HTN
nephrotic system edema
kidney failure edema |
|
|
Term
|
Definition
ototoxicity: tinnutis, vertigo, deafness, fullness (worse with amnioglucocides and etharynic acid)
hyperuricemial: WA competes for transport in PCT to stay in urine
acute hypovolemia: severe, rapid, shock, arrhythmia
orthostatic hypotension
hypokalemic acidosis
sulfonamide allergy |
|
|
Term
| what is the most powerful diuuretic |
|
Definition
|
|
Term
| how much Na is reabsorbed in each portion of nephron |
|
Definition
PCT 50%
loop 40%
DCT 10%
CD 5% |
|
|
Term
| what carbonic anhydrase inhibitors are specific to IOP and used in OPEN angle glaucoma |
|
Definition
brinselamide
derzelamide
methazolamide |
|
|
Term
| why use a thiazide analog |
|
Definition
| thizade diuretics dont work GFR <40 |
|
|
Term
|
Definition
simple cuboidal
impermeable to water |
|
|
Term
|
Definition
inhibits Na/Cl co-transporter and has some action on Ca in PCT
increased Na/Cl in urine pulls water
causes K loss because they increase delivery of Na to CD and Na/K channel causes K excretion
this alters balance of Na/Ca exchanger and increases Ca in the blood
decreases TPR and BP which can decrease CP and causes hypotension |
|
|
Term
|
Definition
HTN: decreases TPR wo major diuretic effect
CHF: decreases extracellular edema
edema: CHF, cirrhosis, kidney edema
hypercalcuria: good for CaOxylate stones
nephrogenic DI: cause hyperosmloar urine (act like ADH) |
|
|
Term
|
Definition
hypokalemic acidosis
hypercalcemia
orthostatic HTN
hyperlipidemia
sexual dysfunction
sulfonamide allergy
hyperuricemia: WA competes with uric A in PCT
hypoglycemia |
|
|
Term
| why do thiazides cause hypoglucemia |
|
Definition
B cells K channels are normally open
diuretic causes loss of K so they stay open longer and dont make much insulin |
|
|
Term
| what are the 4 transporters in the DCT |
|
Definition
Na/Cl synporter from urine to cell
Ca channel from cell to urine
Na/K ATPase on blood side
Na/Ca antiporter with Na going from blood to cell |
|
|
Term
| how is transport in the DCT regulated |
|
Definition
| PTH regulates luminal Ca channels and apical Na/Ca antiporter |
|
|
Term
| why do drugs cause K sparing |
|
Definition
| they increase Na before the CD/CT and the concerntration sucks the K into the CD/CT when Na tries to get out in the exchanger |
|
|
Term
| what are the channels on the luminal side of the principal cell 3 |
|
Definition
Na into cell
N into lumen
water into cell |
|
|
Term
| what are the channels/pumps on the apical side of the principal cell 2 |
|
Definition
Na/K ATPase
H2O ALD controlled channels |
|
|
Term
| what pericellular transport is there in the CD |
|
Definition
|
|
Term
| what are the transporters on the intercalated cells |
|
Definition
ATP pump H into urine
Cl/bicarb antiporter putting bicarb into blood |
|
|
Term
| what is the primary site of H secretion |
|
Definition
| intercalated cells of the CD |
|
|
Term
| how does ADH regulate the CD |
|
Definition
| opens aquporin channels on apical side of cells |
|
|
Term
| how does ALD regulate the CD |
|
Definition
| increases activity in luminal Na and K channels buy increasing activity of Na/K ATPase putting K into urine and Na into blood |
|
|
Term
|
Definition
ALD receptor antagonists stimulate Na reabsorption into urine without K loss
spironolactone also blocks androgen receptors |
|
|
Term
| uses of K sparing diuretics 4 |
|
Definition
duiretic: low efficacy in Na mobalization
secondary hyperaldosteronism: cardiac failure decreases remodeling, cirrhosis, nephrosis
primary hyperaldosteronism: adrenal adenoma
female histurism: spironolactone only due to androgen blocking |
|
|
Term
|
Definition
spironolactone: P450 inducer and prodrug
spironolactone: gynacomastia in males, irregular menses (never give high dose chronically)
hyperkalemia
nausea, letharty, mental confusion |
|
|
Term
| MOA triametrene and amiloride and use |
|
Definition
block Na channels decreasing Na/K ATPase activity and thus retention of K (does not depend on ALD like spironolactone)
not as effective as diuretic so often combine with other diuretic to save K |
|
|
Term
| SE Na channel blocking diuretics 2 |
|
Definition
hyperkalemia
leg cramps (triameterene |
|
|
Term
|
Definition
| lipoproteins (plasma lipid complexes) are elevated increasing overall TG in the blood |
|
|
Term
| complications of hyperlipidemia |
|
Definition
acute pancreatitis
athlerosclerosis |
|
|
Term
| types of lipids, their optimal amounts |
|
Definition
APO B-100
LDL <100mg/dl
IDL
VLDL
TG/LP (lipoproteins) <150mg/dl
HDL >60mg/dl
lipoprotein liase |
|
|
Term
|
Definition
| convey lipids to the artery wall |
|
|
Term
|
Definition
| retreive cholesterol from artery wall and inhibit oxidation of lipoporteins |
|
|
Term
| lipoprotein lipase: location, function, regulation |
|
Definition
on endothelial and adipose cells
hydrolysis of TG on chylomicrons/VLDL
controlled by insulin |
|
|
Term
| what fat regulating enzyme is altered in diabetics? what is the result? |
|
Definition
lipoprotein lipase
decreased insulin causes hypertriglyceridiemia |
|
|
Term
| 3 ways lipid levels are altered |
|
Definition
diet and exercise
inherited genetic deficits
pharmacologic intervention |
|
|
Term
|
Definition
foam cells: transformed macrophages that endocytose lipoproteins and ROS
smooth muscle cells filled with cholesterol esters
atheroma: growth of collagen, fibrin, Ca |
|
|
Term
| treatment of athlerosclerosis outcomes |
|
Definition
| can slow regression but can allow migration of inflammatory activity of macrophages |
|
|
Term
