Term
| what are the 4 epilepsy drugs that work by decreasing Na influx |
|
Definition
oxycarbasepine
carbamazepine
lamotrigene
phenytoin |
|
|
Term
| what are the 5 epilepsy drugs that are mixed MOA |
|
Definition
valproic acid
zonlsamide
topiramate
Gabapentin
pragabalin |
|
|
Term
| what are the 7 epilepsy drugs that interact with GABA |
|
Definition
clonazepam
lorazepam
diazepam
primidone
tigabine
vigabatrin
phenobarbital |
|
|
Term
| what are the 5 epilepsy drugs that i categorized as other |
|
Definition
gabapentin
lavetfracetam
pregabalin
acetazolamide
ethosuxamide |
|
|
Term
|
Definition
stops spread from focus
no effect on seizure threshold
increases inactive state of voltage sensitive Na channels
acts using monohydroxy metabolite |
|
|
Term
|
Definition
stops spread from focus
no effect on seizure threshold
decrease Na influx by prolonging inactive state |
|
|
Term
|
Definition
increases inactivated Na channels
inhibits release of glutamate |
|
|
Term
|
Definition
decreases Na influx into neurons by prolonging active state
stabilizes neuronal membranes
reduces spread from focus
no effect on seizure threshold |
|
|
Term
|
Definition
increase inactivation of Na channels (at different site than phenytoin and carbamazepine)
reduces threshold Ca currents in thalamic neurons (weaker than ethosuxamide)
increases GABA inactivating GABA T-transaminase |
|
|
Term
|
Definition
increases inactive state of Na channels
inhibits T type Ca channels |
|
|
Term
|
Definition
relative to fructose
blocks Na channels
increases GABA actvity
blocks glutamate receptors |
|
|
Term
|
Definition
long acting BDZ
GABA CL ionophore complex
CIV |
|
|
Term
|
Definition
long acting BDZ
GABA CL ionophore complex |
|
|
Term
|
Definition
long acting BDZ
GABA CL ionophore complex |
|
|
Term
|
Definition
relative to phenobarbital
same MOA but effective metabolites do work (phenobarbital, phenylethlmalonamide) |
|
|
Term
|
Definition
| blocks GABA uptake into presynaptic terminals |
|
|
Term
|
Definition
| irreversibly inhibit GABA transaminase |
|
|
Term
|
Definition
enhance GABA inhibition
increase threashold for neuronal firing
inhibit spread of seizure activity from discrete focus |
|
|
Term
|
Definition
GABA analong increases synthesis and release
decreases glutamate and aspartate release
binds A2 subunit of voltage dependent Ca channels |
|
|
Term
|
Definition
steroselective binding site in synaptic plasma membrane in CNS
inhibit firing without affecting mornal excitability prevents hypersynchronization of epileptiform burse firing and propogration of seizure activity
binds to specific synaptic protein SV2A that effects excitability |
|
|
Term
|
Definition
analong of GABA increases GABA synthesis and release (more potent than gabaentin)
decreases glutamate and aspratate release
blocks Na channels |
|
|
Term
|
Definition
| carbonic anhydrase inhibitor |
|
|
Term
|
Definition
| reduce low threshold T Ca currents in thalamic neurons |
|
|
Term
| which epilepsy drugs have a MOA that decreases Na influx (8) |
|
Definition
oxycarbazepine
carbamazepine
lemtrigene
phenytoin
valproic acid
zonidamide
topiramate
pregabalin |
|
|
Term
| which epilepsy drugs have a MOA that acts through a metabolite or is a prodrug (2) |
|
Definition
|
|
Term
| which epilepsy drugs stop spread from a focus (3) |
|
Definition
oxycarbamepine
carbamepine
phenytoin
phenobarbital
levetfracetam |
|
|
Term
| which epilepsy drugs inhibit release of glutamate (4) |
|
Definition
lamotrigene
topiramate
gabapentin
pregabalin |
|
|
Term
| which epilepsy drugs stabilize neuron membranes (3) |
|
Definition
phenytoin
phenobarbitol - increase threshold
levetfracetam - inhibit firing wo affecting normal excitability, prevents hypersynchronization and propogation of seizure |
|
|
Term
| which epilepsy drugs reduce threshold of Ca currents (4), which type of channel |
|
Definition
vaproic acid - at T channels in thalamic neurons
zonlsamide - at T channels in thalamic neurons
gabapentin - A2 subunit of voltage dependent Ca channels
ethosuxamide - at T channels in thalamic neurons |
|
|
Term
| which epilepy drugs interact with GABA (11), how |
|
Definition
valproic acid - inactivate GABA T-transaminase
topiramate - increase GABA activity
clonazepam - GABA Cl ionophore complex
lorazepam - GABA Cl ionophore complex
diazepam - GABA Cl ionophore complex
primidone - enhance GABA inhibition
tigabine - block reuptake
vigabatrin - irreversibly inhibit GABA transaminase
phenobarbital - enhance inhibition
gabapentin - increase synthesis and release
pregabalin - increase synthesis and release |
|
|
Term
| which epilepsy drug blocks carbonhc anhydrase inhibition |
|
Definition
|
|
Term
|
Definition
dizzy, somomn, fatigue, coodrination difficulty
hyponatremia
30% cross hypersensitivty to carbamazepine |
|
|
Term
|
Definition
stupor, coma, resp depression, drowsiness, vertigo, ataxia, blurred vision
nausea, vomiting, hyponatremia, rash
aplastic anemia, agranulocytosis, thrombocytopenia
can induce serious liver disease (get function testing!) |
|
|
Term
|
Definition
benign rash
serious rash (esp in kids): SJS, toxic epidermal necrosis |
|
|
Term
|
Definition
CNS depression: ataxia, behavior change, confusion, hallucinations, drowsiness
gingival hyperplasia
corse facial features in kids
histurism, GI upset, rash, lymphadenopathy, purple glove
anti-arrhythmic (dont stop abruptly)
interferes with B12 metabolism causing megaloblastic anemia
fetal hydnation syndrome (worse in 1st trimester) cleft lip/palate, congenital heart disease, slow growth, MR |
|
|
Term
|
Definition
liver failure, pancreatitis, weight gain, insulin resistance
hyperammonemia encephalopathy (VHE)
hepatotoxic at theraputic doses by elevating enzymes esp in kids <2yo |
|
|
Term
|
Definition
dizzy, solumn, fatigue, coordination difficulty, psychosis
renal stones, weight loss, sweating,
teratogenic |
|
|
Term
|
Definition
|
|
Term
|
Definition
| porconvulsive effect can cause status epilepticus |
|
|
Term
|
Definition
|
|
Term
|
Definition
good threshold between effective dose and CNS depression
kids: depresses cognative performance
sedation, ataxia, vertigo, morbiliform rash, CT disorders |
|
|
Term
|
Definition
dizzy, solumn, fatigue, coordination difficulty
caution with impaired renal flow/dialysis |
|
|
Term
|
Definition
less fatigue that gabapentin
CV drug: some people feel high and report withdrawl symptoms |
|
|
Term
|
Definition
|
|
Term
|
Definition
