test 2 info

pharm 2

beta lactams prolonged titration

pip/taz or meropenum

or vanco if MRSA

what are the ABX options for shock?

3 hrs

how long should the infusion of broad spectrum ABX be for shock?

lactated ringers

plasma lyte

what are the 2 types of cystalloid fluids?

crystalloids : LR or PL

what type of fluid is preferred in shock?

cause vasoconstrction

ang 2

phenylephrine ( alpha only)

vasopressin (ADH)

what are the 3 vasopressors and what do they cause?

NE

E

dopamine

all cause increase contractility + constriction

what are the 3 inopressors and what do they cause?

“MID” cause increased contractiity

milerone

isoproterneol ( beta only)

dobutamine

what are the 3 ionotropes and what do they cause?

PDE3 inhibitor that causes increased contractility

MOA of milrinone ?

1. NE

2. vasopressin

3. Epi

what for the first 3 picks for vasopressors in shock?

phenotalmine

what is the vasopressor vesicants antidote?

IV hydrocortisone

decrease time on a vasopressor

what is the medication option for adrenal insufficiency shock?

CCB except amlodipine

NSAIDs

what meds worsen HF?

BB

ACEI/ARB/ARNI

SGLT2 i

sprinolactone / MRA

what are the GDMT meds for HF?

loops

what med is used for HF sx tx?

bisoprolol

carvedilol

metoprolol succinate

what are the specific BB used in HF?

induce vasodilation + natruiresis

ARNI MOA?

if switching from ACE= need 36 hour wash out

can switch directly to and ARB

what is special abt ARNI when u are switching meds?

BiDil

if angioedma w/ ARB what should u switch to?

“ - flazon”

what do SGLT2i end in?

inhibit Na + glucose reabsorption

SGLT2i MOA?

“DES”

dapagliflazon, empagliflozin, sotagliflozin

what SGLT2 do u not have to have DM for?

gynecomastia

possible ADE of sprinolactone?

K >5 or GFR < 30

MRA CI?

hydralizine / isosorbide dinitrate (BIDIL)

which HF med is best for AA?

vasodilation

BIDIL MOA?

± 2 lbs in a day or ± 5 in a week

what is a red flag when using loops?

weight

what do u need to monitor on loops?

inhibits Na/ K pump → AV node suprression

longer refractory period

digoxin MOA?

yellow halos

more likely if low mg, K and high Ca

digoxin toxicity causes ___?

SGLT2 + fluids

in acute HF what needs to be immediately started?

whats the tx for each group ?

warm/ dry ?

warm / wet?

cold/ dry?

cold/ wet?

milirone → doesnt need Beta receptors

what med should be give when diuretic resistance occurs after give loops?

PDE inhibitor→ no Beta receptors needed

milrinone MOA?

ARNI → entresto

which is the best for HF : ACE/ ARNI/ ARB?

thaizides

what is the best for lower BP in HF?

reduced hospitalizations + sx

digoixin health benefits in HF?

SGLT2

what med do u give for HF stage 3?

Na channel blockers

“ double quarter pounder”

• disopryamide

• quinidine

• procainamide

what is the MOA of class 1a antiarrhytmics + what drugs are in it?

Na channel blockers

“lettuce + mayo”

• lidocaine

• mexiletine

what is the MOA of class 1b antiarrhytmics + what drugs are in it?

Na channel blockers

“fries please”

• flecainide

• propafenone

what is the MOA of class 1c antiarrhytmics + what drugs are in it?

metoprolol

bisprolol

carvedilol

propanolol

etc

what BB of used as antiarrhtymics?

beta blockers

what drugs are class 2 antiarrhythmics?

K channel blockers:

“a dirty dog is stink”

• amiodarone

• dronedarone

• dofetilide

• ibutilide

• sotalol

what is the MOA of class 3 antiarrhytmics + what drugs are in it?

ca channel blockers

• diltiazem

• verapamil

what is the MOA of class 4 antiarrhytmics + what drugs are in it?

digoxin

adenosine

what is the MOA of class miscellaneous antiarrhytmics + what drugs are in it?

