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Pharm Kaplan > Cardiac/Renal Pharm > Flashcards

Cardiac/Renal Pharm Flashcards

1
Q

What class of drug targets phase - in fast-response fibers (the fast i sodium channels)

A

Class I anti-arrhythmic drugs

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2
Q

Which class of drug targets phase 3 of cardiac muscles (repolarization) - slowing the phase down

A

Class III antiarrhythmic drugs

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3
Q

The _____ negative the threshold potential, the slower the conduction velocity.

A

less negative

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4
Q

The _____ negative the resting potential, the faster the conduction

A

More

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5
Q

What class of drug blocks phase - in slow-response fibers (SA/AV node)

A

Class IV antiarrhytmic drugs

Recall: this phase is due to increased Ca, not increased Na like in the cardiac muscle fibers

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6
Q

What (2) classes of drugs can slow phase 4 in pacemaker fibers?

A

Class II and IV antiarrhthmic drugs.
Recall: phase 4 is the pacemaker current - inward Na and Ca and outward K currents

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7
Q

MOA of Class IA

A

target fast Na channels in the open/activated state - increasing action potential duration (ADP) and effective refractory period (ERP)

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8
Q

MOA of Class 1 antiarrhtmics

A

Na+ Channel blockers

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9
Q

Name 2 Class 1A antiarrythmics

A

Quinidine; Procainamide

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10
Q

What are 2 considerations needed with Quinidine [Class 1A]

A 
M2 blockade (inc HR and AV conduction) - need to give Digoxin first in A-Fib.                              
Hyperkalemia (antacids) enhance effects. Also displaces Digoxin
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11
Q

What are 3 side effects of Quinidine [Class 1A]

A

Cinchonism [GI, tinnitus, ocular dysfunction];
Increased QT interval;
Increased QRS duration

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12
Q

Name 2 side effects of Procainamide [Class 1A]

A

SLE;

Hematotoxicity [thrombocytopenia, agranulocytosis] - need regular CBCs

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13
Q

MOA for Class IB

A

Blocks fast Na channels in the inactivated state [keeps them refractory]; Decrease APD therefore Increase diastole and time for recovery

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14
Q

Name 3 Class IB drugs and there route of administration

A

Lidocaine (IV);

Mexiletine; Tocainide - PO

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15
Q

Name 3 uses for Lidocaine [IB]

A

Post MI; Open heart surgery; Digoxin toxicity

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16
Q

What side effects are associated with Lidocaine

A

CNS toxicity [seizures] although it is the LEAST cardiotoxic of all anti-arrhythmics

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17
Q

What are 2 oral formulations of Lidocaine?

A

Mexiletine, tocainide

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18
Q

What is Class IC MOA

A

Block fast Na channels especially His-Purkinje. NO effect on APD

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19
Q

Name 1 Class 1C drug and important info

A

Flecainide - proarrhythmogenic - increases sudden death post MI

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20
Q

What is Class II MOA

A

Beta-blockers: Decrease slope of phase 4 of pacemakers; Decrease SA/AV node activity

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21
Q

Name 3 drugs (+Class) from Class II anti-arrhythmics

A

Propranolol [non-cardioselective];

Acebutolol + Esmolol [Cardioselective]

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22
Q

Indications for Class II anti-arrythymics

A

Prophylaxis post MI; SVTs; [Esmolol IV for acute SVTs]

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23
Q

MOA for Class III antiarrhythmic drugs

A

K+ Channel blockers: Decrease K slowing phase 3 (repolarization); Increases APD and ERP

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24
Q

Name 2 Class III antiarrhythmic drugs w/indications

A

Amiodarone [ANY arrhythmia -Half life > 80 days!];

Sotalol [life-threatening ventricular arrhythmia]

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25
Q

Name 6 side effects of Amiodarone [Class III]

A 
Pulmonary fibrosis;                   
Blue Skin;                  
Phototoxicity;               
Corneal deposits;         
Thyroid dysfunction;             
Hepatic necrosis;
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26
Q

What is special about Sotalol [Class III]

A

Also has B-blockade therefore decreases HR and decreases AV conduction

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27
Q

What antiarrhythmic classes risk torsades

A

IA and Class III

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28
Q

Class IV MOA

A

Ca++ Channel blocker [L-type]. Decrease phase 0 and 4; Decrease SA and AV nodal activity

