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74 Cards in this Set
- Front
- Back
what is the pathway of normal heart impulse
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SA node (pacemaker) to atrium to AV node to ventricles
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what are 2 different ways to get an arrhythmia
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altered pacemaker
altered pathway |
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describe the typical action potential of heart muscle
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resting potential of -90mv
Na+ influx Ca++ influx (causes muscle contraction) K+ efflux |
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what is the best treatment for arrhythmias
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no treatment at all (if patient is otherwise healthy)
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what are the 4 non-drug treatments for arrhythmias
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pacemakers
cardioversion (electric shock) implantation of automatic defibrillators surgical removal of ectopic foci |
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describe the different classes of drugs for treating arrhythmias
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class 1: local anesthetics that decrease Na+ influx; greater effect on ectopic foci
1A: lengthen AP and slow depolarization 1B: lidocaine class 2: inhibit effect of epi on heart (slow HR); DOC for atrial fib class 3: K+ channel blockers (for atrial fib) class 4: Ca++ channel blockers (for supraventricular atrial fib; used for all except ventricular arrhythmias) |
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what are the class 1A anti-arrhythmia drugs
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"PDQ" like "pretty damn quick"
procanamide disopramide quinidine |
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class 1B anti-arrhythmias
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lidocaine
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class 2 anti-arrhythmias
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propanolol
metaprolol |
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class 3 anti-arrhythmias
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sotalol
amiodarone |
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class 4 anti-arrhythmias
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verapamil
dilteazan nifedipine adenosine |
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how do the class 1A anti-arr work
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lengthen AP and slow depolarization
they decrease sodium influx |
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what is quinidine used for
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all arrhytmias (atrial and ventricular)
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side effects of quinidine
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cns effects
tinnitus altered color vision |
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what is procanamide used for
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all tachycardias
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what is the difference between procaine and procanamide
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procanamide is an analog of procaine
procanamide lasts longer and does NOT enter the CNS has lupus like side effects in slow acetylators |
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what is the drug of choice for ventricular tachycardia
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lidocaine
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what type of arrythmias is disopyramide used for
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ventricular
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which anti-arrhytmia drug is like atropine
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disopyramide
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how is lidocaine given
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IV b/c of first pass effect
it is class 1B anti-arrhythmia drug |
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what is a general way to remember class 2 anti-arrhyth drugs
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they are beta blockers
propanolol blocks beta 1 and beta 2 metaprolol blocks just beta 1 |
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which anti-arrhytmia drug acts like all 4 classes of the drugs and thus has many side effects
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amiodarone (class 3)...classified as a K+ channel blocker though
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what are the many side effects of amiodarone
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it is a class 3 anti-arrhythmia drug
blocks K+ channels corneal deposits optic nerve damage (optic neuritis) pulmonary fibrosis skin deposits (b/c it contains iodine and leaves blue/gray color) altered thyroid gland fxn b/c it contains iodine |
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which anti-arrythmia drug contains iodine
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amiodarone
corneal deposits skin deposits altered thyroid gland |
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which 3 anti-arrhythmia drugs cause vasodilation
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verapamil
dilteazan nifedipine all are class 4 (calcium channel blockers) |
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which anti-arrhythmia drug is given IV and decreases firing rate of the AV node
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adenosine
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what does adenosine do
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decreases firing rate of AV node
given IV |
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what clotting factors require Vitamin K
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7,9,10, prothrombin, protein C
so all these are inhibited by coumadin |
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what does activated protein C do
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degrades Va and VIIa and degrades clots
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what does factor Xa do
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catalyzes the reaction of prothrombin to thrombin
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how do you pronounce luncheon
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ask jonas.... its french
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difference between white thrombi and red thrombi ?
