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Cardiology_3 Flashcards

1
Q

Truncus arteriosus gives rise to what?

A

ascending aorta and pulmonary trunk

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2
Q

what are the major types of side effects seen in digoxin toxicity?

A

cholinergic • ECG • hyperkalemia- poor prognostic indicator

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3
Q

what are the cholinergic side effects associated with digoxin toxicity?

A

nausea • vomiting • diarrhea • blurry yellow vision (VanGogh)

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4
Q

ECG side effects seen in digoxin toxicity?

A

↑ PR • ↓QT • ST scooping • T wave inversion • arrhythmia • AV block

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5
Q

factors predisposing to digoxin toxicity?

A

renal failure • hypokalemia • quinidine

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6
Q

how does renal failure predispose digoxin toxicity?

A

↓excretion

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7
Q

how does hypokalemia predispose digoxin toxicity?

A

permissive for digoxin binding at K+ binding site on Na/K ATPase

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8
Q

how does quinidine predispose digoxin toxicity?

A

↓ digoxin clearance; displaces digoxin from tissue binding sites

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9
Q

what is the antidote for digoxin toxicity?

A

slowly normalize K+ • lidocaine • cardiac pacer • anti-digoxin Fab fragments • Mg++

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10
Q

what type of drug are all the type I Na channel blocker antiarrhythmics?

A

local anesthetics

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11
Q

MOA of class I antiarrhythmics?

A

↓ conduction (especially in depolarized cells) • ↓ slope of phase 0 depolarization and ↑ threshold for firing in abnormal pacemaker cells

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12
Q

what does it mean that class I antiarrhythmics are state dependent?

A

selectively depress tissue that is frequently depolarized (tachycardia)

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13
Q

what causes ↑ toxicity for all class I antiarrhythmic drugs?

A

hyperkalemia

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14
Q

which drugs are the Class IA antiarrhythmics?

A

Quinidine • Procainamide • Disopyramide • The Queen Proclaims Diso’s Pyramid

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15
Q

MOA of Class IA antiarrhythmics?

A

↑ AP duration • ↑ ERP • ↑ QT interval

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16
Q

Class IA antiarrhythmias affect what kind of arrhythmias?

A

atrial and ventricular arrhythmias, especially reentrant and ectopic supraventricular and ventricular tachycardia

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17
Q

quinidine toxicity?

A

cinchonism- headache, tinnitus

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18
Q

procainamide toxicity?

A

reversible SLE-like syndrome

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19
Q

disopyramide toxicity?

A

heart failure

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20
Q

toxicities common to all Class IA antiarrhythmics?

A

thrombocytopenia, • torsades de pointes due to ↑ QT interval

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21
Q

which drugs are the class IB antiarrhythmics?

A

Lidocaine • Mexilitine • Tocainide • I’d Buy Lidy’s Mexican Tacos • (phenytoin)

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22
Q

which type of antiarrhythmic is best post MI?

A

IB

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23
Q

MOA of class IB antiarrhythmics?

A

↓AP duration • Preferentially affect ischemic or depolarized Purkinje and ventricular tissue

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24
Q

Class IB antiarrhythmics are useful in what?

A

acute ventricular arrhythmias (especially post MI) and in digitalis induced arrhythmias

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25
Q

toxicity of Class IB antiarrhythmics?

A

local anesthetic • CNS stimulation/depression • cardiovascular depression

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26
Q

which drugs are class IC antiarrhythmics?

A

flecainide • propafenone

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27
Q

mnemonic for IC antiarrhythmics?

A

IC is CI in structural heart disease and post MI

28
Q

MOA of class IC antiarrhythmics?

A

no effect on AP duration

29
Q

clinical use of class IC antiarrhytmics?

A

useful in ventricular tachycardias that progress to VF and in intractable SVT • usually used only as last resort in refractory tachyarrhythmias • for patients without structural abnormalities

30
Q

toxicity of class IC antiarrhythmics?

A

proarrhythmic, especially post MI • significantly prolongs refractory period in AV node

31
Q

effects of class I antiarrhythmics on ventricular AP graph?

