Cardiac/CNS Pharm

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Author:
anddavis
ID:
72247
Filename:
Cardiac/CNS Pharm
Updated:
2011-03-11 11:29:38
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Pharm
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Pharm
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  1. Direct acting cholinomimetics
    • Beth and Meth Piled Directly into the Chold Car
    • Bethanechol
    • Carbachol
    • Pilocarpine
    • Methacholine
  2. Indirect acting cholinomimetics (anticholinesterases)
    • The "stigma" of being anticholine
    • Neostigmine
    • Pyridostigmine
    • Edrophonium
    • Physostigmine
  3. Bethanechol
    • Direct acting cholinomimetic
    • Neurogenic ileus and urinary retention (activates bowel and bladder)
  4. Carbachol
    • Direct acting cholinomimetic
    • Glaucoma, pupillary constriction
  5. Pilocarpine
    • Direct acting cholinomimetic
    • Open and closed angle glaucoma
  6. Methacholine
    • Direct acting cholinomimetic
    • Challenge test for asthma diagnosis
  7. Neostigmine
    • Anticholinesterase
    • Postoperative/neurogenic ileus and urinary retention
    • Myasthenia gravis
    • Reversal of NM junction blockade
  8. Pyridostigmine
    • Anticholinesterase
    • Myasethenia gravis (long acting)
  9. Edrophonium
    • Anticholinesterase
    • Diagnosis of myasthenia gravis
  10. Physostigmine
    • Anticholinesterase
    • Glaucoma (crosses BBB) and atropine overdose
  11. Organophosphate poisoning
    • Anticholinesterase
    • DUMBBELSS
    • Diarrhea, Urination, Miosis, Bronchospasm, Bradycardia, Excitation of skeletal muscle and CNS, Lacrimation, Sweating, Salivation
    • Antidote: atropine and pralidoxime
  12. Muscarininc antagonists
    • Oppose parasympathetic activity
    • Atropine, homatropine, tropicamaide
    • Benztropine
    • Scopolamine
    • Ipratropium
  13. Atropine overdose
    • Hot as a hare
    • Dry as a bone
    • Red as a beet
    • Blind as a bat
    • Mad as a hatter
    • Reverse with physostigmine
  14. Benztropine
    • Muscarinic antagnoist
    • Parkinson's disease
  15. Scopolamine
    • Muscarinic antagonist
    • Motion sickness
  16. Ipratropium
    • Muscarinic antagonist
    • Asthma, COPD
  17. Hexamethonium
    • Nicotinic antagonist
    • Ganglionic blocker
  18. Direct acting sympathomimetics
    • Epinephrine
    • NE
    • Isoproterenol
    • Dopamine
    • Dobutamine
    • Phenylephrine
    • Metaproterenol
    • Albuterol
    • Salmeterol
    • Terbutaline
  19. Indirect acting sympathomimetics
    • Amphetamine (narcolepsy, obesity, ADD)
    • Ephedrine (nasal decongestion, urinary incontinence, hypotension)
    • Cocaine (vasoconstriction and local anesthesia)
  20. Epinephrine
    • Direct acting sympathomimetic
    • Equal alpha and beta activity
    • B1 selective at low dose
    • For anaphylaxis, open angle glaucoma, asthma, hypotension
  21. NE
    • Direct acting sympathomimetic
    • Alpha activity > B1
    • Hypotension (causes decreased renal perfusion)
  22. Isoproterenol
    • Direct acting sympathomimetic
    • Equal B activity
    • AV block
  23. Dopamine
    • Direct acting sympathomimetic
    • D1 = D2
    • Shock (increased renal perfusion), heart failure
  24. Dolbutamine
    • Direct acting sympathomimetic
    • B1>B2 (inotropic, not chronotropic)
    • Shock, HF, cardiac stress testing
  25. Phenylephrine
    • Direct acting sympathomimetic
    • A1>A2
    • Pupillary dilation, casoconstriction, nasal decongestion
  26. Metaproterenol
    • Direct acting sympathomimetic
    • Selective B2
    • Acute asthma
  27. Albuterol
    • Direct acting sympathomimetic
    • B2 selective
    • Acute asthma
  28. Salmeterol
    • Direct acting sympathomimetic
    • B2 selective
    • Long-term asthma treatment
  29. Terbutaline
    • Direct acting sympathomimetic
    • B2 selective
    • Reduce premature uterine contractions
  30. Clonidine
    • Sympathoplegic centrally acting alpha 2 agonist
    • Decreases central adrenergic outflow
    • Hypertension (esp in renal disease)
  31. Alpha-methyldopa