| drowsiness, nausea, vomiting, 10% eosinophilia, blood dysracias |
|
|
Term
| interactions with carbamazepine 6 |
|
Definition
metabolism initiation: cemetidine, diltiazem, erythromycin, isonizad, propoxyphene
never use in primary generalized seizure Na inhibition makes seizure worse |
|
|
Term
| interactions with phenytoin 10 |
|
Definition
inhibit phenytoin metabolism: dicumarol, cimetidine, sulfonamides, isoniazid
phenotyin increases P450: anti-epileptics, anti-coagulants, contraception, doxycycline, methodone, levodopa
stimulates phenytoin metabolism: carbamasepine
never use in primary generalized Na inhibition makes seizure worse |
|
|
Term
| interactions with zonisamide |
|
Definition
| decreases OC effectiveness |
|
|
Term
| interactoins with phenobarbital |
|
Definition
| drugs with hepatic metabolism, induces P450 enzymes |
|
|
Term
| interactions with gabapentin |
|
Definition
| none, able to use other AED |
|
|
Term
| phenytoin administaration, why |
|
Definition
oral or IV
IM percipitates at site of injection
oral absorption is slow but complete in duodenum |
|
|
Term
| zonisamide metabolism and elimination |
|
Definition
metabolized in liver
eliminated in kidney |
|
|
Term
|
Definition
| IV for status epilepticus |
|
|
Term
|
Definition
|
|
Term
|
Definition
| 90% metabolized by hepatic hydroxylation |
|
|
Term
| which epilepsy drugs can you use in pregnancy |
|
Definition
| phenytoin - supplement folate |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| which epilepsy drugs can be used for partial seizure 7 |
|
Definition
oxycarbazepine
lamotrigene
topiramate
vigabatrin
gabapentin
levetfracetam
pregabalin |
|
|
Term
| which epilepsy drugs can be used for neuralgia (3), which type |
|
Definition
carbamasepine - trigeminal
gabapentin - neuropathic pain
pregabalin - peripherial |
|
|
Term
| which epilepsy drugs tx status epilepticus 4, which are DOC 2 |
|
Definition
phenytoin
lorazepam DOC
diazepam DOC
phenobarbital |
|
|
Term
| which epilepsy drugs tx absence seizure 3, which are DOC |
|
Definition
valproic acid
acetazolamide - alt
ethozuximide - DOC |
|
|
Term
| which epilepsy drugs tx tonic / clonic seizure |
|
Definition
|
|
Term
| which epilepsy drug tx febrile seizure |
|
Definition
|
|
Term
|
Definition
firing of areas of neurons in brain (primary focus) which is anatomically normal
possibly inbalance of GABA: GABA transaminase elimase halts GABA to ensure balance in communication, if GABA is lacking it causes seizure |
|
|
Term
| what percipitates a seizure 5 |
|
Definition
change in blood gas, pH, electrolytes, glucose
increase in glutamate activity |
|
|
Term
| explain dual order kinetics |
|
Definition
low blood levels: rate of metabolism proportional to blood level (1st order)
high blood levels: disporportional increase in concentration, steady state may not be reached before toxicity occurs (zero order kinetics) hepatic hydroxylation is filled up. makes t1/2 of drug meaningless |
|
|
Term
|
Definition
drug derived from opium (semisynthetic congers)
opium like |
|
|
Term
|
Definition
all agonist and antagonists natural and synthetic
morphine like |
|
|
Term
|
Definition
strone opiate analgesic
often abused
not a pharmacological word |
|
|
Term
|
Definition
|
|
Term
| what is the ascending pain pathway |
|
Definition
| noxious stimuli > nociceptor > primary afferent neuron > dorsal horn > secondary neuron (spinothalamic) > supraspinal nuclei in thalamus > limbic system and primary somatosensory cortex |
|
|
Term
| what are the two types of primary afferent neurons / nocioceptors |
|
Definition
somatic pain A delta (Ad) fibers
visceral pain C fibers |
|
|
Term
| somatic pain A delta (Ad) fibers: size, composition, speed, location |
|
Definition
small
unmyelinated
fast, high threshold
terminate in laminae I |
|
|
Term
| somatic pain A delta (Ad) fibers: what do they sense, what do they cause |
|
Definition
sense mechanical and thermal
cause sharp localized pain |
|
|
Term
| visceral pain C fibers: size, composition, speed, location |
|
Definition
large
unmyelinated
slow
terminate in laminae II (substantia gelatinosa) |
|
|
Term
| visceral pain C fibers: what do they sense, what do they cause |
|
Definition
sense: mechanical, thermal, chemical
cause: dull, diffuse, achine, burning pain |
|
|
Term
| how do affernt neurons work |
|
Definition
| release excitatory AA into dorsal horn (C fibers also release neuropeptides) |
|
|
Term
| describe the decending pain pathway |
|
Definition
periaqueductal gray in midbrain and nuclei of rostroventral medulla > dorsal horn > NE/SE release > inhibit ascending pathway...
directly: direct synaptic inhibition
indirectly: activate inhibitory interneurons |
|
|
Term
| what are the three endogenous opioid peptides |
|
Definition
enkephalins
endorphins
dynorphin |
|
|
Term
| general locations of enkephalins |
|
Definition
in interneurons
pain areas, emotion areas, motor areas, antonomic reflex areas, inhibitory areas |
|
|
Term
| pain areas of enkephalins |
|
Definition
| laminae I and II, spinal trigeminal nuclei, PAG midbrain |
|
|
Term
| emotion areas of enkephalins |
|
Definition
|
|
Term
| motor sreas of enkephalins |
|
Definition
|
|
Term
| autonomic reflex areas of enkephalins |
|
Definition
| nucleus tractus solitaries |
|
|
Term
| inhibitory areas of enkephalins |
|
Definition
| dorsal horn causing inhibition of secondary ascending pain neurons |
|
|
Term
|
Definition
hypothalamus, nucleus tractus solitaris
anterior pituitary: Co-release with ACTH in response to stress |
|
|
Term
|
Definition
mangocellylar cells of hypothalamus
posterior pituitary: role in fluid homeostasis
CNS: all over, esp laminae I and II |
|
|
Term
| explain how opioid receptors work |
|
Definition
| Gi protein coupled receptor > adenylate cyclase > cAMP > increases K and decreases Ca conductance > inhibits neuron activity |
|
|
Term
| what do opioids cause clinically to help pain |
|
Definition
| effect transmission of pain and pain perception (I feel it but I don't care) |
|
|
Term
| what are the classes of opioid receptors |
|
Definition
Mu (m)
Kappa (k)
Delta (d)
65% homologous |
|
|
Term
| how do opioid analgesics work (the morphine model) |
|
Definition
full agonist of Mu receptors
high doses interact with other opioid receptors |
|
|
Term
| 12 CNS side effects of morphine |
|
Definition
analgesia
euphoria
mood alteration
dec cough reflex in medulla
nausea/emetic: stimulation of chemoreceptor in postrema of medulla
sleep
increased ICP (NO use in trauma!!)
