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137 Cards in this Set

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