| 8 risk factors for coronary artery disease |
|
Definition
increased age
family history
smoking
hypertension
obesity
sedentary
DM
high LDL
low HDL |
|
|
Term
|
Definition
| inhibits lipolysis in IN ADIPOSE decreasing circulating free Fa providing liver with less raw materials to make TG and thus VLDL |
|
|
Term
| overall what fats does niacin raise and lower |
|
Definition
lower: VLDL, LDL, cholesterol, TG
raises: HDL (great extent) |
|
|
Term
|
Definition
| tupe IIB, III, IV hyperlipoproteinemia (elevation of VLDL and LDL) |
|
|
Term
| niasin: administration, excretion |
|
Definition
|
|
Term
|
Definition
cutaneous flushing and warmpth (reduce with aspirin)
puritis (limits use)
gout/hyperuricemia: inhibits tubular secretion of uric acid |
|
|
Term
| what are the 3 fibrate drugs |
|
Definition
gemfibrozil
fenofibrate
fenofibric |
|
|
Term
|
Definition
ligands for nuclear transcription receptor peroxisome proliferation activated receptor alpha (PPAR-a)
upregulate lipoprotein lupase and down regulate APO CIII (lipolysis inhibitor) |
|
|
Term
| overall what fats do fibrates raise and lower |
|
Definition
|
|
Term
|
Definition
| hypertriglyceridemia (decreases TG) |
|
|
Term
| administration of fibrates |
|
Definition
| completely absorbed orally |
|
|
Term
|
Definition
N/V (lessens over time)
lithiasis/malignancy (gelfibrozil): gall stones and hepatobilliary neoplasms
muscle: myositis (inflammation of skeletal muscle) |
|
|
Term
| interactions with fibrates |
|
Definition
| warfarin (compete for binding on plasma proteins increasing warfarin effects) |
|
|
Term
| 3 bile acid binding resins |
|
Definition
| cholestryamine, colespipol, colesevelam |
|
|
Term
| MOA bile acid binding resins |
|
Definition
cationic resin binds negative bile salts and interrupts enterohepatic cycle
bile salts excreted in feves and more cholesterol must be used to replace them so the cells upregulate LDL receptors to pull more cholesterol in |
|
|
Term
| use bile acid binding resins 3 |
|
Definition
type IIa and IIb hyperlipidemias
often in combination with diets and statins |
|
|
Term
| bile acid binding resins: administration, distribution |
|
Definition
|
|
Term
| SE bile acid binding resins |
|
Definition
GI: constipation, nausea, flatulence (lessens over time)
absorption: decreased in absorption of fat soluble vitamins, ascorbate, folate |
|
|
Term
| interactions with bile acid binding resins |
|
Definition
tetracycline, phenobarbitol, digoxin, warfarin, aspirin, statins, thiazides
interacts with most drugs absorption so takes 1-2h before 4h after this drug
chloride salts: hyper chloremic metabolic acidosis |
|
|
Term
| 6 HMG-CoA Reductase inhibitors |
|
Definition
paravastatin
sinvastatin
atorvastatin
fluvastatin
lovastatin
rosuvastatin |
|
|
Term
| MOA HMG-CoA reductase inhibitor |
|
Definition
HMG-CoA is first enzyme and rate limiting step in sterol synthesis converting 3-hydroxy-3-methylglutarate into cholesterol
inhibition of HMG-CoA reductase: depletes intracellular supply of cholesterol
decrease in LDL and increase in LDL receptors: depletion of intracellular cholesterol causes increase in hepatocyte LDL receptors which picks up more LDL from plasma
increased plasma HDL: decrease risk of coronary artery disease (esp atrovastatin) |
|
|
Term
| pharmacokinetics of HMG-CoA reductase inhibitors |
|
Definition
atorvastatin/sinvastatin: first pass removes 50%
excretion in bile and feces |
|
|
Term
| SE HMG-CoA reductase inhibitors |
|
Definition
liver and muscle: evaluate function every 6mo (minor effects in 5y trial)
teratogenic, contraindicated in teens and kids
diminish visual activity (lens is 50% cholesterol)
less inclined to form osteoperosis |
|
|
Term
| interactions with HMG-CoA reductase |
|
Definition
| increase warfarin levels (evaluate prothrombin time frequently) |
|
|
Term
|
Definition
superstatin HMG-CoA reductase inhibitor (same MOA/SE)
lowers LDL 50% more effective
raises HDL 14% more effective |
|
|
Term
|
Definition
sometimes in combo with simvastatin
blocks absorption of cholesterol in SE
decreases cholesterol by 15% (50% in combination with statins) |
|
|
Term
|
Definition
|
|
Term
| what are the 3 categories of psychomotor stimulants |
|
Definition
methylaxanthines
nicotine
amphetamines |
|
|
Term
| what 2 drugs are methylaxanthines |
|
Definition
|
|
Term
| what 8 drugs are amphetamines |
|
Definition
sodium oxybate
modafinil
cocaine
ephedrine
methamphetamine
phentermine
deotroamphetamin |
|
|
Term
| what 3 drugs are used for the same purposes as amphetamines but are not amphetamines |
|
Definition
sibtramine
amoextine
quanfacine |
|
|
Term
| what 2 drugs are methylaxathines |
|
Definition
|
|
Term
|
Definition
| stimulates nicotinic receptors in CNS causing depolarization |
|
|
Term
|
Definition
euphoria
arousal
improves attention
learning
problem solving
reaction time |
|
|
Term
| where is nicotine absorbed 5 |
|
Definition
oral mucosa
lungs
GI mucosa
skin |
|
|
Term
| where is nicotine distributed |
|
Definition
| lipid soluble so everywhere |
|
|
Term
| where is noctine metabolized 2 |
|
Definition
|
|
Term
| how is nicotine used in medicine |
|
Definition
|
|
Term
|
Definition
release of biogenic amines (NE, D, SE) from storage sites in nerve terminals
may interfere with re-uptake of NT into neurons |
|
|
Term
|
Definition
|
|
Term
| amphetamines metabolization |
|
Definition
catabolic pathway
excreted in urine
possible Fe trap of weak base |
|
|
Term
| dopamine SE of amphetamines 4 |
|
Definition
increased alertness
decreased fatigue
decreased appetite
insomnia |
|
|
Term
| CNS SE of amphetamine OD 8 |
