Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
163 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
Antiarrhythmic drug classes?
|
Class I- Na channel blockers
Class II- B blockers Class III- K channel blockers Class IV- Ca channel blockers **refer show-me(ipad) |
|
|
|
Class 1-A: actions on channels?
|
1. Blocks fast Na channels
2. Blocks K channels |
|
|
|
Class 1-A: Na channel blocked in- activated/inactivated state?
|
Activated state(open state)
"State dependent blocking" 1-A= Activated |
|
|
|
Class 1-A: Effect on Action potential duration?
Effect viewed on graph? |
Increased/prolonged APD
Increased/prolonged ERP (effective refractory period) Phase 0 slope drops/prolonged(depolarization) Phase 3 slope drops/prolonged(repolarization) http://en.wikipedia.org/wiki/File:Action_potential_class_Ia.svg |
|
|
|
Class 1-A drugs: Name em
|
1. Quinidine
2. Procainamide 3. Disopyramide |
|
|
|
Quinidine:
MOA? Effects? |
MOA- Class 1-A antiarrhythmic
Effects- 1) 1-A blocking- prolonged APD and ERP 2) Muscarinic block- Increased HR and AV conduction 3) Alpha block- Vasodilation--> reflex tachycardia |
|
|
|
Quinidine:
Primary use? Precaution while usage? |
1. Used in Atrial fibrillation
2. Precaution: INITIAL DIGITALIZATION required to slow AV conduction |
|
|
|
Quinidine: Adverse effects?
|
1. "Cinchonism":
i. Tinnitus ii. Ocular defects iii. CNS stimulation iv. GI distress- diarrhea/const 2. Prolonged QRS/QT 3. Hypotension 4. Syncope 5. TORSADE (hyperkalemia) "Torsade + syncope" |
|
|
|
Quinidine: Drug interaction?
|
1. Displaces digoxin--> increased toxicity
2. Hyperkalemia enhances effects |
|
|
|
Drugs metabolized by N-acetyl transferase in CVS?
|
1. Procainamide
2. Hydralazine |
|
|
|
Procainamide:
effects? |
1. 1-A antiarrhythmic
2. Na and K channel blocker 3. Prolonged QT and QRS 4. Prolonged phase0 and phase 3 5. LESS muscarinic blocker |
|
|
|
Procainamide: adverse effects?
|
1. Hematotoxicity:
Thrombocytopenia + Agranulocytosis 2. Torsades |
|
|
|
Class 1-B: Actions on channels?
|
1. Block fast Na channels
2. Block slow Na "window" current channels |
|
|
|
Class 1-B: Na channel blocked in activated/inactivated state?
|
Blocked in inactivated state
1-B blocks Blocked channels(blocked-inactivated) Inactivated channels- partially depolarized channels |
|
|
|
Drugs used to prevent arrhythmias related complications post MI?
|
1. Lidocaine
2. B-blockers |
|
|
|
Lidocaine: Indications for use?
|
1. Post-MI (Ventricular arrythmias)
2. Open heart surgery 3. Digoxin toxicity |
|
|
|
Lidocaine: Adverse effects?
|
1. Seizures
**considered safest drug of all antiarrhythmics |
|
|
|
I-B class drugs: Name em? Respective routes of administration?
|
1. Lidocaine(IV)
2. Tocainide(Oral) 3. Mexiletine(Oral) "TOss ME the LID" |
|
|
|
Class 1-C: action on channels?
|
Blocks fast Na channels- chiefly HIS PURKINJE fibers.
|
|
|
|
Class 1-C: Effect on Action potential duration?
