Pharm Antihtn

Front 1

causes of arrhythmia

Back 1

coronary ischemia.tissue hypoxia.electrolyte disturbances.Over stimulation of SNS.General anesthetics.Any other condition or drug that may affect cardiac transmembrane potentials and lead to abnormal impulse formation or conduction.

Front 2

Digitalis glycosides can cause what?

Back 2

cause after depolarizations by increasing Calcium influx into cardiac cells; also impair AV node conduction and can cause AV block.

Front 3

“torsade de pointes” caused by what drugs

Back 3

Caused by certain antiarrhythmic drugs, psychotropic drugs, antibiotics and other miscellaneous drugs like cisapride.

Front 4

after polarization caused by what drugs

Back 4

digitalis.

Front 5

abnormal impulse formation After depolarizations occur when and definition

Back 5

abnormal impulses resulting from spontaneous generation of action potentials during or immediately after phase 3 repolarization "ob#

Front 6

Abnormal impulse CONDUCTION example

Back 6

reentry process

Front 7

Sympathomimetics can cause arrhythmias how?

Back 7

increase automaticity of SA node, AV node or His-Purkinje fibers

Front 8

Non-pharmacological therapy for arrhythmias

Back 8

cardiac ablation.implantable defibrillator.

Front 9

fluoroquinolones are known to cause what in the heart?

Back 9

arrhythmias. Especially with longer term use.

Front 10

type 1 / class 1 MOA?

Back 10

a. bind to Na channels when they are open and inactivated, dissociate from the channel during the resting state. More pronounced effect on cardiac tissue that is rapidly firing.

Front 11

type 1 / class 1 are called what?

Back 11

Na channel blockers

Front 12

types 1b within type 1 or class 1 antiarrhythmic drugs?know for your own benefit

Back 12

greater affinity for inactivated state and slow recovery. More pronounced effect on ischemic tissue. Depress phase 0 selectively in abnormal/ischemic tissue, shorten repolarization

Front 13

types 1a within type 1 or class 1 antiarrhythmic drugs?know for your own benefit

Back 13

. greater affinity for open state with slow recovery.Depress phase 0, prolonging repolarization

Front 14

types 1c within type 1 or class 1 antiarrhythmic drugs?know for your own benefit

Back 14

greater affinity for open state and very slow recovery. Greater effect on ventricular conduction . Markedly depress phase 0, minimal effect on repolarization.

Front 15

Type II/Class II are what kind of drugs

Back 15

b-adrenergic receptor blockers a. Decrease slope of phase 4.

Front 16

Type IA drugs MOA?

Back 16

block Na+ channel and K+ channel. Suppress abnormal automaticity but do not significantly affect SA node automaticity and heart rate. All have some antimuscarinic (atropine-like) activity and may inhibit PNS effects on SA node and AV node. Depress phase 0, prolonging repolarization.

Front 17

quinidine is an example of? typle/class?

Back 17

type 1A

Front 18

ADR's of quinidine which are type 1A's?

Back 18

hypotension, GI effects (diarrhea 30-40%), thrombocytopenia, cinchonism (ASA toxicity -tinnitus, blurred vision, dizziness) headache, confusion, torsades de pointes. cinchonism cinchonism

Front 19

DDI's of quinidine which are type 1A's?

Back 19

i. –CYP450 substrate and inhibitor. Several interactions.

Front 20

procainamide is made from what?

Back 20

lidocaine

Front 21

how is procainamide made active in the body?

Back 21

Absorbedfrom gut and converted to active metabolite N-acetylprocainamide(NAPA)

Front 22

i. Indications-of procainamide?

Back 22

Tx most types of supraventricular and ventricular arrhythmias. Produces less hypotension than quinidine IV – so more often used IV for TX of acute ventricular arrhythmias.

