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89 Cards in this Set

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class I antiarrhythmics
- cardiac anesthetic, blocking phase 0 of AP
- class Ia: quinidine, procainamide (prolong repolarization)
- class Ib: lidocaine, tocainide (shorten repolarization)
- class Ic: propafenone (no effect on repolarization)
class II antiarrhythmics
- beta-blockers
class III antiarrhythmics
- phase 3 prolonger
- bretylium, amiodarone
class IV antiarrhythmics
- Ca++ channel blocker
- phase 2 blocker
- Ca++ is coagulant factor IV
- verapamil, diltiazem, nifedipine ("Very Different Names")
what are 4 drugs notable for causing heart block?
ABCD: adenosine, beta-blocker, Ca++ channel blocker, digoxin

don't give 2 from this list at the same time
what are 4 drugs that poison cAMP phosphodiesterase?
4 A's: amrinone, aminophylline, anti-inflammatories, aspirin

[leads to higher cAMP levels -> higher Ca++ levels -> contractility]
what are the ABC's & D of cardiac drugs?
ACE inhibitor
Anesthetics
Anticoagulant

Beta blocker

Ca++ Channel blocker
Cholesterol/triglyceride lowering
Clot busters

Delayed repolarization
Digoxin, other inotropes, Diuretics
Direct vasodilator
what are the ABC's & D of hypertensive drugs?
ACE inhibitor (esp when SCRAP beta blockers)

Beta blockers

Ca++ channel blockers

Direct vasodilators
Diuretics
what cardiac drugs cause a lupus-like syndrome?
procainamide, hydralazine, minoxidil
what 2 cardiac drugs have reciprocal effects?
digoxin and quinidine
mannitol
osmotic diuretic; increases urine osmolarity

C: shock, drug O/D, decrease intracranial & intraocular pressure

X: pulmonary edema (drug moves right to the extracellular compartment and pulls out water)
acetazolamide
carbonic anhydrase inhibitor; leads to self limited NaHCO3 diuresis and lower bicarb stores

C: glaucoma, metabolic alkalosis and altitude sickness

X: hyperchloremic metabolic acidosis, neuropathy, NH3 toxicity, sulfa allergy
furosemide
sulfonamide loop diuretic; blocks cotransport system Na+/K+/Cl- in thick ascending loop; abolish hypertonicity of medulla to prevent concentration of urine; increase Ca++ excretion

C: treat edema (CHF, cirrhosis, nephrotic syndrome, pulmonary edema), HTN, hypercalcemia

X: OH DANG! Ototoxicity, Hypokalemia, Dehydration, Allergy (sulfa), Nephritis, Gout
ethacrynic acid
phenoxyacetic acid derivative (NOT a sulfonamide); same action as furosemide (ie. blocks Na/K/2Cl cotransport system of thick ascending limb

C: diuresis for pts allergic to sulfa drugs

X: similar to furosemide EXCEPT the sulfa allergy
hydrochlorothiazide
thiazide diuretic; block NaCl absorption in early distal tubule ; reduces diluting capacity of nephron and decreases Ca++ excretion

C: HTN, CHF, idiopathic hypercalciuria, nephrogenic diabetes insipidus

X: sulfa allergy, hypo K+, hypo Na+ and hyperGLUC (hyper -Glycemia, -Lipidemia, -Uricemia, -Calcemia)
spironolactone
K+ sparing diuretic; competitive aldosterone receptor inhibitor antagonist in cortical collecting tubule

C: hyperaldosteronism, K+ depletion, CHF

X: hyperkalemia, gynecomastia, antiandrogen effects
triamterene
K+ sparing diuretic; block Na+ channels in the collecting tubule

C: hyperaldosteronism, K+ depletion, CHF

X: hyperkalemia
amiloride
K+ sparing diuretic; block Na+ channels in the collecting tubule

C: hyperaldosteronism, K+ depletion, CHF

X: hyperkalemia
hydralazine
+ cGMP -> smooth muscle relaxation vasodilates arterioles > veins to reduce afterload

C: severe HTN, CHF

X: SLE-like syndrome, compensatory tachycardia, fluid retention
nifedipine
calcium channel blocker; block L-type channels of cardiac and smooth muscle to reduce contractility

C: hypertension, angina [vascular smooth muscle: nifedipine > diltiazem > verapamil]
verapamil
class IV antiarrhythmic act on AV nodal cells, - conduction velocity, + ERP, + PR interval; prevent nodal arrhythmias calcium channel blocker; block L-type channels of cardiac and smooth muscle to reduce contractility [heart: verapamil > diltiazem > nifedipine]