Effect viewed on graph? |
NO effect on APD
Phase 0 slope prolonged/reduces but APD stays the same |
i______
i \ i \ _____i \______ / ___ / \ / \ _____ / \_______ <-----------> No change in APD http://en.wikipedia.org/wiki/File:Action_potential_class_Ic.svg |
|
|
Class 1-B: Effect on APD? Effect viewed on graph?
|
Shortened APD
Phase 3 arrives earlier(phase 2 shortened) **1-B drugs do not affect QRS COMPLEX*** **refer show-me(ipad) http://en.wikipedia.org/wiki/File:Action_potential_Class_Ib.svg |
|
|
|
Class 1-C drugs: Name em?
uses? Contra-indications? |
Flecainide
Encainide Propafenone Limited use- Due to high incidence of sudden death(proarrythmias) 1. May be used in paroxysmal supraventricular tachycardia C/I in Post-MI prophylaxis 2. Ventricular tachycardia that progress to VF. Used as a LAST RESORT in refractory tachycardia IC (Not A, NOT B..... C--last resort) IB- Best for post-MI IC- Contraindicated post-MI |
|
|
|
Class II:
Effect/ Effect on action potential duration? |
Effect: Decreases Ca current
(reduces cAMP-- B(erg)cAMP Effect observed on slow fibers: Reduced(prolonged) slope of phase 4 Reduced AV and SA nodal activity |
|
|
|
B-blockers that used in arrhythmias?
|
1. ProPANolol- Non specific
2. ACEbutalol- Specific 3. Esmolol- Specific 4. Metoprolol 5. Atenolol 6. Timolol |
|
|
|
Class II: Uses/indications?
|
1. Post-MI
2. Supraventricular (atrial) tachycardias |
|
|
|
Class III: Effects on channels?
Effect on APD? Effect viewed on graph? |
1. K channel blockers
2. APD and ERP both prolonged(purkinje mainly) 3. Slowed/prolonged phase 3 slope. http://en.wikipedia.org/wiki/File:Action_potential_Class_III.svg |
|
|
|
Amiodarone:
MOA? |
1. Mimicks ALL classes-
I,II,III,IV 2. Increased APD and ERP in ALL cardiac tissues. 3. Affected lipid membrane |
|
|
|
Amiodarone: uses/indications?
|
ANY arrhythmias
|
|
|
|
Amiodarone: pharmacokinetics?
|
T1/2> 80 days
Long t1/2 "Amiodarone sounds LONG like Toblerone" (long t1/2) |
|
|
|
Class III drugs: Name em.
|
1. Amiodarone
2. Sotalol 3. Dofetilide 4. Dronedarone |
|
|
|
Class 1-B drugs uses?
|
Uses-
1. Post MI 2. Digitalis toxicity-->arrhythmias |
|
|
|
Class 1-C: Adverse effect?
|
1. Proarrhythmic post-MI
2. Prolongs AV node refractoriness. |
|
|
|
Antiarrhythmics used for re-entrant tachyarrhythmias?
|
Class I-A antiarrhythmics
|
|
|
|
B-blockers effect on EKG?
|
Prolongs PR interval.
QT interval prolongation? PR interval prolongation? |
QT: 1-A and III (K channel block)
PR: B-blockers( Class II ) |
|
|
B-blockers- overdose- DOC? MOA?
|
Glucagon
MOA- increases cAMP |
|
|
|
Amiodarone: side effects?
|
1. Pulmonary fibrosis
2. Hepatotoxicity 3. Phototoxicity 4. Corneal deposits 5. Thyroid dysfunction 6. Smurf skin- blue skin- iodination of glucose in skin' |
|
|
|
Pulmonary fibrosis: associated drugs?
|
1. Amiodarone
2. Bleomycin |
|
|
|
Class III drugs: effect on EKG?
|
Increased QT interval
|
|
|
|
Amiodarone: precautions exercised while usage?
|
1. PFT
2. LFT 3. TFT monitoring Lungs Liver Thyroid |
|
|
|
Class V antiarrhythmics?
|
1. Adenosine
2. Mg 3. Digoxin |
|
|
|
Class 1-B drugs uses?
|
Uses-
1. Post MI 2. Digitalis toxicity-->arrhythmias |
|
|
|
Class 1-C: Adverse effect?
|
1. Proarrhythmic post-MI
2. Prolongs AV node refractoriness. |
|
|
|
Antiarrhythmics used for re-entrant tachyarrhythmias?