hypothalamus: alters temp equlibrium
neuroendocrine: dec testosteone and cortisol
miosis
convulsions at high dose (esp kids) |
|
|
Term
| explain how opioids effect the hypothalamus |
|
Definition
alters temp equlibrium
acute: lowers
chronic: increases |
|
|
Term
| explain how opioids cause miosis |
|
Definition
| Mu and K agonists constrict pupil via parasympathetic |
|
|
Term
| what do opioids do to respiration (2) |
|
Definition
decrease response to CO2 in brainstem decreasing respiration
CAUSES DEATH IN MORPHINE POISONING
max effect 5-10 min after IV administration
cough: decreases cough reflex in medulla |
|
|
Term
| what do opioids to do GI (8) |
|
Definition
nausea/emetic: stimulation of chemoreceptor in postrema of medulla
stomach: Mu agonist dec HCl
Si: dec secretions, delay pooing, increase water absorption
LI: propulsive peristalsis stopped causing constipation
billiary: sphincter of oddi constricts and increases pressure and spasm in common bile duct
bladder: stops voiding reflex |
|
|
Term
| CV effects of opioids (2) |
|
Definition
| when standing causes histamine release leading to peripherial vasodilation and orthostatic hypotension |
|
|
Term
| effects of opioids in uterus (2) |
|
Definition
prolong labor
respiratory depression in neonate |
|
|
Term
| effects of opioids in skin (1) |
|
Definition
| dilation of cutaneous vessels in flushing |
|
|
Term
| all opioids have tolerance, cross tolerance, and physical dependence. define each |
|
Definition
tolerance: higher doses are needed to produce same response
cross tolerance: across all opioids
physical dependence: body adapts to presence of drug and requires it to function. termination causes withdrawl |
|
|
Term
| signs of withdrawl from opioids |
|
Definition
pupil dilation
hyperventilation
diarrhea
dysphoria |
|
|
Term
| interactions with opioids (3) |
|
Definition
MAOI: hyperpyrexic coma
sedative/hypnotics: increased CNS depression, respiratory depression
TCA/anti-psych: increased sedation, increased respiratory depression |
|
|
Term
| in order from least to most effective list the 9 pain killers less effective than morphine |
|
Definition
diphenyloxylate D
dextropropoxyphene 1/20
pentazocine 1/15
codine 1/12
tramadolol 1/12
mepheridine 1/10
hydrocodone 1/13
oxycothinin 2/3
oxycodone 2/3 |
|
|
Term
| what are the two drugs that have the same effectiveness as morphine |
|
Definition
|
|
Term
| what are the 6 drugs more effective than morphine from least to most potent |
|
Definition
diacetylmorphine 3-5x
butorphanol 5x
hydromorphone 7x
buprenophine 20-50x
fentynil 80x
sufentanil 800x |
|
|
Term
| what are the two "other" pain killers from least to most potent |
|
Definition
diphenyloxylate
tramadolol |
|
|
Term
| what are the 5 codine/codine derivative pain killers from least to most potent |
|
Definition
dextropropoxyphene
codine
hydrocodone
oxycotinin
oxycodon |
|
|
Term
| what are the 4 mixed pain killers from least to most potent |
|
Definition
pentazocine
nalbuphine
butorphanol
buprenophine |
|
|
Term
| what are the 7 opioid pain killers from least to most potent |
|
Definition
mepheridine
methadone
morphine
diacetylmorphine
hydromorphone
fentynil
sufentanil |
|
|
Term
| which pain killers cannot be taken oral (7) |
|
Definition
morphine* can but it sucks
nalbuphine
diacetylmorphine
butorphanol
buprenophine
fentynil
sufentanil |
|
|
Term
| what painkillers stronger than morphine or equal to can be taken oral (2) |
|
Definition
morphine* but it sucks
hydromorphone |
|
|
Term
| what painkillers can be taken IV IM (9) |
|
Definition
mepheridine
methadone
morphine
nalbuphine
butorphanol
hydromorphone
buprenophine
fentinyl
sufentanil |
|
|
Term
| which pain killers can be taken SC (3) |
|
Definition
morphine
nalbuphine
hydromorphone |
|
|
Term
| what painkiller can be taken nasal |
|
Definition
|
|
Term
| what painkiller can be taken rectal |
|
Definition
|
|
Term
| what pain killer can be taken sublingual |
|
Definition
|
|
Term
| what pain killer can be taken transdermal/transmucosal |
|
Definition
|
|
Term
| which pain killers have a different metabolism, describe it (4) |
|
Definition
codine: 10% converted to morphine
mepheridine: metabolized via N-demythylation to normepheridine
morphine: conjugated with glycorinic A to make morphine 6, excreted as morphine 3
diacetylmorphine: hydrolyzed to 6-monoacetylmorphine (lipid soluble), hydrolyzed to morphine |
|
|
Term
| MOA of the mixed opioids (4) |
|
Definition
pentazocine: partial Mu antagonist, K agonist
nalbuphine: strone K agonist, Mu antagonist
butorphanol: strong K agonist, Mu antagonist
buprenophinel: strong K agonist, Mu antagonist |
|
|
Term
|
Definition
inhibit NE/SE
weak Mu agonist |
|
|
Term
|
Definition
| oxycodone time release in higher doses |
|
|
Term
| which painkillers have a long duration (2) |
|
Definition
|
|
Term
| what pain killer has a rapid onset and short duration |
|
Definition
|
|
Term
| unique SE of dextropropxyphene |
|
Definition
not analgesic
not addictive
low toxicity
supresses CNS |
|
|
Term
| unique use of dextropropxyphene |
|
Definition
| antitussive: cough supression |
|
|
Term
|
Definition
| high dose increases catecholamines and thus BP |
|
|
Term
| unique use of pentazocine |
|
Definition
| help with withdrawl, releave some pain |
|
|
Term
|
Definition
often combined with ASA/APAP, NSAID
antitussive |
|
|
Term
|
Definition
analgesia not completely reversed by antagonist
seizure - never in epileptic!!
little respiratory depression
interacts with SSRI!! |
|
|
Term
|
Definition
|
|
Term
|
Definition
no CV/pupil effects when oral
metabolite cause tremor, twitch, convulsions
EVEN THOUGH ALL SHOULDNT GO WITH MAOI, THIS ONE REALLY SHOULDENT |
|
|
Term
| unique use of mepheridine |
|
Definition
|
|
Term
| unique use of hydrocodone |
|
Definition
| often combined with ASA/APAP, ibprofen |
|
|
Term
|
Definition
| often combined with ASA/APAP |
|
|
Term
|
Definition
|
|
Term
|
Definition
| help with withdrawl (because it has a more mild one) |
|
|
Term
|
Definition
low abuse
depresses respiration |
|
|
Term
| unique SE diacetylmorphine |
|
Definition
| fast euphoria due to lipid solubility |
|
|
Term
|
Definition
| increased workload on heart |
|
|
Term
| unique use of butorphanol |
|
Definition
| not good for chronic pain, acute only |
|
|
Term
|
Definition
| less respiratory depression |
|
|
Term
|
Definition
| added to naltrexone to make auboxone to maintain opioid dependent pt |
|
|
Term
|
Definition
| interaction with deoperidol (neuroleptic anesthesia) |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| which pain killers are used for cough supression |
|
Definition
|
|
Term
| what pain killers are used to help with withdrawl (3) |
|
Definition
pentazocine
methadone
buprenophine |
|
|
Term
| what pain killers are often combined with ASA/APAP, of other mild pain killer |
|
Definition
codine
hydrocodone
oxycotinin |
|
|
Term
| what are the 4 opioid antagonists |
|
Definition
naloxone
naltrexone
nalmefene
methylabaktrexibe |
|
|
Term
| naloxone: administration, duration, distribution |
|
Definition
IV, IM, SC
duration 1-4h
completely metabolized 1st pass |
|
|
Term
|
Definition
| tx opioid dependency and toxicity |
|
|
Term
| naltrexone: administration, duration |
|
Definition
|
|
Term
|
Definition
opioid toxicity and dependence
alcoholism |
|
|
Term
| nalmefene: administration, use |
|
Definition
IV
pure opioid antagonist (best) for tx opioid dependency and toxicity |
|
|
Term
| methylabaktrexible: administration, distribution and SE |
|
Definition
SC
unable to cross BBB so no pain killing |
|
|
Term
|
Definition
| prevent morphine constipation |
|
|
Term
| what is the restriction of all opioid antagonists |
|
Definition
|
|
Term
| what is the story used for pain killers less than morphine |
|
Definition
i died from phenyl
dex tried to operate
he penetrated
the code in my
tramp stamp
me phrend the dean
stole my hydrocodone
oxycotinin
and oxycodone |
|
|
Term
| what is the story used for paiin killers same sa morphine |
|
Definition
meth done
morphed into a
nail biting pheind |
|
|
Term
| what is the story used for pain killers more than morphine |
|
Definition
heroine
butt and or oral
hydrates me
but phrends no me
fender
suffers |
|
|
Term
| how is serotonin made and broken down |
|
Definition
L tryptophan ingested >
facillitated transport into brain (concentration in blood relation to other AA)>
RATE LIMITING: tryptophan hydroxylase + O2 + pteridine >
serotonin >
MAO >
5-hydroxyindole acetic acid >
transport out of brain (inhibited by probenecid) >
small amt in urine (unless malignant carcinoid) |
|
|
Term
| what are the 4 serotonin receptors how do they work, where are they located |
|
Definition
all 16 in brain, not all in body
1: Gi: inc K, hyperpolarize, inhibit
2: Gq: dec K, depolarize, excite
3: ion: dec K, inc Na, depolarize (fast)
4: dec K, hyperpolarize, excite |
|
|
Term
| functions of serotnin in blood and vessels 2 |
|
Definition
platelets contact endothelium which releases 5HT which goes to 5HT2 on platelets causing aggregation and vasoconstriction
vasoconstriction in eplanchnic, renal, pulmonary, cerebral) |
|
|
Term
| functions of serotonin in lungs 2 |
|
Definition
pulmonary vessel constriction
constriction of bronchioles |
|
|
Term
| functions of serotonin in GI |
|
Definition
enterochromaffin cells make it, store it, and use it.