C: supraventricular arrhythmias

X: hypotension, constipation
diltiazem
class IV antiarrhythmic act on AV nodal cells, - conduction velocity, + ERP, + PR interval; prevent nodal arrhythmias calcium channel blocker; block L-type channels of cardiac and smooth muscle to reduce contractility [heart: verapamil > diltiazem > nifedipine]
captopril
ACE-inhibitor; lowers angiotensin II levels and prevents inactivation of bradykinin renin release is increased due to loss of feedback inhibition

C: HTN, CHF, diabetic renal disease

X: "CAPTOPRIL"
enalapril
ACE-inhibitor; lowers angiotensin II levels and prevents inactivation of bradykinin renin release is increased due to loss of feedback inhibition

C: HTN, CHF, diabetic renal disease

X: "CAPTOPRIL"
lisinopril
ACE-inhibitor; lowers angiotensin II levels and prevents inactivation of bradykinin renin release is increased due to loss of feedback inhibition

C: HTN, CHF, diabetic renal disease

X: "CAPTOPRIL"
losartan
angiotensin II receptor antagonist; NOT an ACE inhibitor and does NOT cause cough

C: HTN, CHF, diabetic renal disease

X: hyperkalemia, DON'T give in pregnancy
nitroglycerin
vasodilate by releasing NO in smooth muscle, causing + in cGMP and smooth muscle relaxation dilate veins >> arteries

C: angina, pulmonary edema; aphrodisiac and erection enhancer

X: tachycardia, hypotension, "Monday disease"
isosorbide dinitrate

mxn? X?
vasodilate by releasing NO in smooth muscle, causing + in cGMP and smooth muscle relaxation dilate veins >> arteries

C: angina, pulmonary edema; aphrodisiac and erection enhancer

X: tachycardia, hypotension, headache; "Monday disease" in industrial exposure (tolerance during work week and tachycardia on weekends)
digoxin
block Na+/K+ ATPase of cell membrane, causing + Na+ in cell and + Ca++ in cell (antiport no longer working well) -> + inotropy ; 75% bioavailability, 20-40% protein bound, t(1/2) 40 hrs, urinary excretion

C: CHF (+ contractility); atrial fibrillation (- conduction of AV node) [Youel: digoxin and quinidine are opposites]

X: nausea, vomiting, diarrhea, blurry yellow vision, arrhythmia; made worse by renal failure, hypokalemia, quinidine (displace from tissue binding sites)
quinidine
antiarrhythmic class IA; blocks Na+ channel blocks conduction (esp. depolarized cells), decrease slope of phase 4 depolarization and + threshold for firing in abnormal pacemaker cells; state-dependent (selectively depress tissue that is frequently depolarized)

C: atrial and ventricular arrhythmia [Youel: digoxin and quinidine are opposites]

X: cinchonism (headache, tinnitus); thrombocytopenia, torsade de pointes
amiodarone
[considered class IA and class III antiarrhythmic...more class III]

class IA antiarrhythmic; Na+ channel blocker; lengthens AP blocks conduction (esp. depolarized cells), decrease slop of phase 4 depolarization and + threshold for firing in abnormal pacemaker cells; state-dependent (selectively depress tissue that is frequently depolarized)

C: atrial and ventricular arrhythmia
procainamide
class IA antiarrhythmic; Na+ channel blocker; lengthens AP blocks conduction (esp. depolarized cells), decrease slope of phase 4 depolarization and + threshold for firing in abnormal pacemaker cells; state-dependent (selectively depress tissue that is frequently depolarized)

C: atrial and ventricular arrhythmia; premature ventricular contractions

X: torsade de pointes, drug-induced SLE, pleuritis and pericarditis
disopyramide
class IA antiarrhythmic; Na+ channel blocker; lengthens AP blocks conduction (esp. depolarized cells), decrease slope of phase 4 depolarization and + threshold for firing in abnormal pacemaker cells; state-dependent (selectively depress tissue that is frequently depolarized)

C: atrial and ventricular arrhythmia

X: anticholinergic effects (dry mouth, urinary retention); torsade de pointes
lidocaine
class IB antiarrhythmic; Na+ channel blocker lowers AP duration

DOC for acute ventricular arrhythmias (post MI!) and digitalis-induced arrhthmias

X: CNS effects - drowsiness, numbness, slurred speech
mexiletine
class IB antiarrhythmic; Na+ channel blocker lowers AP duration

DOC for acute ventricular arrhythmias (post MI!) and digitalis-induced arrhythmias

X: blood dyscrasias, nystagmus, thrombocytopenia, leukopenia
tocainide
class IB antiarrhythmic; Na+ channel blocker lowers AP duration

