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Pharm - Ch. 48-9, 51

Antidysrhythmic, Anticoagulant/Antiplatelet/Thrombolytics, and LDL Lowering Drug

Define dysrhythmia Abnormality in rhythm of the heartbeat
True or false: there are two types of dysrhythmias True. Bradydysrhythmias and tachydysrhythmias
In nerve cells, Na+ rushes inside the cell and __ rushes out K+ (potassium)
True or false: muscle cells repolarize more steadily than nerve cells True. K+ takes a longer time to bring the charge of the cell back down to resting state because Ca2+ is rushing inside the cell
True or false: there are only four GROUPS of antidysrhythmic drugs False. There are four major classes, but there is also an "other" category for digoxin and adenosine. These two drugs can be used to treat dysrhythmias.
Class I antidysrhythmic drugs inhibit ___ Na
Class II antidysrhythmic drugs inhibit ___ Ca
Class III antidysrhythmic drugs inhibit ___ K
Class IV antidysrhythmic drugs inhibit ___ Ca
List the different types of drugs used for each of the four classes. Class I: sodium channel blockers. Class II: beta blockers. Class III: potassium channel blockers. Class IV: calcium channel blockers
How is digoxin used to treat dysrhythmias? Digoxin can inhibit the movement of Ca by working on Na-K ATPase.
True or false: nifedipine is a Class IV drug False. Only verapmil as nifedipine does not block the calcium channels of the heart.
List a Class I drug Lidocaine
What is the mechanism of action for Lidocaine? Blocks sodium channels and accelerates repolarization with little or no effect on ECG
What are the major adverse effects of Lidocaine? Dysrhythmias, CNS effects, confusion, paresthesias
True or false: metoprolol is NOT used as a Class II drug False. Metoprolol has same actions as propranolol in blocking calcium.
Propranolol is a ____ beta adrenergic antagonist nonselective
What are the adverse effects of propranolol? When blocking cardiac beta1 receptors, can cause heart failure, AV block, sinus arrest, hypotension. When blocking beta2 receptors, can cause bronchospasm in patients with asthma.
True or false: when treating dysrhythmias in asthmatic patients, it is preferable to give metoprolol True because metoprolol is beta1 selective
List a Class III drug Bretylium
What is the mechanism of action for Bretylium? Delays the repolarization of past potentials. By prolonging action potential duration, one can treat tachycardia or v-fib.
True or false: Bretylium's primary adverse effect is profound hypertension False. HYPOtension is the adverse effect.
A patient given a class III drug has extremely low BP. You would treat with the following ______ or _______ Dopamine or norepinephrine
A patient is given an antidysrhythmic drug that results in hypotension, edema, and constipation. Which drug was administered? Verapamil. These are some of its adverse effects.
List the adverse CARDIAC effects of verapamil Bradycardia, AV block, heart failure with effects on vascular smooth muscle, hypotension, and edema
Describes the stages of hemostasis Stage 1 - formation of platelet plug. Stage 2 - coagulation by intrinsic and extrinsic systems
What is the difference between an anticoagulant drug and a thrombolytic drug? Anticoagulants disrupt the coagulation cascade. Thrombolytic drugs dissolve clots by causing fibrin lysis.
_____ is used to treat arterial thrombosis Antiplatelet drugs
_____ is used to treat venous thrombosis Anticoagulant drugs
List the drugs used as anticoagulants, antiplatelets, and thrombolytics respectively Anticoagulants: heparin and warfarin. Antiplatelets: Aspirin and clopidogrel. Thrombolytic drugs: streptokinase and tPA
True or false: antiplatelet drugs are commonly administered after a patient experiences heart failure True. Aspirin and clopidogrel commonly administered. (Heparin is not an antiplatelet drug, but it is also commonly given as well.)
A nurse receives an order for low MW heparin given PO at 1400. What should she do? Recheck the order because heparin is given via injection or IV. It cannot be given PO.
In an emergency, which drug would you use? Heparin or warfarin? Heparin because it is rapid-acting and can be used in emergency situations. Warfarin is commonly indicated for long-term prevention of venous thrombosis.
True or false: warfarin is an only oral anticoagulant True. At the moment, only oral anticoagulant available in US.
Explain the mechanism of action for heparin Heparin enhances the activity of antithrombin, which inactivates clotting factors.
