Term
| SNP: how do you regonize and treat cyanide toxicity? |
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Definition
| direct-acting, non-select peripheral vasodilator. 44% cyanide. 1st sign of toxicity is tachyphalaxis, increased mixed venous O2, CNS changes, metabolic acidosis, increased lactate level. Treat with O2!!! give amyl nitrate, Na nitrate, Na thiosulfate (nitrates make methemglobin to soak up cyanide) |
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Term
| Most common adverse effects of nitrates? |
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Definition
| postural hypotension, flushing, headache, dizziness, weakness, rash |
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Term
| kinetic profile of nitrates? |
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Definition
NTG and SNP generate nitric oxide which leads to vasodilation.
-large first pass effect
-short 1/2 lives
-large volumes of distribution
-high clearance rates
-large variable in plasma concentration
-can oxidise the ferrous ion og Hgb-> methemoglobinemia |
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Term
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Definition
| select partial alpha 2 agonist that binds to the receptor of norepi and prevents reabsorption and therefore decreases levels of catecholamines |
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Term
| Side effects of ACE inhibitors? |
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Definition
| cough, upper resp. sx, angioedema |
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Term
|
Definition
| 300 mg bolus followed by 150 mg, another 150 can be repeated. |
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Term
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Definition
| 6 mg rapid IVP, followed by 2 12mg boluses-up to 30 mgs. |
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Term
| category Ia antiarrhythmics? |
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Definition
quinidine, procainimide, disopyrimide
++primary atrial--blocks Na channels |
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Term
| category Ib antiarrhythmics? |
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Definition
lidocaine, mexiletine, tocainimide
+ventricular--Na channels |
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Term
| Class Ic antiarrhythmics? |
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Definition
flecanide, propanfenone, moricizine
++ventricular--Na channels |
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Term
| Class II antiarrhythmics? |
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Definition
| Beta blockers, acebutaolol, esmolol, metoprolol, propranolol |
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Term
| Class III antiarrhythmics? |
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Definition
amiodorone, sotalol, ibutilide, dofetilide
++K+ channel blockers
--ventrical and atrial |
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Term
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Definition
that PVCs post-MI do NOT benefit from chronic antiarrhythmic use other than beta-blockers.
-drug companies no longer make class 1 agents
-encainide was removed from market
-made incentive for nondrug therapies such as implanted difibrilators |
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Term
| which drug has significant proarrhythmic? |
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Definition
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Term
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Definition
| used post-MI with ventricular ectopy or with poor LV function |
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Term
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Definition
sinus brady or arrest.
heart block.
prolonged QT.
pulmonary toxicity-2-17% of patients and fatal in 10% of those.
happens in >400 mg/day especially in the elderly orw/pre-existing lung dx.
GI Liver toxocity, N/V
-thyroid toxicity, blue skin!
-neuro-tremors, neuropathy |
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Term
| what makes Solotol different than the other class III drugs? |
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Definition
it is a racemic mixture of classIII and beta blocker effects.
-low lipid solubility,not protein bound
- it is not metabolized
-ecreted by kidneys unchanged, therefore lower dose for kidnsy dx |
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Term
| Ibutilide-use and precautions. |
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Definition
| Pure class III for A-fib. may cause torsades therefore replace K+ and Mg+ prior to giving and never give with other drugs that prolong QT. |
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Term
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Definition
| Ibutilide, Sotalol, Quinidine, Procainamide, Amiodorone, TCA, haloperinol. |
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Term
| Dofetilide-use and precautions? |
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Definition
pure class III used for a-fib/flutter. significant prorrhythmic-constant EKG. hosp. admission when initiating.
renal pts and QTc not candidates. |
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Term
| How are anitarrhythmics metabolized and excreted? |
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Definition
| Most metabolized in the liver and excreted through the kidneys. |
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Term
| known drug interactions with Digoxin? |
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Definition
Increase:diltiazem, verapamil, quinidine, amiodorone, propafenone, spironlactone/triamterene, indomethacin, motrin, cyclosporine.
Decrease: phenobarb, phenytoin, Tums, sucralfate |
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Term
| What channels do the diferent classes of antiarrhythmics act? |
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Definition
Class I-Na+ channel
Class II-beta blockers (Ca+ channel)
Class III-K+ channel
Class IV- Ca+ channel |
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Term
| thiazides-when to use, what effects and metabolic changes caused? |
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Definition
essential HTN, initially decreases fluid volume, but long term control of HTN from peripheral vasodilation.
causes hyperglycemia and increased uric acid->aggrevates gout
Increases excretion: Na, Cl, Bicarb, K |
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Term
| Loop diuretics: when to use, side effects and metabolic changes? |
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Definition
Used to mobilize edema, not for HTN. Decreases:K+, Cl-, pre-load,
Increases: dig toxicity, Sugar, urea, NMB, pulmonary edema |
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Term
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Definition
| intact BBB, can lead to pulmonary edema w/CHF, hypovolemia, electrolyte disorders, plasma hyperosmolality |
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Term
| ARBs: when to use, warnings, and drug names? |
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Definition
WHen pt can't tolerate ACEI. blocks receptor site of angiotensin. Can cause hyperkalemia, renal insufficiency and angioedema.
Drugs end in sartan-losartan, valsartan |
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Term
| renin antagonists: which drugs and warnings? |
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Definition
| includes ARBs, ACEI, Beta blockers, clonidine. prevents vasoconstriction by blocking conversion of angiotensin. decreases aldosterone which increased excretion of Na and H2O and increase of K+ and H+. |
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Term
| most powerful endogenous vasoconstrictor? |
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Definition
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Term
| Most powerful endogenous vasodilation? |
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Definition
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Term
| Excess bradykinins can cause? |
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Definition
septic shock, allergic reactions(cough)
carcinois syndromes |
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Term
| decscription and uses for aprotinin? |
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Definition
classified as:antifibrinolytic, anticoagulant, platelet protective and antiinflammatory.
Used to reduce or prevent blood loss in pts having CABG that are at high risk of bleeding from : re-operation, preexisting coagulopathies, surg. of great vessels, when beliefs prevent blood transfusions. |
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Term
| Special considerations for Aprotinin? |
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Definition
when checking an ACT (activated clotting time) make sure the test has kaolin to prevent false positive high.
+test dose required.
+side effects: increases risk of post-op renal dysfunction, phlebitis, dyspnea, fever, and confusion |
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Term
| mechanism of action of serotonin? |
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Definition
| serotin is a neurotransmitter that is widely distributed(90% in GI tract) responsible for emesis and pain transmission. Antagonism of 5HT3 in GI tract can stop N/V-ie:ondansetron(zofran),dolansetron (anzemet) |
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Term
| sumatriptan uses and precautions? |
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Definition
5HT1 agonist used to TX migraines and cluster HA, or after wet tap.
Potent coronary artery vasoconstrictor-do not use with CAD, MI or angina |
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Term
| precautions with dolansetron? |
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Definition
| increases QT interval so avoid with hypokalemia, hypomagnesemia, pts on diuretics, meds that also increase QT or pts with congenital QT syndrome. |
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