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29
Q

Name 2 Class IV drugs

A

Verapamil and Diltiazem

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30
Q

Use of Class IV antiarrhythmics

A

Supraventricular tachycardia

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31
Q

Side effects of Class IV antiarrhythmic [5]

A

Constipation (Verapamil); Dizziness; Flushing; Hypotension; AV block (additive block with B-blockers, digoxin)

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32
Q

What drug interacts with Class IV antiarrhythmics

A

Digoxin is displaced by verapamil from tissue-binding sites

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33
Q

What receptor does Adenosine work on and what are its effects

A

Adenosine receptor = Gi –> Decrease SA and AV nodal activity

34
Q

Adenosine use

A

DOC for paroxysymal SVTs and AV nodal arrhythmias. Given IV b/c half life <10seconds)

35
Q

3 Adenosine SE

A

Flushing; Sedation; Dyspnea

36
Q

Adenosine drug interactions

A

Is antagonized by theophylline (tx for COPD) and cafffene

37
Q

Name 4 methods of altering sympathetic activity to treat HTN

A
  1. alpha 2 agonists;
  2. Interfere with storage vesicles;
  3. Alpha 1 blockers;
  4. Beta blockers
38
Q

Name 2 alpha 2 agonists used to treat HTN

A

Clonidine; methyldopa

39
Q

Clonidine Class; use; SE; drug interactions

A

Alpha 2 agonist. Tc mild-moderate HTN and opiate withdrawl;
Decreases TPR and HR;
SE: CNS depression, edema;
Drugs interactions: TCAs decrease antihypertensive effects

40
Q

Methyldopa: class, use, MOA, SE, Drug interactions

A

Alpha 2 agonist;
Decrease TPR and HR;
Mild-Moderate HTN and HTN IN PREGNANCY;
SE: + COOMBS TEST, CNS depression, Edema;
Drug I: TCAs decrease antihypertensive effects

41
Q

Name 2 drugs that interfere with storage vesicles that are used to treat HTN

A

Reserpine; Guanethidine

42
Q

Reserpine: MOA; SE

A

Destroys vesicles thus decrease NE in periphery thus decrease CO and TPR. Also decreases NE, DA, 5-HT in CNS.
SE: Severe depression (suicide); Edema; inc GI secretions

43
Q

Guanethidine: MOA, sE [2]; Drug interaction

A

Inhibit NE release;
SE: diarrhea, edema;
DI: TCA block reuptake into nerve endings

44
Q

Describe how alpha 1 blockers tx HTN; 3 SE; and one advantage

A

Prazosin; doxazosin; terazosin;
MOA: Decrease arteriolar and venous resistance –> decreases preload. GET REFLEX TACHYCARDIA;
SE: 1st dose syncope, orthostatic hypotension, urinary incontinence;
Advantage: Lipids - increases HDL and lowers LDL

45
Q

What 2 drugs work through NO and are direct-acting vasodilators [used for HTN]

A

Hydralazine, nitroprusside

46
Q

What drug is used IV for HTN emergencies?

A

Nitroprusside

47
Q

Hydralazine MOA, indications, SE [3]

A

MOA: decrease TPR via ARTERIOLAR DILATION
moderate-severe HTN
SE: SLE-like symptoms; edema; reflex tachy

48
Q

Nitroprusside MOA; SE; Use

A

MOA: decrease TPR via BOTH arteriolar venule dilation;
DOC IV HTN emergency;
SE: Cyanide toxicity - must coadminister nitrites and thiosulfates

49
Q

What 2 drugs can you use to tx HTN that open K+ channels

A

Minoxidil and Diazoxide

50
Q

Minoxidil MOA, Indication; 3 SE

A

Direct acting to open K+ channels, hyperpolarization of SM -> ARTERIOLAR vasodilation;
Severe HTN; Baldness;
SE: Hypertichosis; edema; reflex tachycardia

51
Q

Diazoxide MOA; indication; 3 SE

A

Direct acting to open K channels - hyperpolarization of SM - ARTERIOLAR vasodilation;
HTN emergencies;
SE: Hyperglycemia, edema, reflex tachycardia

52
Q

Name 3 Ca_ channel blockers

A

Verapamil, Diltiazem; Dihydropyridines (nifedipine)

