Cardiovascular and Renal Drugs Flashcards
digoxin MOA
-inhibits Na+/K+ ATPase -
( “knocked over banana vending machine”)
-leads to increased intracellular Na+
(“offwhite man holding salty peanuts, salty peanuts in floor”)
-increase intracellular Na+ promotes Calcium inlfux through the Na+/Ca+2 exchanger
(“salty peanuts guy opens the door for the Calci-YUM guy”)
-results in increased contractillity
(“blue shirt guy flexes his arm “)
what is Digoxin used for ?
- Anti-arrhythmic effect (“turntable”)
- symptomatic treatment of chronic systolic HF (“deflated balloon”)
-direct stimulation of the Vagal nerve can treat Atrial arrhythmias
(“las VAGas”)
side effects of Digoxin
-hyperkalemia as a result of acute toxicity
(“pile of bananas”)
-induce various Arrhythmias
(“various dancers on heart shaped dancing floor”)
-chronic use of Digoxin may cause scooped concave ST segment on ECG
(scooped ice cream can says :”taSTy”)
-Bradycardia due to parasympathetic activation of SA node
(“Dangling heart watch” , “SA music note”)
- Heart block in case of toxicity (“AV music note”)
- GI symptoms (“nauseated dancer”)
- Xanthopia (“yellow spotlight”)
Digoxin is contraindicated in …
-SA node heart block
(**use with caution in beta blockers**)
what may exacerbate digoxin toxicity ?
Hypokalemia
- loop diuretics may cause hypokalemia , diarrhea , vomiting
Renal insufficiency
can make digoxin toxicity worse and will precipitate digoxin rise, the long flag indicates the long 1⁄2 life of digoxin, and increasing susceptibility to toxicity
- many arrhythmics inhibit renal clearance of digoxin, increasing susceptibility to toxicity
what can reverse digoxin Toxicity ?
immune fab (“FAB uolous las vegas” sign)
which drugs can treat Acute heart failure ?
Milirinone
(donkey sign says “hes One in a million”)
Nesiritide
(elephant sign says “necessary to turn the tide”)
Milirinone MOA
-inhibits phosphodiesterase
(“don’t phoster disinterest”)
-decreases CAMP breakdown
(sign says “join the CAMPaign”)
-increases cardiac contractility
(“red donkey flexing arms”)
-causes arteriolar dilation in HF, but watch for hypotension
(“dilated red donkey ears”)
Nesiritide MOA
-BNP analog that increases cGMP
-Nesiritide causes arteriolar AND venous dilation, reducing afterload and preload→natiuresis
(“elephant has dilated red ears and blue legs”)
(“BuMP the GruMP”)
Name the ACE inhibitors
- *-PRIL**
- *CAPTO/**pril
- *ENALA/**pril
- *RAMI/**pril
- *LISINO/**pril
ACE inhibitors MOA
inhibit ACE ⇒ATI is not converted to ATII
→ counteracts ATII effects
- dilate efferent arteriole → decrease GFR
- decrease Aldosterone Release →decrease Na+ reabsorption (natiuresis)
- decrease pressor effects of ATII
(“floppy red suspenders”)
ACE inhibitors are used to treat …
-1st line treatment for CHF
(“failing heart balloon”)
-used in myocardial infarction
(“mandolina player playin dem Broken heart strings”)
-1st line agents used for HTN
(“High pressure candy pipes”)
-slow the progression of diabetic nephropathy
(“Diasweeties Candy shop”)
- ACEi reduce Mortality
(“Angel above le cross”)
which patients should be started on ACEi therapy ?
-patients with albuminuria and BP > 130/80
(“albums in diasweeties candy shop”)
what side effects might ACEi cause ?
-can cause significant hypotension and syncope in patients with high renin levels (in heart failure)
(“fainting poker player with floppy red suspenders”)
-can cause hyperkalemia due to decreased aldosterone levels
(“raised banana daquiri”)
-dry cough due to an increase of bradykinin
(“coughing dealer”)
-ACE increases the risk of fetal hypotension
(“Tarantula on mama’s back”)
when are ACEi contraindicated and why ?
- ACE inhibitors are contraindicated inhereditary angioedema ( to C1 esterase deficiency) due to increased Bradykynin activity .
- ACE inhibitors are contraindicated in bilateral renal artery stenosis due to further decrease in GFR
- use of ACEi can precipitate acute renal failure charachterized by persistent increase in creatinine levels-azotemia
which drugs should be avoided during ACEi therapy ?
NSAIDs should be avoided since they inhibit the actions of prostaglandins and bradykynin , causing vasoconstriction of afferent arteriole→GFR decrease
- can precipitate acute kidney injury
Possible side effects of ARBs
- Hyperkalemia (“banana daquiri on taken chair”)
Name a drug which can directly inhibit renin
Aliskiren
(“high limit-high risk slots”)
name a possible side effect of Aliskiren ?
