Pharm II Exam 1 Notes - Pharamacology II Midterm 1 Notes...

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Pharamacology II – Midterm 1 Notes Lecture 25 – CHF Drug Pharmacokinetics Clinical Uses ADR’s Other Digoxin Little biotransformation in the liver, mostly excreted as unchanged drug by the kidney. Vd = 6.3 L/kg, F=75%, TI = 1.2-2.0 ng/mL. Inhibits Na-K ATPase pump in cardiac muscle. This causes an increase in Na in the cell which causes an increase in Ca in the cell via the Na/Ca exchanger. The increased Ca increases muscle contraction. Mechanical effects are to increase: contractility, ventricular ejection volume, CO, renal perfusion. Electical effect: early and toxic reponse. Reduces symptoms but does not prolong life. Acts as a parasympathomimetic at AV node to reduce atrial flutter and fibrillation (so for atrial fibrillation). 70% exists in free form, inactive is bound to albumin. Drug-drug interactions with quinidine (increases Cp of digoxin), digoxin toxicity includes: arrhythmias, nausea, vomiting, diarrhea, visual distrubances (halos, color perception problems), drowsiness, confusion. Itraconazole inhibits the ATP dependent efflux pump in renal tubules that moves digoxin into the urine; this increases the Cp of digoxin to toxic levels. Over dose treatment: correct K deficiency, use lidocaine for arrhythmic response, use Digoxin Immune Fab fragment to bind digoxin. Cardiac glycoside w/ + inotropic effect. Most frequently used. Comes from (digitalis lanata) foxglove, also from white oleander. Digitalis Cardiac glycoside w/ + inotropic effect. Looks like foxglove. Digitoxin Cardiac glycoside w/ + inotropic effect. From various species of foxglove. Seldom used. Ouabain Actions similar to digitoxin Cardiac glycoside w/ + inotropic effect. Glycosides Cardiac glycoside w/ + inotropic effect. Steroid nucleus + lactone ring + sugar residue. PDE Inhibitors Used IV only in acute heart failure, high Inhibition of the phosphodiesterase 3 + inotropic agents. Examples are:
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incididence of liver toxicity. isoenzyme in cardiac smooth muscle causes an increase in cAMP and cGMP, this results in increased intracellular Ca and increase contraction force. theophylline, inamrinone and milrinone. ACE inhibitors Vasodilator 30% of Pt develop a cough, renal damage to fetus ang II is 40x more potent vasoconstrictor than NE. Examples are: catopril, enalapril, benazepril. Angiotensin Antagonists Block Angiotensin II receptors. Same clinical effects as ACE inhibitors. Fetal kidney damage Examples: Lorsartin BNP Agonist IV only Counter balance the renin- angiotensin-aldosterone system to increase Na/H2O loss and cause vasodilation. Naturally occuring peptide hormone synthesized in the ventricles, 32 aa ring structure. Atrial Natriuretic peptic is 28 aa peptide hormone synthesized in the atria. Examples:
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Pharm II Exam 1 Notes - Pharamacology II Midterm 1 Notes...

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