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137 Cards in this Set
- Front
- Back
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Name 5 determinants of the level of myocardial oxygen consumption
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There are five: end diastolic volume, blood pressure, heart rate, contractility, ejection time
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Do nitrates affect preload or afterload?
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preload
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Do Beta-blockers affect preload or afterload?
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afterload
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What is the effect of nitrates on: End diastolic volume?
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Decrease EDV
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What is the effect of nitrates on: blood pressure
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Decrease BP
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What is the effect of nitrates on: contractility?
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Increase Contractility (reflex response)
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What is the effect of nitrates on: heart rate?
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Increase Heart Rate (reflex response)
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What is the effect of nitrates on: ejection time?
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Decrease ejection time
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What is the effect of nitrites on: MVO2
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Decrease MVO2
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What is the effect of Beta-blockers on: End diastolic volume?
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Increase EDV
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What is the effect of Beta-blockers on: blood pressure?
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Decrease BP
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What is the effect of Beta-blockers on: contractility?
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Decrease contractility
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What is the effect of Beta-blockers on: heart rate?
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Decrease heart rate
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What is the effect of Beta-blockers on: ejection time?
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Increase ejection time
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What is the effect of Beta-blockers on: MVO2
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Decrease MVO2
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What is the effect of Nitrites + beta-blockers on: EDV?
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NO effect or decrease
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What is the effect of Nitrites + beta-blockers on: BP?
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Decrease BP
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What is the effect of Nitrites + beta-blockers on: Contractility?
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Little/no effect
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What is the effect of Nitrites + beta-blockers on: HR?
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Decrease HR
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What is the effect of Nitrites + beta-blockers on: Ejection time?
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Little/no effect
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What is the effect of Nitrites + beta-blockers on: MVO2?
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Very decreased
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Nifedipine blocks___channels
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calcium
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In its effects on myocardial oxygen consumption, is Nifedipine similar to Nitrates or B-blockers?
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Nitrates (Nifedipine is similar to Nitrates)
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In its effects on myocardial oxygen consumption, is Verapamil similar to Nitrates or B-blockers?
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B-blockers
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Dose nitroglycerin dilate arteries or veins more?
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Veins>>arteries
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Does nitroglycerin increase or decrease cGMP in smooth muscle?
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Increase
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In industrial exposure to nitroglycerine, weekend withdrawal is characterized by which three symptoms?
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Tachycardia, dizziness , and headache ("Monday disease")
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Toxic dosage of nitroglycerine causes which three symptoms?
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Tachycardia, hypotension, headache
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How do Nitroglycerin and Isosorbide dinitrate work?
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Vasodilate by releaseing NO in smooth muscle, causing increase in cGMP and smooth muscle relaxation. Decrease preload
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What 3 clinical uses of Nitroglycerin?
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Angina, pulmonary edema. Also used as an aphrodisiac and erection enhancer.
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What 3 clinical uses of Isosorbide dinitrate?
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Angina, pulmonary edema. Also used as an aphrodisiac and erection enhancer.
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Digitalis has its action on which cell membrane transporter?
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Na/K ATPase
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Ryanodine has its action on which channel?
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Calcium release channel in the sarcoplasmic reticulum
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Calcium enters cardiac cells through which channel?
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Voltage-gated calcium channel
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Cytoplasmic calcium concentrations in cardiac cells can be decreased by sequestering calcium in the sarcoplasmic reticulum. Calcium enters the SR through which transporter?
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Calcium pump in the wall of the SR
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Calcium channel blockers have their effect on which calcium transporters?
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Voltage-gated calcium channel
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What is the site of action of beta blockers on cardiac muscle?
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Voltage-gated calcium channel
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Voltage gated calcium channels in cardiac muscle can be inhibited by what two types of drugs?
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Ca+2 channel blockers and beta blockers
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How are Calcium release channels in the SR of cardiac muscle activated?
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Activated by Ca entring from the outside through the voltage gated Ca channels
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What is the bioavailablity of digoxin?
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75%
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What is the percent of digoxin that is protein bound?
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20-40%
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What is the t1/2 of digoxin?
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40 hours
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What is the mechanism of excretion of digoxin?
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urinary excretion
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What is digoxin's effect on the intracellular Na+ level?
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Increase
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What is digoxin's effect on the intracellular calcium level?
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Increase
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Why does digoxin result in positive inotropy
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Na-Ca antiboport does not function effectivley when there is high intracellular Na, wihc causes high intracellular Ca -> increase inotropy
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What are the 2 clinical uses of cardiac glycosides and why?
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CHF (increase contractility) and afib (decreases conduction at AV node)
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What are three things that increase the toxicity of digoxin?
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renal failure, hypokalemia (potentiates drug's effect) and quinidine (decreases drug clearance & displaces digoxin from tissue binding sites)
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Name 4 ECG changes ellicited by digoxin administration
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increase PR, decrease QT, scooping of ST segment, T-wave inversion
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Name three symptoms of digoxin toxicity
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Nausea, vomiting, diarrhea, blurry vision, arrhythmia
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Which potentiates the effects of digoxin- hypo- or hyperkalemia?