DOC for acute ventricular arrhythmias (post MI!) and digitalis-induced arrhythmias

X: AV block, hypotension
flecainide
class IC antiarrhthmic; Na+ channel blocker no effect on AP

C: good for V-tachs that progress to VF and intractable SVT; last resort in refractory tachyarrhythmias (Pharm Recall: treat life-threatening supraventricular and ventricular arrhythmias)

X: pro-arrhythmogenic, so last-line agent
encainide
class IC antiarrhythmic; Na+ channel blocker no effect on AP

C: good for V-tachs that progress to VF and intractable SVT; last resort in refractory tachyarrhythmias

X: pro-arrhythmic, especially post-MI
propafenone
class IC antiarrhythmic; Na+ channel blocker no effect on AP

C: good for V-tachs that progress to VF and intractable SVT; last resort in refractory tachyarrhythmias

X: proarrhythmic effects
propranolol
class II antiarrhythmics; beta blocker - cAMP, - Ca++ currents; suppress abnormal pacemakers by decreasing slope of phase 4; AV node especially sensitive

X: impotence, worsen asthma, CV effects, CNS effects, mask hypoglycemia
esmolol
class II antiarrhythmics; beta blocker; short acting - cAMP, - Ca++ currents; suppress abnormal pacemakers by decreasing slope of phase 4; AV node especially sensitive

X: impotence, worsen asthma, CV effects, CNS effects, mask hypoglycemia
metoprolol
class II antiarrhythmics; beta blocker - cAMP, - Ca++ currents; suppress abnormal pacemakers by decreasing slope of phase 4; AV node especially sensitive


X: impotence, worsen asthma, CV effects, CNS effects, mask hypoglycemia
atenolol
class II antiarrhythmics; beta blocker - cAMP, - Ca++ currents; suppress abnormal pacemakers by decreasing slope of phase 4; AV node especially sensitive; decreased automaticity


X: impotence, worsen asthma, CV effects, CNS effects, mask hypoglycemia
timolol
class II antiarrhythmics; beta blocker - cAMP, - Ca++ currents; suppress abnormal pacemakers by decreasing slope of phase 4; AV node especially sensitive

X: impotence, exacerbate asthma, CV effects, CNS effects (sedation, nightmares), mask hypoglycemia
sotalol
class III antiarrhythmic; K+ channel blocker

C: Vtach; used when other antiarrhythmics fail; + AP duration, + ERP, + QT interval

X: torsade de pointes; excessive beta block
ibutilide
class III antiarrhythmic; K+ channel blocker

C: Vtach; used when other antiarrhythmics fail; + AP duration, + ERP, + QT interval

X: torsade de pointes
bretylium
class III antiarrhythmic; K+ channel blocker; blocks NE release

C: used for refractory v-fib and v-tach during times of cardiac arrest; + AP duration, + ERP, + QT interval
amiodarone
class III antiarrhythmic; K+ channel blocker (drug structure is related to thyroid hormone)

C: treat refractory atrial flutter/fibrillation and v-tach; + AP duration, + ERP, + QT interval

X: thyroid dysfunction, hepatocellular necrosis, interstitial pulmonary fibrosis
dofetilide
class III antiarrhythmic; K+ channel blocker

C: Vtach; used when other antiarrhythmics fail; + AP duration, + ERP, + QT interval
adenosine
other anti arrhythmic

DOC to diagnose/abolish AV nodal arrhythmias
K+
other anti-arrhythmic depress ectopic pacemaker, esp in digoxin toxicity
Mg+
effective in torsades de pointes and digitoxin toxicity
lovastatin
HMG-CoA reductase inhibitor; lowers LDL a lot and raises HDL a little;

X: expensive, reversible + LFTs and myositis
pravastatin
HMG-CoA reductase inhibitor; lowers LDL a lot and raises HDL a little; X: expensive, reversible + LFTs and myositis
simvastatin
HMG-CoA reductase inhibitor; lowers LDL a lot and raises HDL a little;

X: expensive, reversible + LFTs and myositis
atorvastatin
HMG-CoA reductase inhibitor; lowers LDL a lot and raises HDL a little;

X: expensive, reversible + LFTs and myositis
niacin
moderate decrease in LDL and moderate increase in HDL;

X: red, flushed face which goes down with aspirin and long term use
cholestyramine
bile acid resin; moderate decrease in LDL; X: pts hate it, tastes bad, GI discomfort
colestipol
bile acid resin; moderate decrease in LDL; X: pts hate it, tastes bad, GI discomfort
ezetimibe
cholesterol absorption blocker; moderate decrease in LDL;

