قبل ما نبدوا في الdrugs لازم نفهموا الpathophysiology للHF و هذا فيديو لفوده تلقو فيه الشرح~ ☝️

أحتمال يجن إكسبلاين أو شورت نوت~

❕list drugs used to reduce preload afterload and myocardial contractility in CHF vs AHF? ⭐
▫️CHF
(preload): loop - ACEI ARBs - nitrates
(after load): ACEI ARBs - hydralazine
(contractility): Digoxin

▫️AHF
(preload): loop - nitrates - nitroprusside
(afterload): nitroprusside
(contractility): dopamine - dobutamine - inamrinone

❕advantages of ACEI in HF? ⭐⭐⭐
▫️improve exercise tolerance & congestive symptoms
▫️decrease mortality in HF
▫️renoprotective
▫️do not induce reflex tachycardia

⭐⭐⭐❕Explain advantages of ARBs?
▫️no bradykinin production
▫️antagonize Ag II formed by ACE
▫️avoid hormonal escape
▫️increase activity of AT2 → ↑VD

❕List precautions when using nitroprusside?
▫️give slow IV
▫️freshly prepared in saline with opaque foil
▫️frequent monitoring of BP
▫️avoid prolonged administration to prevent cyanide toxicity

⭐❕Explain the beneficial effects of spironolactone in reducing mortality in HF?

❕beneficial effects of beta bl. in reducing mortality in HF ⭐⭐⭐
▫️نزله سلايد

❕CI of digoxin? ⭐⭐

❕Explain why digoxin CI with AF+WPW? ⭐
▫️b/c blocks AVN → ↑conduction in accessory tract

❕Explain why digoxin CI with erythromycin?
▫️b/c decrease inactivation of digitalis by killing GIT flora lead to increase absorption and toxicity

❕Explain digitilization? ⭐⭐⭐
(مهم مهم جدا الدكتورة عاودتها كم مرة)
▫️to achieve therapeutic bl. lvl & to avoid toxicity
▫️low dose 0.125-0.25 mg/d (Css reached in one week)

❕TTT of digitalis toxicity? ⭐⭐

❕Order of therapy in CHF? ⭐

نقاط مهمة mcq 📌

⭐▫️beta bl only used in HF (carvedilol - bisoprolol - metoprolol) مهمة

▫️nitroprusside not used in chronic only acute

▫️nitrates + hydralazin used together in HF

▫️ACEI prevent myocardial hypertrophy & remodeling & lower BP w/o reflex tachy

▫️captopril contain SH + rapid onset + short duration

▫️ACEI used in early MI with aspirin + fibrinolytics + beta bl


⭐▫️ACEI CI with bilateral renal artery stenosis (مهمة) Explain
b/c GFR is maintained by VC of the efferent arteriole by AgII

❔because they ↓ Ang-II → ↓ VC of the efferent arterioles → ↓ GFP and ↓ GFR →lead to aggravation of renal failure in both kidneys and hyperkalemia

▫️diuretics give for fluid control → ↓pulmonary congestion + ↓peripheral ankle edema

⭐▫️diuretics 1st choice in refractory pulmonary edema

⭐▫️drugs that lower mortality: (ACEl ARBs - beta bl - spironolactone)

▫️digoxin inhibits Na/K ATPase

▫️digoxin increase contractility

▫️digoxin can cause arrhythmia

▫️digoxin cause vagal stim. at (therapeutic dose) & sympathetic stim. at (toxic dose)

⭐▫️it inhibits SAN →↓HR (indicate optimal digitalization) + AVN block and increase ERP (مهمة)

⭐▫️digoxin drug of choice for HF + AF

▫️it has narrow safety margin and give yellow green coloured vision

⭐▫️digibind is first choice for TTT of digitalis toxicity

▫️dopamine given in AHF + cardiogenic shock

▫️Milrinone - Inamrinone are inodilators inhibit phosphodiesterase III

⭐▫️Sacubitril-Valsartan are inhibitor of neprilysin enzyme

⭐▫️Ivabradine TTT stable angina + CHF with ejection fraction less than 35%
▫️it selectively inhibit hyperpolar. of cyclic nucleotide channel (funny channels) on SAN

الحق صارلي شوية إحباط من أخبار اليوم بس حنزل الباقي بيش نستفيدوا كلنا~
نعرفش نقول كلام محفز 😂 بس نديروا اللي علينا و ان شاء الله التعب مش حيعدي عالفاضي نتوكلوا على الله بس و كلنا نطلعوا منها راضيين~ 🤍

نبدوا بال 4) drugs used in arrhythmia 💫

أول شيء الدكتورة قالت ان الجزئية هدي متقدمة واجد بالنسبة لثالثة فناخدوا عليه نقاط معينة نركزوا عليها~

هدي بداية تسجيل المحاضرة قالت شن المهم و شرحت باثوفسيولوجي بيش نفهموا ال drugs

اللي قالت عليهن يجن شورت نوت

1 list vaughan william classification

2 adverse effects of class I a

3 adverse effects of Amiodarone

4 precautions should be done to pt taking Amiodarone

نقاط مهمة mcq 🔴

▫️every anti arrhythmic drugs have pro arrhytmogenic actions

▫️procainamide has moderate dissociation rate - moderate conduction block + ganglion blockade

▫️drugs inhibit action of quinidine: (digoxin - beta bl. - verapamil) ↓AVN

▫️class I a used on broad sprectum
▫️class I b on ventricular arrhythmias
▫️class I c on SV arrhythmias
▫️class III (Amiadarone) broad spectrum (terminate PSVT)
▫️class IV (verapamil) SV arrhythmias (2nd choice if PSVT with asthma)

▫️lidocaine blocks inactivated Na channels in ischemic tissue

⭐▫️lidocaine best used after MI or cardiac surgery

▫️(case) pt developed arrhythmia after cardiac surgery which drug of choice?
lidocaine

▫️class 1b (lidocaine) not used orally and can cause convulsions

▫️class Ic marked (AVN) conduction block

▫️class 1c (propafenone) CI in bronchospasm

⭐▫️Amiodarone (مهمة كلها) K channel bl

⭐▫️(case) use beta bl. in exercise - thyrotoxicosis - pheochromocytoma

▫️Adenosine used in emergency - PSVT (drug of choice)
CI in asthma (case)

▫️(case) verapamil drug of choice in prophylaxis PSVT

▫️(case) beta bl. drug of choice in SV arrhythmia after MI

▫️(case) lidocaine drug of choice in ventricular arrhythmia from MI or from digitalis toxicity

▫️cinchonism is adverse affects of quinidine (tinnitus - loss of hearing - blurred vision)

ان شاء الله كملت جزئية السي في اس و كل النقاط المهمة تساعدكم في التاتوريال و الفاينل و ربي يوفقنا~ 🙏🏻