Cardio Pharm

Question 1

what is the MOA of 1st gen B-blockers

Answer 1

non-selective B1, B2, and alpha receptor blockers

Question 2

what is the MOA of 2nd gen B-blockers

Answer 2

B1 receptor blockers

Question 3

what is the MOA of 3rd gen B-blockers

Answer 3

vasodilating - act on blood vessels; may produce non selective or cardioselective B-blockade

Question 4

what occurs from B1 receptors being blocked in the treatment of A-fib

Answer 4

reduction of sympathetic stimulation of the heart - decreases myocardial conductivity and sympathetic tone

Question 5

what are major AEs of B-blockers

Answer 5

sinus bradycardia/arrest, bronchospasm in asthmatic patients

Question 6

what is the MOA of non-dihydropyridine Ca channel blockers

Answer 6

identical to B-blockers (reduces conductivity and contractility of heart)

Question 7

what is MOA of digoxin

Answer 7

cardiac glycoside, positive inotropic action (increases contractility & force of ventricular contraction –> increases CO), decrease cardiac conduction

Question 8

what are major side effects of digoxin

Answer 8

dysrhythmias, drug interaction +++

*caution with loop diuretics & hypokalemia, predisposes patients to dysrhythmias

Question 9

what drugs control heart rate for the treatment of afib

Answer 9

b-blockers, ND-CCBs, & digoxin

Question 10

what antiarrhythmic drugs are used for afib

Answer 10

sotalol (B-blocker), propafenone, amiodarone

Question 11

What is the MOA for sotalol

Answer 11

blocks K channels at higher doses; acts like non selective B-blocker at lower doses

Question 12

what is an adverse event of sotalol

Answer 12

dysrhythmias (inc torsades do pointes & QT prolongation)

Question 13

what are contraindications for sotalol

Answer 13

pre-existing dysrhythmias, conduction disorders, renal impairment, HFrEF, CHF

Question 14

what is the MOA for propafenone

Answer 14

Na channel blocker, also weakly inhibits B-adrenergic receptors and inhibits Ca influx

Question 15

what are AEs of propafenone

Answer 15

hypotension, bradycardia, ventricular proarrhythmia

Question 16

what are CIs of propafenone

Answer 16

severe hepatic or renal failure, ischemic CAD/hx MI, HFrEF

Question 17

what is the MOA for amiodarone

Answer 17

blocks K and Na channels to delay repolarization

Question 18

what are the black box warnings for amiodarone

Answer 18

pulmonary and liver toxicity

CI in pregnancy

Question 19

what are the three rate control drugs used for afib

Answer 19

1. B blockers
2. non-dihydropyridine CCBs
3. digoxin

Question 20

what are some examples of non-dihydropyridine CCBs

Answer 20

diltiazem, verapamil

Question 21

what is the MOA of B-blockers for the treatment of afib

Answer 21

decrease automaticity of SA node, decrease velocity of conduction through AV node, decrease myocardial contractility

Question 22

what is the MOA of ND-CCBs in the treatment of afib

Answer 22

slow SA node automaticity, delay AV nodal conduction, reduce myocardial contractility

Question 23

what is a CI for ND-CCBs

Answer 23

LVED<40% (B-blocker preferred)

Question 24

what is the MOA of digoxin in the treatment of afib

Answer 24

decrease conduction through AV node adn automaticity of SA node

Question 25

what is the most serious AE from digoxin

Answer 25

dysrhythmias –> caution with drugs that affect K (ACEi, ARBs, diaretics)

Question 26

what is the MOA for antiarrhymic drugs (for afib)

Answer 26

sotalol - inhibit K channels
propafenon - inhibit Na channels
amiodarone - inhibit both

Question 27

what are the two anticoag drugs used for stroke prevention in afib

Answer 27

DOACs (apixaban, dabigatran), warfarin