|
Class I-A antiarrhythmics
|
|
|
|
B-blockers effect on EKG?
|
Prolongs PR interval.
|
|
|
|
B-blockers- overdose- DOC?
|
Glucagon
|
|
|
|
Amiodarone: side effects?
|
1. Pulmonary fibrosis
2. Hepatotoxicity 3. Phototoxicity 4. Corneal deposits 5. Thyroid dysfunction 6. Smurf skin- blue skin- iodination of glucose in skin' |
|
|
|
Pulmonary fibrosis: associated drugs?
|
1. Amiodarone
2. Bleomycin |
|
|
|
Class III drugs: effect on EKG?
|
Increased QT interval
|
|
|
|
Amiodarone: precautions exercised while usage?
|
1. PFT
2. LFT 3. TFT monitoring Lungs Liver Thyroid |
|
|
|
Class V antiarrhythmics?
|
1. Adenosine
2. Mg 3. Digoxin |
|
|
|
Adenosine:
MOA? |
Activates adenosine receptors---> Gi coupled cAMP decrease---->
Decreased SA and AV node activity |
|
|
|
DOC for paroxysmal supraventricular tachycardia?
|
Adenosine
|
|
|
|
Adenosine: indications?
Adverse effects? |
1. Paroxysmal supraventricular tachycardia. (DOC)
2. Adverse effects: i. Chest pain(bronchospasm) ii. Flushing iii. Hypotension iv. Flushing |
|
|
|
FDA approved drugs for supraventricular tachycardia?
|
Verapamil
|
|
|
|
Magnesium: Uses?
|
1. Torsades
2. Seizures 3. Premature labor |
|
|
|
Drugs causing torsades?
|
1. K channel blockers
2. TCAs 3. Antipsychotics- Thioridazine |
|
|
|
DOC for supraventricular tachycardia?
|
Verapamil
|
|
|
|
Calcium channel blockers: Adverse effects?
|
1. CONSTIPATION
2. Dizziness/Flushing/ Hypotension 3. ****AV BLOCK- ADDITIVE effects with |
|
|
|
A/arrhythmics that cause: AV Block
|
1. B-blockers
2. Digoxin 3. CCBs Almost all antiarrhythmics can produce AV blocks |
|
|
|
Class 1-C: Effect on EKG?
|
Prolonged QRS
|
|
|
|
Drugs used in rx of digitalis induced arrhythmias?
|
1. Mg
2. K 3. Lidocaine |
|
|
|
Drugs used in treatment of re-entrant arrhythmias?
|
1. 1-a
2. Digitalis (Here's one(1) AD for re-entry permie) |
|
|
|
Short acting arrhythmics?
|
Esmolol
Adenosine Esmolol- oh so small (short acting) |
|
|
|
Digoxin: indications for arrhythmias?
|
Used in atrial fibrillation/flutter
|
|
|
|
K+:
Indication for use? MOA? |
Use: Digitalis induced arrhythmias
MOA: Reduces other ectopic pacemakers |
|
|
|
Antihypertensive drugs that alter sympathetic activity?
|
1. alpha 1 blockers
a. Prazosin b. Doxazosin c. Terazosin 2. Alpha 2 AGONISTS: a. Methyldopa b. Clonidine 3. Beta blockers: 4. Reserpine 5. Guanethidine |
|
|
|
MOA of each:
Alpha1 blockers Alpha 2 agonists Beta blockers Reserpine Guanethidine? |
Alpha - 1 blockers block alpha-1 receptors(mediate vasoconstriction)---> vasodilation---> reduced TPR(ARTERIOLAR and VENOUS)--->(reflex tachycardia)
Alpha-2 agonists: Decrease in sympathetic activity-->Reduced TPR and heart rate B-blockers: 1. Reduced renin release--> reduced AT-II--> vasodilation + reduced volume 2. Reduced Systolic force (-ve inotropicity) Reserpine: destroys vesicles Guanethidine: Inhibits norepinephrine release |
|
|
|
Class of autonomic antihypertensive drugs that cause reflex tachycardia?