|
Definition
restlessness
tenseness
irritability
weaness
insomnia
confusion
delirium
paranoid hallucinations
suicdal/homicidal |
|
|
Term
|
Definition
headahce
palpitation
arrhythmia
HTN
circulatory collapse
sweating |
|
|
Term
| what organ systems are affected in amphetamine OD 3 |
|
Definition
CV
Cns
autonomic - sweating |
|
|
Term
| why are amphetamines abused 2 |
|
Definition
tolerance develops to anorexia and wuphoria
psychological dependence with chronic use |
|
|
Term
| why are amphetamines used in medicine 2 |
|
Definition
nacrolepsy: uncontrollable desire for sleep
ADHD: hyperactivity in children |
|
|
Term
|
Definition
less central effects
more peripherial effects |
|
|
Term
|
Definition
more central effects
less peripherial effects
less euphoria and CNS effect |
|
|
Term
|
Definition
| piperdine amphetamine derivative |
|
|
Term
|
Definition
|
|
Term
|
Definition
| acts on adrenergic and dopamine pathways (similar to aphetamine) |
|
|
Term
|
Definition
| short term behavorial modification, with diet and exercise in obese (3wk) |
|
|
Term
| SE/interactions with phentermine 2 |
|
Definition
contraindicated with CV issues
HTN crisis with MAOI |
|
|
Term
|
Definition
| a and b adrenergic antagonist, enhances NE release |
|
|
Term
|
Definition
|
|
Term
|
Definition
| block reuptake of dopamine by inhibiting NT in pre-synaptic neuron |
|
|
Term
|
Definition
similar properities to amphetamine
wea dopamine reuptake inhibitor |
|
|
Term
|
Definition
narcolepsy
high dose for ADHD |
|
|
Term
|
Definition
|
|
Term
|
Definition
| unspecific CNS depressant |
|
|
Term
|
Definition
narcolepsy
cataplexy: muscle weakness
reduces attacks (take at bed time 2.5-4h after falling asleep) |
|
|
Term
|
Definition
depression
bedwetting
sleep walking
abuse potential |
|
|
Term
|
Definition
| inhibits re-uptake of NE and SE and interacts with receptors causing hunger |
|
|
Term
|
Definition
|
|
Term
| contraindications and interactions with sibutramine 7 |
|
Definition
HTN
CV disease
stroke
glaycoma
renal/hepatic disease
cardiac valve disorders
interaction - MAOI |
|
|
Term
|
Definition
| re-uptake inhibitor of NE and SE |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| agonist at post synaptic a-2A adrenergic receptors |
|
|
Term
| contraindications quanfacine |
|
Definition
| caution with cardiac problems |
|
|
Term
| what are the two main sources of caffiene |
|
Definition
coffee- coffea arbica
cola - cola acuminate |
|
|
Term
| how much caffiene is the effective oral dose, what 3 symptoms |
|
Definition
85-150mg
increased alertness
loss of fatigue
better attention |
|
|
Term
| how much caffiene is OD, what are 3 signs |
|
Definition
>200mg
nervousness
restlessness
tremors |
|
|
Term
|
Definition
|
|
Term
|
Definition
phosphodiesterase inhibitor increases cAMP
adenosine A1/2 receptor antagonist
increases neurotransmission amplifying cyclic nucleotide second messengers |
|
|
Term
| where is throphylline absorbed 3 |
|
Definition
|
|
Term
| where is throphylline metabolized and how 2 |
|
Definition
liver
demythlation
oxidation |
|
|
Term
| wht is throphylline used for, how is it dosed |
|
Definition
high dose: seizure refractory to anti-convulsants
any dose: stimulates resporation, N/B, increase CP and HR (lessens with repeated use) |
|
|
Term
| what is the initial effet of low dose alcohol |
|
Definition
| stimulant due to supression of inhibitor systems |
|
|
Term
| what is the effect of high dose alcohol (non chronic) 3 |
|
Definition
sedation
impairs recent memory
causes black outs |
|
|
Term
| what is the effect of heavy alcohol consumption on the body 9 |
|
Definition
toxic to liver, CV disease, endocrine, GT, malnutrition, CNS dysfunction
tolerance, physical dependence, withdrawl |
|
|
Term
| how much alcohol does it take to be dangerous in the presence with another CNS depressant |
|
Definition
| respiratory depression occurs at 200-300mg/dl so at this time |
|
|
Term
| how much alcohol does it take to be dangerous even without another CNS depressant |
|
Definition
>300mg/dl
unconcious
severe respiratory and CV depression
black outs |
|
|
Term
| what is the highest amt of alcohol recorded consumed without death |
|
Definition
|
|
Term
| what what amount of alcohol is driving impaired and when is the person unable to drive |
|
Definition
impaired from 0-100mg
inability from 100mg+ |
|
|
Term
| what amount of alcohol will someone stagger |
|
Definition
|
|
Term
| where does alcohol distribute to in the body |
|
Definition
everywhere
even CNS (fetal alcohol syndrome) |
|
|
Term
| explain the metabolism of ethanol |
|
Definition
liver > alcohol DH turns it into acetaldehyde
acetaldehyde DH turns it into acetate
acetate goes to tissues and is odidized into CO2 and water |
|
|
Term
| explain excretion of ethanol |
|
Definition
varies with genetic mix of isoenzymes and blood concentration
leads to limited zero order kinetics metabolism |
|
|
Term
| what do asians ahve a defficiency in |
|
Definition
|
|
Term
| what 3 drugs are used to treat chronic alcoholism |
|
Definition
disulfram
anltrexone
acamprostate Ca |
|
|
Term
|
Definition
| inhibits ADH and ALDH so acetyaledhyde accumulates |
|
|
Term
|
Definition
vasodilation
throbbing headache
hypotension
thirst
sweating
CP
vomiting |
|
|
Term
|
Definition
|
|
Term
|
Definition
in vitro affinity for GABA a and b receptors but dosent share their effects suggesting other MOA
decreases effect of naturally occuring excitatory NT glutamate in the body |
|
|
Term
|
Definition
| decreases plesant high associated with alcohol comsumption |
|
|
