Cardiology Drugs Flashcards
Drug for narrow complex PSVT
Adenosine
drug for pulseless VT/VF or to stabilize VT or AF it is also proarrhythmic
Amiodarone
Beta blockers are used for:
SVT, MI
Calcium channel blockers help control
SVT
Use dobutamine, dopamine, epi and norepi for
bradycardia, hypotension and asystole
A proarrhythmic drug used for SVT
digoxin
proarrhythmic drug used for ventricular tachycard
lidocaine and procainamide (which can also be used for SVT
Emergency med for pulseless VT/VF
vasopressin
Drug to use with caution in wide complex PSVT
adenosine– do not use at all in poison or drug induced arrest
Procainamide +amiodarone can lead to
QT prolongation
Adenosine
for narrow complex PSVT, may cause ischemia, bronchoconstriction, increased ICP .
dont use in wide complex tachycardia or drug or poison induced arrest
Amiodarone
for pulseless VT/VF, stable VT of unknown origin AF rate control.
SE: AV block, hypotension, proarrhythmia
CI: QT prolongation
Atropine
Sinus brady, type IIa AVB, asystole
SE: tachycardia, ischemia
CI: hypothermic brady, type II (infranodal) AVB or new 3rd degree AVB with wide QRS
Beta blockers
use for MI, SVT
SE: bronchospasm, hypotension, bradycardia, worsening heart failure
CI: brady cardia or 2nd or 3rd degree AV block
Calcium Channel blocker
SVT
SE: AV block, hypotension, bradycardia, worsened CHF
CI: WPW, ventricular arrhythmia, also using beta blocker
catecholamines
use for bradycardia, hypotension, asystole
SE: Hypertension, tachycardia, ischemia, arrhythmia, hyptension
CI: evolving MI, use only after volume resussitation, SBP <100 and signs of shock dont use dobutamine
Digoxin
SVT SE: proarrhythmia CI: hypokalemia, hypercalemia or hypomagnesemia defibrillation WPW, AV block
Lidocaine
ventricular tachyarrhthmias
SE: proarrhythmia, seizure, heart failure
CI: prophylaxis after MI, liver dysfunction or CHF, evolving MI
Procainamide
Vent (but not Torsades) and SVT
SE: proarrhythmia (torsade), hypotension, worsening CHF
CI: low magnesium or potassium, MI, hypotension (infuse slowly) polymorphic VT
Vasopressin
pulseless VT/VF, vasodilitory shock
SE: bradycardia, ischemia
CI: CAD
Aldosterone antagonist side effects
hyperkalemia, esp if renally impaired, gynecomastia
ACE-I side effects
angioedema, renal failure, hypotension, hyperkalemia, hepatitis, neutropenia, cough, rash, taste disturbance
ARBs side effects
rare angioedema, hepatitis, headache, dizziness, fatigue
beta blocker side effects
bronchospasm, hypotension, bradycardia, CHF, CNS effects (lipophilic agents may lead to depression, psychosis, dizziness, weakness, fatigue, dreams, insomnia) GI effects, reduced PV perfusion, impotence, hypo or hyperglycemia
calcium channel antagonist side effects
hypotension, bradycardia, worsening hof CHF, dizziness, flushing, peripheral edema, constipation, postural hypotension, taste disturbance
centrally acting blood pressure lowering agent side effects
withdrawal hypertension, hypotension, hepatitis (methyldopa), bradycardia (clonidine), frequent CNS effects, gi effects, sexual dysfunction, xerostomia (clonidine)
clopidogrel side effects
idiopathic thrombocytopenic purpura, GI effects
digoxin
heart block, ectopic arrhythmia, ventricular extra beats, ventricular tachycardia, PSVT, GI” effects, CNS effects (drowsiness, confusion, dizziness, vision abnormalities)
Direct thrombin inhibitors names
lepirudin, argatroban, bivalirudin
Direct thrombin inhibitor side effects
bleeding without antidote, allergic reaction and antibody formation (lepirudin)
Fondaparinux side effects
bleeding risk, renal impairment
hydralazine side effects
hypotension, hepatitis, neuropathy, flushing, GI effects
LMWH side effects
bleeding, heparin induced thrombocytopenia
LMWH names
enoxaparin, dalteparin
loop diuretic side effects
dehydration, hypokalemia, hyponatremia, pancreatitis, jaundice, deafness, thrombocytopenia, serious skin disorders, dizziness, gout
Nesiritide (Natrecor) side effects
hypotension, headache, renal impairment, increased mortality
Nitrate side effects
syncope, TIA, headache flushing, palpitations, peripheral edema
Potassium Sparing Diuretics side effects
hyperkalemia, dehydration, GI effects, CNS effects, rashes, gynecomastia and breast tenderness
Ranolazine (Ranexa) side effects
Prolonged QT interval (low risk of Torsades de pointes
Thiazide diuretic side effects
dehydration, rare thrombocytopenia, cholestatic jaundice, pancreatitis, hepatic encephalopathy (if cirrhosis), dizziness, gout, hyperglycemia, orthostasis, hypokalemia, hypermagnesemia, hypercalcemia, GI effects
Warfarin side effects
Abnormal bleeding, rare necrosis or gangrene of skin, “purple toe syndrome” (cholesterol microembolizations) osteoporosis
Amiodarone drug interactions
typically INCREASES level of other drugs including cyclosporin, dignoxin,k dofetilide, phenytoin (but may also decrease!), procainamide, quinidine, simvastatin (not recommended to give more than 20mg with amiodarone due to risk of myopathy), warfarin
Digoxin drug interactions