A

all class I- clockwise decrease in slope of phase 0 • IA- prolong AP- rightward stretch of phase 3 • IB- shorten AP- leftward shrink of phase 3 • IC- no effect- barely to the left of normal AP

32
Q

the class II antiarrhythmics are what type of drugs?

A

β blockers

33
Q

which drugs are used as class II antiarrhythmics?

A

metoprolol • propanolol • esmolol • atenolol • timolol

34
Q

MOA of class II antiarrhythmics drugs?

A

↓ SA and AV nodal activity by ↓ cAMP, ↓ Ca++ currents • suppress abnormal pacemakers by ↓ slope of phase 4

35
Q

which class II antiarrhythmic is very short acting?

36
Q

what part of the heart is particularly sensitive to class II antiarrhythmics?

37
Q

ECG changes seen with class II antiarrhythmics?

A

↑ PR interval

38
Q

clinical use of class II antiarrhythmics?

A

ventricular tachycardia, SVT, slowing ventricular rate during atrial fibrillation and atrial flutter

39
Q

toxicity of class II antiarrhythmics?

A

impotence • exacerbation of asthma • CV effects • CNS effects • may mask the signs of hypoglycemia

40
Q

CV AE of class II antiarrhythmics?

A

bradycardia • AV block • CHF

41
Q

CNS effects of class II antiarrhythmics?

A

sedation • sleep alterations

42
Q

AE specific to metoprolol?

A

dyslipidemia

43
Q

treat overdose of metoprolol with what?

44
Q

cardiac AE specific to propanolol?

A

can exacerbate vasospasm in Prinzmental’s angina

45
Q

which are the class III antiarrhythmics?

A

Amiodarone • Ibutilide • Dofetilide • Sotalol • AIDS

46
Q

all class III antiarrhythmics are what type of drug?

A

K+ channel blockers

47
Q

MOA of class III antiarrhythmics?

A

↑AP duration, ↑ ERP

48
Q

when are class III antiarrhythmics used?

A

when others fail

49
Q

ECG changes caused by class III antiarrhythmics?

A

↑QT interval

50
Q

AE of sotalol?

A

torsades de pointes • excessive β block

51
Q

AE of ibutilide?

A

torsades de pointes

52
Q

AE of amiodarone?

A

pulmonary fibrosis • hepatotoxicity • thyroid dysfunction (40% I by weight) • corneal deposits • skin deposits (blue/grey) resulting in photodermatitis • neurologic effects • constipation • CV effects (bradycardia, heart block, CHF)

53
Q

what are the antiarrhythmic effects of amiodarone?

A

has class I , II, III, and IV effects because it alters the lipid membrane

54
Q

what do you need to check when using amiodarone?

A

PFTs • LFTs • TFTs

55
Q

effect of all class III antiarrhythmics on ventricular AP curve?

A

wide rightward stretch in phase 3 prolongs AP and ERP

56
Q

which drugs are class IV antiarrhythmics?

A

verapamil • diltiazem

57
Q

all class IV antiarrhythmics are what type of drug?

A

Ca channel blockers

58
Q

MOA of class IV antiarrhythmics?

A

↓ conduction velocity, ↑ ERP, ↑ PR interval

59
Q

clinical use of class IV antiarrhythmics?

A

prevention of nodal arrhythmias (SVT)

60
Q

toxicity of class IV antiarrhythmics?

A

constipation • flushing • edema • CV effects (CHF, heart block, sinus node depression)

61
Q

MOA of adenosine as antiarrhythmic?

A

↑ K+ out of cells →hyperpolarizing the cell + ↓Ica

62
Q

adenosine is the drug of choice for what?

A

diagnosing/abolishing supraventricular tachycardia

63
Q

duration of action of adenosine?

64
Q

toxicity of adenosine?

A

flushing • hypotension • chest pain

65
Q

effects of adenosine blocked by what?

A

theophylline and caffeine

66
Q

clinical use of Mg++ as antiarrhythmic?

A

effective in torsades de pointes and digoxin toxicity

► Med Notes (62 decks)

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