Front 23

ADR's of procainamide

Back 23

hypotension, GI effects, CNS effects,hematologic (thrombocytopenia), anticholinergic effects, liver toxicity, lupus-like syndrome. (50%) lupus-like syndrome. (50%)

Front 24

DDI of procainamide

Back 24

i. CYP2D6 substrate

Front 25

Disopyramide is what class / type

Back 25

type 1A/Class 1A

Front 26

Disopyramide indications

Back 26

ventricular arrhythmias

Front 27

Disopyramide ADR's

Back 27

hypotension,anticholinergic effects(blurred vision, urinary retention), CHF, CNS effects including hallucinations.

Front 28

Type IB drugs MOA?

Back 28

Electrophysiological properties make them particularly suitable for ventricular arrhythmias. Strong affinity for Na channels in depolarized ischemic tissue, but lack of effect on Na channels in normal cardiac tissue. Depress phase 0 selectively in abnormal/ischemic tissue, shorten repolarization

Front 29

why does lidocaine work in the ventricles???

Back 29

lidocaine does work in ischemia, which is why it works well in the ventricles.

Front 30

lidocaine indications

Back 30

i. Ventricular tachycardia and other acute ventricular arrhythmias. Not useful for supraventricular arrhythmias. Also a local anesthetic.

Front 31

lidocaine first pass effect stuff I should know

Back 31

i. Extensive first pass hepatic inactivation after PO, therefore must be given IV.

Front 32

lidocaine ADRs

Back 32

CVS (bradycardia, hypotension, heart block), CNS(drowsiness, paresthesias, disorientation, muscle twitching- may lead to seizures). May also cause psychosis and respiratory depression

Front 33

Type IC drugs MOA

Back 33

block Na+ channels and block the rate of rise of the action potential during phase 0 to a greater extent than other class I drugs. They slow conduction velocity throughout the heart and especially in His-Purkinje system. Markedly depress phase 0, minimal effect on repolarization.

Front 34

flecamide indications

Back 34

i. Treatment of supraventricular arrhythmias and documented life threatening ventricular arrhythmias.

Front 35

flecamide ADR's

Back 35

reentry ventricular tachycardia, CHF, GI, CNS,blurred vision

Front 36

flecamide DDI's

Back 36

CYP450 substrate, CYP2DR inhibitor

Front 37

Propafenone MOA

Back 37

– block Na+ channels and block the rate of rise of the action potential during phase 0 to a greater extent than other class I drugs. They slow conduction velocity throughout the heart and especially in His-Purkinje system. Markedly depress phase 0, minimal effect on repolarization . Similar effects as flecainide except less effects on QT interval. Also has some beta blocking activity.l

Front 38

flecamide MOA

Back 38

– block Na+ channels and block the rate of rise of the action potential during phase 0 to a greater extent than other class I drugs. They slow conduction velocity throughout the heart and especially in His-Purkinje system. Markedly depress phase 0, minimal effect on repolarization

Front 39

Propafenone indications

Back 39

i. Treatment of supraventricular arrhythmias and documented life threatening ventricular arrhythmias

Front 40

Propafenone ADR's

Back 40

– reentry ventricular tachycardia. -same as flecainide but also hematological.

Front 41

Propafenone DDi's

Back 41

CYP450 substrate, CYP1A2, 2D6 inhibitor

Front 42

TYPE II/CLASS II DRUGS MOA

Back 42

1. inhibitsSNS activation of cardiac automaticity and conduction. Slow heart rate,decrease AV node conduction velocity and increase AV node refractory period

Front 43

TYPE II/CLASS II DRUGS Indications?

Back 43

1. Used for prevention and treatment of supraventricular arrhythmias and for their ability to reduce ventricular ectopic depolarizations and sudden death in pts with myocardial infarction

Front 44

Esmolol indications?how?how long?Who gets it?

Back 44

acute SVT tx. rapidly metabolized, short half life.Only hospital patients get it IV. No PO form.

Front 45

Metoprolol and Propranolol tx what?

Back 45

a. Both available PO or INJ for treatment and suppression of supraventricular and ventricular arrhythmias

Front 46

Metoprolol indications?