several drugs increase serum digoxin levels: amiodarone, propafenone, quinidine, verapamil
Dolfetilide drug interactions
Risk of Torsades de pointes with amiodarone (no amiodarone for 3 months!) cimetidine, class 1&II antiarrythmic agents, hydrochlorothiazid, detoconazole, megestrol, prochlorperazine, trimethoprim, verapamile, ziprasidone
Proprafenone drug interactions
increases level or effect of: digoxin, metoprolol, warfarin
Ranolazine (Ranexa) drug interactions
CYP3A inhibitors (azole antifungals, clarithromycin, diltiazem, erythromycin, protease inhibitors, verapamil, grapefruit, QTc prolonging drugs (class I and II antiarrhythmics)
CYP3A inhibitors:
azole antifungals, clarithromycin, diltiazem, erythromycin, protease inhibitors, verapamil, grapefruit, QTc prolonging drugs (class I and II antiarrhythmics
Warfarin drug interactions
Increases effect or risk of bleeding: acetaminophen, amiodarone, azole antifungals, glycoprotein IIb/IIIa inhibitors (abciximab, eptifibatide, tirofiban (ReoPro, Integrilin, aggrastat)
metronidazole, propafenone, thrombolytics, trimethoprim/sulfmethoxazole
Decreases effect: Rifampin,cholestyramine (use colestipol)
What is Kussmaul Sign?
Increased JVP with inspiration –constrictive pericarditis
What is a loud first heart sound associated with?
(? opening) aortic valve; hyperdynamic left ventricular function OR snapping SHUT of the mitral valve with force
What is a soft first heart sound associated with?
aortic valve; left ventricular dysfunction and a long PR interval
What is Hypertrophic Cardiomyopathy characterized by?
dynamic outflow obstruction; worse with dehydration, exercise, position, or decreased venous return. (therefore murmur is loudest with valsalva, softer with squat or handgrip)
Which maneuvers decrease venous return?
hand grip and squat
which maneuvers increase venous return?
Valsalva
Which murmurs get softer with the Valsalva?
aortic valve stenosis, pulmonary valve stenosis and mitral valve regurgitaion.
A distinguishing sound of mitral valve prolapse.
systolic click
A distinguishing sound of pulmonary valve stenosis
opening click that gets softer on inspiration. It is the only right sided sound that gets softer with inspiration. (this is caused by the premature opening of the pulmonary valve with inspiratory increase in flow to the right ventricle)
Description of the murmur of Aortic Stenosis
sustained apical impulse, vibration over the right upper sternal border, grade 4/6 murmur that is late peaking and a single second heart sound.
Description of the cardiac findings of Hypertrophic Cardiomyopathye with outflow obstruction
sustained apical pulse, brisk carotid pulsations, Normal JVP. grade 3/6 systolic murmur best herd in the 2nd interspace, RSB and radiating to the neck, there is a fourth heart sound. Valsalva is LOUDER.
Which heart sound is pathological in the ill, but not in the healthy?
3rd heart sound. May represent heart failure or early rapid filling of the left ventricle
What causes a 3rd heart sound?
early rapid filling of the lateral ventricle (in healthy young and/or pregnant patients) or high filling pressure associated with heart failure in most adults
What causes a 4th heart sound?
stiff left ventricle from HTN or other causes
When do we operate in mitral regurg?
Asymptomatic or Symptomatic, EF<60% has worse prognosis, Left ventricular end-diastolic dimension is more than 45mm
Cardiac exam of mitral stenosis (severe)
first heart sound is loud (or soft), second heart sound is physiologically split with a loud pulmonary component. The apical impulse is tapping, nondisplaced and discrete. There is a high-pitched, early diastolic snapping sound heard at the apex and a long, low-pitched diastolic rumbling murmur heard best with a beel in the LLD. There is sternal lift and JVP is 10cm.
Signs of Left atrial fluid overload (mitral stenosis or others)
increased JVP, sternal lift and increased pulmonary component of the 2nd heart sound. (usually you will also find pulmonary HTN)
What does a short interval from second heart sound to opening snap mean?
aortic valve opening to the opening snap of the mitral valve is shortened in mitral stenosis due to the increased pressure in the atrium.
In less severe mitral stenosis, what does the regurgitant murmur sound like?
holosystolic beginning withthe first heart sound. As the mitral stenosis worsens the pressure in the left atrium increases and the regurg murmur is shorter.
Which murmurs are suggestive of aortic valve disease?
blowing diastolic murmur and systolic ejection murmur.
What EKG findings might you get with Mitral Stenosis
Left Atrial enlargement (usually), Right ventricle and atrial enlargement if pulmonary hypertension.
Common cause of rupture of the papillary muscle
MI
Common cause of rupture of the mitral chordae
a complication of long-standing mitral valve prolapse due to myxomatous degneration
Rheumatic fever causes which valular problem?
Mitral stenosis, typically appears in the 30s with mild symptoms, then inthe 40s with A fib.