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arterial (white)
venous (red) origin |
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what is a thrombus
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a clot that adheres to a vessel wall
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what type of thrombi would most likely have fibrin and platelets, and is associated with atherosclerotic plaque
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white thrombi
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embolus
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a piece of a thrombus that breaks off and can potentially plug a downstream vessel
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where is heparin stored
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mast cells
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what enzyme does heparin activate
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lipoprotein lipase
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2 ways heparin works
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either directly inhibiting thrombin
or inhibiting Xa, which is needed to facilitate prothrombin --> thrombin |
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what do you treat a heparin overdose with
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protamine sulfate
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how does synthetic heparin (fondaparinux) work
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ONLY on Xa
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fodaparinux
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synthetic heparin
only acts on Xa |
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decreases number of platelets
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anagrelide
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ADP receptor blockers anticoagulants
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"clopid"/"grel"
ticlopidine clopidogrel prasugrel |
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mechanism of action of aspirin for anticoagulats
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inhibits ENZYME (COX) which decreases amout of TXA2
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fibrinogen receptor blockers (GP IIB/IIIA blockers) for anticoag.
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abciximab
tirofiban eptifibatide |
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phosphodiesterase inhibitors for anticoag. and mech of action
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cilostazol
dipyridamole inhibit ENZYME (PDE) which causes increased cAMP which inhibits platelet aggregation |
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which things dissolve fibrin clots
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streptokinase/urokinase
TPA drotrecogin alfa (activated protein C) |
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what are the hemostatic agents (cause platelet aggregation and possibly clotting)
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"A.T.E. A."...."i ATE A clot"
aminocaproic acid tranexamic acid estrogen astringents |
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which drugs are calcium chelators (inhibit calcium)
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EDTA
citric acid |
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compare heparin, low molec. wt. heparins, and fondaparinux
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heparin: inhibits thrombin and Xa by activating AT3 (also activates lipoprotein lipase)
low mol. wt. hep's (parins): inhibit Xa (also thromin a little) fondaparinux: inhibits ONLY Xa |
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mechanism of action of heparin
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activates AT3 which will inhibit thrombin and Xa
activates lipoprotein lipase which will break down FA's in blood |
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what do you take if you overdose on heparin
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protamine sulfate
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what are the leech drugs and how do they work
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leeches are "rude" and say "arg"
"irudin"s argatroban (used to treat HIT) inhibit thrombin |
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which drugs can inhibit thrombin
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heparin
low mol.wt. heparins (parins) leech drugs (irudins and argatroban) |
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which drug is activated protein c
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drotrecogin alfa
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mechanism of action of drotrecogin alfa
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(it is activated protein C) so protein C degrades Va and VIIIa and dissolves clots
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coumadin is an analog of what
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vitamin K (so it inhibits the action of real vitamin K which inhibits 7,9,10, PT)
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mechanism of action of coumadin
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it is an analog of vitamin K so it inhibits the action of real vitamin K which inhibits 7,9,10, PT
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side effects of heparin
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bleeding
osteoporosis with long term use thrombocytopenia (HIT) |
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heparin is a ______ drug
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natural drug...extracted from dead cow/pig
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which drug is used to treat heparin induced thrombocytopenia (HIT)
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argatroban (leech drug that inhibits thrombin)
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which drug is used to treat disseminated intravascular coagulation (DIC)
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drotrecogin alfa
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which anticoagulant is pregnancy category X
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coumadin
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what do you do if you overdose on coumadin
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take vitamin K
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in what type of people will coumadin not work so well
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vegans or people who eat a lot of food with vitamin K in it
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side effects of ticlopidine, clopidogrel, and prasugrel
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(the ADP receptor blockers)
decrease WBC's: neutropenia, agranulocytosis, thrombocytopenia |
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side effects of fibrinogen receptor blockers
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thrombocytopenia
decrease platelet aggregation white thrombi (arterial) |
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which drug is a monoclonal antibody
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abciximab
any drug that has "mab" is a monoclonal antibody |
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Who's the world's greatest athlete?
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The guy who finishes first and third in a masturbation contest.
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What is the difference between a woman and a washing machine?
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You can put your load in a washing machine and it won't call you a week later.
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What is the cheapest meat?
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Deer balls, they're under a buck.
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What is the difference between a clever midget and a venereal disease?
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One is a cunning runt, and the other is a running cunt
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What do you do when your dishwasher stops working?
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Yell at her.
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What's the difference between a priest and pimples?
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Pimples don't come on your face until you're 13.
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