Hyperkalemia
(“slot machine showing 3 bananas”)
in case of Hereditary angioedema , which drugs can replace ACEi therapy ? why ?
ARBs can be used as a replacement therapy since they don’t affect bradykynin serum levels
Name the ARBs
-SARTAN (chair says “SoRry TAkeN”)
LO/ sartan
CANDE/ sartan
VAL/ sartan
MOA OF ARBs
Angiotensin II receptor blockers
which drugs act on the Proximal Convoluted Tubule ?
**Acetazolamide
Mannitol**
Acetazolamide MOA
Inhibits Carbonic Anhydrase enzyme
- less H+ into the interstitium
- Na+/H+ exchanger inhibited
-cause bicarbonate (HCO3-) to stay in the tubular lumen leading to urine alkalization
(“Spilled alkaline substance on inside track”)
-prevent sodium reabsorption leading to natiuresis
(“Dropping salty peanuts on the inside of track”)
(“Acid from battery breaks car battery”)
Acetazolamide can be used to treat …
-managment of **glaucoma
-**
managment of idiopathic intracranial hypertension
-treats **mountain sickness
-**
prevents formation of uric acid kidney stones due to increase in pH
Acetazolamide side effects
- normal anion gap **metabolic acidosis-type II RTA
- hypokalemia
-**
promote formation of **calcium phosphate stones
-**
Sulfa drug
Mannitol is used to treat …
-increased intracranial pressure
(“High pressure head balloon”)
-increased intraocular pressure
(“Spilled eyeball cups”)
Mannitol Side Effects
- can cause pulmonary edema
- exacerbate heart failure
- hypo/hyper natremia
Mannitol Moa
Osmotic Diuretic
Name the Loop Diuretics
THE MOST EFFICIENT DIURETICS EVA !
Furosemide (SULFA)
Ethacrynic acid (NON-SULFA)
Loop Diuretics MOA
Site of action : TAL
- impermeable to water -diluting segment
(“secured water in car”) - Blocks NKCC transporter and cancels positive luminal charge
- K+ no longer effluxes from cells thus promote excretion of Mg+2 and Ca+2
- induce expression of COX-2 which synthesizes prostaglandins
- prostaglandins dilate afferent arteriole, increase RBF and enhance diuretic action
Loops diuretics are used for …
- 1st line for the symptomatic treatment of acute decompensated heart failure
- 1st line treat symptoms of pulmonary edema in an acute heart failure exacerbation
- loop diuretics treat ascites in liver failure
- can be useful in the treatment of HTN
which group of drugs may interfere with the actions of Loop Diuretics and why ?
NSAIDs - decrease prostaglandins synthesis ,thus interfere with the actions of loop diuretics
Side Effects of Loop Diuretics
- loop diuretics may cause hypokalemia
- prolonged use of loop diuretics can cause hypomagenesmia
- Loop diuretics can cause hypocalcemia (rare)
- can cause dose related hearing loss
- Interstitial nephritis can be caused by loop diuretics
- loop diuretics can cause hyperuricemia, may lead to gouty arthritis
- can cause contraction alkalosis
which group of drugs may interfere with the actions of Loop Diuretics and why ?
NSAIDs - decrease prostaglandins synthesis ,thus interfere with the actions of loop diuretics
Loop Diuretics MOA
Site of action : TAL
- impermeable to water -diluting segment
(“secured water in car”) - Blocks NKCC transporter and cancels positive luminal charge
- K+ no longer effluxes from cells thus promote excretion of Mg+2 and Ca+2
- induce expression of COX-2 which synthesizes prostaglandins
- prostaglandins dilate afferent arteriole, increase RBF and enhance diuretic action
Name the Loop Diuretics
THE MOST EFFICIENT DIURETICS EVA !
Furosemide (SULFA)
Ethacrynic acid (NON-SULFA)
can loop diuretics prolong the the life of the heart ?
No.
Names of the Thiazide Diuretics
-Hydrochloroathiazide (“Chloro-thighs” )
-Chlorothalidone (“thiodore roosevelt”)
Thiazides MOA
-block NaCl Transporter
- intracellular levels of Na+ drops → Ca+2/Na+ exchanger on basolateral membrane is enhanced
- more Ca+2 is reabsorbed
Thiazides are used to treat …
-one of the 1st line treatments for mild-moderate hypertension
(“high pressure pipes”)
-useful in treatment of symptomatic heart failure
(“balloon guy holding lithium and floppy heart balloon”)
- ***Loop Diuretics are 1st Line***
-thiazides may treat nephrogenic diabetes insipidus
and reduce polyuria and polydypsia
-thiazides can prevent Calcium stones
(“worker removing stones from tube slide”)
-patients with osteoporosis may benefit from thiazide treatment
(“life guard holding new calcium chalk”)
what are the side effects seen with Thiazide diuretics treatment ?