Term
| why is ethanol used in medicine, in conjunction with what other procedure |
|
Definition
ethanol competes for ADH and prevents conversion of toxic substances
usually the toxic substance isnt broke down into a toxin and must be removed by hemodialysis |
|
|
Term
| how is methanol broken down in the body |
|
Definition
| ADH metablizes it to formaldehyde and formic acid |
|
|
Term
|
Definition
|
|
Term
| how is ethylene glycol broken down in the body |
|
Definition
ADH metabolizes to glucolic and oxalic acids
causes renal toxicity and severe acidosis |
|
|
Term
|
Definition
50-70yo
15% have family history
bradykinesia: slowness of movement
muscle rigidity: tremor, posture instability
shiffling gait
frequent falls
cognitive impairment
death due to immobility (pulmonary embolism, aspiration pneumonia) |
|
|
Term
|
Definition
ROS or diminished antioxidants or both damage nigrostrital dopaminergic area
dopamine can undergo auto-odidative reactions forming H2O2
Fe and H2O2 cause hydroxyl radicals and cellular damage through proteins, lipids, and DNA
MPTP is metabolized to MPP radical which is a neurotoxin causing the disease |
|
|
Term
| how is dopamine nroken down |
|
Definition
AMO degrades into DOPAC and HDO@
H2O2 is broken into OH by Fe or into water by glutathione |
|
|
Term
| chages in the CNS in parkinsons disease |
|
Definition
loss of pigmented dopamine neuronsin substantia nigra (midbrain)
lewy bodies: abnormal cytoplasmic inclusions
loss of nitrostriatal dopamine neurons (no stimulation to D1/2 increases GABA input to cerebral cortex)
increased ACh: dopamine can no longer inhibit release, increased GABA transmission occurs as result |
|
|
Term
| what are the two dopamine receptors and their function |
|
Definition
D1 stimulates direct pathway
D2 inhibits indirect pathway
dopamine acting on either receptor causes excitatory input for the cerebral cortex |
|
|
Term
| what are the 6 categories of parkinsons therapy |
|
Definition
increased dopamine
direct dopamine receptor agonist
dopamine storage uptake/reelease
inhibit MAO-B
anti-cholinergics
inhibit COMT |
|
|
Term
| what drugs increase dopamine 1 |
|
Definition
|
|
Term
| what drugs are dopamine receptor agonists 4 |
|
Definition
bromoctyptine
perfolide
pramipexole
ropinirole |
|
|
Term
| what drugs are dopaine release/uptake drugs |
|
Definition
|
|
Term
| what drug is a MOA-B inhibitor |
|
Definition
|
|
Term
| what drugs are anti-muscarinic agents 2 |
|
Definition
truhexylphenidyl
benzotropine |
|
|
Term
| what drugs are COMT inhibitors 2 |
|
Definition
|
|
Term
|
Definition
| meabolic precursor of dopamine |
|
|
Term
|
Definition
| crosses BBB on active carrier (aromatic AA) so can reach brain but little does |
|
|
Term
| where is levodopa metabolized 3, how |
|
Definition
liver, kidney, GI
formulated with peripheral L-aromatic AA decarboxylase inhibitor (carbidopa) |
|
|
Term
| what are the SE of levodopa no matter how long youve been taking it 3 |
|
Definition
decarboxylation to dopamine in dopaminergic neurons in striatum causes SE
nausea and vomiting (less when combined with carbidopa)
on-off phenomenon |
|
|
Term
| what are the early SE of levodopa 5 |
|
Definition
N/V
orthostatic hypotension
tachycardia
arrhythmia
dark urine |
|
|
Term
| what are the late SE of levodopa 5 |
|
Definition
dyskinesias: choreiform movements
hypersentive receptors
mental disturbance: hallucinations, wild dreams, delusions |
|
|
Term
| what is the on-off phenomenon |
|
Definition
when blood levels of levodopa drop there is an immediate reversal of symptoms (esp in sustained release formula)
deelops 2y into therapy
B6 increases peripherial breakdown and levodopa makes this worse |
|
|
Term
|
Definition
| DOC and most effective for parkinsons disease |
|
|
Term
|
Definition
D2 agonist
D1 partial antagonise
may save other dopaminergic neurons from oxidative stress |
|
|
Term
|
Definition
| often used as adjunct to levodopa to lessen on-off phenomenon |
|
|
Term
|
Definition
dyslinesias
orthostatic hypotension
mental disturbance: hallucinations, wild, dreams, delusions
pleuropulmonary and retroperitoneal fibrosis (ergot like) |
|
|
Term
|
Definition
no longer on market
causes heart valve fibrosis due to activation of 5HT 2B receptors
agonist of D1 and D2 receptors
more potent than bromocryptine |
|
|
Term
| MOA pramipexole and ropinirole |
|
Definition
| non-ergot dopamine agonist at D2/3 receptors |
|
|
Term
| USE pramipexole and ropinirole 3 |
|
Definition
first line or adjunct for parkinsons
in pt who have not had levodopa
may delay need for levodopa
restless leg syndrome
fibromyalgia |
|
|
Term
| SE pramipexole and ropinirole |
|
Definition
less hallucinations and orthostatic hypotension (like ergot agonists)
reward seeking behavior: drinking, smoking, gambling |
|
|
Term
| how is pramipexole elimiated by |
|
Definition
|
|
Term
| contraindications to primipexole |
|
Definition
| cimetidine increases t1/2 by 40% |
|
|
Term
|
Definition
anti-viral drug alters dopamine release of uptake (uless mass effect) anticholinergic effects
litte effect on tremor
good gainst rigidity and bradkyinesia |
|
|
Term
|
Definition
|
|
Term
|
Definition
orthostatic hypotension
dry mouth
hallucinations |
|
|
Term
|
Definition
MOA-B is prodominate form in striatum and causes most oxidative metabolism of dopamine that causes harm in parkinsons
low doses do not affect MOA-A bu high doeses will causing severe HTN |
|
|
Term
|
Definition
| severe HTN in high dose due to MOA-A mass effect |
|
|
Term
|
Definition
|
|
Term
| MOA trihexylphenidyl and benstropine |
|