|
Alpha-1 blockers:
Reduce |
|
|
|
Prolonged QT interval syndrome?
|
1. Familial genetic condition with a defect in cardiac K channels.
2. Increased risk of torsades **Class IA and Class III increase risk of torsades in thesepts*** |
|
|
|
Hyperkalemia OR hypokalemia cause arrhythmia- which one?
|
Both
|
|
|
|
Clonidine: uses?
|
Antihypertensive(mild-mod)
Opiate withdrawal |
|
|
|
Methyldopa: uses?
|
Antihypertensive during pregnancy
|
|
|
|
Clonidine/methyldopa: added advantage as an antihypertensive?
|
**No reflex tachycardia**
|
|
|
|
clonidine/methyldopa: side effects?
|
1. Methyldopa:
allergic reaction--> hemolysis Type II hypresensitivity--> methyldopa has high protein binding-->acts as hapten-->AB production against it (POSITIVE COOMB'S TEST) 2. Edema (both)---vasodilation(?) 3. CNS depression (both) |
|
|
|
Clonidine/methyldopa: drug interaction?
|
TCAs decrease a/hypertensive effects of alpha-2 agonists
|
|
|
|
A/hypertensive drugs interfering with storage vesicles?
|
1. Reserpine
2. Guanethidine |
|
|
|
Reserpine: effects?
|
Destroys vesicles--> reduced norepinephrine/serotonin/dopamine
"reSERPINE: Serpent eats/destroys eggs(vesicles)" |
|
|
|
Reserpine: side effects?
|
1. Depression SEVERE(decreased norepinephrine/serotonin/dopamine)---> SUICIDE
2. Edema 3. GI secretions increased--> ulcers/diarrhea |
|
|
|
Guanethidine: MOA?
|
Accumulates in nerve endings by REUPTAKE--> Binds vesicles--> inhibits release
"Guam is a prison prevents RELEASE of prisoners(epinephrine)" |
|
|
|
Guanethidine: Side effects?
|
Diarrhea
Edema |
|
|
|
Bretylium: toxicity?
ibitulide: toxicity? |
Bretylium: New arhythmias
Ibitulide: Torsade |
|
|
|
Guanethidine: drug interaactions?
|
TCAs block reuptake of guanethidine
|
|
|
|
Prazosin: uses?
|
A/hypertensive
BPH (nocturia and frequency decreased) |
|
|
|
"Zosins": side effects?
|
1. First dose syncope
2. Orthostatic hypotension 3. Urinary incontinence |
|
|
|
B-blockers side effects?
Precautions to be observed? |
1. Sexual dysfunction
2. Dyslipidemia: a. Increased LDL b. Increased TGs 3. Fatigue Precautions: 1. Asthma 2. Vasospastic disorders: PVDs/gangrene 3. Diabetics: a. Masking of tachycardia due to hypoglycemia from treatment b. Dyslipidemia |
|
|
|
Alpha-1 blockers: advantage of using as antihypertensives?
|
Good effect on lipid profile
(Increased HDL Decreased LDL) |
|
|
|
A/hypertensive drug associated with diarrhea?
|
Guanethidine
|
|
|
|
A/hypertensive drugs safe in pregnancy?
|
1. Hydralazine
2. Methyldopa |
|
|
|
Direct vasodilators used as a/hypertensives?
|
1. Hydralazine
2. Nitroprusside 3. Minoxidil 4. Diazoxide 5. "Dipines" |
|
|
|
Hydralazine: use?
MOA? |
1. Use: Moderate-severe hypertension
2. MOA: arteriolar dilation |
|
|
|
Hydralazine: side effect?
|
1. SLE like syndrome
2. Edema 3. Reflex tachycardia |
|
|
|
Nitroprusside: use?
