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Pharmacology Drugs > Cardiac Drugs > Flashcards

Cardiac Drugs Flashcards

1
Q

What are the examples of Class 1A drugs and how are they administered?

A
  • Procainamide
  • Quinidine
  • Disopyramide

Both Oral or IV

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2
Q

What are examples of Class 1B drugs and how are they administered?

A
  • Lidocaine (IV)

- Mexelitine (Oral)

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3
Q

What are the examples of Class 1C drugs and how are they administered?

A
  • Flecainide
  • Propafenone

Both Oral or IV

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4
Q

What is the mechanism of action of Class 1 cardiac drugs?

A

-Na+ channel blocker

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5
Q

What are the effects on the cardiac activity for Class 1A cardiac drugs?

A
  • Decrease in conduction
  • Increase in refractory period
  • Decrease in automaticity by decreasing slope of phase 4 and fast potentials
  • Increase in threshold
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6
Q

What are the effects on the cardiac activity for Class 2 cardiac drugs?

A
  • Increase in action potential duration in AV node to slow AV conduction velocity
  • Decrease phase 4 depolarization (catecholamine dependant)
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7
Q

What are the effects on the cardiac activity for Class 1B cardiac drugs?

A
  • Fast binding offset kinetics
  • APD slightly decreased (normal tissue)
  • Increase in threshold potential
  • Decrease in phase 0 conduction in fast beating or ischaemic tissue
  • No change in phase 0 in normal tissue (no tonic block)
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8
Q

What are the effects on the cardiac activity for Class 1C cardiac drugs?

A
  • Very slow binding offset kinetics
  • Substantially decrease phase 0 in normal hearts
  • Decrease automaticity by increasing threshold
  • Increase in action potential duration (APD) and increase in refractory period especially in rapidly depolarizing atrial tissue
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9
Q

What are examples of Class 2 cardiac Drugs and their route of administration?

A
  • Propranolol (oral, IV)
  • Bisoprolol (oral)
  • Metoprolol (oral)
  • Esmolol (IV)
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10
Q

What is the mechanism of action of Class 2 cardiac drugs?

A

Anti-adrenergic

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11
Q

What is the effect on an ECG of Class 2 cardiac drugs?

A
  • Increase in PR

- Decrease in HR

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12
Q

What are the uses of Class 2 cardiac drugs?

A
  • Treatment of sinus and catelocholamine dependant tachycardia
  • Converting re-entrant arrhythmias at AV node
  • Protecting the ventricles from high atrial rate to slow AV conduction
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13
Q

What are the side effects of Class 2 cardiac drugs?

A
  • Bronchospasm so be careful with asthmatic

- Hypotension

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14
Q

When can’t Class 2 cardiac drugs be used?

A
  • Partial AV block

- Ventricular failure

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15
Q

What are the effect of Class 1A cardiac drugs on the ECG?

A
  • Increased QRS
  • Increased QT

+/- PR

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16
Q

What are the uses of Quinidine?

A
  • Quinidine has anti-cholinergic to speed AV conduction
  • Used with digitalis, beta blocker and Ca2+ channel blocker.
  • Quinidine maintains sinus rhythms in atrial fibrillation and flutter, to prevent recurrence, Brugada syndrome.
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17
Q

What are the uses of IV Procainamide?

A

-IV Procainamide used acutely to treat supraventricular and ventricular arrhythmias.

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18
Q

What are some side effects of Class 1A cardiac drugs?

A
  • Hypotension
  • Pro-arrhythmia (generation of a new arrhythmia e.g. Torsade de Points)
  • Reduced cardiac output
  • Dizziness, Confusion, Insomnia, Seizure at high dose
  • Gastrointestinal effects common
  • Lupus-like syndrome (esp procainamide)
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19
Q

What is the effect of Class 1B drugs on the ECG?

A
  • None in normal

- In fast beating or ischaemic, Increase in QRS

20
Q

What are the uses of Class 1B cardiac drugs?

A
  • Acute: Ventricular tachycardia especially during ischaemia

- Not used in atrial arrhythmias or AV junctional arrhythmias

21
Q

What are the side effects of Class 1B cardiac drugs?

A
  • Less pro-arrhythmic than Class 1A
  • CNS effects such as dizziness and drowsiness
  • Abdominal upset
22
Q

What are the effects of Class 1C cardiac drugs on the ECG?

A
  • Increase in PR
  • Increase in QRS
  • Increase in QT
23
Q

What are the uses of Class 1C cardiac drugs?