Definition
blocks cholinergic transmission to augment dopamine
modest anti-parkinson action |
|
|
Term
| use of trihexylphenidyl and benstropine |
|
Definition
|
|
Term
| SE trihexylphenidyl and benstropine |
|
Definition
| same as high dose atropine |
|
|
Term
|
Definition
selective inhibitor of COMT (minor enzyme in pathway of levodopa metabolism)
often combined with carbidopa which blocks peripherial decarboxylase and 3-O-methyldopa is formed that competes with levodopa for active transport in the CnS
inhibition of COMT decreases 3-O-methyldopa increasing central levodopa uptake
helps with on-off phenomenon |
|
|
Term
|
Definition
hepatotoxic: measure heptatic enzymes
blood dyscarcies |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
not hepatotoxic
no blood dyscrasias |
|
|
Term
|
Definition
| short acting (administer with ea dose of levodopa/carbidopa) |
|
|
Term
| cause of alzheimers disease |
|
Definition
loss of cortical and subcortical neurons causes dementia
due to b-amyloid causing ROS attack and loss of cholinergic transmission |
|
|
Term
| 3 acetylcholinesterase inhibitors, 1 SE |
|
Definition
tacrin: hepatotoxic
donepezil
rivastigmine |
|
|
Term
| what 2 categories of drugs tx alzheimers disease |
|
Definition
acetylcholinesterase inhibitors
n-methyl-d-aspartate receptor antagonist |
|
|
Term
| what drug is a n-methyl-d-aspartate receptor antagonist |
|
Definition
|
|
Term
|
Definition
overstimulation of NMDA receptors by glytamate lets Ca flow freely into the cell
sustained over exposure of the cells causes cellular degeneration |
|
|
Term
| what symptomatic tx can be used in alzheimers disease |
|
Definition
depression - SSRI (citalopram, paroxetine, sertaline, fluoxetine, edcitalopran)
psychosis/agitation: atypical anti-psychotics (risperidone, olanzapine, queitapine) |
|
|
Term
| 5 drugs that treat bleeding |
|
Definition
aminocarpoic acid
factor VIII
factor IX
protamine sulfate
vitamine K |
|
|
Term
|
Definition
| inhibit plasminogen activation and stops bleeding |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| protamine sulfate: origin, composition |
|
Definition
derived from fish sperm testes
high arginine (basic) |
|
|
Term
|
Definition
positive protein interacts with negative heparin antagonizing effects
interacts with platelts and fibrinogen stopping bleeding |
|
|
Term
|
Definition
| interferes with anticoagulant activity of warfarin (response takes 24h) causing bleeding |
|
|
Term
|
Definition
iron
folic acid
cyanocobalamin B12
erythropoietin |
|
|
Term
|
Definition
stops growth
mensturation
pregnancy |
|
|
Term
| tx Fe deficiency 2, what the difference |
|
Definition
ferrous sulfate - oral
ferrous gluconate - oral, less GI upset |
|
|
Term
| 6 causes of folic acid deficency |
|
Definition
increased demand: pregnancy, lactation
SI pathology
alcoholism
dihydrofolate reductase inhibitors: methotrexate, trimethoprim |
|
|
Term
| cause of B12 deficiency 4 |
|
Definition
| diet, poor absorption no intrinsic factor (pernicious anemia), loss of reuptake inhibitos |
|
|
Term
|
Definition
oral or SQ
life long if has pernicious anemia |
|
|
Term
|
Definition
| treat anemia due to end stage renal disease, HIV, cancer |
|
|
Term
| 5 categories of blood thinners |
|
Definition
direct thrombin inhibitors
indirect thrombin inhibitors
platelet aggregation inhibitors
GP IIb/IIIa receptor blockers
thrombolytic drugs - not technically anticoagulants |
|
|
Term
| 4 indirect thrombin inhibitors |
|
Definition
heparin
enoxaprin
warfarin
rivaroxban |
|
|
Term
| 2 direct thrombin inhibitors |
|
Definition
|
|
Term
| 6 platelet aggregation inhibitors |
|
Definition
aspirin
copidogrel
parsugrel
ticagrelor
cilostazol
dipyridamole |
|
|
Term
| 3 GP IIb/IIIa receptor blockers |
|
Definition
triofiban
efitfibatide
aciximab |
|
|
Term
|
Definition
streptokinase
urokinase
antistreplase
altelpase (t-PA) |
|
|
Term
| where does heparin come from |
|
Definition
| hg intestinal mucosa or beef tongue |
|
|
Term
|
Definition
glycoasmine and hucoronic / iduronic acid
acetylated/sulfated lucosamine
unsulfated hydroxyl groups |
|
|
Term
|
Definition
| arginine binds lysing on serine protease anti-thrombin III (a clotting inhibitor) |
|
|
Term
| what does high dose heparin inhibit 4 |
|
Definition
|
|
Term
| what does low dose heparin inhibit |
|
Definition
|
|
Term
| what does chronic or intermittent dose heparin inhibit |
|
Definition
reduces AT-III activity
increasing thrombosis |
|
|
Term
|
Definition
IV administration: binds proteins causing hematoma
increased half life in kidney or liver failure
hemorrhage: monitor bleeding time
thrombocytopenia: after 8d therapy can develop anti-platelet antibodies |
|
|
Term
| signs of heparin hypersensitivity 4 |
|
Definition
chills
fever
prophylaxis
uticaria
anaphylaxis |
|
|
Term
| contrindications of heparin 5 |
|
Definition
bleeding disorders
alcoholids
hypersensitivity
surgery to brin, eye, spinal cord
does not cross placenta but shows 13-20% still birth in last trimester |
|
|
Term
|
Definition
deep SC or IV
short term use (days)
acute anticoagulation: IV volus then continous influsion |
|
|
Term
| where is heparin metabolized |
|
Definition
| reticuloendothelial system (liver cirrhosis and kidney failure increase t1/2) |
|
|
Term
|
Definition
DVT
pulmonary embolism
acut eMI
aurgical prophylaxis
dialysis prophylaxis
DOC: pregnancy women with prosthetic valve or venothromboembolism |
|
|
Term
|
Definition
low molecular weight heparin
longer anticoagulation |
|
|
Term
| explain the reactions and clotting factors used in clotting with vitamin K |
