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48 Cards in this Set
- Front
- Back
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Organic Nitrates
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-Converted to NO which activates guanylate cyclase -> dephosporylation of myosin light chain -> SM relaxation
-Dilation of large veins decrease preload -Dilation of coronary vasculature increasing bloodflow -AE: headaches, tachycardia, xerostomia |
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Amyl nitrite
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(A nitr-I-te)
Drug of abuse (sexual pleasure and euphoria) Inhalation for angina and cyanide poisoning AE: headaches, tachy, orthostatic hypotension |
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Isosorbide dinitrate
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Moderate to long acting oral nitrate
Angina prophylaxis and CHF Slower onset than NG |
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Beta-blockers
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-Useful in exertional but not vasospastic angina
-Reduce frequency and severity of angina by reducing myocardial O2 consumption -More useful in white and young patients -AE: CNS side effects, lowered HDL, rebound HTN -CI: Diabetics (cause hypoglycemia), COPD, PVD |
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Pindolol
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B-blocker with ISA
Vasodilatory beta-blocker |
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Nebivolol
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Cardio-selective B-Blocker
Vasodilatory via NO |
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Calcium-Channel Blockers
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Bind to inactivated voltage dependent Ca channels preventing them from opening on depolarization ->muscle relaxation
Counteracted by increasing Ca or sympathomimetics Also has a diuretic effect but with few compensatory effects Used in angina or ischemic patients who have diabetes or COPD or cannot tolerate B-blockers AE: AV conduction anomalies, constipation |
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Verapamil (Calan, Veralan, Covera-HS)
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Ca-channel blocker (Diphenyl alkyl amine)
Used; HTN, Angina, SV tachyarrythmia, LV hypertrophy Least selective Ca-channel blocker- both cardiac effect and vasodilatory effect CI: Pts. with depressed cardiac or AV conduction issues (CHF) AE: AV conduction anomalies, CONSTIPATION (most frequent) |
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Diltiazem (Cardizem, Dilacor, Cartia, Diltia)
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Ca-channel blocker (benzothiazepine)
Used: HTN, Angina, SV tachyarrythmia Affects both cardiac and smooth muscle, relieves coronary artery spasm (useful for variant angina) AE: AV conduction anomalies, constipation |
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Nifedipine
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Ca-channel blocker (dihydropyridine)
Used: Prinzmetal's angina, HTN, Raynaud's Only effects smooth muscle, no cardio or conduction effects AE: PERIPHERAL EDEMA (most common) NOT constipation |
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Anti-platelet/anti-coagulant therapy for angina
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Aspirin, herparin, and warfarin all reduce infarction in unstable angina patients
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Ranolazine
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Partial fatty-acid oxidation inhibiter
Shifts heart metabolism from FAox to glycolysis, reducing O2 demand Minimal effects on heart function and BP AE: QT prolongation and testicular toxicity |
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Class Ia Antiarrythmics
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Bind to inactivated Na channels
Delay conduction, depress phase O, prolong phase III and IV repolarization Used in both atrial and ventricular arrhythmias caused by increased normal automaticity Precipitate torsade de pointes (long QT interval V-Tachy) "Double Quarter Pounder" |
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Quinidine (Quinidex, Cardioquin)
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Class Ia Antiarrythmic
Also maintains sinus after cardioversion AE: Cardiotoxic (blocks, asystole, V-tach), Cinchronism, Lupus-Like Syndrome |
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Procainamide (Pronestyl, Procan)
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Class Ia Antiarrythmic
AE: Lupus-like syndrome, psychosis |
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Dispyramide (Norpace)
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Class Ia Antiarrythmic
Also negative inotropic and peripheral vasoconstriction (useful for LV dysfunction) AE: anticholinergic effects (dry mouth, constipation, etc.) |
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Class Ib Antiarrythmics
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Depress phase O in abnormal tissues
Effective in arrhythmias caused by abnormal automaticity, little effect on atrial or AV arrhythmias No effect on normal cells therefore normal ECG Lettuce, Mayo, Tomato" |
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Lidocaine
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Class Ib Antiarrythmic
Shortens phase III repolarization Stops ventricular reentry Used for acute V-arrhythmias AE: fewer effects |
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Mexiletine (Mexitil)
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Class Ib Antiarrythmic
Also used for diabetic neuropathy |
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Tocainide (Tonocard)
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Class Ib Antiarrythmic
Also used for neurologic disorders (seizures, diabeta neuropathy) AE: Serious agranulocytosis |
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Class Ic Antiarrhytmics
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Depress phase O of action potential, effect conduction in both normal and abnormal tissues
-Significant effects even at normal HR -Used in refractory arrhythmias of both atria and ventrical -Very high risk of precipitating arrhytmia "More Fries Please" |
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-Flecainide (Tambocor)
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Class Ic Antiarrhytmic
Negative inotropic (aggravate CHF) Can precipitate fatal v-tach |
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Moricizine
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Class Ic Antiarrhytmic
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Propafenone
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Class Ic Antiarrhytmic
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Class II Antiarrythmics
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Beta-blockers
Diminish phase IV depolarization, depressing automaticity and prolonging AV conduction Mech: beta blocking and reducing Na and Ca currents Use: Post-MI arrhythmia prophylaxis AE: Cardiodepression |
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Esmolol
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Class II Antiarrythmic
Extremely short acting B1 selective (continuous IV) Temporary control of ventricular rate in superventricular arrhythmias |