MOA? |
DOC for hypertensive crysis
Venodilator + Arteriodilator nitRopRusside- used in cRysis(hypertensive) |
|
|
|
Drugs used in
i. Mild-moderate hypertension? ii. Moderate- severe hypertension? |
i. Alpha-2 agonists:
methyldopa/ clonidine ii. Nitroprusside: DOC for hypertensive crisis Hydralazine |
|
|
|
DOC for hypertensive emergencies?
|
Nitroprusside
|
|
|
|
Nitroprusside: Toxicity?
|
Cyanide poisoning
|
|
|
|
Nitroprusside toxicity treatment?
|
Amyl nitrite
/Sodium nitrite + Na-thiosulfate Nitrites convert Hb-->Methb Methhb+CN-->cyanmethb Cyanmethb+Na-thiosulfate--> Na-thiocyanate-->eliminated |
|
|
|
Minoxidil: MOA?
|
K channel opener--> Hyperpolarization of membrane--> relaxation of blood vessels
|
|
|
|
Minoxidil: arteriodilator/ venodilator?
|
Arteriodilator
|
|
|
|
Diazoxide: MOA?
Arterio/venodilator? |
1. K channel opener--> Hyperpolarization of membrane--> relaxation of blood vessels
2. Arteriodilator |
|
|
|
Drugs used in hypertensive crysis?
|
1. Nitroprusside
2. Diazoxide |
|
|
|
Minoxidil: side effects?
|
1. Hypertrichosis
2. Hypotension-- Reflex tach 3. Hyperglycemia 4. Edema |
|
|
|
CCBs:
MOA? Uses? |
Block L-type calcium channels-->
Reduce CO Reduce TPR Angina Hypertension Antitarrhythmics |
|
|
|
CCBs: side effects?
|
1. Hypotension--> reflex tach
2. Gingival hyperplasia |
|
|
|
Aliskerin: MOA?
|
Renin blocker-->
1. Decreased Aldosterone--> reduced volume 2. Decreased ATII--> Vasodilation |
|
|
|
ACE-Is: MOA
ARBs: MOA |
ACEIs inhibit ACE
ARBs block AT-1 receptors Ultimately both result in reduced volume and TPR(from vasodilation) |
|
|
|
ACEIs/ARBs/Aliskerin: Effect on bradykinin?
|
ACEIs inhibit degradation of bradykinin
|
|
|
|
Bradykinin effects?
|
1. Pain mediation
2. Vasodilation 3. Angioedema 4. Post-natal constriction of PDA 5. Persistent cough |
|
|
|
Bradykinin effects?
|
1. Pain mediation
2. Vasodilation 3. Angioedema 4. Post-natal constriction of PDA 5. Persistent cough |
|
|
|
ACEIs/ARBs/Aliskerin: Uses?
|
1. Mild-moderate hypertension
2. DIABETIC NEUROPATHY 3. CHF |
|
|
|
ACEIs/ARBs/Aliskerin: Uses?
|
1. Mild-moderate hypertension
2. DIABETIC NEUROPATHY 3. CHF |
|
|
|
ACEIs/ARBs/Aliskerin:
side effects? |
ACEIs:
1. Dry cough- persistent(ACEIs only) 2. Angio-Edema(ACEIs only) 3. Hyperkalemia 4. Acute renal failure in renal artery stenosis 5. Altered taste |
|
|
|
ACEIs/ARBs/Aliskerin:
side effects? |
ACEIs:
1. Dry cough- persistent(ACEIs only) 2. Angio-Edema(ACEIs only) 3. Hyperkalemia 4. Acute renal failure in renal artery stenosis 5. Altered taste |
|
|
|
Administration of ACEIs/ARBs/Aliskerin causes Acute renal failure in renal artery stenosis: reason?
|
In renal artery stenosis--> renal perfusion drops-->renin increases(response)-->GFR adequate
If ARBs/ACEIs/Aliskerin administered--> decreased GFR---> Acute renal failure |
|
|
|
Administration of ACEIs/ARBs/Aliskerin causes Acute renal failure in renal artery stenosis: reason?
