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QT prolonging drugs
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Class Ia drugs
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Cardiology Boards
| Question | Answer |
|---|---|
| QT prolonging drugs | Class Ia, Class III, erythromycin, haldol, cisapride, anti-histamines |
| Class Ia drugs | quinadine, procainamide, disopyramide |
| Class III drugs | sotalal, NAPA, ibutalide, dofetalide, amiodarone |
| Potentiate warfarin effect | amiodarone, propafenone, quinadine, erythromycine |
| antagonize warfarin effect | rifampin, vitamin k, barbiturates |
| increase digoxin levels | amiodarone, quinadine, flecainide, propafenone, verapamil |
| lower digoxin levels | antacides, phenytoin, reglan, |
| drugs affected by grapefruit (increased levels) | statins, terfenidine, felodipine/nifedipine, verapamil,versed, cyclosporine |
| calcineurin inhibitor side effects | HTN, renal insufficiency, hemolytic uremic syndrome (HUS), bone marrow suppression, cushing syndrome |
| cyclosporine side effects | gingival hyperplasia, hirsutism, tremor |
| tacrolimus side effects | glucose intolerance |
| azathiprine | hepatic dysfunction, increased levels with allopurinol (more bone marrow suppression) |
| MMF | GI intolerance, viral infections |
| rapamycin | poor wound healing, oral lesions, hyperlipidemia |
| lipophilic b-blockers metabolized in liver | propranolol, metoprolol, labetolol |
| hydrophilic b-blockers metabolized by kidney | atenolol, nadolol, sotalol |
| Sotalol and dofetilide - mode of elimination | renal elimination antiarrythmics |
| hepatic elimination antiarrythmic meds | quinidine, lidocaine, mexilitine, phenytoin, propafenone, amiodarone, diltiazem |
| drugs that require 50% dose reduction in pts with moderate cirrhosis | warfarin, statin, verapamil/nifedipine, propafenone |
| hepatic metabolism inhibitors | cimetidine, diltiazem, verapamil, erythromycin, anti-fungals |
| hepatic metabolism inducers | barbiturates, carbamezapine, phenytoin, rifampin |
| drugs that increase risk of statin related myopathy | gemfibrozil, niacin, verapamil, amiodarone, CSA, anti-fungals, HIV drugs, grapefruit juice -- decrease dose of statin 50% |
| incidence of rupture with lytics | no increase if lytics given early, but it can occur early if lytics given late (>14 h) |
| absolute contraindications to lytics | any ICH, known AVM, known IC neoplasm, ischemic CVA within 3 months, active bleeding, CHI or facial trauma within 3 months, suspected dissection |
| diabetic retinopathy and menses - contraindication to lytics? | no |
| risk of ICH with different lytics | SK < tPA and TNK < rPA < TNK+LMWH age>75 |
| which heparin do you use with lytics? | ONLY UFH (IIb age <75) (III age >75) |
| blood thinners to give with lytic therapy | UFH or LMWH (but lower dosing), ASA, Plavix (excluded pts >75 in COMMITT and CLARITY) |
| LMWH in Primary PCI | no role, always use UFH |
| blood thinners to give with primary PCI | UFH, ASA, GPIIb/IIIa (Abciximab), Plavix |
| Class I Recs Primary PCI | MI < 12h, door to balloon < 90 mins |
| Class I Primary PCI for Shock or new LBBB | < 18 hours of shock or <36h h of MI < 75 years old |
| Supravalvular aortic stenosis | associated with hyperlipidemia and Williams Syndrome |
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