1a= intermediate

1b= low

1c= high

what is the potentcy level for each class of 1 anitarrhytmics?

anticholingeric

class 1 a antiarhtymics ADE?

procainamide ( class 1a)

what drug causes lupus like syndrome + dyscrasis ?

pulm fibrosis

thyroid toxicity

hepatotoxicity

blue-grey skin color change

amiodarone ADE?

24-107 days

how long is amiodrarone ½ life?

QTc > 400 msec

dofetilide CI?

must be started in the hospital and monitored w/ EKG for 3 days

what is special abt dofetilide?

ibutilide (covert)

what drug is only used to cardiovert?

must montior in hospital for 3 days

what is special about sotalol?

slows AV node conudction, intreptus re-entry pathway, restores NSR

adenosine MOA?

PVT

adenosine use?

atropine

first line for sinus brady + AV blocks?

adenosine

what is the go to med for PSVT?

vagal maneuver or adenosine

stable PSVT/SVT tx?

adenosine or electrical cadioversion

unstable PSVT/SVT tx?

improves AV conduction

atropine MOA?

slows AV conduction

adenosine MOA?

BB or non-DHP CCB

tx for PVC?

magnesium sulfate

torsades tx?

no pulse = defibrilation

pulse = cardioversion

no pulse tx vs pulse tx?

sotalol + dofetilide

what 2 drugs have to be monitored by EKG in hopsital?

eliquis

what is the preffered anticoagulant for afib?

1. anticoagulation

2. control modifable risk factors

3. rate/ rhythm control

what are the 3 pillars for tx of afib?

warfarin

what is the tx of choice for antiphospholipid disoder, mitral stenosis and artifical valves?

dabigatran (pradaxa)

what is the direct thombin inhibitor?

directly inhibts factor 2a (thrombin)

diabigatran (pradaxa) MOA?

dabigartran (pradaxa)

what DOAC causes dyspepsia?

no

does dabigatran (pradaxa) need a lead in for afib?

eliquis

xarelto

edoxaban (savaysa)

what are the Xa inhibitors?

no

does edoxaban ( savaysa) need a lead in for afib?

inhibits vitmain K facotrs and protein C + S ( 1972)

warfarin MOA?

no NSAIDS , give tylenol

what pain med can be give when on warfarin?

afib =2-3

mitral valve= 2.5-3

what is warfarin targert for afib and for mital valve ?

requires >5 day bridge until INR therapeutic

what is special abt warfarin?

APAP + FAB 5 ( flaygly, amiodarone,bactrium, FQ, fluconazole)

what increase warfarin INR?

immediate cardioversion

add anticoag if > 48 hrs

if unstable AFIB what is tx? what is > 48 hrs?

long term anticoag

stable afib tx?

IV BB or non DHP CCB

afib w/ RVR no decomp HF tx?

IV amiodarone

afib w/ RVR decomp HF tx?

electrical cardioversion + anticoagulation

tx for afib + hemodynamically unstable?

BB , non DHP CCB, amiodarone , digoxin

what are the med options for long term rate control?

BB , non DHP CCB

what is 1st line for chronic long term rate control in HF?

dronedarone

what should be absolutely avoid in HF?

1c and group 3

what are the common meds for rhythm control?

class 1 c or class 3

no HF or no MI tx for afib?

amiodranone or dofetilide

HFrEF or MI tx?

BB or CCB

you must be on ___ to use pill in the pocket?

flecainide

propafenone

what are the med options for pill in the pocket?

statins

BB

thiazides

steroids

what meds worsen diabetes?

decrease liver glucose production and increases tissue uptake

metformin MOA?

lactic acidosis

GI , B12 deficiency

what is metformin ADE/BBW?

GFR< 30

if GFR 30-45 = decrease dose by 50 %

when can metformin not be use?

pioglitazone (actos)

rosiglitazone (avandia)

what are the 2 thiazolidinesiones (TZD)?

activates PPAR-gamma ( in adipose) to increase insulin sensitivity

thiazolidinesiones MOA?

edema

caution use with : HF, fractures, bladder cancer

thiazolidinesiones ADE?