A
  • Wide spectrum
  • Used for supraventricular arrhythmias (fibrillation and flutter) + Class 2
  • Premature ventricular contractions
  • Wolff-Parkinson White syndrome
24
Q

What drug use should be avoided in supra-ventricular arrhythmias?

A
  • Class 1C drugs such as Flecainide
  • Can slow the atrial rate enough for the ventricles to respond
  • This can lead to abnormally fast rhythm of the ventricles due to increased ventricular response to supraventricular arrythmias
  • Use of Class 2 or Class 3 drugs as well
25
Q

What are some side effects of Class 1C?

A
  • Pro-arrhythmia and sudden death especially with chronic use and in structural heart disease
  • CNS and gastrointestinal effects like other local anaesthetics
26
Q

What are some examples of Class 3 cardiac drugs and route of administration?

A
  • Amiodorone (Oral or IV)

- Sotalol (Oral)

27
Q

What is the action of Class 3 cardiac drugs?

A

-Potassium antagonist

28
Q

What are the cardiac effects of Class 3 cardiac drugs?

A
  • Increase in refractory period
  • Increase in action potential duration
  • Decrease in phase 0 and conduction (Na+)
  • Increase in threshold
  • Decrease in phase 4 (beta blocker and Ca2+ block)
  • Decrease speed of AV conduction
29
Q

What are the cardiac effects of Class 3 cardiac drugs?

A
  • Increase in action potential duration and refractory period in atrial and ventricular tissue
  • Slow phase 4 via beta blocker
  • Slow AV conduction
30
Q

What is the effect of Amiodorane on the ECG?

A
  • Increase in PR
  • Increase in QRS
  • Increase in QT interval
  • Decrease in HR
31
Q

What is the effect of Sotalol on the ECG?

A
  • Increase in QT

- Decrease in Heart Rate

32
Q

What are the uses of Amiodorane?

A

-Wide spectrum and used for most arrhythmias

33
Q

What are the uses of Sotalol on the ECG?

A

-Wide spectrum: supraventricular and ventricular tachycardia

34
Q

What are the side effects of Amiodorane?

A
  • Pulmonary fibrosis
  • Hepatic injury
  • Increase in LDL cholesterol
  • Thyroid disease
  • Photosensitivity
  • Optic neuritis (transient blindness)
  • May need to reduce digoxin dose and monitor warfarin more closely
35
Q

What are the side effects of Sotalol?

A
  • Pro-arrhythmia
  • Fatigue
  • Insomnia
36
Q

What are some examples of Class 4 drugs and route of administration?

A
  • Verapamil (oral or IV)

- Diltiazem (oral)

37
Q

What is the mechanism of action of Class 4 drugs?

A

-Ca2+ channel blocker

38
Q

What is the mechanism of action of Adenosine?

A
  • Natural nucleoside
  • Binds to A1 receptors and activate K+ currents in AV and SA node
  • Decrease in action potential duration
  • Hyper-polarization
  • Decrease in heart rate
  • Decrease in Ca2+ currents
  • Increase in refractory period in AV node to slow AV conduction
39
Q

What are the uses of Adenosine?

A
  • Convert re-entrant supraventricular arrhythmias
  • Hypotension during surgery
  • Diagnosis of CAD
40
Q

What is the mechanism of action of Vernakalant?

A
  • Blocks atrial specific K+ channels

- Slows atrial conduction and increase potency with higher heart rates

41
Q

What is the mechanism of action of Ivabradine?

A
  • Block funny current expressed in sinus node

- This slows the sinus node and does not affect blood pressure

42
Q

What are the uses of Ivabradine?

A
  • Reduce inappropriate sinus tachycardia

- Reduce heart rate in heart failure and angina but avoid blood pressure drops

43
Q

What is the mechanism of action of Digoxin?

A
  • Enhances vagal activity (increase K+ currents, decrease Ca2+ and increase refractory period)
  • Slows AV conduction and slows HR
44
Q

What are the uses of Digoxin?

A

-Treatment to reduce ventricular rates in atrial fibrillation and flutter

45
Q

What is the mechanism of Atropine?

A
  • Selective Muscurinic antagonist

- This blocks vagal activity to speed up AV conduction and increase heart rate

46
Q

What are the uses of Atropine?

A

Treat bradycardia

47
Q

What are examples of cardiac Glycoside?

A

DIgoxin

Pharmacology Drugs (22 decks)

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