Asocieri de: antiaritmice

1. Asocieri de: antiaritmice
1. IA(Chinidina /Procainamida) +IB(Mexiletin)- CI: NU assoc Cls/Subcls IA+IC
2. I + βB (nu Sotalol) DACA: QT↑ NU IA, Amiodarona, Sotalol
3. Propanolol+Mexiletina/Flecainida – diminua ef Proaritmic Amiodarona+βB – ef aditive
4. IA+ Sotalol - date clinice incomplete
5. Disopiramida +verapamil
6. Clonidina+Verapamil – hipotens
7. Propafenona + Chinidina/ Procainamida
2. Ef. Adv la antiaritmice CI.:
1. Amiodarona: Fibroza pulm, neuropat perif, depozite cornee, disf hep, tiroid : Bo pulm, hep
2. BB: bronhospasm, hiperglicelie : astm, D-Insdep, bloc card
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 : bo. dig cr, QT>, hipoK
10. Sotalol: Tor vf, Brspasm, : astm, DZinsdep, QT>, hipoK
3. 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. MgCl2 – FiA, intoxic cu digitala, Tor vf
4. Cdtii pat. ce determ Aritmii: TS, durere, hipovol, IC, tireotoxicoza, anxietate, hiopK, hipoMg, bradicardie, acidoza, intoxicatie cu digitala
5. In ce aritmii se da Digoxina: FlA, FiA : 62,5 -250 μg/zi p.o. corelata cu varsta , IC asociata cu FiA
6. To vf : MgSO2: 2g in 1-2min, repetat la 5-10min, alternativ Isoproterenol sau Paging(↑QT), adm de K ↓ PA
7. Geneza To vf: blocK, antihist, fenotiazidice, antidepresive triciclice, Ketoconazol, dieta proteica lichida
8. AA ↑ QT: Chinidina, Disopiramida, Amiodarona, Sotalol, Bepidil, Producol, Prenilamida, deriv triciclici, Feniltiazina, Eritromicina, Antihistaminice: Terfenadina, Astemizol, ↑QT pe fond de hipoK,Mg
9. AA ↑ PRR(perioada refractara rlativa): IA, III, Sotalol
10. AA PROaritmogene: IA, IC, III, Sotalol
11. Cum actioneaza Cls I pe PR: IA ↑, IB↓ , IC normal
12. Cum act Cls I pe PA: IA↑, IB↓, ↑PA, ↑Fz 3 , ↓depolarizarea
13. Cum act Cls III: blocheaza can de K , ……..↑ durata Fz 3, ↑ PA, ↑ PR
14. Cum act Cls IV pe Fz 0 : ↓ depolarizarea spontana, ↓ frecventa conducere AV, ↓ PA
15. Cum actioneaza Fz.4 pe PA si per refrac: ↓PA, ↓ PR
16. Cls III – pe ce Fz si cum actioneaza – ↑ Fz 3, creste PA si PR
17. Prin ce mecanism scade PA cls II: prin deprimarea Fz 4, cresterea PR si scaderea AV
18. In ce afect se da Bloc α Adr: Hiperplazie de prostata, Hiperlipidemie
19. Fazele repolarizarii la AA:
20. In ce AA se da MgSO4: FiA, FiV, To.Vf, intoxicatie cu digitala, postIMA
21. Indicatii MgSO4 = laxative osmotice in constipatie, atrag apa = ↓ densit bol fecal
22. Care sunt aritmiiile grave:FiV, Tahicardie V cu complexe largi
23. Cls II – mecanisme si efecte: ef = deeprima Fz 4 a depolarizarii, ↑PR, ↓PA, ↓AV;, mec: bloc Rβ-adrenerg
24. Determina tahicardie reflexa: nitratii, clonidina, hidralazina, vasodilatatoarele directe!!, IEC
25. Sunt cunoscute ca hipoglicemiante: β-blocantele.
26. Medicam ce act pe alfa 2 centrali: Clonidina, alfa-metil dopa, Guanfacina, Monoxidina, Rilmetidina
27 Clase de medicam in IC: IEC, β-B , diuretice
28. 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

29. . Ce NU se da in HTA + Sarcina: 1. IEC –tub crest = Irenala fat,
2. BRTA1
3. Diuretice- ↓ vol plasm, ↓circul placentara, ↓ nutritia fat
30. Diuretice din HTA: 1. Tiazidice: ICC, HTA -1 varstnic, 2. sistolica izolata varstnic, 3. ……
2. Ansa: ICC, IRenala
3. Aldostero: ICC, Post IMA
31. Indicatii : Aritmice + HTA:
1. BB selective
2. Ca bloc: Verapamil, Diltiazem(dupa ↓ K posttrat diur-favor ectopii V Proaritmigene)
32.Asocieri : 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
33. . Cdtii pato HTA + BB : AP, postIMA, ICC, sarcina, tahiaritmii, cele cu acti intrinseca-sunt tahicardizante – CI
34. NU se dau HTA + BB : OBLIGATORII: astm, BPOC, BAV2/3, POSIBILE: b vasc perif, intoler la gluc, pers fizice active – atleti
35. IEC indicatii: CI:
1. IC toate stadiile :sarcina, stenoza de aorta severa,
2. HTA- cu risc ↑ DZ : stenoza bilat a art renele, IRenala severa
3. IMA, post IM cu disf VS :HiperK, cardiomiopatie
4. Nefropatie diabetica
5. Protectie CV, postIM remodelare
36. Ef nitratilor in IC: scade vol V, scade PA, scade timp de ejectie, vasodilatare coronariana epicardica,
37. Ci in sarcina: IEC, B-bolc, diuretice
38. Ef. Adv
 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

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