Basic Cardiac Pharmacology Flashcards
Increases Contractility
Digoxin
Dobutamine (used only in acute HF)
Reduce Preload
diuretics
vasodilators
ACE inhibitors/ARBs
Reduce afterload
diuretics
vasodilators
ACE inhibitors/ARBs
Beta blockers
Class IA for atrial fibrillation, atrial flutter, ventricular tachycardia
binds to activated sodium channels and block the flow of sodium ions in the cardiac myocyte (prolongs action potential)
e.g. quinidine, procainamide, disopyramide
Class IB for post-ischemic arrhythmia, ventricular fibrillation, ventricular tachycardia
bind to both activated and inactivated sodium channels and block the flow of sodium ions into the cardiac myocyte (shortens action potential)
e.g. lidocaine, tocainide, mexiletine
Class IC for severe refractory ventricular arrhythmia
binds to activated sodium channels and block the flow of sodium ions into the cardiac myocyte (no effect on action potential)
e.g. flecainide, encainide, propafenone
Class III for atrial and ventricular arrhythmias
binds to potassium chanels and blocks the flow of potassium into the cardiac myocyte (prolongs action potential)
e.g. Sotalol, Ibutilide, Bretylium, Amiodarone
Class IV for supraventricular tachycardia, rate reduction in patients with atrial fibrillation
block voltage-gated calcium channels thereby blocking the flow of calcium into the cell
e.g. Verapamil, Diltiazem
Causes excretion of Na and reduction of volume
Diuretics
Calcium channel blocker that exerts more effect on the vessels than the heart
Dihydropyridines (Nifedipine, Felodipine, Amlodipine)
Calcium channel blocker that exerts more effect on the heart
Nondihydropyridines (Verapamil, Diltiazem)
Antihypertensive that decreases the workload of the heart
Beta blockers
Blocks the AT1 receptor of Angiotensin II
ARBs
Notorious for drug-induced cough
ACE Inhibitors (by increasing bradykinin)
Blocks the action of aldosterone in the collecting tubules
Spironolactone, Eplerenone
Used in hypertension with comorbid Benign Prostatic Hyperplasia (BPH)
Alpha 1 blockers (Terazosin, Prazosin)
Maintenance medication during pregnancy
Methyldopa
(Anti-ischemic) Nitrates
Decrease in angina symptoms
No effect on mortality
(Anti-ischemic) Beta-blockers
Decrease in progression to MI (THR 55-60 bpm)
(Anti-ischemic) Calcium-channel blockers
Used in patients who cannot have beta blockers because of bronchospasm
(nondihydropyridines)
(Anti-ischemic) Oxygen
Only used if O2 sat
(Anti-platelet) Aspirin
prevents platelet activation
decrease in mortality and re-MI
LD: 162-325mg
MD: 72-162 mg/day
(Anti-platelet) Clopidogrel
ADP receptor blocker given in addition to ASA decrease MI, stroke LD: 300-600mg MD 75mg/day
(Anticoagulant) Unfractionated Heparin (UFH)
target aPTT 50-70sec (ratio of 1.5 to 2.5)
LD: 60 u/kg, max4000u
MD: 12 u/kg/hr, max1000u
(Anticoagulant) Enoxaparin
No PTT monitoring needed
1mg/kg SC BID
(Anticoagulant) Fondaparinux
Decreased risk of bleeding
2.5mg SC OD
(dyslipidemia)
Class: Statins
Competitively inhibits the rate limiting enzyme in cholesterol synthesis (HMG-CoA reductase)
highly dec LDL
inc HDL
dec TAG
side effect: rhabdomyolysis
(dyslipidemia)
Class: Ezetimibe
Inhibits absorption at the intestinal border
dec LDL
HDL and TAG
(dyslipidemia)
Class: Fibrates
Upregulates lipoprotein lipase
dec LDL
inc HDL
highly dec TAG
side effect: hepatotoxicity
(dyslipidemia)
Class: Niacin
Decreases lipolysis in adipose tissues
dec LDL
highly inc HDL
dec TAG
side effect: flushing
(dyslipidemia)
Class: Resins
Inhibit reabsorption of bile acids
dec LDL
slightly inc HDL
TAG