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hypokalemia
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What is the antidote for digoxin overdose? (4)
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Slowly normalize K+, lidocaine, cardiac pacer, anti-dig Fab fragments
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Which phase of the cardiac action potential do antiarrhythmics decrease the slope of?
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Phase 4 depolarization
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What is another use of Class I antiarrhythmics (Na channel blockers?)
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Local anethetics
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What is the mechanism of action of Class I antiarrhythmics?
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Slow or block conduction (especially in depolarized cell) at the Na channel -> decrease slope of phase 4 and increase threshhold for firing in abnormal pace maker cells.
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Why do class I antiarrthmics depress tissue that is frequently depolarized?
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They are state dependent
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What type of antiarrhythmic is Amiodarone?
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Class 1A (Class 1A includes Quinidine, Amiodarone, Procainamide, Disopyramide, "Queen Amy Proclaims Diso's pyramid."
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What type of antiarrhythmic is Quinidine?
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Class 1A (Class 1A includes Quinidine, Amiodarone, Procainamide, Disopyramide, "Queen Amy Proclaims Diso's pyramid."
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What type of antiarrhythmic is Procainamide?
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Class 1A (Class 1A includes Quinidine, Amiodarone, Procainamide, Disopyramide, "Queen Amy Proclaims Diso's pyramid."
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What type of antiarrhythmic is Disopyramide?
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Class 1A (Class 1A includes Quinidine, Amiodarone, Procainamide, Disopyramide, "Queen Amy Proclaims Diso's pyramid."
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Do class 1A antiarrhythmics increase or decrease the effective refractory period?
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Increase ERP (effective refractory period)
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Do class 1A antiarrhythmics increase or decrease the AP duration?
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increase AP duration
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Do class 1A antiarrhythmics increase or decrease the QT interval?
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increase QT interval
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When are 1A antiarrhythmics useful (2)?
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atrial and ventriculare arrhythmias
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What are 4 the toxicity of qinidine?
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cinchonism-ha, tinnitus; thrombocytopenia; torades de pointes due to increased QT interaval
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What is the toxicity of procainamide
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reversible SLE-like syndrome (HIPP)
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What do class 1B antiarrhythmics do to the AP duration?
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Decrease AP duration
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What type of antiarrhythmic is mexiletine?
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Class 1B (includes Lidocaine, mexiletine, tocainide)
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What type of antiarrhythmic is Lidocaine?
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Class 1B (includes Lidocaine, mexiletine, tocainide)
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What type of antiarrthmic is tocacaide?
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Class 1B (includes Lidocaine, mexiletine, tocainide)
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Where do IB antiarrhythmics act (3)
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affect ischemic or depolarized purkinje and vetnriculare tissue
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What are 2 cases when IB antiarrhythmics are useful?
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actute ventriculare arrhythmias (esp. post MI) and in digitalis induces arrthmias -> give lidocaine)
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What are 3 toxicities of class IB antiarrhythmics?
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local anethetic, CNS stimulation/depression, cardiovascular depression
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What type of antiarrhythmic is Encainide?
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Class IC (includes flecainide, encainide, propafenone)
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What type of antiarrhythmic is Flecainide?
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Class IC (includes flecainide, encainide, propafenone)
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What type of antiarrhythmic is Propafenone?
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Class IC (includes flecainide, encainide, propafenone)
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What are two cases IC antiarrhythmics are useful?
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V-tachs that progress to VF & intractable SVT
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What effect do class 1C antiarrhythmics have on the AP duration?
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No effect!
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What is the last resort for treatmetn of refractory tachyarrhythmias?
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Class IC (includes flecainide, encainide, propafenone)
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What is the contraindication for IC antiarrhythmics? Why?
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post MI (b/c proarrthymic in this case)
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What does esmolol do to the cAMP in cardiac cells?
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decreases cAMP (a beta-blocker)
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What does atenolol do the calcium currents in cardiac cells?
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decreases calcium current (beta-blocker)
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Timolol decreases the slope of which phase of the cardiac AP cycle?
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Phase 4 (a beta-blocker)
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What does propanolol do the the PR interval?
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Increases interval (beta-blocker), AV node is especially sensitive
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Is esmolol a short- or long-acting beta blocker?
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very short-acting
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What are 4 toxicities of beta blockers?
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Impotence, exacerbationof asthma, cardiovascular effects, CNS effects
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What are 3 negative cardiovascular effects of beta blockers?
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bradycardia, AV block, CHF
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What are 2 CNS effects of Beta blockers?
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sedation and sleep
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What is the danger of giving beta blockers?
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Hypoglycemia
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Does amiodarone increase or decrease AP duration?
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Increase (K+ channel blocker)
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Does sotalol increase or decrease the effective refractory period?
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Increase (K+ channel blocker)
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Does bretylium increase or decrease the QT interval?
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Increase (K+ channel blocker)
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Name a symptom of sotalol toxicity.
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Torsades de pointes (K+ channel blocker)
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Name 8 of the symptoms of amiodarone toxicity.
