Cardio Pharmacology II Flashcards
mnemonic for antiarrythmics (I-IV)
Some - Sodium Channel Blockers (I)
Block - Beta Blockers (II)
Potassium - Potassium Channel Blockers (III)
Channels - Calcium Channel Blockers (IV)
Class IA drug mnemonic and drug names
The Queen Proclaims Diso’s Pyramid
Quinidine, Procainamide, Disopyramide
Class IB drug mnemonic and drug names
I’d Buy Lido’s Mexican Tacos
Lidocaine and Mexiletine
Class IC drug mnemonic and drug names
Can I have Fries, Please?
Flecainide and Propafenone
Class II drug class
Beta Blockers
Class III drug mnemonic and drug names
AIDS
Amiodarone, Ibutilide, Dofetilide, Sotalol
Class IV drug names
Verapamil and Diltiazem
What antiarrythmics are state dependent and what does that mean?
Class I
selectively depress tissue that is frequently depolarized (tachycardia)
Mechanism of class IA? (3)
increase AP duration, increase ERP in ventricular action potential, increase QT interval
clinical use of class IA?
atrial and ventricular arrhythmia
What are class IA drugs especially good at treating?
re-entrant and ectopic SVT and VT
What drug causes Cinchonism (headache, tinnitus)?
Quinidine
What drug causes reversible SLE-like syndrome?
Procainamide
What drug causes heart failure?
disopyramide
What AA class causes thrombocytopenia?
Class I Quinidine, Procainamide, Disopyramide
What do class I AA increase the risk for due to their mechanism?
torsades de pointes due to increased QT interval
mechanism of class IB? (1)
decreases AP duration
Where does class IB preferentially work?
preferentially affect ischemic or depolarized Purkinje and ventricular tissue
What other drug can also fall into the IB category?
Phenytoin
What drug class is used especially post-MI
IB (Lidocaine and Mexiletine)
What is the use of class IB?
acute ventricular arrhythmia (post MI)
digitalis-induced arrhythmia
What drug class is used to treat acute ventricular arrhythmia (post MI)?
IB (Lidocaine and Mexiletine)
what drug class is used to treat digitalis-induced arrhythmia?
IB (Lidocaine and Mexiletine)
What class of AA have a side effect of CNS effects (seizures)?
IB (Lidocaine and Mexiletine)
mechanism of Class IC drugs? (3)
significantly prolongs ERP in AV node and accessory bypass tracts.
no effect on ERP in purkinje and ventricular tissue.
minimal effect on AP duration
What class is used as a last resort for refractory VT?
IC
What is the clinical use of class IC drugs?
SVTs, including atrial fibrillation
last resort for refractory VT
What class of AA are contraindicated post-MI and why?
Class IC because it is proarrhythmic
When are class IC drugs contraindicated?
contraindicated post-MI and in structural and ischemic heart disease
Mechanism of Class II? (4)
decrease SA and AV nodal activity by decreasing cAMP
decrease Ca++ currents
suppress abnormal pacemakers by decreasing slope of phase 4
increases PR interval (AV node is sensitive)
Which Class II drug is very short acting?
Esmolol
What is the clinical use of Class II AA?
SVT, ventricular rate control for atrial fibrillation and atrial flutter
What drug class can mask the signs of hypoglycemia?
Class II B-Blockers
What drug class can cause impotence?
Class II B-Blockers
General side effects of B-Blockers
exacerbates COPD/asthma
CV depression and CNS depression
all B-Blockers except which two cause unopposed A1 agonism if given for pheochromocytoma or cocaine toxicity
Carvedilol and Labetalol
What class II AA causes dyslipidemia?
Metoprolol
what class II AA can exacerbate vasospasm in Prinzmetal Angina?
Propranolol
How do you treat B-Blocker overdose? (3)
Saline, Atropine, Glucagon
mechanism of Class III? (3)
increase AP duration, increase ERP, and increase QT interval
clinical use of Class III (3)
Atrial fibrillation, atrial flutter
What Class III AA treat ventricular tachycardia? (2)
Amiodarone and Sotalol
What AA has class I, II, III, and IV effects?
Amiodarone
What tests should you run when using Amiodarone?
PFTs, LFTs, TFTs
Adverse effects of Sotalol?
torsades de pointes and excessive B blockade
What class III AA has B-Blocker activity?
Sotalol
Adverse effects of Ibutilide?
Torsades De Pointes
Why does Amiodarone cause thyroid issues?
Hypo/Hyperthyroidism due to it being 40% iodine by weight
What side effects of Amiodarone are due to it acting as a hapten? (3)
corneal deposits
blue/gray skin deposits leading to photodermatitis
What organ toxicities occur when taking Amiodarone?
pulmonary fibrosis and hepatotoxicity
What drug toxicity does Amiodarone predispose you to and why?
Digoxin
decreases clearance of Digoxin
Cardiovascular adverse effects of Amiodarone?
bradycardia, heart block, HF
What AA is very lipophilic?
Amiodarone
mechanism of class IV? (3)
decrease conduction velocity
increase ERP
increase PR interval
clinical use of Class IV? (2)
prevention of nodal arrhythmias (SVT)
rate control in atrial fibrillation
What are the adverse effects of class IV drugs? (4)
Constipation
Flushing
Edema
CV depression
Mechanism of Adenosine
increases K+ out of cells hyperpolarizes the cell and therefore decreases inward Ca++ current
Adenosine is the DoC for what?
diagnosing and terminating PSVT and SVT associated with Wolf Parkinson White Syndrome
How fast acting is adenosine?
within 15 seconds
What drugs blunt the effect of Adenosine and how?
Theophylline and Caffeine
both are adenosine receptor antagonists
What AA has an adverse effect of chest pain and sense of impending doom, and bronchospasm?
Adenosine
What are the uses of Mg++? (2)
treats Torsades de Pointes and Digoxin toxicity