Back 46

i. given IV in early phase of MI followed by PO – protects the heart against the damage caused by ischemia and free radicals that may be formed during reperfusion of coronary arteries when fibrinolytics are used.

Front 47

Acebutolol can be used in preg when

Back 47

B/D in 2nd & 3rd trimester

Front 48

Amiodarone MOA

Back 48

block K+ channels and prolong the ventricular action potential depolarization and refractory period. i. Type III, but also blocks Na channels, Ca channels and b-adrenergic receptors. Decreases SA node automaticity, decreases AV node conduction velocity and prolongs AV node and ventricular refractory periods.q=iO

Front 49

Amiodarone properties

Back 49

i. organic iodine compound similar to thyroid hormones. Unusual kinetics, very long half-life (40 days).

Front 50

amiodarone indications

Back 50

POfor supraventricular and ventricular arrhythmias incl AF, atrial flutter, SVT and life threatening ventricular tachycardia. IV for acute life-threatening VF or sustained VT.

Front 51

amiodarone ADR's

Back 51

Several.GI effects, CV effects (hypotension, AV block, arrhythmias incl torsades (less torsades than other Class III agents), visual disturbances, thyroid dysfunction,pulmonary fibrosis and pneumonitis, blue-gray skin discoloration

Front 52

amiodarone DDI

Back 52

CYP450 substrate and inhibitor of almost all isoenzymes. Several DDI which increase levels of other important drugs like digoxin, phenytoin, warfarin skin

Front 53

Dronedarone properties

Back 53

i. –structurally similar to amiodarone but with shorter half-life, less lipophilicity and no iodine group so les risk of thyroid, pulmonary and neurological side effects

Front 54

Dronedarone MOA

Back 54

block K+ channels and prolong the ventricular action potential depolarization and refractory period. i. Type III, but also blocks Na channels, Ca channels and b-adrenergic receptors. Decreases SA node automaticity, decreases AV node conduction velocity and prolongs AV node and ventricular refractory periods.

Front 55

Dronedarone indications

Back 55

– to reduce risk of CV hospitalization inpatients with Afib or A-flutter with certain CV risk factors

Front 56

Dronedarone ADR's

Back 56

Like amiodarone but w/ less thyroid, pulmonary and neurological (visual) ADRs

Front 57

Dronedarone DDI's

Back 57

several CYP450 DDIs esp w digoxin, CCBs and warfarin. Watch warfarin carefully.

Front 58

Ibutilide MOA

Back 58

-Different MOA than other Type III drugs. Promotes influx of Na+ through slow inward Na channels which counteracts the outward K+ current thereby prolonging repolarization.oral chemical cardioversion.

Front 59

Sotalol MOA?

Back 59

i. non-selective beta-blocker with ability to block K+ current during ventricular action potential.

Front 60

Dofetilide indications and MOA

Back 60

chemical cardioversion and blockK+ channels.prolong the ventricular action potential depolarization andrefractory period

Front 61

Bretylium MOA

Back 61

prolongs ventricular action potential in normal tissue more than ischemic tissue

Front 62

TYPE IV DRUGS are what?

Back 62

CCB's non DHP

Front 63

CCB's MOA

Back 63

1. decrease AV node conduction velocity and increase AV node refractory period (blocks Ca+from entering slow channels during depolarization)

Front 64

CCB's indications

Back 64

IV for acute PSVT, PO for AF (avoid if coexisting HF).

Front 65

non DHP- CCB's examples

Back 65

verapamil and diltiazem

Front 66

Adenosine MOA

Back 66

activates specific G protein-coupled adenosine receptors resulting in hyperpolarization and slowing of AV node conduction velocity.

Front 67

adenosine indications

Back 67

SVT or PSVT

Front 68

adenosine ADR's

Back 68

a. flushing,dizziness, bradycardia, syncope

Front 69

digoxin MOA

Back 69

a. increases vagal tone, slows AV node conduction velocity and increases AV node refractory period

Front 70

digoxin gives you an arrhythmia how do you tx it?

