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70 Cards in this Set
- Front
- Back
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Drugs to convert atrial rhythm (A. Fib, A. Flutter, PSVT)
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ibutilide, dofetilide, sotalol
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Drugs to slow ventricular rate
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beta blockers
(metoprolol/esmolol), calcium channel blockers (diltiazem/verapamil), digoxin, adenosine |
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Drugs for Long-term management of A. Fib, A. Flutter or PSVT
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in order
1: beta blockers, metoprolol/propanolol, and/or non-DHP calcium channel blockers, 2: amiodarone, sotalol, dofetilide, flecainide |
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Drugs to Convert Ventricular arrhythmias
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amiodarone (possibly with epinephrine), lidocaine, procainamide, adenosine, verapamil, metoprolol
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Drugs to Treat Torsades de pointes
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magnesium sulfate IV & possibly isoproterenol
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. Long-term management of Ventricular arrhythmias
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primary: mexiletine, sotalol, flecainide,
secondary: amiodarone |
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Class IV Anti- Arrhythmia drugs
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Verapamil & diltiazem
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What kind of Drugs are Verapamil & diltazem
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CCB's
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Class III Anti- Arrhythmia dugs are known as what (usually)
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K+ channel blockers
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Class III Anti- Arrhythmia( K Ch blocker) drugs
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Amiodarone
Dofetilide Sotalol Ibutilide |
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Amiodarone & Sotalol have what affect on the heart
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Increases PR interval and increase refractory period
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Amiodarone onset of action and duration of action
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onset: 2 weeks
Duration : 4 weeks |
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What class III Anti- Arr. drugs should not be used with a QT > 440msec
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Dofetilide
Sotalol |
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Class II Anti- Arr. Drug class
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Beta- Blockers (Beta- Receptor Blockers)
` |
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Class II drugs (Beta- Blockers ) specific Anti- Arr. Drugs
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Esmolol--> Most often for acute HTN emergencies
Propranolol Metroprolol |
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What class of Anti- Arrhythmic drugs are the only drugs that reduce mortality in asymptotic patients
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Class II Drugs Beta Blockers
Propranolol Metroprolol |
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Class I Anti-Arrhytmia drug Class
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Na+ Channel Blockers
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Class IA and IC drugs are ______ Na+ channel blockers
Class IB drugs are ______ Na+ Ch blockers |
Open
Inactivated |
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Class IA Anti-Arr. specific drugs
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Quinidine (Can cause torsade de pointes)
Procainamide Disopyramide |
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Which Class IA drug increases Digoxin plasma levels
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Quididine
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Which Class IA drug can cause Transient lupus erythematosus like syndrome
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Procainamide
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Class 1B Anti-Arr. Drug
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Lidocaine I.V
Mexiletine (oral) |
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Lidocaine, A class IB drug, Has what effect on the heart
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SA node supression/bradycardia
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Class 1C Anti- Arr. Drugs
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Propafenone
Flecainide (oral) |
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Which Class of Anti-arr. drugs would you use for life-threathening ventricular arrhythmias?
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Class 1C drugs
Flecainide and propafenone are used to treat supraventricular arrhythmias and life-threatening ventricular arrhythmias |
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True or False:
Most Anti-Arrhythmic drugs are not used for mild arrhythmias |
True
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What is severe chest tightening that occurs when coronary blood flow is inadequate to supply the oxygen required by the heart.
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Angina pectoris
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What is the Most common type of Angina
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Stable angina & angina of effort
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What is the M.C.C of Angina?
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an atherosclerotic obstruction of the large coronary vessel
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What Anti-Ischemic drugs works best in treating variant Angina
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Calcium channel
blockers |
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Two different categories of Ca+ channel blocking drugs
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Dihydropyridines
Non-dihydropyridines |
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Specific Dihydropyridine (CCB) drugs
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amlodipine, nifedipine
Decreased arteriolar tone and systemic vascular resistance results in decreased arterial and intraventricular pressures. No change in S.A node activity |
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Specific NON-Dihydropyridine (CCB) drugs
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bepridil, diltiazem, and verapamil
also decrease HR and contractility, which cause a further decrease myocardial oxygen demand. Decrease S.A node activity |
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Nitrates(angina drugs) have what affect on the heart
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Nitrates cause Venodilation, relax venous smooth muscle
Decreases Preload and Decreases LVEDP Dilations of afterload Decrease wall tension |
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True or False:
Beta blockers are vasodilators that are used for treating acute anginal attacks |
false
These drugs are not vasodilators Used in the management of angina of effort. Not useful in variant angina or acute anginal attacks. |
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the following blood pressure describes what condition?
140-160/90-99 |
Stage 1 Hypertension
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What is the short term goal of Tx for Hypertension?