HYPER
Glycemia (“elevated candy jar”)
Lipidemia (“elevated butter stick”)
Calcemia (“elevated Calci-YUM ice cream”)
Uricemia - may precipitate gout (“yellow knitting needles”)
HYPO
Kalemia (“Banana peel on floor”)
Natremia (“salty peanuts on floor”)
——————————————————————————–
-can cause contraction/metabolic alkalosis
- may decrease the amount of Lithium cleared from the kidney , thus increase serum Lithium
- Sulfa drugs
Site of Action of Thiazide Diuretics
Distal Convoluted Tubules
what is the difference between Ca+2 Reabsoprtion in PCT and DCT ?
PCT- passive , paracellular
DCT- active , controlled by PTH
what is the site of action of K+ sparing Diuretics ?
Collecting Duct
what are the two types of cells found in the collecting ducts ?
Principal cells
the main Na+ reabsorbing cells and the site of action of aldosterone, K+-sparing diuretics, and spironolactone.
they secrete K+ through an apical membrane potasium channel.
α-intercalated cells
cells which contain apical H+ ATPase, explaining its ability to secrete protons.
Name the K+ sparing Diuretics
Amiloride
(“Almonds”)
Triamterene
(“Tangerines”)
Eplerenone
(“apple with the teacher”)
Spironolactone
(“inspector with spiral bound notebook”)
Aldosterone MOA
- upregulates ENaCs on the apical membrane
- upregulates Na+/K+ ATPse on the basolateral membrane
- upregulates K+ channels on the apical membrane
- upregulates H+ ATPase apical membrane
K+ sparing Diuretics MOA
Amiloride , Triamterene
ENaC inhibition
Spironolactone , Eplerenone
Aldosterone receptor antagonists
what are Amiloride and Triamterene used for ?
-useful in treatment of Li+ induced nephrogenic Diabetes insipidus
(“inspidus fountain in the background”)
-Amiloride and Triamterene are useful in the treatment of Liddles syndrome (overactive ENaCs)
(“Little midget blocked by tangerines and almonds carts”)
at higher doses Spironolactone can ..
-is a synthetic steroid inhibit Androgen receptors , more specifically 17-alpha Hydroxylase enzyme thus lowers testosterone levels in the body
(“17 alpha-fry-droxylase” “fried male symbol)
- may treat symptoms of androgen excess in PCOS such as Hirsutism (“bubbling ovary fryers”)
what are the side effects seen with K+ sparing diuretics therapy ?
-can cause mild or even dangerous hyperkalemia
(“Elevated banana’s in stand”)
-may cause a normal anion gap metabolic acidosis
(by decreasing the function of the H+ATPase)
- K+ sparing diuretics inhibit the effects of aldosterone in the collecting duct causing a **type 4 renal tubular acidosis → **only one associated with hyperkalemia**.
- **
What are two classes of diuretics which prevent cardiac remodeling and improve outcomes in heart failure?
(1) Aldosterone receptor antagonists
- Spironolactone
- Eplerenone
(2) ACE Inhibitors
- Capto , Lisino, Rami , Enala - PRIL
possible side effects of Spironolactone
- inhibits androgen receptors and 17-alpha hydroxylase enzyme
- Gynecomastia (“hairy dudismo with lids on chest”)
- impotence and decreased libido (“Droopy churro”)
what is the site of action of K+ sparing Diuretics ?
Collecting Duct
Calcium Channel Blockers MOA
Block L-type voltage gated calcium channels
(“L-Shaped handle”)
what are the 2 main groups of CCBs? what is the main difference between the two ?
1) Dihydropiridines
Blocks calcium channels in **Smooth Muscle
2)Non-Dihydropiridines**
Blocks calcium channels in Cardiac Muscle
Name the Non-Dihydropiridines
Verapamil
(“very vannilla” flavor)
Diltiazem
(“Delicious dark choclate” flavor)
Non-Dihydropiridines MOA
(“Non-Dairy” section”)
-Block L-type voltage gated calcium channels in Cardiac muscle
- decrease cardiac contractility
(“weak kid trying to squeeze out some ice cream from the nozzle”) - decrease activity of SA and AV nodes
(“Music notes on non-dairy sign”)
⇒ may cause bradycardia
(“Low dangling heart pocket watch”)
- act as a negative ionotrope and chronotrope thus decrease myocardial oxygen demand
(“discarded oxygen line”) - Verapamil → very minimal dilatory activity
(“Small sized ice-cream nozzle”)
Diltiazem → has some vasodilatory activity
(“Medium sized ice-cream nozzle”)
Dihydropiridines MOA
Block L-type Calcium Channels found in cardiac muscle
- vasodilate coronary arteries. (“dilatd coronary crown”)
- Reduce coronary resistance, increase coronary blood flow and may enhance development of collaterals
-increased peripheral vasodilation
- lower systemic blood pressure
- decrease myocardial oxygen demand
(“discarded oxygen line”) - reduce afterload
(“reducued navil load because no ice-cream inside”)
Calcium Channel Blockers Can Treat …
-CCB’s treat hypertension
(“High pressure pipes”)
-CCB’s treat stable angina
(“angina anvil”)
-CCB’s treat prinzmetal angina
(“Anvil medal on red crown lady”)
what can Non-Dihydropiridines be used for?