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Class III Antiarrhythmics
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Potassium Channel Blockers
Reduce outward K current during repolarization Prolong AP duration without changing phase O or resting potential (prolong refractory period) Effect on all cells (shown on EKG) |
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Ibutilide (Corvert)
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Class III Antiarrhytmic
Promotes slow sodium channel influx, prolonging AP and slowing sinus rate Used for rapid conversion of AFib or AFlutter Now cardioversion more commonly used |
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Sotalol (Betapace)
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Class III Antiarrythmics
Non selective beta blocker with class II and III properties Use: AFib and severe BTach Betapace and Betapace AF CANNOT be substituted AE: Torsade de pointes |
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Amiodarone (Cordarone, Pacerone)
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Class III Antiarrhythmic
Also Class Ia (Na channel blocking), II (depresses nodal automaticity), and IV (Ca channel blocking) effects Use; Severe Atrial and Vent. arrhythmias, ANGINA Contains iodine (related to thyroxine) AE: Pulmonary fibrosis, hyper/hypothyroidism Now Dronedarone substitutes (less side effects) |
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Class IV Antiarrhythmics
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Calcium channel blockers
Useful for arrhythmias that traverse Ca dependent cardiac tissues (AV node) -A Flutter, Afib, PSVT Work best when heart beating rapidly |
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Verapamil (Calan, Isoptin)
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Class IV Antiarrhythmic
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Diltiazem (Cardizem, Dilacor)
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Class IV Antiarrhythmic
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Adenosine (Adenocard)
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Purine nucelotide, stimulates K channels in SA node, reducing AP duration and inducing sinus bradycardia
Used for reentrant PSVT with Wolff-Parkinson-White syndrome Short duration (continuous IV) AE: flushing, cheast pain, hypotension |
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Digoxin
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Prolongs effective refractory period, diminishing conduction velocity
Used to managed ventricular events in Afib and flutter AE: Ectopic ventricular beats -> V-fib (treat with lidocaine) |
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Magnesium
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Antiarrhythmic in digitalis induced arrhythmia
Effects Na/K ATPase and Na, Ca, K channels |
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Potassium
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Depresses ectopic pace makers caused by digitalis toxicity (hypokalemia)
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Digoxin
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Cardiac Glycoside
Mech: Inhibit Na/K ATPase (universal poison), increasing Na in cells which is exchanged for Ca Use: Refractory/End Stage HF, Control ventricular rates in AFib Does not decrease mortality/morbidity, Hypokalemia increases concentration AE: Ectopic AV beats, AV block, slow V response |
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Dopamine
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B-Agonist
Increase cAMP -> PK phophylates Ca channels -> high Ca Increase cardiac output and decrease V filling pressure (help symptoms but increase mortality) Use: Short term management of end-stage CHF |
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Dobutamine
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B-Agonist
Increase cAMP -> PK phophylates Ca channels -> high Ca Increase cardiac output and decrease V filling pressure (help symptoms but increase mortality) Use: Short term management of end-stage CHF Primarily B-1 selective inotrope w/ no effect on dopaminergic receptors |
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Milrinone (Primacor)
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Phosphodiesterase Inhibitor
Increase cAMP -> High intracellular Ca Increase contractility, but not beneficial to mortality Used for acute or exacerbated chronic CHF, short term parental drug AE: Arrhythmias |
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Imamrinone (Inocor)
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Phosphodiesterase Inhibitor
Increase cAMP -> High intracellular Ca Increases CO, decreases vascular resistant and pulmonary pressure Use for short term IV management of CHF AE; Exacerbates AFib/Flutter, may increase mortality and morbidity |
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Nitroprusside
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Vasodilator
Decreases excessive preload and afterload Helpful in patients with high filling pressures whose principal symptom is dyspnea (pulmonary congestion) Nitroglycerine and Isosorbid dinitrate (oral) also used |
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Hydralazine
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Vasodilator
Use: Moderate to severe HTN Dilates arterioles Drug of choice in patients with fatigue and low ventricular output Almost always given with B-Blocker (for reflex tachy) and diuretic (for sodium retention) AE: Lupus-like syndrome, arrhythmia, angina |
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Nesiritide (BNP, Natrecor)
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Human B-type natriuretic peptide (NOT ANP)
Produce balanced arterial and venous dilation via cGMP Use: Acute decompensated CHF AE: Worsening of renal failure BNP more potent and longer acting than ANP |
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"-pril"
Captopril Enalapril Benazepril Lisinopril |
ACE Inhibitors
Inhibit ACE -> decreased angiotensin II Reduce PVR w/o reflex cardiac effects Also inhibit Aldosterone -> decrease Na and H2O Use: HTN, CHF, decrease mortality and morbidity More effective in white and young patients when used alone, often used post MI, Renally protective AE: fetotoxic, dry cough (low bradykinin) altered taste, hyperkalemia (use K-sparing diuretics with caution!), angioedema All except fosinopril and moexipril eliminated renally |
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Valsartan (Diovan)
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Angiotensin II Receptor Blocker (ARB)
Selectively blocks AT1-R which mediates vasopressor and aldosterone effects of angiotensin II Use: HTN and CHF in pt's intolerate to ACE inhibitors Reduce left ventricular hypertrophy Reduce mortality and morbidity, but not in combination treatment AE: fetotoxic, but no dry cough or angioedema |
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Carvedilol (Coreg)
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B Blocker
Non-selective a1, b1, b2 blocker (not a2), but more beta Mech: Antagonize catecholamines, upregulates B receptors, decrease HR, reduce remodelling Reduce mortality in stable class II and III HF, but can cause decompensation of severe CHF Also used: Bisoprolol, Metoprolol |
