Cardiac Pharma 2

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1

Used to treat urinary retention, cholinergic agonist

Bethanechol

2

Bethanechol details

-Do not use in urinary/intestinal obstruction

-increase digestive enzymes (parasympathetic)

- parasympathetic overload (brady, low BP, bronchoconstriction)

3

Indirect acting cholinergic agonists inactivate

cholinesterase

4

What are irreversible cholinergic agonists (cholinesterase inhibitors) primarily used for?

Glaucoma

5

What are reversible cholinergic agonists (cholinesterase inhibitors) used for?

Myasthenia gravis and alzheimers

6

Parasympathetic effects

Increased Salivation

Decreased HR

Decreased BP

Pulm. secretions

Bronchoconstriction

Increased motility

Pupil constrict

7

Sympathetic effects

Increased HR

Increased BP

Dry mouth

Decreased motility

perspiration

pupil dilation

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Cholinergic overdose antidote?

ATROPINE

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Cholinergic crisis?

Muscular weakness

increased salivation

10

Cholinergic agonists may cause

Orth. hypoTN

11

Antidote for atropine?

Physostigmine

12

Cholinisterase inhibitor side effects

GI distress, nausea, vomiting, diarrhea, salivation, bronchoconstriction, anorexia, bradycardia, hypotension, sweating

13

How long does cholinesterase take to replenish after use of an irreversible cholinesterase inhibitor?

Days or weeks

14

Mydriasis

Pupil dilation

15

Atropine comes from what plant?

Belladonna

16

Anticholinergics are also called

Parasympatholitics

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Cholinergics are also called

Parasympathomimetic

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Anti parkinson drugs are

Anticholinergic-- benztropine

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Benztropine side effects

nausea, vomiting, dry mouth, dizziness, headache, drowsiness, depression, weakness, confusion, mydriasis, urinary retention

20

Two important factors: Atropine

-DO not take if you have narrow angle glaucoma--IOP

- Drowsiness common-do not drive

21

Anticholinergic drugs can do what to eyes?

Increase intraocular pressure

22

INE

anticholinergic

23

il

ace inhibitor

24

ol

beta blocker

25

factors that determine stroke volume

preload, contractility, afterload

26

Digialis/ digoxin is made from

white foxglove

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How do digitalis glycosides help HF?

increase contraction and lower HR through decreasing conduction

28

Digitalis glycosides inhibit

the NA/K pump

29

Cardiac glycosides can be used for

conduction illnesses

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Digitalis

decrease conduction/decrease HR

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What can promote digoxin toxicity?

Electrolyte deficits, thiazide diuretics, loop diuretics, proton pump inhibitors

32

Digoxin side effects

nausea vomiting dizziness visual impairments depression anxiety

33

Digoxin antidote

digoxin immune fab

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Cardiac glycosides main function

increase myocardial contraction

35

3 factors digoxin toxicity

Increased automaticity

AV conduction suppression

decreased ventricular refractory

36

Crazy list of herbal interactions with digoxin

Milk thistle

korean ginseng

ginko

ginger

goldenseal

coleus

ephedra

aloe

licorice

hawthorne

psillium

st johns wort

37

Digoxin and hypokalemia

toxicity

38

Digoxin details

-take apical pulse

-dixoxin level higher than 2 ng/ml toxic

- monitor potassium

39

Drugs for angina

nitrates

CCBs

Beta blockers

40

SL nitro

1-3 min

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transdermal patch nitro

40-60 min

42

Which antianginal is highly protein bound?

CCBs

43

Peripheral edema can be caused by

CCBs

44

Drug with high rate of cardiac death in high doses

nifedipine

45

Beta blocker for ventricular dysrhythmias

Acebutelol

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Chlyomicrons

transport fatty acids and cholesterol to liver

47

Apolipoproteins HDL

apo-A-1

48

Apolipoproteins LDL

apo-B-100 (has vldl) apo-B-48

49

Niacin is vitamin

B3

50

Niacin works on

VLDL and LDL

51

Statins inhibit

cholesterol synthesis in the liver

52

Statins may cause

cataracts

rhabdo

53

Statins do

EVERYTHING

lower VLDL, LDL< cholesterol

increase HDL slightly

54

Niacin side effects

hypotension, hyperglycemia, dizziness, headache, cough, hyperuricemia, peptic ulcer, pruritis

55

Atorvastatin may cause

tendon rupture

diabetes

rhabdo

cataracts

hemorrhagic stroke

56

hyperlipidemia labs

homocisteine

LDL
HDL
VLDL

C-reactive protein

57

What is homocysteine

amino acid linked to heart disease, stroke, Alzheimer's,

58

What is C-reactive protein?

inflammatory protein found in cardiovascular disease

59

HDL should be

>60

60

Cholesterol

<200

61

Triglycerides

<150

62

LDL

<100

63

Antihyperlipidemics effect what organ negatively

Liver

64

Antihyperlipidemics cause what kind of distress

GI

65

What can combat the negative effects of niacin?

Aspirin

66

Cilostazol

Direct acting vasodilator treats PAD and claudication

67

Cilostazol

Headache, diarrhea, abnormal stools

GI distress, headache, dizziness, nasopharyngitis, influenza, peripheral edema