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Decrease elevated B.P to 130/80
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4 basic types of Anti-Hypertensive drugs
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Diuretics
Sympatholytic drugs Direct Vasodilators Drugs that prevent the production of Angiotensin II |
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What Effect do all diuretics have on the Cardiovascular system?
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Decrease PRELOAD
Decrease PVR Decrease C.O Decrease Blood Volume No change in LVH |
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What are specific Loop Diuretics?
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furosemide, bumetanide
Most potent Diuretic Can cause hypokalemia |
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When should you use thiazide diuretics?
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In patients with mild-moderate HTN and NORMAL renal and cardiac function
Good first choice drug in mild HTN Often given with Spironolactone to reduce hypokalemic risk |
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What are the 3 classes of Sympatholytic Drugs?
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α-Adrenoceptor antagonists (a1)
β-Adrenoceptor antagonists Centrally acting drugs (a2 agonists) |
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What are the Cardiovascular effects of a1- antagonist drugs?
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decrease PVR
No change/increase C.O Decrease L.V.H receptors found in vascular smooth muscle |
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What are specific a1-Adreneceptor antagonist?
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doxasosin, prazosin, terazosin,
phenoxybenzamine, phentolamine |
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First dose Syncope is associated with what Sympatholytic (anti hypertensive) Drug?
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a1-Antagonist
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What effects do B-Blockers have on the heart?
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No change or Decrease in PVR
Decrease C.O Decrease L.V.H |
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Which B-blockers are first choice in treating Hypertension?
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Carvedilol or labetalol since they are cardio protective
and have a antioxidant effects |
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specific B1- selective :
Specific non-selective B-Blocker: B & a selective B-blocker: |
atenolol
propanolol carvedilol & labetalol |
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Why would you not want to give a patient with diabetes B-blockers?
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can block beta receptors in pancreas and liver– bad for diabetic patients
can cause impaired glycogenolysis |
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What central acting Anti-HTN is used during pregnancy (a2 antagonist)
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Methyldopa
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What Anti-HTN B-blocker can be used during pregnancy?
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Labetalol and possibly propanolol
NOT atenolol |
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Can CCB's Dihydropyridine be used during pregnancy?
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Yes, because they has less cardiac effect than Non-dihydro such as Diltiazem and Verapamil
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Should you used ACEI or ARB's during pregnancy?
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NO!!!!!
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What is the first choice in treatment for Mild HTN?
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Thiazide diuretics
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Can you use B-blockers to treat HTN in an asthmatic patient?
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NEVER use a Non selective B-Blocker in a asthmatic patient.
Use A-1 selective B-blockers such as Prazosin |
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What are the least preferred drugs to give to a prego patient?
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ACEI, ARB, aliskiren, diuretics
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Best drug combo for treating a patient with VARIANT Angina.
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CCB's and Nitrate. (diltiazem/verapamil)
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True or False:
Low concentrations of organic nitrates produce dilation of veins that predominates over that of arterioles. |
True- venodilation reduces preload
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Which Anti-Angina drug is useful in preventing reflex tachycardia induced by organic nitrates or by dihydropyridine calcium channel blockers
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B-Blockers (carvedilol, propranolol etc..)
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Would you use antiarrhythmic drugs on a pt with a mild arrhythmia?
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No
Antiarrhythmic drugs may be life saving in moderately severe to highly symptomatic patients. |
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What 3 events are necessary for reentry- retrograde conduction in arrhythmia's?
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Obstacle to normal AP conduction
Unidirectional block Conduction time must exceed refractory period |
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What class of Na ch blockers can be used for fetal Supra ventricular arrhythmias? what specific drug in that class?
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Class IC open Ch. blockers
Flecainide |
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What Class II Anti-Arr drug is the only drug to reduce mortality in asymptomatic patients?
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B-blockers
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What Class III Anti-Arr drug can can cause torsade and also Bronchospasms?
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Sotalol- B-blocker
Don't use with asthmatic patient |
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Which of the following is true of class III anti arrhythmic drugs?
a. Block K ch b. May cause Torsade c. Prolong QT d. All true e. a and c |
d
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Class IV Anti-Arr drugs are what type of drugs?
Specific type? specific drugs? |
CCB's
NON-DHP Verapamil and Diltiazem |
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Adenosine is an I.V drug used to Tx: what?
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Acute SVT
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What is the most preferred long term treatment for management of atrial flutter/fibrillation & paroxysmal supraventricular tachycardia?
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beta blockers, metoprolol/propanolol, and/or
non-DHP calcium channel blockers, |
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Best long term Management of ventricular arrhythmias
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Long-term management: primary: mexiletine, sotalol, flecainide, secondary: amiodarone
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Stimulation of Beta-2 receptors
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Sympathomimetics on smooth muscle > bronchodilation
Mechanism: Increased cAMP > relaxation of airways |