released bia vagal stimulation to cause emesis |
|
|
Term
| functions of serotonin in CNS 9 |
|
Definition
| sleep, cognotion, sensory, motor, temp, pain, appetite, sex, hormone secetion |
|
|
Term
| is serotonin hydrophillic or phobic what does this mean about its distribution and function |
|
Definition
phillic
cannot cross BBB, must be made in brain
not all cells that use it make it so they need transporter |
|
|
Term
| why can serotonin be hallucinogenic |
|
Definition
| N and O methylated properities |
|
|
Term
| what is the chemical class of serotonin |
|
Definition
|
|
Term
| what compound is relative to serotonin, how is it foemed |
|
Definition
melatonin
N acetylation
O methylation
in pineal gland controlled by light |
|
|
Term
| ergot: where does it come from, what does it to (biochem and physio) |
|
Definition
fungus on rye and grain
interacts with 5HT, D, and a receptors different interaction in different systems
vasoconstriction, cerebral constriction, supress sensory neuropeptides |
|
|
Term
| complication of all ergots |
|
Definition
| vasoconstriction can cause gangrene and misscarriage |
|
|
Term
| migraine: family hx, sex, onset, location, character, duration, associated symptoms |
|
Definition
hx: yes
sex: females
onset: variable
location: usually unilateral
character: pulse, throb
duration; 2-72h
symp: aura (15%), photosensitive, sound sensitive, pale, nausea, vomiting. aggrevated by physical activity |
|
|
Term
| cluster headache: family hx, sex, onset, location, character, duration, associated symptoms |
|
Definition
hx: no
sex: males
onset: in sleep
location: behind/around eye
character: sharp, steady
duration: 15-90min
symp: uni/bilateral sweating, flushing, congestion, ptosis, lacrimation, pupillary changes |
|
|
Term
| tension headahce: family hx, sex, onset, location, character, duration, associated symptoms |
|
Definition
hx: yes
sex: females
onset: stress
location: bilateral around head
character: dull, persistant, tight
duration: 30 mim - 7d
symp: mild photophobia, noise phobia, anorexia |
|
|
Term
| mild migraine: definition, tx |
|
Definition
occasional throbbing, no major impairment
mild analegesics combo analegesics, amiemetics |
|
|
Term
| moderate migraine: definition, tx |
|
Definition
some impairment in function, nausea
combination anaglesics, ergots, sumatriptan, amiemetics |
|
|
Term
| severe migraine: definition, tx |
|
Definition
>3/mo, functional impairment, nausea, vomiting
ergot, sumatriptan, animetics, prophylaxis |
|
|
Term
| what drugs are used in migraine prophylaxis 5, what is #1 |
|
Definition
#1 B blocker
Ca channel blocker
TCA
serotonergic agonist
MAOI |
|
|
Term
| what B blocker are used in migraine prophylaxis 5 |
|
Definition
propranolol
timolol
atenolol
nadolol
metoprolol |
|
|
Term
| what TCA are used in migraine prophylaxis 2 |
|
Definition
amitriptyline
nortryptyline |
|
|
Term
| what serotonergic agonist are used in migraine prophylaxis 2 |
|
Definition
methylserglide
cyproheptadine |
|
|
Term
| what MAOI are used in migraine prophylaxis 2 |
|
Definition
|
|
Term
| what are triggers someone can avoid for migraine |
|
Definition
| alcohol, foods, irregular sleep, stress, time zone shift, altitude, barometric pressure, menstural cycle |
|
|
Term
|
Definition
citalopram
paroxetine
sertaline
fluoxetine
fluboxamine
escitalopram
depression, PMDD, OCD, anxiety, migrane prophylaxis |
|
|
Term
| serotoniin agonists and their receptors (3) |
|
Definition
sumatriptan: 5HT-1D
LSD: 5HT-2A, 2C
buspirone: 5HT-1A |
|
|
Term
| serotonin antagonist and their receptors: |
|
Definition
odansteron: 5HT-3
risperidone: 5HT- 2A, 2C, D
cyproheptadine: 5HT-2A
methysergide: 5HT-2A, 2C |
|
|
Term
|
Definition
ergoloid methylate
ergonovine
ergotamine
bromocryptine
methysergide
dihydroergotamine |
|
|
Term
|
Definition
constrict vessels
supress release of neuropeptides |
|
|
Term
|
Definition
non selective
ergot derivative |
|
|
Term
|
Definition
| K channel open, hyperpolarization, inhibitory |
|
|
Term
|
Definition
| inhibit 5HT-2A on smooth muscle |
|
|
Term
|
Definition
LSD and methylergovine relative
inhibits vasoconstriction and vasopressin
inhibits 5HT-2A, 2C on smooth muscle |
|
|
Term
|
Definition
|
|
Term
|
Definition
psychic alterations
hallucinations |
|
|
Term
|
Definition
|
|
Term
|
Definition
| gynecomastia: D receptor inhibition allows activity of prolactin |
|
|
Term
|
Definition
| inflammatory fibrosis (esp heart) in prolonged tx |
|
|
Term
| administration sumatriptan 3 |
|
Definition
IV - NO causes coronary vasospasm
oral - poor absorption
SC
nasal |
|
|
Term
| administration odansteron 2 |
|
Definition
|
|
Term
| administration methysergide |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
nausea and vomiting (esp from chemo due to enterochromaffin release of 5HT in SI stimulation emesis
vagal afferents through 5HT-3 receptors initiate vomiting, this is stopped |
|
|
Term
|
Definition
migraine prophylaxis
counteract sex SE of SSRI |
|
|
Term
|
Definition
migraine prophylaxis
vascular headache prophylaxis
depression
schizophrenia |
|
|
Term
|
Definition
migraine
depression
schizophrenia |
|
|
Term
|
Definition
| increase brain metabolism |
|
|
Term
|
Definition
| increase strength, duration, and frequency of uterine contraction to decrease uterine bleeding |
|
|
Term
|
Definition
|
|
Term
|
Definition
post partum hemorrhage
abortion bleeding control |
|
|
Term
|
Definition
| caffiene + belladonna + phenobarbitol |
|
|
Term
|
Definition
|
|
Term
|
Definition
ergot derivative
inhibit vasoconstriction and vasopressin
inhibit 5HT action on smooth muscle |
|
|
Term
|
Definition
| caffiene + belladonna + phenobarbitol |
