Anti HTA- asocieri

1. Anti HTA- asocieri:
 IR: • BIC: • Prev I:
1. diur tiazidice 1. Ca bloc cu ef prelung 1. IEC
2. spirono K-ce retin K nu I generatie 2. Ca bloc
3. BB cu eliminare renala 2. beta bloc 3. diuretice
4. Ca blocante 3. nitrati 4. alfa 1 bloc
5. IEC 4. IEC inclusiv prev sec • PrevII:
 DZ: • Sarcina: 1. IEC
1. IEC 1. alfa metil dopa 2. alfa 1 bloc
2. Ca bloc 2. labetalol labetlaol iv. urgenta,
3. beta 1 bloc 3. prazosin Nitroprusiat Na ce
4. la varst diur 4. MgSO4 creste p. intra cran.
5. aldost ce retin K 5. BB= atenolol, metoprolol • HVS:
 Dislipid: 6. Ca bloc = nifedipina, verapamil 1. IEC
1. IEC • IC: 2. BRTA2
2. Ca bloc 1. IEC - ↓mortalitatea cu 1/6 3. beta 1 bloc
 BIP 2. B1B –selective- metoprolol, carvedilol(1/4) 4. Clonidina
1. IEC • AVC 5. alfa metil dopa
2. Ca bloc 6. beta+alfa bloc
3. alfa 1 bloc
2. Ce NU se da in HTA + Sarcina: 1. IEC –tub crest = Irenala fat,
2. BRTA1
3. Diuretice- ↓ vol plasm, ↓circul placentara, ↓ nutritia fat
3. Diuretice din HTA: 1. Tiazidice: ICC, HTA -1 varstnic, 2. sistolica izolata varstnic, 3. ……
2. Ansa: ICC, IRenala
3. Aldostero: ICC, Post IMA
4. Indicatii : Aritmice + HTA:
1. BB selective
2. Ca bloc: Verapamil, Diltiazem(dupa ↓ K posttrat diur-favor ectopii V Proaritmigene)
5.Asocieri de:
 Diuretice
 Anti HTA
1. Diuretic + BB Principiu: Sinergism- ef pozitive
2. Diuretic+ IEC Antagonism – ef adv
3. Ca bloc din tulb de ritm + BB protector fata de tulb de ritm
4. Ca bloc + IEC – eficienta in ↓ TA
5. BB + alfa B - rar
 AA:
1. IA(Chinidina +IB(Mexiletin)- inhib can de Na activ vs can de Na inactiv CI: NU assoc Cls/Subcls
Procainamida) IA+IC
2. I + BB (nu Sotalol) DACA: QT↑ NU IA, Amiodarona, Sotalol
3. Propanolol+Mexiletina/Flecainida – diminua ef Proaritmic Amiodarona+BB – ef aditive
4. IA+ Sotalol - date clinice incomplete
5. Disopiramida +verapamil
6. Clonidina+Verapamil – hipotens
7. Propafenona + Chinidina/ Procainamida




6. Ef. Adv CI.:
 AA
1. Amiodarona: Fibroza pulm, neuropat perif, depozite cornee, disf hep, tiroid : Bo pulm, hep
2. BB: bronhospasm, hiperglicelie : astm, D-Insdep
3. Ca bloc: ICC, BAV : disf V, tulb cond
4. Disopiramida: ICC, Tor Vf, Ret. urinara, glaucom, ↑QT, tulb ritm, : QT>, prostatism,IR,glaucom
5. Flecainida: ↑ mortalitatea Post IM, bradi aritmii : tulb de cond
6. Procainamida: Sdr. Lupoid , agranulocitoza : artrita cr. Discrazie sg
7. Lidocaina+ Mexiletina : tremor : Parkinson
8. Propafenona: ICC, Brspasm, proaritmic : astm, tulb cond, disf VS
9. Chinidina: Tor vf, ↑ QT, diaree, hipoK : bo. dig cr, QT>, hipoK
10. Sotalol: Tor vf, Brspasm, DZins dep : astm, DZinsdep, QT>, hipoK
 Brdilat β2Adr: toleranta, agitatie, tremor, nervoza, cefalee, transpir, slabiciuni, roseata pielii, greata, voma, aritmii, HTA, hipoK
 Stabilizatori mastocitari: cefalee, gat uscat, brspasm tranzitoriu, tuse, roseata tegum
 Imm super : deriv Tioguanina –suprima maduva hematopoetica, Mitutirixative?- supresie medulara, alopecie, nefrotoxic, afect. Epit intest, Inflix- IResp super ↓ Ig A secretoare?