X: rare + LFTs
gemfibrozil
fibrate; big drop in triglycerides; X: myositis, + LFTs
clofibrate
fibrate; big drop in triglycerides;

X: myositis, + LFTs
bezafibrate
fibrate; big drop in triglycerides; X: myositis, + LFTs
fenofibrate
fibrate; big drop in triglycerides; X: myositis, + LFTs
streptokinase
thrombolytic; aid in conversion of plasminogen to plasmin, which cleaves thrombin and fibrin clots;

C: early MI, early ischemic stroke

X: bleeding
urokinase
thrombolytic; aid in conversion of plasminogen to plasmin, which cleaves thrombin and fibrin clots;

C: early MI, early ischemic stroke

X: bleeding
tPA (alteplase)
thrombolytic; aid in conversion of plasminogen to plasmin, which cleaves thrombin and fibrin clots;

C: early MI, early ischemic stroke

X: bleeding
APSAC (anistreplase)
thrombolytic; aid in conversion of plasminogen to plasmin, which cleaves thrombin and fibrin clots;

C: early MI, early ischemic stroke

X: bleeding
heparin
anti coagulant; catalyzes the activation of antithrombin III, decreases thrombin and Xa, short half life

C: immediate anticoagulant for PE, stroke, angina, MI, DVT; used in pregancy since it doesn't cross placenta; follow PTT

X: bleeding, thrombocytopenia, drug-drug interactions
warfarin/coumadin
anti coagulant; interferes with normal synthesis and gamma-carboxylation of vitamin K dependent clotting factors II, VII, IX, X, protein C & S; WEPT (Warfarin Extrinsic +PT); long half-life

C: chronic anticoagulation; contraindicated in pregnancy

X: bleeding, teratogenic, drug-drug interactions
aspirin
NSAID; acetylates and irreversibly inhibits both COX1 and COX2 to prevent conversion of arachidonic acid to prostaglandins; NO effect on PT or PTT

C: antipyretic, analgesic, anti-inflammatory, anti-platelet

X: gastric ulceration, bleeding, hyperventilation, Reye's syndrome, tinnitus
clopidogrel
anti platelet; irreversibly block ADP receptor and inhibit fibrinogen binding by preventing glycoprotein IIb/IIIa expression

C: acute coronary syndrome; coronary stenting; reduce incidence or recurrence of thrombotic stroke
ticlopidine
anti platelet; irreversibly block ADP receptor and inhibit fibrinogen binding by preventing glycoprotein IIb/IIIa expression

C: acute coronary syndrome; coronary stenting; reduce incidence or recurrence of thrombotic stroke

X: neutropenia
abciximab
anti platelet; bind to the glycoprotein receptor IIb/IIIa on activated platelets

C: acute coronary syndromes, percutaneous transluminal coronary angioplasty

X: bleeding, thrombocytopenia
X: hydrochlorothiazide
hypokalemia, hyponatremia

hyperGLUC: hyper-
Glycemia
Lipidemia
Uricemia
Calcemia
X: loop diuretics
potassium wasting, metabolic alkalosis, hypotension, ototoxicity
X: clonidine
dry mouth, sedation, severe rebound hypertension

[stimulates presynaptic alpha2 adrenergic receptor; leads to decreased NE release]
X: methyldopa
sedation, positive Coombs' test
X: hexamethonium
sever orthostatic hypotension, blurred vision, constipation and sexual dysfunction
X: reserpine
sedation, depression, nasal stuffiness, diarrhea

(blocks NE release)
X: guanethidine
orthostatic and exercise hypotension, sexual dysfunction, diarrhea

[blocks NE release]
X: beta blockers
impotence, asthma, CV effects (bradycardia, CHF, AV block), CNS effects (sedation, sleep alterations)
X: hydralazine*
nausea, headache, lupus-like syndrome, reflex tachycardia, angina, salt retention

*take with beta blockers to avoid reflex tachycardia, diuretic to block salt retention
X: minoxidil
hypertrichosis, pericardial effusion, reflex tachycardia, angina, salt retention

*take with beta blockers to avoid reflex tachycardia, diuretic to block salt retention
X: nifedipine, verapamil
dizziness, flushing, constipation (verapamil), nausea
X: nitroprusside
cyanide toxicity (releases CN)
X: captopril and other ACE inhibitors
Cough
Angioedema
Proteinuria
Taste changes
hypOtension
Pregnancy problems (fetal renal damage)
Rash
Increased renin
Lower angiotensin II
(hyperkalemia)
X: losartan
fetal renal toxicity, hyperkalemia
what cardiac drugs are particularly contraindicated in pregnancy?
ACE inhibitors and losartan (ARB)