|
In renal artery stenosis--> renal perfusion drops-->renin increases(response)-->GFR adequate
If ARBs/ACEIs/Aliskerin administered--> decreased GFR---> Acute renal failure |
|
|
|
ACEIs alternative for better side effect profile?
|
ARBs
Aliskerin |
|
|
|
ACEIs alternative for better side effect profile?
|
ARBs
Aliskerin |
|
|
|
ACEIs- C/I?
|
Pregnancy: Fetal renal damage
|
|
|
|
ACEIs- C/I?
|
Pregnancy: Fetal renal damage
|
|
|
|
ACEIs/ARBs/Aliskerin: Venodilators/arteriodilators?
|
Arteriodilators
(Aceis are Arteriodilators) |
|
|
|
ACEIs/ARBs/Aliskerin: Venodilators/arteriodilators?
|
Arteriodilators
(Aceis are Arteriodilators) |
|
|
|
First line drugs used in pregnancy?
|
Hydralazine+ Methyldopa
|
|
|
|
First line drugs used in pregnancy?
|
Hydralazine+ Methyldopa
|
|
|
|
Angina- DOC?
|
B-blockers
CCBs ABC- Angina- B blockers, Ca channel blockers |
|
|
|
Angina- DOC?
|
B-blockers
CCBs ABC- Angina- B blockers, Ca channel blockers |
|
|
|
Diabetes- DOC?
|
ACEIs, ARBs
|
|
|
|
Diabetes- DOC?
|
ACEIs, ARBs
|
|
|
|
Bradykinin effects?
|
1. Pain mediation
2. Vasodilation 3. Angioedema 4. Post-natal constriction of PDA 5. Persistent cough |
|
|
|
ACEIs/ARBs/Aliskerin: Uses?
|
1. Mild-moderate hypertension
2. DIABETIC NEUROPATHY 3. CHF |
|
|
|
ACEIs/ARBs/Aliskerin:
side effects? |
ACEIs:
1. Dry cough- persistent(ACEIs only) 2. Angio-Edema(ACEIs only) 3. Hyperkalemia 4. Acute renal failure in renal artery stenosis 5. Altered taste |
|
|
|
Administration of ACEIs/ARBs/Aliskerin causes Acute renal failure in renal artery stenosis: reason?
|
In renal artery stenosis--> renal perfusion drops-->renin increases(response)-->GFR adequate
If ARBs/ACEIs/Aliskerin administered--> decreased GFR---> Acute renal failure |
|
|
|
ACEIs alternative for better side effect profile?
|
ARBs
Aliskerin |
|
|
|
ACEIs- C/I?
|
Pregnancy: Fetal renal damage
|
|
|
|
ACEIs/ARBs/Aliskerin: Venodilators/arteriodilators?
|
Arteriodilators
(Aceis are Arteriodilators) |
|
|
|
First line drugs used in pregnancy?
|
Hydralazine+ Methyldopa
|
|
|
|
HTN+ Angina- DOC?
|
B-blockers
CCBs ABC- Angina, b blockers, CCBs (HTN + angina) Angina- B blockers, Ca channel blockers |
|
|
|
HTN + Diabetes- DOC?
|
ACEIs, ARBs
|
|
|
|
HTN + Post MI- DOC?
|
B-blockers
|
|
|
|
HTN + Heart failure(?)- DOC?
|
ACEIs/ARBs B-blockers
|
|
|
|
BPH+ HTN- DOC?
|
alpha blockers
|
|
|
|
Dyslipidemia + HTN- DOC?
|
Alpha blockers
CCBs ACEIs/ARBs |
|
|
|
Pulmonary hypertension- drugs used for rx?