53
Q

Verapamil and Diltiazem MOA, indications, SE

A

Decrease CO and TPR; [Ca+ Channel blocker]
HTN; Angina; Antiarrhythmic;
SE: Constipation

54
Q

Nifedipine MOA; 2 indications, 2 SE

A

Ca channel blocker - decrease TPR;
HTN; Angina;
SE: Reflex tachy, Gingival hyperplasia

55
Q

Captopril: MOA; Use (3); SE 4

A

ACEi: Block formation of Angiotensis II –> Dec Aldosterone; Vasodilate
Use: HTN; CHF; Protective of Diabetic neuropathy
SE: DRY COUGH, Hyperkalemia, Angioedema, Contraindicated in pregnancy

56
Q

Losartan: MOA,Use 3; SE3

A

ARB: Block AT1 receptor (NO Bradykinin issues);
Use: Mild-moderate HTN, CHF, protective of diabetic neuropathy;
SE: Hyperkalemia, Angioedema, Contraindicated in pregnancy

57
Q

Aliskiren: MOA; use 1; SE3

A

Renin inhibitor –> Blocks formation of Angiotensin 1 (no effect on bradykinin);
Use: HTN
SE: Hyperkalemia, Angioedema, contraindicated in pregnancy

58
Q

What is the big issue with ACEi’s and ARBs?

A

Can cause acute renal failure in renal artery stenosis

59
Q

Name 3 treatments of pulmonary HTN

A

Bosentan (ETA receptor antagonist); Epoprostenol (PGI2); Sildenafil (PDE inhibitor)

60
Q

Bosentan: MOA, SE4, Special consideration

A

ETA receptor antagonist (endothelin = powerful vasoconstrictor);
SE: HA, flushing, hypotension, reflex tachycardia;
Contraindicated in pregnancy

61
Q

Epoprostenol: MOA; Special consideration

A

Prostacyclin PGI2;

Contraindicated in pregnancy;

62
Q

Sildenafil: MOA

A

Inhibits type V PGE –> increases cGMP –> Pulmonary artery relaxation

63
Q

DOC (class) for chronic management of CHF

A

ARBs & ACEi

64
Q

DOC (class) for acute CHF

A

Inotropes

65
Q

Treatment for Wolff-Parkinson-White Syndrome

A

Class Ia or III

66
Q

Inamrinone; Milrinone: MOA, use

A

Phosphodiesterase inhibitors –> increases cAMP. Is an inotrope for heart failure

67
Q

Dobutamine MOA

A

Beta 1 receptor agonist (rapidly desensitizes) - used in Heart failure

68
Q

Digoxin: Direct effect

A

inhibit cardiac Na/K ATPase –> inc intracellular Na –> dec Na/Ca exchange therefore intracellular Ca increases –> inc actin-myosin interation therefor increased contractile force

69
Q

Digoxin: indirect effect

A

Inhibit neuronal Na/K ATPase:
increases vagal tone - dec HR - more filling = inc CO;
Increases sympathetic stimulation via Beta 1 +NE

70
Q

Digoxin: dosing information

A

Long half life - need LD;
Renal clearance: caution with renal impairment;
Large Vd - displaced by verapamil, quinidine

71
Q

Digoxin can be used for: 2

A

CHF; Supraventricular Tachy

72
Q

Digoxin: SE6

A

anorexia, nausea, ECG change –> disorientation (drunk), ‘halos’, cardiac arrhythmia

73
Q

Nitrates: MOA for angina

A

prodrug of NO - cGMP relaxes SM around veins - venodilation - lower preload, lower O2 requirements;
Dec infarct size and post-MI mortality

74
Q

Name the 2 nitrates and route of administration

A

Nitroglycerin: sublingula, IV, transdurmal;
Isosorbide: oral for chronic use

75
Q

SE of nitrates: 6

A

Flushing, HA, orthostatic hypotension, reflex tachycardia, fluid retnetion, Methemoglobinemia

76
Q

Dosing issue with Nitrates

A

Tachyphylaxis - run out of GSH - tolerance

77
Q

What drug can you not administer with Nitrates

A

Sildenafil –> cardiovascular toxicity

78
Q

What calcium channel blocker is great for vasospastic angina

A

Nifedipine

79
Q

What drug is contraindicated in vasospastic angina

A

Beta-blockers

80
Q

Beta blockers + what drug is good for Angina of effort

A

Carvedilol

Pharm Kaplan (4 decks)

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