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Pulmonary fibrosis, corneal deposits, hepatoxicity, skin deposits resulting in photodermatitis, neurologic effects, constipation, bradychardia, heart block, CHF, hypothyroidism/hyperthyroidism. (Therefore, should check PFTs, LFTs, and TFTs)
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What are the 2 toxicities of bretilium?
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new arrhythmias, hypotention
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Does verapamil increase or decrease the conduction velocity of the AV nodal cells?
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Decrease (calcium channel blocker)
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How does diltiazem affect the effective refractory period and the PR interval?
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Increases ERP, increases PR (calcium channel blocker)
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What are 2 Ca channel blockers and what are they used for?
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Verapamil, diltiazem. Used in prevention of nodal arrhythmias (SVT)
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What are 5 toxicities of Ca channel blockers?
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Constipation, flushing, edema, CV effects, torsades de pointes (bepridil)
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What are the 3 CV effects of Ca channel blockers?
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CHF, AV block, sinus node depression
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Name a potential use of Mg+ to treat arrhythmias.
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To treat torsades de pointes and digoxin toxicity
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Name a potential use of K+ to treat arrhythmias.
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Depress ectopic pacemakers, especially in digoxin toxicity
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Name a use of adenosine in treating arrhythmias.
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To diagnose and abolish AV nodal arrhythmias.
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What can be used to diagnose/abolish AV nodal arrhythmias?
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Adenosine
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What is effective in torsades de pointes and digoxin toxicity?
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Mg+
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Changes in CO affect two major pathways?
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1. Carotid sinus firing, sympa discharge 2. Renal blood flow, renin-ang pathway
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What is the effect of the following drugs: Positive inotropic drugs
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Increases cardiac output
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What is the effect of the following drugs: Beta blockers
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Inhibit renin release
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What is the effect of the following drugs: Ace inhibitors
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Inhibit ACE
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What is the effect of the following drugs: AII antagonists
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Inhibits effects of AngII including increasing the preload, increasing the afterload and remodelling
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What is the effect of the following drugs: Vasodilators
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Decrease the preload and afterload
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What is the effect of the following drugs: Diuretics
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Decrease the preload and afterload
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What are the adverse effects of hydrochlorothiazide
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Hypokalemia, hyperlipidemia, hyperuricemia, lassitude, hypercalcemia, hyperglycemia
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What are the adverse effects of loop diuretics
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Hypokalemia, met alk, hypotension, ototoxicity
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What type of drugs are: clonidine, methyldopa, ganglionic blockers, reserpine, guanethidine, prazosin, beta blockers?
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sympathoplegics
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Adverse effects of clonidine?
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dry mouth, sedation, severe rebound HTN
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Adverse effects of methyldopa?
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sedation, positive coombs test
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Adverse effects of Hesamethionium?
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Severe orthostatic hypotention, blurred vision, constipation, sexual dysfunction
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Adverse effects of guanethidine?
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orthostatic HTN, blurred vision, constitpation, sexual dysfuncction
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Adverse effects of reserpine?
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sedation, depression, nasal stuffiness, diarrhea
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adverse effects of beta blockers?
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impotence, asthma, cardiovascular, cns
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Adverse effects of guanethidine?
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orthostatic and exercise Hypotension, sex dysfxn, diarrhea
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Adverse effects of prazosin?
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1st dose orthostatic hypotension, dizzy, headache
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The following are what class: hydralazine, minoxidil, nifedipine, verapamil, nitroprusside
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vasodilators
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which vasodilator causes lupus like syndrome? Other toxicities?
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hydralazine, nausea, headache, reflex tachycardia, angina, salt retention
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adverse effets of minoxidil?
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hypertrichosis (hair growth - think Rogaine with minoxidil!), pericardial effusion, reflex tachycardia, angina, salt retention
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Side effects of nifedipine, verapamil?
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dizziness, flushing, constipation, nausea
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which vasodilator causes cynide toxicity?
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nitroprusside
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Adverse effects of ACE-I Captorpil? Think CAPTOPRIL
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C: cough, A: angioedema, P: proteinuria, T: taste changes, O: hypOtension, P: pregnancy problems like fetal renal damage, R: rash, I: increased renin, L: lower angiotensin. Also hyperkalemia.
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Losartan is a ----------- R-Inhibitor? With ____-toxicity and ____kalemia
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angiotensin II, fetal renal tox, hyperkalemia
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Which two anti-HTN drugs do you use with B blockers to prevent reflex tachycardia, diuretic to block salt retention?
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hydralizine, minoxidil
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What is hydralizine's mechanims and clinical use?
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increase cGMP --> smooth muscle relaxation. Vasodilates arteries > veins. Reduces afterload. Used for severe HTN or CHF
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Calcium channel blockers, name three
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pg. 315 - nifedipine, verapamil, diltiazem
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Where do Calcium channel blockers have their effect?
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voltage dependednt L type Ca of cardiac and smooth muscle
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Rank the effects of Nifedipine, verapamil and diltiazem on vascular smooth muscle
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smooth muscle nifed> diltia > verapamil
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Rank the effects of Nifedipine, verapamil and diltiazem on cardiac muscle
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heart: vera> diltia> nifedepine
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What is the calcium channel blockers use? (3)
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HTN, angina, arrythmias (not nifedipine)
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