Cardiac Drugs Reverse Flashcards
Acute severe HTN, HF, safe for pregnancy. Given with B-blocker to prevent reflex tachycardia.
Hydralazine - use? 2+2
Acute ventricular arrhythmias (ESP POST MI)Digitalis-induced arrhythmias
Lidocaine & Mexiletine - use? (2)
AFib/Flutter
Ibutilide & Dofetilide - use
AFib/FlutterVT
Amiodarone & Sotalol - use
Angina, acute coronary synddrome, pulmonary edema
Nitroglycerin, Isosorbide dinitrate, Isosorbide mononitrate - use? (3)
Atrial arrhythmiasVentricular arrhythmiasRe-entrant and ectopic SVT/VTs
Quinidine, Procainamide, Disopyramide - use? (3)
Block voltage-dependent L-type Ca channels of cardiac and smooth muscle –> decrease muscle contractility in heartDecrease conduction velocityIncrease ERPIncrease PR interval
Diltiazem/verapamil - mech? (4)
Block voltage-dependent L-type Ca channels of cardiac and smooth muscle –> decrease muscle contractility in vascular smooth muscle
Nimodipine, Clevidipine, Nifedipine - mech?
Cardiac depressionAV block Peripheral edema, FlushingDizzinessConstipationGingival hyperplasia
Diltiazem - side fx? (7)
Cholinergic - nausea, vomiting, diarrhea, blurry yellow vision, arrhythmias, AV block
Hyperkalemia
Digoxin - side fx
Cinchonism (headache, tinnitus)
Thrombocytopenia
Torsades de pointes due to increased QT interval
Quinidine - side fx? (3)
Class IA antiarrhythmic (Na channel blocker)
Increase AP duration
Increase ERP in ventricular AP
Increase QT interval
Quinidine, Procainamide, Disopyramide - mech
Class IB antiarrhythmic (Na channel blocker)
Decrease AP duration
Prefers affect ischemic or depolarized Purkinje and ventricular tissue
Lidocaine, Mexiletine - mech? (2)
Class II Antiarrhythmics
Decrease SA and AV nodal activity by decreasing cAMP, Ca currents.
Decreases slope of phase 4
AV node is particularly sensitive - increases PR interval
B-blockers (-olol) - mech (4)
Class III Antiarrhythmic - K channel blocker
Increases AP durationIncreases ERP
Increases QT interval
Ibutilide, Dofetilide, Sotalol - mech? (4)
Class III Antiarrhythmic - K channel blocker Increases AP duration Increases ERP Increases QT interval Has Class I - 4 effects
Amiodarone - mech? (5)
CN toxicity
Nitroprusside - side fx?
CNS stimulation/depression
CV depression
Lidocaine, Mexiletine - side fx? (2)
Decrease LDL
Ezetimibe - use
Decrease LDL greatly
Increase HDL
Decrease TG
Statins - use (3)
Decrease LDL
Increase HDL (best)
Decrease TG
Niacin (Vit B3) - use?
Decrease LDL
Increase HDL slightly
Increase TG slightly
Cholestyramine, Colestipol, Colesevelam - use (3)
Decrease LDL
Increase HDL
Decrease TG greatly
Gemfibrozil, Bezafibrate, Clofibrate, Fenofibrate - use?
Diagnosing and abolishing SVT
Adenosine - use
Direct inhibition of Na/K ATPase to indirectly inhibit the Na/Ca exchanger leading to increase in IC Ca = positive inotropy
Stimulates vagus nerve to decrease HR
Digoxin - mech?
Dopamine D1 receptor agonist - coronary, peripheral, renal, and splanchnic vasodilation. Decreases BP and increases natriuresis.
Fenoldopam - mechanism?
Dyslipidemia
Metoprolol - side fx?
Exacerbate vasospasm in Prinzmetal angina
Propanolol - side fx?