|
1. Bosentan
2. Epoprostenol 3. Sildenafil |
|
|
|
Bosentan:
Use? MOA? Route of administration? Side effects? C/I ? |
Use: Pulmonary hypertension
Endothelin receptor blocker. (ET-1 receptor) Endothelin- powerful vasoconstrictor Route: Oral Side effects: (Hypotension Flushing Headache) C/I: pregnancy |
|
|
|
Eposprostenol:
Use? MOA? Route of administration? |
Use: Pulmonary hypertension
MOA: Prostacyclin analogue: vasodilation Route: Infusion pumps |
|
|
|
Sildenafil:
Use? MOA? |
Use: Pulmonary hypertension
PDE V inhibitor--> Increased cGMP-->Pulm Artery relaxation (sildenafil 10 worded- 10/2= 5- PDE 5 inhibition) |
|
|
|
Milrinone
Inamrinone: Use? MOA? Route? |
Inotropes for CHF
MOA: PDE 3 inhibitors--> increased cAMP-->peripheral vasodilation and stimulation of heart (CHor ko INam MILega) Chf- INamrinone and MILrinone |
|
|
|
Sympathomimetics?
|
1. Digoxin
2. Dobutamine 3. Dopamine |
|
|
|
Dobutamine dopamine: use in CHF not effective: reason?
|
Due to tachyphylaxis
|
|
|
|
Digoxin: effects?
|
Inhibition of Na/K ATPase-->
Increased intracellular Na--> Decreased Na/Ca exchange--> Increased intracellular Ca--> Increased Ca release from SR--> Increased contractile force Inhibition of neuronal Na/K ATPase--> Vagal stimulation and sympathetic stimulation |
|
|
|
Digoxin: drug interaction?
|
Digoxin has protein binding.
May be displaced by other drugs (Verapamil Quinidine) Diuretics: Hypercalcemia Hypokalemia Hypomagnesemia |
|
|
|
Wolf-Parkinson White syndrome?
Rx? |
Accessory conduction pathways
Rx: Class 1a or Class III drugs (Quinidine or Amiodarone) DO NOT use any AV conduction blocker Avoid- ABCD: A-Adenosine B-B-blocker C-CCBs D-Digoxin |
|
|
|
Digoxin: uses?
|
CHF
Supraventricular tachycardia |
|
|
|
Digoxin: adverse effects?
|
1. Anorexia
2. Nausea 3. ECG changes 4. Disorientation(drunk) 5. Visual effects-halos 6. Cardiac arrhythmias |
|
|
|
Digoxin toxicity: management?
|
1. Lidocaine
2. Replenish lost electrolytes 3. Fab ABs against digoxin |
|
|
|
Nesiritide:
MOA? Use? |
Recombinant form of BNP
Binds to BNP receptors --> increases cGMP --> vasodilation Acutely decompensated heart failure |
|
|
|
Digoxin: ECF findings?
|
"PAT with block"
Paroxysmal atrial tachycardia with AV block ST depression T wave inversion |
|
|
|
Nitroglycerine:
MOA in angina? Arteriolar or venodilator? |
Nitroglycerine --> Nitrosothiol --> NO --> Guanylate cyclase --> cGMP --> Relaxation
Nitroglycerine converted to nitrosothiol by cysteine Decreased preload --> decreased cardiac work --> reduced oxygen requirement **Venodilator** --> REDUCE INFARCT SIZE and post MI mortality |
|
|
|
Nitroglycerine: routes of administration?
|
1. Sublingual
2. Transdermal 3. IV formulation |
|
|
|
Oral route for _____ nitrate?
|
Isosorbide mononitrate
|
|
|
|
Nitrates: precautions?
|
C/I in pts taking sildenafil-->
excess accumulation of cGMP--> excess vasodilation --> hypotension --> shock --> death from mi |
|
|
|
Nitrates: side effects?
|
Flushing-headache-orthostatic hypotension-reflex tach-Fluid retention
Methemoglobinemia |
|
|
|
Nitrates- unique dosing- not continuous: why such a pattern?
|
To avoid tachyphylaxis
|
|
|
|
Angina: Type where b-blockers are C/I?
|
Vasospastic
|
|
|
|
"IN ANGINA OF EFFORT- CARVEDILOL IS CLINICALLY EQUIVALENT TO ISOSORBIDE"
|
General statement
|
|