List three indications for heparin Pulmonary embolism, evolving stroke, prevention of venous thrombosis
What are the SE of heparin? Hemorrhage, heparin-induced thrombocytopenia, hypersensitivity reactions
What is the advantage of using low molecular weight heparin versus regular heparin? Unfractionated heparin was discovered to cause more SE. Low molecular weight heparin has a smaller chunk of active heparin molecule so there are fewer side effects associated.
True or false: warfarin is an agonist of vitamin K False. Antagonist.
What is the mechanism of action for warfarin? Decrease synthesis of clotting factors by antagonizing vitamin K
What is a use for warfarin? Long-term prevention of venous thrombosis
List the SE of warfarin Hemorrhage, multiple DDIs (which can increase/decrease anticoagulant effect and/or promote bleeding)
True or false: any drug with an affinity for albumin will alter warfarin binding True. Warfarin is 99% bound to albumin so DDI can occur as result of changes in albumin binding
What is the mechanism of action for aspirin and clopidogrel? They decrease platelet aggregation
Aspirin is indicated for what uses? Prevention of arterial thrombosis and prevention of MI
What is an adverse effect of aspirin and clopidogrel? Major GI bleeding
Explain how a GI bleed may be caused by aspirin Aspirin antagonizes an enzyme known as COX, which activates platelets and also produces a protective layer for stomach mucosa. Both functions can be affected if aspirin given too much
True or false: baby aspirin can be given to children False. Due to concern of Reye's syndrome, aspirin not administered to pediatric patients
Explain the mechanism of action of streptokinase and tPA They bind to plasminogen and promote lysis of fibrin to dissolve clots
What are the uses of thrombolytic drugs? MI, DVT, massive pulmonary emboli
List the SE of streptokinase and tPA Bleeding, antibody production, hypotension, fever
True or false: thrombolytic drugs can be used prophylactically False. These drugs can only remove thrombi that have already formed. Anticoagulants are used as prophylaxis of thrombus formation.
Drugs used to lower LDL cholesterol levels work through ___ mechanisms Indirect
What is an HMG-CoA Reductase Inhibitor? A class of drugs that inhibit HMG-CoA reductase, a liver enzyme that produces cholesterol.
What is the prototype of HMG-CoA reductase inhibitors? Lovastatin.
Lovastatin increases the number of LDL receptors. Explain how this works to lower LDL levels Inhibits the enzyme producing cholesterol, causing a decrease in cholesterol production within the liver. Liver looks for other sources of cholesterol. Liver cells increase # of LDL receptors and grab onto free floating LDL molecules, lowering LDL levels
What are the benefits of using a HMG-CoA Reductase inhibitor? Lower LDL, increase HDL, increase plaque stability
What are the adverse effects of Lovastatin? Headache, rash, muscle soreness, heptaotoxicity. Also classed as a category X drug
Nicotinic acid decreases the production of _____ and ______ VLDLs and LDLs
Nictonic acid ____ the ______ inside adipose tissue Inhibit, lipolysis
What are the SE of niacin? Skin flushing, hepatotoxicity, GI-related, hyperglycemia
List the types of drugs used to lower LDL cholesterol levels HMG-CoA reductase inhibitors, bile acid-binding resins, nicotinic acids, fibric acid derivatives
What is a drug classified as a bile acid-binding resin? Cholestyramine
Explain the mechanism of action for cholestyramine Increases LDL receptors in liver, prevents reabsorption of bile in intestine. As a result, bile excretion accelerated. Body compensates by synthesizing bile from LDLs.
List adverse effects of cholestyramine Constipation, decrease absorption of fat-soluble vitamins (ADEK)
True or false: cholestyramine is not absorbed through GI True
List the therapeutic uses of aspirin (that aren't related to platelet aggregation) 1) relief of mild-to-moderate pain, 2) analgesic, antipyretic, anti-inflammatory, 3) dysmenorrhea
What are the mechanisms of action for aspirin as related to COX enzymes? Aspirin can irreversibly inhibit COX enzymes. COX-2 inhibition suppresses inflammation, pain and fever. COX-1 inhibition protects against MI by suppressing platelet aggregation
True or false: aspirin is contraindicated in pregnancy True. Category D drug!
What is the prototype for fibric acid/fibrates? Gemfibrozil
True or false: gemfibrozil increases the clearance of LDLs False. Increases clearance of VLDLs
What is the mechanism of action of gemfibrozil? Activates PPAR-gamma, which increases clearance of VLDLs and reduces high triglyceride levels
List the adverse effects of gemfibrozil Rashes, GI, gallstones, hepatotoxicity
True or false: gemibrozil's SE are relatively mild True
Created by: choel