|
|
Term
| administration ergotamine |
|
Definition
PO, SL, retro rocks
should not exceede 6mg/d or 10mg/wk
take 1-2mh/0,5h until relief |
|
|
Term
| administration of dihydroergotamine |
|
Definition
|
|
Term
|
Definition
CP, coronary vasoconstriction, tachy, brady
numbness, tingling of fingers and toes
nausea, vomiting |
|
|
Term
| contraindications of ergotamine 4 |
|
Definition
| pregnancy, peripherial vascular disease, hepatic/renal impairment |
|
|
Term
| contraindications of dihydroergotamine 4 |
|
Definition
| pregnancy, peripherial vascular disease, hepatic/renal impairment |
|
|
Term
| interactions of ergotamine 4 |
|
Definition
| azithro, dirithro, clathro, erythromycin causes ergotism (HTN, ischemia) |
|
|
Term
| interactions of dihydroergotamine 4 |
|
Definition
| azithro, dirithro, clathro, erythromycin causes ergotism (HTN, ischemia) |
|
|
Term
|
Definition
| acute migraine or cluser headache |
|
|
Term
|
Definition
| migraine or cluster headache |
|
|
Term
| what is the most common supraventricular arrhythmia |
|
Definition
|
|
Term
| describe EKG in premature atrial contraction, cause |
|
Definition
until early P wave/ORS (hides normal P in it) followed by pick back up of sinus
SA node is resetting |
|
|
Term
|
Definition
asymptomatic- none
BB, type Ic |
|
|
Term
| describe EKG in premature junctional complex, cause |
|
Definition
sinus rhythm followed by premature abnormal P wave (upside down or hidden) and QRS with wide S
complex originates from AV node/His |
|
|
Term
| Tx premature junctional complex 2 |
|
Definition
BB
type IC anti arrhythmics |
|
|
Term
| cause of physiological sinus tachycardia 5 |
|
Definition
| pain, exercise, fever, anxiety, hypotension, anemia |
|
|
Term
| cause of inappropirate sinus tachycardia |
|
Definition
| increase HR with normal activity due to SNS increase, PNS decrease, viral illness causing autonomic dysutonomia |
|
|
Term
| signs of inappropirate sinus tachycardia |
|
Definition
| palpitations, CP, GI upset, syncope |
|
|
Term
| TX inappropirate sinus tachycardia 2 |
|
Definition
|
|
Term
| describe the EKG for AFib |
|
Definition
irregular irregular
rapid ventricles 120-160, atria 500
fine fibrillations of P waves with irregular random QRS |
|
|
Term
| physiology of AFib, complications |
|
Definition
atria automaticity and reentry mostly at atria and pulmonary veins
blood pools and clots in atria apendages and causes thrombus and stroke |
|
|
Term
|
Definition
acute hyperthyroid
acute alcohol/drugs
post-op
coronary disease
SVA - AV reentry
increases with age 5%>75yo |
|
|
Term
|
Definition
asymptomatic
fatigue
SOB
syncope
exercise intolerance
palpitations/angina |
|
|
Term
| risk factors for stroke 8 |
|
Definition
valve disease
mechanical valve
previous thromboembolism
heart failure
systole dysfunction
HTN
DM
age |
|
|
Term
| explain the CHAD2 score scoring and what treatment it correlates with |
|
Definition
CHF, HTN, DM, >75yo = 1
previous stroke/TIA = 2
0= no therapy / aspirin
1= aspirin / warfarin
2 = warfarin / thrombin inhibitor |
|
|
Term
| what drug is a trombin inhibitor |
|
Definition
|
|
Term
| how is asymptomatic AFib treated |
|
Definition
if <100BPM then give anticoag according to CHAD2
if >100bph then try BB, CCB, digoxin. if this dosent work try antiarrhythmic...
A: if has CAD then amioderone, soditol, dofetilide
B: if has LV dysfunction, tachy, cardomyopathy then use limited soditol
C: if has LVH/HTN then use fleconide or class 1C
if this dosent work ablate |
|
|
Term
| how is symptomatic stable AFib treated |
|
Definition
IV heparin +
amiodorine, drocamamide, or dofetilide ibuilid
maintain with direct thrombin inhibitor 1 mo
CCB, BB, or digoxin to control ventricle rate
quinidine or disopyramide
if this dosent work ablate |
|
|
Term
| how is symptomatic unstable AFib treated |
|
Definition
IV heparin
TEE if >24h
synch cardiovert biphasic 200J
maintain with direct thrombin inhibitor 1 mo
CCB, BB, or digoxin to control ventricle rate
quinidine or disopyramide
if dosent work ablate |
|
|
Term
| when do you ablate, 3 types |
|
Definition
when all TX dosent work
when LV problems occur
focus: ablate near pulmonary veins
AV: eliminate and put in pace maker
coxmaze: ablate all reentry spots |
|
|
Term
| describe an EKG in AFlutter / microreentrant atrial tachycardia |
|
Definition
regular irregular
atria 200-300
ventricles 130-150
less tolerated than AFib
spiked P waves with regular ventricle contraction between many |
|
|
Term
| descirbe a multifocal atrial tachycardia EKG |
|
Definition
| P waves with at least 3 different morphlogies |
|
|
Term
| cause of multifocal atrial tachycardia 2 |
|
Definition
| pulmonary or septic infection |
|
|
Term
| TX multifocal atrial tachycardia 2 |
|
Definition
|
|
Term
| what do you never use in multifocal atrial tachycardia 4 |
|
Definition
BB
amioderone
flecinide
propefanone |
|
|
Term
| what does a AV reentry tachycardia / proxysmal supraventricular tachycardia look like, cause |
|
Definition
rate 150-250
atria and vantricles both contract
retrograde P waves
AV node has two pathways: 1 slow, 1 fast. current goes doen slow and up fast |
|
|
Term
|
Definition
teens - 30s
alcohol, drugs, excitement
no underlying heart disease |
|
|
Term
|
Definition
avoid trigger
ablation
B/Ca blocker |
|
|
Term
|
Definition
1. vasovagal
2. IV adensine or IV class IV
3. maintience: CCB, BB, digoxin |
|
|
Term
| what does an accelerated junctional rhythm EKG look like, cause |
|
Definition
50-99
depolarization near the AV node or on it
abnormal P waves or none |
|
|
Term
| cause accelerated junctional rhythm 2 |
|
Definition
digitoxin toxicity
ablation of SA |
|
|
Term