Back 70

lidocaine

Front 71

indications for quinidine

Back 71

i. TX most types of supraventricular and ventricular arrhythmias

Front 72

ADR's of quinidine

Back 72

cinchonism, hypotension,GI effects (diarrhea 30-40%), thrombocytopenia, cinchonism (ASA toxicity - tinnitus, blurred vision,dizziness) headache, confusion, torsades de pointes.

Front 73

Mexiletine metabolism

Back 73

do not undergo first pass effect therefore used PO

Front 74

Mexiletine indications

Back 74

long term basis for suppression of ventricular arrhythmias

Front 75

ADR's of mexilentine

Back 75

GI and CNS effects, agranulocytosis with tocainide

Front 76

Moricizine unusuualy properties

Back 76

phenothiazine analogue.

Front 77

Moricizine indications

Back 77

documented life-threatening ventriculararrhythmias. (Long term use may be associated with increased mortality rate inpts with history of MI)

Front 78

abnormal conduction example? and what causes them?

Back 78

reentry arrythmias.re-excitation caused by same impulse that already went through that part.

Front 79

sotalol indications

Back 79

ventricular arrhythmias, a fib (avoid in Heart failure)

Front 80

sotalol ADR's

Back 80

dosedependent torsades de pointes, hypotension, bradycardia, bronchospasm

Front 81

dofetilide ADR's

Back 81

dose dependant torsades de pointes, CNS effects.

Front 82

bretylium indications and ADR's

Back 82

indications VF.ADR's GI effects, orthostatic hypotension, CNS effects

Front 83

digoxin indications

Back 83

AF, PSVT.

Front 84

digoxin ADR's

Back 84

GI, CNS, arryhthmias (you can tx arrhythmias with lidocaine)

Front 85

MagnesiumSulfate MOA?

Back 85

slowsrate of SA node impulse formation and prolongs conduction time

Front 86

MagnesiumSulfate indications

Back 86

VT , VF, and torsades de pointes

Front 87

MagnesiumSulfate ADR's?

Back 87

diarrhea, CNS depression, flushing

Front 88

how to manage A fib?

Back 88

first control rate with BB's, CCB's or digoxin. Rhythm control you can do electrical cardioversion, cardiac ablation, pharmacological conversion. with cardioversion make sure to anticoag for 3 weeks prior to cardioversion.Perform a TEE to check for thrombi.

Front 89

risk factors for A fib induced stroke on the chad2 scale and how many points each has?

Back 89

CHF= 1HTN= 1Age >75 = 1DM= 1Previous stroke =2

Front 90

stroke rate for chad 2 scores?0123456

Back 90

0= 1.92= 2.83= 44=8.55=12.56=18.2

Front 91

Chad2 score tx from points.012 or more

Back 91

0 aspirin 81-325 mg daily.1 aspirin 81-325 mg daily or warfarin with INR 2-3 based on patient preference.2 or more is warfarin INR 2-3 unless they need to avoid warfarin.

Front 92

Lupus like syndrome

Back 92

Procainamide

Front 93

Cinochism

Back 93

Quinidine.

Front 94

Anticholinergic effects

Back 94

Disopyramide

Front 95

Psychosis

Back 95

Lidocaine

Front 96

Blue/green skin.

Back 96

Amiodarone

Front 97

Arrhythmia

Back 97

Digoxin

Front 98

Pulmonary fibrosis

Back 98

Amiodarone

Front 99

Dose dependant torsades de pointes

Back 99

Dofetilide

Front 100

Thyroid dysfunction

Back 100

Amiodarone

Front 101

Hematologic effects

Back 101

Propafenone

Front 102

Diarrhea in 30 to 40% of patients

Back 102

Quinidine

Front 103

Agranulocytosis

Back 103

Mexilitine

Front 104

Phenothiazine analogue

Back 104

Moricizine