    • Sympathoplegic centrally acting alpha 2 agonist
    • Decreases central agrenergic outflow
    • Hypertension (esp in pregnancy)
  32. Non-selective alpha blockers
    • Phenoxybenzamine (irreversible)
    • Phentolamine (reversible)
    • Pheochromocytoma (before surgery)
  33. Prazosin, terazosin, doxazosin
    • A1 selective antagonists
    • HTN, urinary retention in BPH
    • 1st dose hypotension
  34. Mirtazapine
    • A2 selective antagonist
    • Depression
  35. Beta blockers
    • -olol
    • HTN, angina, MI, SVT, glaucoma
    • Impotence, exacerbation of asthma, bradicardia
  36. Propranolol
    • Non selective B blocker
    • Also timolol, nadolol, pindolol
  37. Atenolol
    B1 selective antagonist
  38. Esmolol
    Short acting B1 selective antagonist
  39. Metoprolol
    • B1 selective antagonist
    • Can cause HLD
  40. Carvedilol
    Nonselective alpha and beta antagonist
  41. Labetalol
    Nonselective alpha and beta antagonist
  42. Pindolol
    Partial beta agonist
  43. Acebutolol
    Partial beta agonist
  44. Hydralazine
    • Increase cGMP --> smooth muscle relaxtion (arterioles > veins)
    • Reduces afterload
    • Usind in severe HTN, CHF, HTN in pregnancy (with methyldopa)
    • Reflex tachycardia (give with B blocker), SLE-like syndrome
  45. Minoxidil
    • Minoksidil
    • K channel opener - relaxes smooth muscle
    • Severe HTN
    • Hypertrichosis, reflex tachycardia
  46. Calcium channel blockers
    • Amlodipine, nifedipine, verapimil, diltiazem
    • Block voltage-dependent calcium channels --> reduce contractility of smooth muscle (first two) and cardiac muscle (second two)
    • HTN, angina, arrythmias (varapimil, diltiazem), Raynaud's
  47. Nitroglycerin
    • Release NO in smooth muscle --> increase cGMP --> smooth muscle relaxation (dilate veins >> arterioles)
    • Angina, pulmonary edema
    • Reflex tacycardia, hypotension, flushing
  48. Nitroprusside
    • Increase cGMP by release of NO
    • Malignant HTN
    • Can cause cyanide toxicity
    • Fenoldopan (D1 agonist) and diazoxide (K channel opener - can cause hyperglycemia) also used for malignant HTN
  49. Digoxin
    • Cardiac glycoside
    • Directly inhibits Na/K ATPase --> inhibits Na/Ca exchanger --> increased intracellular Ca --> positive inotropy
    • CHF, atrial fibrillation; don't give in WPW or other reentrant tachycardia
    • Cholinergic side effects, increased PR, decreased QT, can cause paroxysmal SVT at high doses
  50. Class IA antiarrythmics
    • Na channel blockers
    • The Queen Proclains Diso's Pyramid
    • Quinidine, procainamide, disopyramide
    • Decrease slope of phase 4 depolarization
    • Increase ERF, increase QT interval
    • Reentrant and ectopic SVT, V-tac
    • Torsades from quinidine, SLE-like syndrome from procainamide
  51. Class IB antiarrythmics
    • Na channel blockers
    • Lidocaine, Mexiletine, Tocainide
    • I'd Buy Lidy's Mexican Tacos
    • Decrease slope of phase 4 depolarization
    • Acute ventricular arrythmias (post-MI), digitalis-induced arrythmias
  52. Class IC antiarrythmics
    • Na channel blockers
    • Flecainide, Encainide, Propafenone
    • Contraindicated post-MI
    • V-tach, V-fib, intractable SVT
  53. Class II antiarrythmics
    • Beta blockers
    • Decrease slope of phase 4, increase PR interval
    • V-tach, SVT, atrial fib, atrial flutter
    • Treat overdose with glucagon
  54. Class III antiarrythmics
    • K channel blockers
    • Sotalol, ibutilide, amiodarone
    • Increase AP duration and ERP
    • Ibutilide can cause torsades
    • Amiodarone: blue, blind, and coughing up your liver and thyroide
  55. Class IV antiarrythmics
    • Ca channel blockers
    • Verapimil and diltiazem
    • Increase PR intercal and ERP
    • Prevention of nodal arrythmias (SVT)
  56. Adenosine
    • 1st line for diagnosing/abolishing SVT
    • Very short acting (15 seconds)
    • Effects blocked by theophylline
  57. Potassium
    Depresses extopic pacemakers in hypokalemia
  58. Mg
    Effective in torsades and digoxin toxicity

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