| TX accelerated junctional rhythm 3 |
|
Definition
correct toicity
class 1A or 1C |
|
|
Term
|
Definition
Hypoxia- copd
Ischemia + irritability
Sympathetic
Drugs- BB, digoxin, cocaine
Electrolyte- dec K, inc Ca
Brady/tachy
Stretch- LVH/HTN |
|
|
Term
| explain the ion movements in the 4 phases of cardiac muscle contraction |
|
Definition
4. K leaks out
0: Na rush in
1: Na slows, K rush out
2: K rush out, Ca rush in
3: K rush out
4: K leaks slowly |
|
|
Term
| explain the state of the Na gates in cardiac muscle contraction |
|
Definition
4: resting - resting
0: M gates open - open
1: H gates close - absolute/effective refractory, inactive
2: absolute/effective refractry
3: switches mid phase to relative refractory
4: resting |
|
|
Term
| explain the ion movements in the phases of SA/AV contraction |
|
Definition
4: Na leaks slowly in
0: Ca rushes in
3: K rushes out
4: Na leaks in |
|
|
Term
| explain how to read the boxes on EKG |
|
Definition
1 little = 0.04s
1 big = 0.2 sec, 0.5mV
2 big = 1mV
5 big = 1 sec
30 big = 6 sec
# peaks x 10 = rate |
|
|
Term
|
Definition
| stops for >1 beat (3 sec is ok in athlete) |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| channel blocking dosent work well in resting (4) |
|
|
Term
|
Definition
Ca overload
SNS
digitoxin
MI |
|
|
Term
|
Definition
dec HR
de K
prolonged 3
prolonged QT |
|
|
Term
|
Definition
|
|
Term
| what are the three conditions needed for reentry |
|
Definition
1. obsticle
2. unidirectional block
3. long enough to outlast refractory |
|
|
Term
| why are reentrys scary for pt |
|
Definition
| AFib will be accelerated if it happens and cause m ore deterioration |
|
|
Term
|
Definition
PR>0.12
wide QRS
D waves in some leads
consistantly abnormal P waves |
|
|
Term
| what pathway does WPW take |
|
Definition
|
|
Term
| what pathway does lown ganong levine take |
|
Definition
|
|
Term
| what does lown ganong levine EKG look like |
|
Definition
|
|
Term
| how is a reentry treated 4 |
|
Definition
vasovagal
IV adenosine or diltzem
maintience: BB, CCB, digoxin, fleccanide, procamide |
|
|
Term
| how is a person with reentry in AFib treated |
|
Definition
1. cardiovert
2. procanamide, ibutalide, amioderone |
|
|
Term
| what does a 1st deg AV block look like |
|
Definition
slowed conduction through node and tissue
common, asymptomatic, PR>200ms |
|
|
Term
| what does a mobitz type 1 (wenchebach) look like |
|
Definition
usually benign
block on or by node
progressive lengthening of PR until one is dripped |
|
|
Term
| what does a mobitz type II look like |
|
Definition
block below AV node can progress to 3rd deg
may need pacemaker
consistant PR interval until one is dropped |
|
|
Term
| what does a 3rd deg AV block look like |
|
Definition
AV dissociation, ventricles and atrial are independent
block at AV, upper BB, lower BB
ventricles 30-45
atria 60-100 |
|
|
Term
|
Definition
autnomic- vasovagal
lyme, chagas, sphyilis
metabolic: ince K, dec adrenal
drugs: digoxin, CCB, adenosine |
|
|
Term
|
Definition
type 1: none or atropine/epi/amnioderone
type 2: atropine/eip/amnioderone
type 3: atropine/epi/amnioderone or pacemaker |
|
|
Term
| what does a EKG for premature ventricular complex look like, cause |
|
Definition
normal sinus with an out of place wide QRS, hides P wave
comes from purkinje
compensatory pause |
|
|
Term
|
Definition
bigeminy: sinus/PVC/sinus/PVC/snus
tigeminy: sinus/sinus/PVC/sinus/sinus/PVC
pair/couple: sinus/PVC/PVC/sinus/PVC/PVC/sinus |
|
|
Term
| what increases risk of PVC 3 |
|
Definition
|
|
Term
| what should you NEVER take with a PVC |
|
Definition
| antiarrhythmics = DEATH prolong QT |
|
|
Term
| what is a complication of PVC |
|
Definition
|
|
Term
|
Definition
asymp- nothing
symp- BB, K channel blocker |
|
|
Term
| describe the 2 kinds of VTach EKG |
|
Definition
monomorphic: large repeating, regular QRS
polymorphic: oscilating sizes of QRS |
|
|
Term
|
Definition
| origin below bundle of His sustained |
|
|
Term
|
Definition
sustained: >30sec, >3PVC
nonsustained: <30sec |
|
|
Term
| what drugs should you NEVER use in VTach 2 |
|
Definition
|
|
Term
| how is someone who is stable with VTach tx |
|
Definition
satolol
amoderone
phenytoin
lidocaine - MI
propafenene
cardiovert - synch
maintain: quinidine, phenytoin, mexiletine-MI, dysopramide, sotalol |
|
|
Term
| how is someone who is unstable with VTach tx |
|
Definition
cardiovert
maintain: quinidine, phenytoin, mexiletine-MI, dysopramide, sotalol` |
|
|
Term
| describe the 2 EKG types for VFib |
|
Definition
coarse: spiky fibrillations
fine: small fibrillations |
|
|
Term
| VFib: 2 types, tx, effect in blood |
|
Definition
no CO
primary: no CHF
secondary: with CHF
TX: asnch cardiovert |
|
|
Term
| what is the cause of long QT syndrome |
|
Definition
| defect in cardiac ion channel causing repolarization and prolonged plateau |
|
|
Term
|
Definition
implant defiv ig hx arrahytmic or syncope
avoid long QT drugs |
|
|
Term
|
Definition
erythromycin
clathromycin
procanamide
quinidine
flecanide
sotalol
amioderone |
|
|
Term
|
Definition
|
|
Term
| evaluation of tachycardia |
|
Definition
EKG
24h holder
telemetry
electrophysiolgy
ECHO stress test |
|
|
Term
|
Definition
autonimic dysruption
sick sinus syndrome
hypothyroid
hypotension
hypothremia
physiological - athlete
inflammatory - pericarditis
structural heart disease - CAD
vasovagal
BB
CCB
digoxin
lithium
methadone
K channel blocker |
|
|
Term
|
Definition
block Na channels in abnormal high frequency rhythms
affinity for open/inactive channels |
|
|
Term
| MOA of class 1 A-C, half life |
|
Definition
A: N and K block, 1-10sec. increase ERP, supress 0
B: Na block. decrease ERP, increase ) slope.
