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15 Cards in this Set
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- Back
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Quinidine // Procainamide // Disopyramide
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Type IA Antiarrhythmics
Mech: Block Na+ Channels and K+ channels. Effects: ↓ Na+ channels open Ventricles/Atria: Prolong Phase 0 Depolarization. Nodes (AV/SA): ↓ # of funny Na channels open --> longer time to depolarize ↓ K+ channels open Ventricles/Atria: Prolongs Phase 3 (repolarization) --> Longer Refractory Period & Longer QT Use: Atrial & Ventricular Arrhythmias Ectopic and Reentrant SVT & V-Tach Toxicities: Quinidine - Thrombocytopenia, Torsades De Pointes, & Tinnitus Procainamide - SLE-like syndrome |
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Phenytoin // Lidocaine // Mexilitine // Tocainide
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Type IB Antiarrhythmics
Mech: Na Channel Blocker & K+ Channel Opener Effects: Na Channel Blocker Ventricles/Atria: ↓ slope of Phase 0 SA/AV Nodes: ↓ # of funny Na Channels --> Longer to Depolarize Nodes K+ Channel Opener Atria/Ventricle: ↓ repolarization time --> ↓ Refractory time & ↓ QT Use: Ischemic or Depolarized Purkinje/Ventricle. POST-MI Acute Ventricular Arrhythmia (POST-MI) Digitalis Induced Arrhythmia Toxicity: Local Anesthetic, CV Depression |
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Flecainide // Encainide // Propafenone
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Type IC Antiarrhythmics
Mech: Na Channel Blocker (No effect on K+ channels) Effect: Atria/Ventricles: Lengthens Depolarization Time (Phase 0) AV/SA Node: ↓ # of funny Na channels, longer to depolarize Use: ONLY HEALTHY TISSUE SVT & VTach-->V-Fib Toxicity: Proarrhythmic (↑↑↑ POST MI) **only used as LAST RESORT for refractory VENTRICULAR TACHYARRHYTHMIAS** |
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Type II Antiarrhythmics
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Beta-Blockers (Propanolol, Timolol, Esmolol, Metoprolol)
Mech: Block Beta Adrengergic Receptors Effects: Nodal Cells (AV Node VERY SENSITIVE) 1. ↓ Dromotropy: ↓ Open Ca Channels. ↓ conduction velocity through AV Node 2. ↓ Chronotropy: ↓ Funny Na Channels open --> Longer to depolarize, ↓ HR. *Also ↓ contractility by ↓ intracellular Ca Use: SVT V-Tach ↓ ventricular rate with Aflutter & Afib Tachycardia HTN Toxicities: Impotence CV Depression (Bradycardia, AV Block) Asthma Exacerbation **Metoprolol: Dyslipidemia** Basic Pharm Note: Remember: Beta adrenergic receptors are Gs receptors and work via ↑ Adenylyl Cyclase --> ↑ cAMP --> ↑ Prot. Kinase A --> Phosphorylation of Proteins |
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Type III Antiarrhythmics
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Drugs: Sotalol, Ibutilide, Amiodarone
Mech: K+ Channel Blockers Effect: Prolong Phase 3 (repolarization) of ONLY VENTRICULAR/ATRIAL cells. ↑ Refractory Period, ↑ QT Use: When other antiarrhythmics FAIL. Toxicity: Amiodarone: Pulmonary Fibrosis, Hepatotoxicity, Thyroid Abnormalities (hypo or hyper). [check PFTs, LFTs, TFTs]; also photosensitivity Sotalol: Beta Blockade; Torsades Isobutilide: Torsades |
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Type IV Antiarrhythmics
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Verapamil & Diltiazem
Mech: Calcium Channel Blockers; ESPECIALLY in AV Node. Effects: ↑ PR Interval, ↑ Refractory Period ↓ Conduction Velocity Use: Prevention of NODAL Arrhythmias Toxicities: CHF AV Block Flushing Constipation **Heart: Verapamil>Diltiazem>Nifedipine** **Vessels: Nifedipine>Diltiazem>Verapamil** |
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Statins (Simvastatin, Atorvastatin, etc.)
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Mech: HMG-CoA Reductase Inhibitors
Effects: ↓↓↓ LDL ↑ HDL ↓ Triglycerides Toxicity: Rhabdomyolysis |
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Niacin
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Mech: Inhibits Lipolysis in adipose tissue and ↓ secretion of VLDL
Effects: ↓↓ LDL ↑↑ HDL ↓ TG Toxicity: ↑ Uric Acid Flushing C/I: GOUT |
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Bile Acid Resins (Cholestyramine // Colestipol)
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Mech: Bind Bile Acids in the Intestine which Inhibits the reuptake of Cholesterol. The Liver then needs to synthesize more cholesterol to make into bile. So, it upregulates its B-100 receptors and uptakes more LDL --> ↓ LDL
Effects: ↓↓ LDL ± HDL ± TG Toxicity: Tastes bad, ↓ absorption of Fat-soluble Vit., risk of gallstones C/I: Gallstones |
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Cholesterol Absorption Blockers
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Mech: Block absorption of cholesterol by the intestinal brush border
Effects: ↓↓ LDL No effect on HDL No effect on TG Toxicity: Rare ↑ LFTs |
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Fibrates (Gemfibrozil // Clofibrate)
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Mech: Upregulate Lipoprotein Lipase Activity --> ↑ TG Clearance
Effects: ↓ LDL ↑ HDL ↓↓↓ TG Toxicity: Myositis, ↑ LFTs |
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What Cholesterol/Triglyceride Lowering Drug Should you use if your primary goal is to ↑ HDL?
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Niacin.
Mech: Inhibits Lipolysis in adipose tissue and ↓ VLDL secretion |
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What Cholesterol/Triglyceride Lowering Drug Should you use if your primary goal is to ↓ Triglycerides?
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Fibrates
Mech: ↑ Lipoprotein Lipase Activity --> ↑ Triglyceride Clearance |
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What Cholesterol/Triglyceride Lowering Drug Should You Use if Your Primary Goal is to ↓ LDL?
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You can use any of them, except FIBRATES.
1st Line is probably Statins. |
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Important Contraindications to consider when prescribing certain Cholesterol/Triglyceride lowering drugs?
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Niacin: GOUT
Cholestyramine - GALLSTONES |