Flushing hTN Chest pain Sense of impending doom Bronchospasm
Adenosine - side fx
GI upset
Decreased absorption of other drugs and fat soluble vitamins
Cholestyramine, Colestipol, Colesevelam - side fx? (2)
Heart failure
Thrombocytopenia
Torsades de pointes due to increased QT interval
Disopyramide - side fx? (3)
Hepatotoxicity (LFTs)
Myopathy (esp w/ fibrates & niacin)
Statins - side fx? (2)
HF (increase contractility)AFib (decrease conduction at AV node and depression of SA node)
Digoxin - use? (2)
HTN
Angina
AFib/flutter rate control
Prevention of nodal arrhythmias
Diltiazem/verapamil - use? (4)
HYPERPROLACTINEMIA Cardiac depression AV block Peripheral edema, Flushing Dizziness Constipation Gingival hyperplasia
Verapamil - side fx? (8)
Hypertensive emergency (5)
Nitroprusside, Fenoldopam, Clevidipine, Labetalol, Nicardipine - use? (1)
Impotence Exacerbation of COPD and asthma CV fx (bradycardia, AV block, HF) CNS fx (sedation) Mask hypoglycemia
B-blockers (-olol) - side fx? (5)
Increases cGMP –> smooth muscle relaxation. Vasodilates arterioles > veins; afterload reduction
Hydralazine - mechanism?
Inhibit conversion of HMG-CoA to mevalonate, decrease mortality in CAD patients
Statins - mech?
Inhibits lipolysis (hormone-sensitive lipase) in adipose tissueReduces hepatic VLDL synthesis
Niacin - mech? (2)
Myopathy (increased risk with statins)Cholesterol gallstones
Gemfibrozil, Bezafibrate, Clofibrate, Fenofibrate - side fx
None
Dofetilide - side fx
Prevent cholesterol absorption at small intestine brush border
Ezetimibe - mech
Prevent intestinal reabsorption of bile acids; liver uses cholesterol to make more
Cholestyramine, Colestipol, Colesevelam - mech
Proarrhythmic, especially post-MI (contraindicated)
Flecainide, Propafenone - side fx?
Pulmonary fibrosis Hepatotoxicity Hypo/hyperthyroidism Neurologic fx Constipation CV effects (bradycardia, heart block, HF) Check PFTs, LFTs, and TFTs
Amiodarone - side fx (7)
Rare increase in LFTs
Diarrhea
Ezetimibe - side fx? (2)
Red flushed face (fix with NSAIDs/long term use)
Hyperglycemia
Hyperuricemia
Niacin (Vit B3) - side fx?
Reflex tachycardia (tx with B-blockers)
Flushing
Headache
“Monday disease”
Nitroglycerin, Isosorbide dinitrate, Isosorbide mononitrate - side fx? (4)
Reflex tachycardia, fluid retention, headache, angina, lupus-like syndrome
Hydralazine - toxicity? (5)
Reversible SLE-like syndrome
Thrombocytopenia
Torsades de pointes due to increased QT interval
Procainamide - side fx? (3)
Saline
Atropine
Glucagon
B-blockers (-olol) - antidote? (3)
Shifts K out of cells to hyperpolarize and decrease Ca
Very short acting
Effects blunted by theophylline and caffeine
Adenosine - mech & considerations (2)
Short acting, increase cGMP via direct release of NO
Nitroprusside - mechanism?
Significantly prolongs ERP in AV node and accessory bypass tracts
No effect on ERP in Purkinje and ventricular tissue
Minimal effect on AP duration
Flecainide, Propafenone - mech? (3)
Slowly normalize K+Cardiac pacer
Anti-digoxin Fab fragments
Mg2+
Digoxin - antidote (4)
Subarachnoid hemorrhage
Nimodipine - use? (1)
SVTs, including AFibLast resort in refractory VT
Flecainide, Propafenone - use? (2)
SVT
Ventricular rate control for AFib/flutter
B-blockers (-olol) - use (2)
Torsades de pointes
Ibutilide - side fx
Torsades de pointes
Digoxin toxicity
Mg2+ - use (2)
Torsades de pointes
Excessive B blockade
Sotalol - side fx
Upregulate LPL to increase TG clearance
Activates PPAR-a to induce HDL synthesis
Gemfibrozil, Bezafibrate, Clofibrate, Fenofibrate - mech
Vasodilate by increasing NO in vasc smooth muscle - increase cGMP and smooth muscle relaxation. Veins more than arteries to decrease preload.
Nitroglycerin, Isosorbide dinitrate, Isosorbide mononitrate - mech?