 IPP: Omeprazol- Hipergastrinemie secundara, Hiperplazia mucoasei gastrice
 Teofilina: C-V: TS, TSV, ESV, FiA, FlA, TahicA, Tahic multifocala, aritmie cu instabil hemodinamica
7. AA neclasificate: 1. Atropina – bradicardie sinusala
2. Adrenalina – stop card
3. Izoprenalina – bloc card
4. Digoxin – FiA
5. Adenozin – TSV
6. CaCl2 – TV prin hiper K
7. M gCl2 – FiA, intoxic cu digitala, Tor vf
8. Ef corticosteroizi: Confirmat - inhib locala: ↓ nev de corticoster sistem, ↓ simpt sau exacerb AB, ↓ nev de brdilat β2 Adr de urgenta, ↓ crize nocturne/echivalent AB nocturn – tuse, imbunatateste indicii calitate vietii, ameteli functie pulm
Posibil: ↓ cz deces, ↓ vit declin fct pulm, ↑ per de remisie sustinuta a crizelor
9. Ef Brdilat: Brdilatatie, stabilizare mastocitara, inhib elib LT, ↓ permeabilμ vasc, ↓ exudat + edem cai aeriene,
↑ clearence mucociliar, ↑ secret mucus
10. ↑ Sv BB in IC : ↓ risc de aritmii –ef anti aritmic prin ↑ activ sinaptice in ICC
11. clase de madicam in IC: IEC, BB (digoxin, nitriti, diuretice)
12. Cdtii pato HTA + BB : AP, postIMA, ICC, sarcina, tahiaritmii, cele cu acti intrinseca –sunt tahicardizante – CI
13. NU se dau HTA + BB : OBLIGATORII: astm, BPOC, BAV2/3, POSIBILE: b vasc perif, intoler la gluc, pers fizice active – atleti
14. Medicam ce act pe alfa 2 centrali: Clonidina, alfa-metil dopa, Monoxidina, Rilmetidina, Guanfacina
15. Cdtii pat. ce determ Aritmii: TS, durere, hipovol, IC, tireotoxicoza, anxietate
16. In ce aritmii se da Digoxina: FiA : 62,5 -250 μg/zi p.o. corelata cu varsta
17. To vf : MgCl2: 2g in 1-2min, repetat la 5-10min, alternativ Isoproterenol sau Paging(↑QT)
18. Geneza To vf: blocK, antihist, fenotiazidice, antidepresive triciclice, Ketoconazol, dieta proteica, lichida
19. AA ↑ QT: Chinidina, Disopiramida, Amiodarona, Sotalol, Bepidil, Producol, Prenilamida, deriv triciclici, Feniltiazina, Eritromicina, Antihistaminice: Terfenadina, Astemizol, ↑QT pe fond de hipoK,Mg
20. AA ↑ PR(perioada refractara): ..?? IA, IC, III, Sotalol
21. AA PROaritmogene: IA, IC, III, Sotalol
22. Cum actioneaza Cls I pe PR:
23. Cum act Cls I pe PA: IA↑, IB↓
24. Cum act Cls III: ↑ durata Fz 3, ↑ PA, ↑ PR
25. Cum act Cls IV pe Fz 0 : ↓ depolarizarea spontana, ↓ frecventa conducere AV, ↓ PA
26. In ce afect se da Bloc alfa Adr: Hiperplazie de prostata, Hiperlipidemie
27. Cls Laxative:
1. Volum – metilceluloza, Plicarbophil
2. Emoliere – Docusat Cu/Na
3. Lubrefianti – Ol. Parafina/ Magnezia Usta
4. Iritante – Senna, Fenolftaleina, Ol. Castor, Ol. Ricin
5. Osmolice – MgSO4, citrat, polietilengliol electroliti = Fortans, Lactuloza – ↓ NH3, encefalie portala
28. Indicatii MgSO4 = laxative osmotice in constipatie, atrag apa = ↓ densit bol fecal
29. UG +HP: Clase:
1. Anticecretor –IPP: Omepraz40, Lansopraz15-30, Pantopraz40
2. BRH2 : Cimetidina 800zi, Ranitidina 300, Famotidina 40
3. Protectoare Bismut 525x3/zi
4. Antibio……. : Metronidazol 400x3/zi Timidazol, Claritromicina 500x2/zi, Amoxicilina 500x3/zi
30. Ef adv Cimetridina: cefalee +/- somn, fatigabilitate, greata, voma, diaree, constipatie, tr-penie, ginecomastie, alopecie, impotenta, atralgie, disc-abd
31. Da Tahicardie reflexa: Clonidina, vasodilat directe, IEC
32. IEC indicatii: CI:
1. IC toate stadiile :sarcina
2. HTA- cu risc ↑ DZ : stenoza bilat a art renele
3. IMA, post IM cu disf VS :HiperK
4. Nefropatie diabetica
5. Protectie CV, postIM remodelare
33. Bo. inf int :Clase:
1. 5Aminosalicilati – Sulfasalozina, Mesalazina – Sulfapiridina 4g/zi in 4 prize initial 500mgx2/zi., similar Olsalazina
2. GCz Prednison 40mg/zi
3. Imm Supres : daca nu raspunde la GCz
 deriv deTioguamina = 6Mercaptopurina 1,5mg/kg/zi
 Azatiopurina 2-2,5mg/kg/zi tipm 3-6 luni
 Metotrexat 15-25mg/sapt i.m. ef bun in Bo. Crohn
 Ciclosporina 4mg/kg/zi infuzie c% sange tot 300-400mg/ml – ef ↑ in RCUH ce nu rasp la GCz
4. Infliximab – Ig ce leaga TNFalfa pe care-l neutralizeaza
34. Scopul terapeutic in Astm:
35. Asocieri de diuretice:
36. ce medicam este cunoscut ca fiind hiperglicemiant?
37. Ef nitratilor in IC:
38. Ci in sarcina:
39. Antimimetice- 5med +eficicienta ptr fiecare:
40. consecinte Cls II- Fz 4:
41.Asocieri rationale in HTA:
42. Ce medicam ↑ sensibilit la digoxina?
43. PR in Fz1.:
44. Ce medicam ↑ rezist perif cr.?
45. Ef. Stabilizatorilor mastocitari: