Drugs For Cardiac Disfunction

Front 1

What is Arrhythmia?

Back 1

Disorder of normal electrical and contractile rhythmicity

Front 2

What are the effects of Arrhythmia?

Back 2

1. Dec in cardiac efficiency
2. Dec in cardiac output

Front 3

Is arrhythmia in atria or ventricle worse?

Back 3

Arrhythmia of ventricular origination is more dangerous than one of atrial origination

Front 4

What is the objective of treatment for arrhythmia?

Back 4

1.Maintain/restore ventricular rhythm and output
2. maintain/restore atrio-ventricular coordination

Front 5

What are the four functional classes of antiarrhythmic drugs?

Back 5

1. (1A & 1B) Na channel blockers
2. B1 adrenoreceptor antagonists
3. K channel blockers
4. Ca Channel blockers

Front 6

What are the Class 1 A Na Channel blocker Drugs?

Back 6

They are broad spectrum Antiarrhythmics:

Quinidine
Procainamide
Disopyramide

Front 7

What does Quinidine do?

Back 7

Class 1 A Na Channel blocker
AntiArrhythmia

Front 8

What does Procainamide do?

Back 8

Class 1 A Na Channel blocker
AntiArrhythmia

Front 9

What does Disopyramide do?

Back 9

Class 1 A Na Channel blocker
AntiArrhythmia

Front 10

What is the Class 1 A Na channel blocker mechanism?

Back 10

Blocks Na channel in Ventricular muscle which does:
1.Dec depolarization rate of AP
2. Delays repolarization of AP which INC AP duration
which INC refractory period
Which DEC automaticity
3. Prevents premature abnormally timed AP (Ectopic activity
4. NO effect on SA node automaticity
NO effect on AV node conduction

Front 11

What are the Class 1B Na channel blocking drugs?

Back 11

Lidocaine
Mexiletine

Front 12

What is the drug lidocaine?

Back 12

Class 1B Na Channel blocker

Front 13

What is the drug Mexiletine?

Back 13

Class 1B Na Channel blocker

Front 14

What is the mechanism of Class 1B Na Channel blockers?

Back 14

1. Blocks Na Channel in Ventricular muscle
2. "Targets" Na CHannels in "damaged" (depolarized) cells
3. DEC automaticity of "damaged" cells
4. Early repolarization of AP
which DEC AP duration

Front 15

Effect of Class 1B on ECG?

Back 15

DEC QT interval
no effect on refractory period

Front 16

What is the effect of Class 1B on heart?

Back 16

DEC Ventricular "drive"

Front 17

What are the uses of Class 1B Drugs?

Back 17

1.Life threatening ventricular arrhythmias
2. Emergency: iv Administration
3. Prophylactic: Oral Admin

Front 18

What are the side effects of Class 1 drugs?

Back 18

1. Hypotension due to DEC CO (effect on heart) & DEC TPR (effect on blood vessels)
2. Bradycardia
3. Cardiac Arrest

Front 19

What is the Class 2 of antiarrhythmics?

Back 19

B1-Blockers

Front 20

What are the Class 2 drugs?

Back 20

Propanolol
Atenolol
Pindolol

Front 21

What is Pindolol?

Back 21

B Antagonist
Class 2 Antiarrhythmic

Front 22

What is Atenolol?

Back 22

B Antagonist
Class 2 Antiarrhythmic

Front 23

What is Pindolol?

Back 23

B Antagonist
Class 2 Antiarrhythmic

Front 24

What is the mechanism of Class 2 antiArrhythmics?

Back 24

1. Blocking of sympathetic input to heart
2. DEC SA node automaticity
3. DEC AV node conduction rate
4. DEC contractility
5. DEC Ventricular ectopic automaticity

Front 25

Effect of Class 2 on ECG?

Back 25

INC PR duration
(INC Pwave to Pwave duration)

Front 26

What are the uses of Class 2 AntiArrhythmics?

Back 26

1. Elevation of sympathetic outflow
-sinus tachycardia
-Supraventricular tachycardia
2. Exercise induced arrhytmias
3. Post MI ventricular ectopic automaticity

Front 27

What are the side effects of Class 2 Antiarrhythmics?

Back 27

1. Cardiac: AV Block, Sinus arrest
decreased exercise tolerance
exacerbation of congestive heart failure

2. Propanolol only:
Bronchiole spasm
Coronary artery spasm

Front 28

What are the Class 3: K channel blocker drugs?

Back 28

Amiodarone

Front 29

What is amiodarone?

Back 29

A class 3: K channel blocker drug

Front 30

What is the mechanism of class 3 Antiarrhythmics?

Back 30

1. Blocks K channels
2. DEC AP repolarization
which INC AP duration
Which INC refratory period

Front 31

What is the effect of Class 3 Antiarrythmics on ECG?

Back 31

INC QT duration

Front 32

What are Class 3 antiarrhythmics used for?

Back 32

Supraventricular tachycardia
Supraventricular fibrillation
Recurrent Ventricular tachycardia

Front 33

What is the forth class of Antiarrhythmics?

Back 33

Ca Channel Blockers
AKA Ca Channel antagonists

Front 34

What are the drugs for Class 4 Ca Channel Blockers of antiarrythmics?

Back 34

Verapamil
Nifedipine
Diltiazem

Front 35

What is Verapamil?

Back 35

1. Ca Channel antagonist
2. Antiarrhythmic

Front 36

What is Nifedipine?

Back 36

1. Ca Channel antagonist
2. Antiarrhythmic

Front 37

What is Diltiazem?

Back 37

1. Ca Channel antagonist
2. Antiarrhythmic

Front 38

What is the mechanism of Class 4 antiarrhythmics?

Back 38

Block Ca channels

Front 39

What are the effect on the heart of class 4 antiarrhythmics?

Back 39

1. DEC SA node automaticity
2. DEC Myocardial contractility
3. DEC conduction rate
4. DEC ectopic ventricular automaticity

Front 40

What is the effect of class 4 antiarrhythmics on ECG?

Back 40

INC PR interval
No effect on refractory period

Front 41

What are Class 4 antiarrhythmics used for?

Back 41

1. Supraventricular tachycardias
2. Used more often as antihypertensive and anti-anginal agents

Front 42

What are the side effects of Class 4 antiarrhythmics?

Back 42

-Hypotension
-Bradycardia
-AV node block

Front 43

What is congestive heart failure?

Back 43

Inability of heart to supply sufficient
blood to meet body oxygen
requirements
-Associated with congestion (slow blood
movement) in capillary vessels

Front 44

What is CHF associated with?

Back 44

-increased blood volume
-increased blood pressure
-edema
-capillary congestion
-dyspnea (pulmonary congestion)

Front 45

What causes CHF?
(Physiologically)

Back 45

Usually due to DEC cardiac contractility
asociated with DEC cardiac muscle mass
and with DEC cardiac output

Front 46

Progression of CHF?

Back 46

Usually slow progressive onset although
acute heart failure does occur

Front 47

What are the symptoms of CHF?

Back 47

Symptoms of DEC CO
-Fatigue
-Shortness of breath

Front 48

What are the causes of CHF?

Back 48

-Coronary artery disease
-Rheumatic heart disease
-Arrhythmias
-Hypertension
-Valve disease
-Renal disease
-Drug induced

Front 49

Whats the difference between normal heart and CHF heart?

Back 49

Increase in preloard doesnt have as much of an effect on CO

Front 50

What are the objectives in treatment of CHF?

Back 50

1. INC Contractility of ventricular muscle
-Cardiac glycosides
-Amrinone
-Sympathomimetics
2. INC Renal excretion of Na and water
-Diuretics
3. DEC Arterial pressure by vasodilation
-Vasodilators

Front 51

WHat drug is used to INC contractility of ventricular muscle for CHF?

Back 51

Cardiac Glycosides

Front 52

What are cardiac glycosides, amrinone, and sympathomimetics used for?

Back 52

In treatment of CHF
To INC contractility of ventricular muscle

Front 53

In the treatment of CHF, What drugs are used to INC Contractility of ventricular muscle?

Back 53

cardiac glycosides, amrinone, and sympathomimetics

Front 54

What is the cardiac glycosides used for CHF?

Back 54

Digitalis from foxglove plant Digitalis purpurea
-Digoxin
-Digitoxin

Front 55

What is Digoxin?

Back 55

Cardiac Glycoside

Front 56

What is Digitoxin?

Back 56

Cardiac Glycoside

Front 57

What is the action on heart of cardiac glycosides?

Back 57

-INC slope of load-output relationship
-Positive inotropic effect

Front 58

What are the direct effects on the heart of Cardiac glycosides?

Back 58

INC Cardiac contracility
1. Inhibition of NA K ATPase
2. Depolarization of muscle
3. INC Ca Intracellularly
4. INC contraction force
DEC AV node conduction

Front 59

What are the indirect effect of cardiac glycosides on heart?

Back 59

reflex DEC heart rate
reflex DEC peripheral resistance

Front 60

What are the symptoms of Glycoside toxicity?
Cardiac

Back 60

-AV block
-Premature ventricular contraction
-Brady cardia
May be life threatening

Front 61

What are the symptoms of Glycoside toxicity?
Extracardiac

Back 61

-Nausea
-Confusion
-Visual Disturbances

Front 62

What is the treatment of Glycoside toxicity?

Back 62

1. Antiarrhythmics
- Lidocaine or phenytoin
2. EDTA solution if hypercalemic

Front 63

What is Milrinone used for?

Back 63

Treatment of CHF
INC ventricular contractility
used for acute heart failure

Front 64

What is Amrinone used for?

Back 64

Treatment of CHF
INC ventricular contractility
used for acute heart failure

Front 65

How do Milrinone and Amrinone work?

Back 65

1. Phosphodiesterase inhibitor
- INC cAMP in cells
2. INC heart contractility
3. Vasodilator (DEC afterload and preload)
4. It is a short term treatment

Can be used concurrent with digoxin

Front 66

What is a sympathomimetic?

Back 66

β1 agonists
dobutamine
dopamine
isoproterenol

Front 67

What are sympathomimetics used for?

Back 67

CHF treatment
to INC Ventricular Contractility

Front 68

What do sympathomimetics do?

Back 68

-INC Myocardial contractility
BUT dopamine and Isoproterenol induce tachycardia which INC oxygen demand
Dobutamine does not induce tachycardia but is short lived and must be iv

Front 69

What diuretics are used for CHF treatment?

Back 69

-Loop Diuretics
-Thiazides
-MR antagonists
-Pore Blockers

USE "high ceiling" diuretics sucg as Furosemide in emergency situations

Front 70

How do Diuretics help treat CHF?

Back 70

INC Urin production
Which, DEC blood volume
Which, DEC edema
Which, DEC workload on heart

Front 71

How do Vasodilators help treat CHF?

Back 71

Vasodilation -> DEC afterload -> DEC work load on heart

Front 72

What vasodilators are used to treat CHF?

Back 72

-Hydrazaline
-Ca Channel blockers
-Organic Nitrates
-ACE inhibitors
- a1 Adrenoreceptor antagonists

Front 73

What is Hydrazaline used for?

Back 73

Vasodilation
CHF treatment

Front 74

How does Hydrazaline work?

Back 74

Causes vasodilation by acting
directly on smooth muscle of
vascular wall by unknown
mechanism

Front 75

How do Ca Channel Blockers work to treat CHF?

Back 75

Vasodilation
Inhibit Ca influx into smooth
muscle fibers of vascular wall to
reduce muscle tone

Front 76

What are the Ca CHannel blocking drugs used for CHF?

Back 76

Verapamil
Diltiazem
Nifedipine

Front 77

How do Organic Nitrates work?

Back 77

Release nitric oxide (NO)
NO causes cGMP increase in
smooth muscle fibers of vascular
wall; cGMP induces relaxation

Front 78

What are the organic nitrates used for CHF?

Back 78

Amyl nitrate
Nitroprusside

Front 79

Whats the difference between taking organic nitrate sublingually or swallowed?

Back 79

Sublingual - Immediate relief
Swallowed - continuous relief & prophylactic

Front 80

How do ACE inhibitors treat CHF?

Back 80

Vasodilation
Inhibit conversion of Angiotensin I to
Angiotensin II
Angiotensin II is vasoconstrictor

Front 81

What drugs are used for ACE inhibition?

Back 81

Captopril
Enalapril

Front 82

How are a1 adrenoreceptor antagonists used in treatment of CHF?

Back 82

Vasodilation
Reduce effective sympathetic
input to smooth muscle fibers and induces relaxation of these
fibers

Front 83

What a1 antagonists are used for CHF treatment?

Back 83

Prazosin
Carvedilol

Front 84

What is angina pectoris?

Back 84

Literally “pain in the chest”

Front 85

What is the pain in angina pectoris from?

Back 85

Pain due…
..to local myocardial ischemia
..to insufficient oxygen supply to
myocardium
..to imbalance of oxygen supply to heart and work done by heart

Front 86

What are the 3 types of Angina Pectoris?

Back 86

1. Classical, stable, or exercise induced
2. Unstable or preinfarction
3. Variant or vasospastic

Front 87

What causes classical, stable, or exercise induced angina pectoris?

Back 87

-Thrombi or atherosclerotic plaques in coronary vessels
-Sufficient blood flow at rest
-Insufficient blood flow attainable in exercise
-Not usually producing damage of myocardium

Front 88

What causes unstable or preinfarction angina?

Back 88

-Thrombi or atherosclerotic plaques in coronary vessels
-Insufficient blood flow at rest
-May produce permanent myocardial damage & MI

Front 89

What causes Variant or vasospastic angina?

Back 89

-No physical obstruction in coronary vessels
-Coronary arteries undergo spontaneous constriction
-No known trigger in many instances

Front 90

What are the risk factors for angina? chronic

Back 90

-Diabetes
-Age
-Anxiety
-Obesity

Front 91

What are the risk factors for acute attacks of angina?

Back 91

-Stress
-Exercise
-Change of temperature (stress)

Front 92

What are the surgical treatments for Angina?

Back 92

Attempt to clear blockage
-angioplasty
Attempt to detour blockage
-bypass surgery

Front 93

What are the pharmacological treatments for angina?

Back 93

3 classes of drugs
1.Organic nitrates
2.Ca Channel blockers
3.B-adrenergic antagonists

Front 94

What are the organic nitrate drugs? used for angina

Back 94

Nitroglycerin
Amyl Nitrate
Isosorbie dinitrate

Front 95

Where is the major site of metabolism of organic nitrates?

Back 95

Rapidly absorbed in GI
BUT major site of metabolism is liver

Can be sublingual/chewable, inhalant & oral forms

Front 96

How do organic nitrates help angina?

Back 96

Coronary artery dilation
-ONLY healthy vessels tho
INC coronary blood flow -> INC cardiac oxygen supply

Front 97

WHat are organic nitrates used for?

Back 97

Angina & CHF

Front 98

What are the side effects of organic nitrates?

Back 98

Vasodilation
-Reflex tachycardia
-orthostatic/postural hypotension