C: Na, Ca, K blocker. depress slope 0, decrease max depolarization |
|
|
Term
| explain how the class 1A-C graph looks |
|
Definition
A: lengthens 0 slope, lower plateu height, elongated 3
B: lengthens 0 slope less than A, shortens 3
C: lengthens 0 slope most, shortens plateau height |
|
|
Term
|
Definition
quinidine
procanamde
disopyramide |
|
|
Term
|
Definition
lidocaine
mexiletine
phenytoin |
|
|
Term
|
Definition
|
|
Term
|
Definition
B adrenergic agonist
lengthen (decrease) slope of 0 and 4 (shift right)
decrease automaticity at SA, HR, CO
lengthen PR |
|
|
Term
| what drugs decrease mortality in arrhythmia pt |
|
Definition
|
|
Term
| 4 B blockers used for arrhythmia and when |
|
Definition
propanolol, atenolol, metoprolol: decrease sudden cardiac death after MI arrhythmia
esmolol: shor tacting, IV acute arrhythmia |
|
|
Term
| why is esmolol short acting |
|
Definition
| metabolized by RBC t1/2 9 min |
|
|
Term
|
Definition
K channel blockers
elongaed ERP |
|
|
Term
|
Definition
sotalol
amiodarone
dronedarone
dofetilide
ibutilid |
|
|
Term
|
Definition
Ca channel blockers
increase slow of 0, elongate ERP
increase AV.SA conduction
block inactive and active Ca channels mostly at SA/AV node
increase PR due to AV delay |
|
|
Term
|
Definition
|
|
Term
| dofetilide/ibutilid: administration, use, SE |
|
Definition
IV acute
NOT for long duration AFib/Flutter they dont respond
SE torsades
USE: drug cardiovert in WTD arrhythmia, AFib, AFlut |
|
|
Term
| amiodarone, dronedarone MOA |
|
Definition
blocks Na, Ca, K
increases QRS, PR, QT |
|
|
Term
| SE amniodarone, droendarone |
|
Definition
sinus brady
PULMONARY ACEOLITIS/FIBROSIS
hepatotoxicity
photosensitivity
thyroiditis/blue skin- amioderone |
|
|
Term
| use: amniorarone, droendarone |
|
Definition
| ANY supraventricular tachycardia drug cardiovert: AFib/flut (ok with CAD), VTac, AV Block, WPW tachyarrhythmia |
|
|
Term
|
Definition
prolong QT
ERP prolong
B blocker dec SA automaticity |
|
|
Term
|
Definition
EAD
bradycardia
dyspnea
fatigue
torsades |
|
|
Term
|
Definition
MOST MI
maintance post-VTach
drug cardiovert- VTach, LV dysfunction and CAD asymp AFib/Flut |
|
|
Term
|
Definition
antimalaria
anti-M inc HR
a1 blocker dec HR and cause hypotension and long PR
widen QRS and QT |
|
|
Term
|
Definition
mortality in non life threat arrhythmia
hypertension
vertigo
tinnutis
headache diarrhea
torsades
AFib/flutter (due to dec K)
hypokalemia |
|
|
Term
|
Definition
shorted t1/2
acetylated to NAPA which blocks K |
|
|
Term
|
Definition
mortality in non-life threat arrhythmia
hypotension
lupus like due to NAPA acetylation
torsades (hypokalemia) |
|
|
Term
| disopyramide: administration, MOA |
|
Definition
oral
anti-M dec HR
decrease PR interval |
|
|
Term
|
Definition
mortality in non life threat arrhythmia
hypotension
glaucoma
dry mouth
urinary retention
constipation
torsades |
|
|
Term
|
Definition
| local anastetic decreases automaticity in purkinje blocking NA |
|
|
Term
| lidocaine administration and exretion |
|
Definition
IV high first pass
eliminated in liver |
|
|
Term
|
Definition
drowsiness
slurred speech
confusion
convlusions |
|
|
Term
| administration and MOA mexiletine |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
anticonvulsant
blocks NA and purkinke |
|
|
Term
|
Definition
vertigo confusion, gingival hyperplasia
P450 inducer |
|
|
Term
|
Definition
effects normal heart
prolongs AP in atria and ventricles
inc PR, QRS, QT |
|
|
Term
|
Definition
mortality in ventricle arrhythmia
blurred vision
dizzy
headache |
|
|
Term
|
Definition
| flecanide for life threatning ventricular arrhythmias |
|
|
Term
|
Definition
| increased mortality in non life threating arrhythmia |
|
|
Term
|
Definition
accelerated junctional rhythm
maintience VTach/VFib
maintience AFib/Flut |
|
|
Term
|
Definition
accelerated junctional rhythm
drug cardiovert WPW arrhythmia
maintain WPW |
|
|
Term
|
Definition
accelerated junctional rhythm
maintain AFib/Flut
maintain VFib/Tach
drug cardiovert WPW arrhythmia |
|
|
Term
|
Definition
| chem cardiovert VTach/Fib MI |
|
|
Term
|
Definition
| maintain aftr VTach/Fib MI |
|
|
Term
|
Definition
maintain aftr VTach/Fib MI
chem cardiovert VTach/Fib MI |
|
|
Term
|
Definition
premature atrial contraction
junctional premature complex
not responding asymptomatic AFib/Flutter with HTN/LVH
accelerated junctional rhythm
proprafenone: cardiovert VTach/Fib |
|
|
Term
|
Definition
prematyre atrial contraction
junctional premature complex
inappropirate sinus tachycardia
maintain AFib/Flut
maintain PST/AV reentry
dec symp ot PVC
maintain WOW |
|
|
Term
|
Definition
maintain AFib/Flut
multifocal atrial tachycardia
PST/AV reentry
maintain WPW |
|
|
Term
|
Definition
increase aytomaticity
increase refractory in opurkinjue
decrease refractory in ventricles and atria
parasympathetic via vagus increases PR and and dec conduction |
|
|
Term
|
Definition
increased CA and automaticity causes DAD
extra systole
tachycardia
PVC
fibrillation
visual changes (yellow) |
|
|
Term
|
Definition
maintain AFib/Flut
maintain PST
maintain WPW
VTACH PROPHYLAXIS |
|
|
Term
|
Definition
high dose activates Gi decreasing Ca current decreasing conduction velocity increasing ERP decreasing AV velocity
t1/2 8sec must be IV bolus |
|
|
Term
|
Definition
| flushing, CP, hypotension |
|
|
Term
|
Definition
DOC IV bolus supraventricular tachycardia
PST/AV reentry
WPW |
|
|
Term
|
Definition
decrease ectopic pacemakers
esp from digitalis |
|
|
Term
|
Definition
|
|
Term
|
Definition
| stops digitalis arrhythmia and torsades |
|
|
Term
| what is the general order for tx htn 12 |
|
Definition
thiazide diruetic
ACE inhibitor / ARB
CCB
BB
other: renin inhibitor, ALD receptor antagonist, a1 adrenergic blocker, a2 agonist, peripherial adrenergic blockers, non-specific adrenergic blockers, vasodilators |
|
|
Term
| what is the general order for tx of CHF 10 |
|
Definition
ACEI/ARB
BB: metaprolol, bisprolol
Non-specific BB: carvedilol
amlodipiine
hydralazine
inotropic: B agonist, phosphodiesterase inhibitor, nesiritide, digitalis |
|
|
Term
| explain the theatment of eldelry of AA with HTN 2 |
|
Definition
|
|
Term
| explain the TX of HTN post MI 2 |
|
Definition
24h: ACEI
maintain: ARB, BB |
|
|
Term
| explain the TX of HTN in pt with renal failure 1 |
|
Definition
|
|
Term
| explain TX of HTN in pt with DM 1 |
|
Definition
|
|
Term
| explain TX of HTN in pregnant pt |
|
Definition
|
|
Term
| explain TX of HTN in pt with renal HTN |
|
Definition
|
|
Term
| what is #1 and #2 choice for acute HTN |
|
Definition
1. sodium nutroprusside
2. non-specific adrenergic blockers (labelalol, carvedilol) |
|
|
Term
| explain TX of HTN in pt with asthma or peripherial vascular disease |
|
Definition
|
|
Term
| what HTN drugs can tx diabetic nephropathy 2 |
|
Definition
|
|
Term
| ther than HTN what can BB treat 4 |
|
Definition
hyperthyroid
migraine prophylaxia
glaucoma
cardiomyopathy |
|
|
Term
| other than HTN what can a1 adrenergic blocker tx |
|
Definition
|
|
Term
| what than HTN what vasodilator has another use, what is it |
|
Definition
| minoxidil: topical male pattern baldness |
|
|
Term
| what drug do you use in CHF renal failure pt (#1 and #2) |
|
Definition
DOC: ACEI/ARB
2: hydralazine |
|
|
Term
|
Definition
chlorthalidone
hydrochlorothiazide |
|
|
Term
|
Definition
|
|
Term
| 2 ARN (ANGII receptor blocker) |
|
Definition
|
|
Term
| 3 CCB, which can be used for CHF |
|
Definition
verapamil
diatiazem
amlodipine - CHF and HTN |
|
|
Term
| explain naming of BB, which can be used in CHF |
|
Definition
A-M B1 selective -olol
N-Z B1/2 non-selective -olol
metapropolol
bispropolol |
|
|
Term
|
Definition
|
|
Term
| 2 ALD receptor antagonist |
|
Definition
|
|
Term
|
Definition
prazosin
terazosin
doxazosin |
|
|
Term
|
Definition
|
|
Term
| 1 peripherial adrenergic blocker |
|
Definition
|
|
Term
| 2 non-specific adrenergic blockers, which is used in CHF |
|
Definition
labetalol
carvedilol - CHF and HTN |
|
|
Term
| 4 vasodilators, which can be used for CHF |
|
Definition
hydralazine - CHF and HTN
minoxidil
Na nitroprusside
isorbide dinitrate |
|
|
Term
| 4 categories of inotropic drugs |
|
Definition
B adrenergic antagonist
phosphodiesterase inhibitor
nesiritide
digitalis |
|
|
Term
| 1 B adrenergic antagonist |
|
Definition
|
|
Term
| 2 phosphodiesterase inhibitor |
|
Definition
|
|
Term
| what is nesiritide made of |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
stops electrolyte transport causing Na/water excretion
decreases BV, CO and BO
increases urine output
urineoutput, CO, and BV return to normal in days but BP stays fixed due to vascular reactivity to NE and secreased structural resistance
overall: DECREASES PRELOAD |
|
|
Term
|
Definition
stops conversion of ANGI to ANGII and bradyinin to inactive
causes vasodilation: inc preload and afterload
water/NA excretion: dec preload
prevents ALD cardiac remodel
stops renin feedback and renin builds up |
|
|
Term
|
Definition
stops ATI receptors so ANGII can't activate ALD or vasoconstrict
vasodilation: dec preload and afterload
water/Na excretion: dec preload
stops cardiac remodeling |
|
|
Term
|
Definition
block L Ca channels in HEART MUSCLE slowing phase 4/0 at AV
decreases CO, increases PR, negative inotropic |
|
|
Term
|
Definition
| blocks L Ca channel in VESSELS AND HEART causing vasodilation and dec CO |
|
|
Term
|
Definition
block L Ca channels in VESSELS causing vasodilation
most likley to cause reflex tachycardia |
|
|
Term
|
Definition
antagonize B1 on heart dec CO
antagonize B1 on JG decreasing renin
vasodilation
Na/water excretion
stops cardiac remodeling - some...