|
Definition
(factors II, VII, IX, X: glutamic acid) + (VitK) + (vitamin L epoxide reductase) + (CO2 carboxylation) -->
(factors II, ViI, ix, I: glytamic-COOH/carbodyglutamicA) + (epoxide) -->
binds Ca and causes cell membranes to stick for clotting |
|
|
Term
|
Definition
| blocks vit K epoxide reductase and cofactors for clotting are not activated |
|
|
Term
|
Definition
| hemorrhage: monitor clotting time |
|
|
Term
| what substances increase activity of warfarin 5 |
|
Definition
chronic alcohol
barbituates
gluthemide
grisofulvin
rifampin |
|
|
Term
| what substances decrease activity of warfarin 8 |
|
Definition
acute alcohol
cimetidine
chloramphenicol
cortimoxazole
disulfiram
metronidazole
phenylbutazone
aspirin - not directly |
|
|
Term
| what 2 health conditions are contraindicated with warfarin |
|
Definition
hepatic disease
vitamin K dericiency
augment response |
|
|
Term
| administration o warfarin 2 |
|
Definition
|
|
Term
| how is warfarin distributed |
|
Definition
99% bound to albumin
prevents spread to CSF, placenta, milk |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| anticoagulation perdictable and does not require clotting monitoring |
|
|
Term
| administration rivaroxban |
|
Definition
|
|
Term
|
Definition
| recombinate from leech saliva made in yeast |
|
|
Term
|
Definition
irreversible thrombin antagonist
1 lepirudin: 1 thrombin |
|
|
Term
|
Definition
|
|
Term
|
Definition
| reversible thrombin antagonist |
|
|
Term
|
Definition
|
|
Term
|
Definition
venous thrombosis
artial fibrillation |
|
|
Term
|
Definition
| irreversibly block thromboxane A2 synthesis from arachadonic acid in platelets |
|
|
Term
|
Definition
prolonged bleeding
hemorrhagic stroke
GI bleeds |
|
|
Term
| metabolism of aspiring timing |
|
Definition
| effects life span of plate ets 7-10d |
|
|
Term
|
Definition
| prophylaxis of stroke, MI, infarcts |
|
|
Term
|
Definition
| selective inhibitor of ADP binding to platelet receptor (synergistic to aspirin |
|
|
Term
|
Definition
| prophylaxis: stroke, MI, post-MI infarcts |
|
|
Term
|
Definition
| inhibit ADP pathway involved in fibrinogen and platelet binding (prodrug) |
|
|
Term
|
Definition
| platelet inhibition of ADP induced platelet aggregation |
|
|
Term
|
Definition
| fastest onset of platelet aggregation inhibitors |
|
|
Term
|
Definition
| inhibit ADP pathway in fibrinogen and platelet aggregation and vasodilation |
|
|
Term
|
Definition
increased HR
ventricular tachycardia |
|
|
Term
| administration cilostazol |
|
Definition
| co-administration with aspirin 23-33% inhibition of AD{ |
|
|
Term
|
Definition
| intermittent claduication |
|
|
Term
|
Definition
| increased cAMP inhibiting cyclic neculotide phosphodiesterase in platelets |
|
|
Term
| administration of dipyridamole 2 |
|
Definition
within warfarin: inhibits embolism from prosthetic valves
with aspirin: mild increase in aspirin effects |
|
|
Term
|
Definition
increase effects of aspirin
prophylaxis: embolization from prosthetic valves (with warfarin) |
|
|
Term
|
Definition
| mimic arginine-glycine-aspartic acid on fibrinogen |
|
|
Term
|
Definition
| IV adjunct to percutaneous coronary intervention |
|
|
Term
|
Definition
| prophylaxis: cardiac ischemia complications |
|
|
Term
|
Definition
|
|
Term
| administration efitfibatide 2 |
|
Definition
usually with aspirin and heparin
IV adjunct to percutaneous coronary intervention |
|
|
Term
| how long does efitfibatide last |
|
Definition
| platelet function returns in 6-12h |
|
|
Term
|
Definition
| prophylaxis: cardiac ischemia complication |
|
|
Term
|
Definition
| monoclonal Ab aginst receptor blocks fibrinogen binding |
|
|
Term
|
Definition
| IV adjunct to percutaneous intrvention |
|
|
Term
|
Definition
| platelet function returns in 24-48h |
|
|
Term
|
Definition
| prophylaxis: cardiac ischemia complications |
|
|
Term
|
Definition
activates plasmin which breaks down fibrin
degrades fibrinogen factors V and VII |
|
|
Term
|
Definition
increased plasmin may cause bleeding by dissolving platelet plugs
hypersensitivity to BCS |
|
|
Term
| signs of streptokinase hypersensitivity 3 |
|
Definition
|
|
Term
| streptokinase administration |
|
Definition
must give enough to overwhelm antibodies to avoid hypersensitivity
give within 4h of MI then infuse for 1h |
|
|
Term
|
Definition
|
|
Term
|
Definition
DVT
pulmonary embolism
MI
peripherial arterial
thrombosis/emboli
unclotting cathetcs and shunts |
|
|
Term
|
Definition
| human cultures of fetal renal cells |
|
|
Term
|
Definition
| enzyme degrades fibrinenzyme degrades fibrin |
|
|
Term
|
Definition
|
|
Term
|
Definition
| only use when pr is sensitive to streptokinase |
|
|
Term
|
Definition
streptokinase and noncovalent 1:21 complex plasminogen
acetylates catalytic site of plasminogen so its inactive until fibrin binds |
|
|
Term
|
Definition
|
|
Term
| metabolism of antistreplase |
|
Definition
de-acetylation lengths thrombolytic effect after IV injection
t1/2 90min |
|
|
Term
|
Definition
DVT
pulmonary embolism
MI
peripherial arterial
thrombosis/emboli
unclotting cathetcs and shunts |
|
|
Term
|
Definition
| low affinity for plasminogen but rapidly binds plasminogen bound to fibrin in thrombus (fibrin selective at low dose) |
|
|
Term
|
Definition
|
|
Term
|
Definition
DVT
pulmonary embolism
MI
peripherial arterial
thrombosis/emboli
unclotting cathetcs and shunts
DOC for older clots |
|
|
Term
|
Definition
|
|
Term
|
Definition
HTN
CHF
in diabetic renal benifit |
|
|
Term
|
Definition
cough
angioedema: rapid sewlling of face after 1st dose |
|
|
Term
| contraindications of ACEI 1 |
|
Definition
|
|
Term
|
Definition
propranolol - no selective
desmolol, atenolol, metoprolol - B1 selective |
|
|
Term
| which BB are prefered in cardiac conditions |
|
Definition
|
|
Term
| contraindications to BB 3 |
|
Definition
asthma
diabetes
peripherial vascular disease: vasospastic angina |
|
|
Term
|
Definition
slows heart down
decreased CO
fatigue
never abruptly DC |
|
|
Term
|
Definition
HTN
CHF
anti-arrhythmic SVT class 2
angina |
|
|
Term
|
Definition
BB only used in arrhythmia
short t1/2 10 min |
|
|
Term
|
Definition
losartin
block ANG II receptor, benifits similar to ACEI |
|
|
Term
|
Definition
HTN
CHF
renal benifit in diabetes |
|
|
Term
|
Definition
|
|
Term
| contraindications of ARB 2 |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| vasodilates using NO with specificity for arterioles |
|
|
Term
|
Definition
| work through NO with sepcificity to VEINS |
|
|
Term
|
Definition
HTN
CHF - back up if unable to use ACEI/ARB |
|
|
Term
|
Definition
| drug most likley to cause drug induced lupus in slow acetylators |
|
|
Term
|
Definition
|
|
Term
|
Definition
main effect inside CNS
stimulates A2 inhibitory recetors decreasing sympathetic output |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| block PDE5 increasing cGMP and NO which causes vasodilation |
|
|
Term
|
Definition
pulmonary HTN
erectile dysfunction |
|
|
Term
| contraindications slidenafil |
|
Definition
| never use with nitrates, both work in same pathway too much dilation occurs |
|
|
Term
|
Definition
verapamil
diltaziam
amidopine |
|
|
Term
|
Definition
cardiodepressant
blocks L type Ca channels on heart |
|
|
Term
|
Definition
cardiodepressant
blocks L type Ca channels on heart mostly |
|
|
Term
|
Definition
vasodilates, drops BP
blocks L type Ca channels on vessels |
|
|
Term
|
Definition
HTN
angina
arrhythmia SVT class 4 |
|
|
Term
|
Definition
|
|
Term
|
Definition
HTN
angina
arrhythmia SVT class 4 |
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Term
|
Definition
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Term
|
Definition
reflex tachycardia
gingival hyperplasia |
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Term
|
Definition
positive inotrope
inhibits Na/K ATPase on cardiac myosites
when Na goes up Ca does too and gets stored in sarcoplasmic reticulum so not it releases more causing positive inotropic effect |
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Term
|
Definition
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Term
|
Definition
low theraputic index
arrhythmia
blurry yellow vision |
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Term
| contraindications of digoxin |
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Definition
hypokalemia can enhance digoxin toxicity
digoxin and K bind same site on Na/K ATPase |
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Term
| 4 drugs used for ventricular tachycardia |
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Definition
procanamide
lodicaine
sotalol
amiodarone |
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Term
| 4 types of drugs used for SVT |
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Definition
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Term
| 2 drugs used to ventricular tachycardia and SVT |
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Definition
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Term
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Definition
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Term
| Procanamide: type, MOA, use |
|
Definition
1A
block Na and K
ventricular arrhythmia |
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Term
| lidocainel type, moa, use |
|
Definition
1B
BB
ventricular arrhythmia |
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Term
|
Definition
3
block K and BB
any arrhythmia |
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Term
| amioderone: type, MOA, use |
|
Definition
3
block Na, K, Ca, BB
any arrhythmia |
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Term
|
Definition
lupus in slow acetylators
torsades |
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Term
|
Definition
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Term
|
Definition
torsades - low risk
liver damage
pulmonary fibrosis
thyroid problems - due to iodine |
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Term
|
Definition
stimulate adenosine receptors (Gi coupled so still inhibitory(
short half life 8s |
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Term
| 2 Na channel blocker anti convulsants |
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Definition
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Term
|
Definition
Na channel blocker
glutamate inhibitor |
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
teratogenic
gingival hyperplasia
p450 inducer
zero order kinetucs |
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Term
|
Definition
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Term
|
Definition
liver problems
hyperammonemia
teratogenic |
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
| DC if any sign of rash could be SJS |
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Term
|
Definition
morphine
meperidine
buprenorphine |
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
meiosis
depressed respiratory - fatal
decreased GI/GU
gall bladder spasms |
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Term
|
Definition
decreased respiration
serotonin syndrome |
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Term