improves symptoms, exercise tolerance |
|
|
Term
|
Definition
| low dose, build over 4-5 wks |
|
|
Term
|
Definition
stops conversion of angiotensinogen to ANG I
vasodilation
Na/water excretion
stoms cardiac remodeling - some...
increased renin due to loss of neg feedback |
|
|
Term
| MOA ALD receptor antagonist |
|
Definition
K sparing diruetics (not awesome diruetics) block ALD which causes K wasting
cause Na/water excretion decreasing preload |
|
|
Term
| MOA a1 adrenergic blockers |
|
Definition
| block a1 on ARTERIOLES AND VEINS causing vasodilation |
|
|
Term
|
Definition
| decrease sympathetic outflow from brainstem vasopressors (main regulator of Na retention) |
|
|
Term
| MOA peripherial adrenergic blockers |
|
Definition
blocks reuptake of NE/E causig depletion and decreased SNS
vasodilation, dec CO |
|
|
Term
| MOA non-specific adrenergic blockers |
|
Definition
block A1, B1, B2
decrease TPR without reflex tachycardia |
|
|
Term
|
Definition
| NO causes ARTERIOLE dilation (increases flow most) |
|
|
Term
|
Definition
| opens K channels hypopolarizing, dilates ARTERIOLES |
|
|
Term
|
Definition
| NO dilates VEINS AND ARTERIES |
|
|
Term
| administration Na nitroprusside |
|
Definition
|
|
Term
|
Definition
| VENOdilator, decreases proload |
|
|
Term
|
Definition
B adrenergic antagonist: dobutamine, dopanine
pisphodiesterase inhibitor: inamirone, milrone |
|
|
Term
|
Definition
|
|
Term
|
Definition
| antagonize B1 and increase CO |
|
|
Term
| administration dobutamine |
|
Definition
|
|
Term
| administration of dopamine and effect |
|
Definition
<2ug/kg: D1 vasodilate renal
2-5ug/kg: V1 inc CO
5015ug/kg: A1 vasoconstrict, inc TPR |
|
|
Term
| MOA phosphodiesterase inhibitor |
|
Definition
increase cAMP, phosphorlyates Ca channel
increases CO |
|
|
Term
|
Definition
| vasodilate veins and arteries |
|
|
Term
| MOA digtaliz and digitoxin |
|
Definition
reversibly bind Na/K ATPase
chances Ca/Na channel
Ca comes in
increases CO
decreases SNS, TPR |
|
|
Term
| what is the difference between digitalis and digitoxin |
|
Definition
digitoxin: t1/2: 15d
digitalis: t1/2: 48h
toxin is more toxic |
|
|
Term
|
Definition
K depletion (restrict Na intake)
increased glucose (don't DC if become diabetic) |
|
|
Term
| interactions thiazide diruetics, why |
|
Definition
| digitallis: messes with Na/K ATPase |
|
|
Term
| contraindications thiazide diruetics 3, why |
|
Definition
DM: increases glucose
chronic arrhythmia, acute MI: messes with K |
|
|
Term
|
Definition
catopril cough: due to brady build up
angioedema: face and mouth
teratogenic
acute renal failure |
|
|
Term
| why does ACEI cause acute renal failure |
|
Definition
| ANG II constricts efferent arteriole when renal perfusion is low (never use in bilateral renal artery stenosis) |
|
|
Term
| interactions/contraindications ACEI 2 |
|
Definition
never use with ARB
dont use in renal artery tenosis |
|
|
Term
|
Definition
teratogenic
acute renal failure |
|
|
Term
|
Definition
constipation
dizzy
naturitic |
|
|
Term
| interactions/contrindications of verpamil 3 |
|
Definition
no diruetic: its a naturitic
no CHF
no BB |
|
|
Term
| interactions/contrindications of dialtiazem 3 |
|
Definition
no diruetic: its a naturitic
no CHF
no BB |
|
|
Term
|
Definition
|
|
Term
|
Definition
gingival hyperplasia
dizzy
reflex tachycardia |
|
|
Term
| contraindications amlodipine |
|
Definition
|
|
Term
|
Definition
inc LDL and TG
withdrawl: rebount HTN
hypotension
bradycardia
decreased lobido, lethargy
B2: bronchoconstriction, increases glucose |
|
|
Term
| contraindications to BB 2 |
|
Definition
| dont use non-selective in asthmatic or diabetic |
|
|
Term
|
Definition
slight cough
angioedema
teratopenic |
|
|
Term
| SE ALD receptor antagonist |
|
Definition
|
|
Term
| contraindications to ALD receptor antagonist 2 |
|
Definition
|
|
Term
| how can you prevent hyperkalemia in ALD receptor antagonist |
|
Definition
| use in combo with ACRI/ARB |
|
|
Term
| SE a1 adrenergic blocker 2 |
|
Definition
postural HTN on 1st dose
dizzy |
|
|
Term
|
Definition
sedation
dry mouth
withdrawl: rebound HTN
hemolytic anemia - methyldopa |
|
|
Term
|
Definition
sedation
bradycardia
depression |
|
|
Term
|
Definition
bronchoconstriction
arrhythmia (C blockade)
dec lobido |
|
|
Term
|
Definition
lupus like in slow acetylators
reflex tachycardia |
|
|
Term
| SE Na nitroprusside, why 2 |
|
Definition
hypotension
metabolized to cyanide |
|
|
Term
|
Definition
|
|
Term
|
Definition
| anorexia, nausea, vomiting, headache, fatigue, confusion, blurred yellow vision |
|
|
Term
| digitalis toxicity signs 8, why |
|
Definition
Ca overload increases automaticity causing DAD leading to ...
increased systole
tachycardia
PVC
fibrillation
complete block
VTac
VFib |
|
|
Term
| things that cause predisposition to digitalis toxicity 4 |
|
Definition
hypoklemia: arrhythmia
wuinidine and verapamil: displace it
diuretics: increase its binding |
|
|