|
Definition
| when you put it with a full Mu agonist it causes withdrawl |
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Term
|
Definition
mu antagonist
IV antidote to quickly reverse opioid action |
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Term
|
Definition
5HT1D agonist
vasoconstriction |
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Term
|
Definition
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Term
| before you treat metabolic acidosis what do you need to consider |
|
Definition
if they have ketoacidosis or lactic acidosis they may restore bicarbonate on their own in hours and may not need to be treated
hyperchloremic (diarrhea) will be unable to regenerate bicarbonate and kidney will take days to compensate so need alkali therapy |
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Term
| how do you treat metabolic acidosis 2 |
|
Definition
sodium bicarbonae
tromethamine |
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Term
| what are the benifits of using sodium bicarbonate to treat metabolic acidosis |
|
Definition
fluid, electrolute and pH replacement
increase cardiac funtion, perfusion, oxygenation, and lactate metabolism |
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Term
| what are SE of sodium bicarbonate treatment 5 |
|
Definition
IV: CO2 generated diffuses better across cell membranes into myocardial and CSF cells which can DECREASE pH more there
shift of Hb saturation curve LEFT impairs oxygen release
sodium and water overload
decreased ionized Ca and thus myocardial contractability
bicarbonate overshoot causes alkalosis if administered too fast |
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Term
|
Definition
alkaline Na free organic amine proton acceptor combines with ions to form carbonic acid to form bicarbonate
osmotic diuretic ability increases urine flow, pH, and excretion of acids, CO2, and electrolytes |
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Term
| what do you need to think about before you treat metabolic alkalosis |
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Definition
begin with focus on treating cause, if that dosent work then correct the values
increase tubular bicarbonate threshold: decrease ECF, hypochloremia, hypokalemia, duiretics, Ng suction |
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Term
| how do you treat NaCl responsive metabolic alkalosis 4 |
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Definition
expand intravascular volume and replenish NaCl stores......
NaCl and K solutions
acetazolamide
hydochloric acid
ammonium chloride |
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Term
| how do you treat NaCl resistant metabolic alkalosis 3 |
|
Definition
spironolactone
amiloride
triametrine |
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Term
| when to use acetazolamide, why |
|
Definition
| volume expanded or intolerant to Na pt only because it its less effective as bicarbonate levels fall |
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Term
|
Definition
| converted by liver to urea and free hydrochloric acid |
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Term
|
Definition
limits DCT H inhibition of ALD stimulated Na reabsorption
blocks ALD effect on H ion secretory pump |
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Term
| MOA amiloride and trimetrene |
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Definition
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Term
| if the pt has decreased pH, increased CO2 what do they have |
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Definition
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Term
| if the pt has decreased pH and normal (or slight decrease) CO2 what do they have |
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Definition
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Term
| if the pt has increased pH and normal (or slight increase) CO2 what do they have |
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Definition
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Term
| if the pt has increased pH and decreased CO2 what do they have |
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Definition
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Term
| if the pH and CO2 move in opposite directions and they acidic what do they have |
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Definition
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Term
| if the pH and CO2 move in same direction and their acidic what do they have |
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Definition
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Term
| if the pH and CO2 move in the opposite direction and their basic what do they have |
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Definition
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Term
| if the pH and CO2 move in the same direction and their basic what do they have |
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Definition
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Term
| how do you treat respiratory acidosis 2 |
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Definition
establish airway
give oxygen or ventilation |
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Term
| how do you treat respiratory aklalosis 5 |
|
Definition
if pH <7.5 no tx
if pH >7.5 paper bag, control hyperventilation, oxygen therapy for hypothermia, mechanical ventilation if severe |
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