-Verapamil can be used for Migraine Prophylaxis
(“pounding headbell”)
-they have antiarrhythmic properties, this will help with A .Fib and A .Flutter
(“Jukebox with records”)
what can Dihydropiridines be used for ?
-IV dihydropyridines such as Clevidipine and Nicardipine can treat hypertensive emergency
(“Emergency shut off switch”)
-Nifedipine is used to treat hypertension in pregnancy or post-partum
(“Pregnant knife lady”)
-Nifedipine and Amlodipine can treat raynaud’s syndrome-an exaggerated response to cold temperature or stress
(“guy in toppings stand has blue fingertips”)
-can be used to treat subarachnoid hemorrhages commonly associated with berry aneurysms
(“brain shaped ice-cream with berries”)
- Nimodipine prevents vasospasms after a subarachnoid hemorrhage, vasodilates cerebral vessels (berry brain ice-cream “need Mo’dippin”)
Dihydropiridines Side Effects
- CCB’sc an worsen heart failure due to hypotension, and can increase sympathetic activity
- Short acting Nifedipine has a high chance of side effects because of how active it is.
- Nifedipine can exacerbate myocardial ischemia due to reflex tachycardia – avoid in patients with unstable angina or MI
(“Knife cutting heart shaped apple”) - Dihydropiridines can cause reflex tachycardia, especially with Nifedipine
(female doctor holding “Heart reflex hammer”)
-can cause lightheadedness, Headache, flushing,
(“lightheaded monkey customer”)
-Peripheral edema due to preferential dilation from precapillary vessels from the arterioles increased capillary hydrostatic pressure
(“ monkey customer wearing Baggy pants”)
(“failing heart balloon”)
Non-Dihydropiridines Side effects
-verapamil can cause constipation
(“Clogged toilet)
-verapamil can cause gingival hypertrophy
(“toilet plummer has expanding gum in his mouth”)
-verapamil and diltiazem care relatively contraindicated in patients with heart block
(“remain unblocked” sign next to door)
-Verapamil or diltiazem combined with a beta blockers may produce excessive AV block
(“remain unBlocked” sign next to door)
a Diuretic used as a first line agent for treating primary hypertension
Hydrochlorothiazide
(may be less effective than chlorthalidone )
What four drug classes are used in the treatment of primary hypertension?
- Thiazide diuretics
- ACE inhibitors
- Angiotensin II receptor blockers (ARBs)
- Dihydropyridine Ca2+ channel blockers
Black and elderly patients respond well to which drugs for treatment of primary hypertension ?
1) hydrochlorothiazide
2) long-acting dihydropyridine Ca2+ channel blockers
first line treatment for hypertension in patients with heart failure, MI, and/or diabetes
-ACEi
(“ACE casino tables”)
-angiotensin II receptor blockers
Hypertensive emergency occurs when …
systolic BP >180 or diastolic BP >120 with end-organ damage
an α- and β-antagonist, can be used for hypertensive emergency
Labetalol
(“Alpha and beta organ stops”)
Many agents used in hypertensive emergencies are potent…
Potent Vasodilators
(“Dilated red smoke stack”)
Potent vasodilation (e.g. following hypertensive therapy) may cause …
hypotension followed by reflex tachycardia and increased renin levels
Vasodilation (e.g. following hypertensive therapy) reduces…
Afterload
(sailor unloads scale)
IV Ca2+ channel blockers that may be used in hypertensive emergency
Clevidipine
(“clover on nice card”)
Nicardipine
(“nice card”)
Hydralazine can ..
dilate arterioles, and decreased after-load via increasing cGMP
- **has little effect on venous circulation**
cause hypotension, which may induce a reflex tachycardia that can worsen angina
Hydralazine is often co-administered with a …
β-blocker to minimize the reflexive sympathetic activation and tachycardia
Hydralazine can rarely cause…
drug-induced lupus, which may manifest as myalgias, arthralgias, and joint swelling
what can be combined with Hydralazine in order to treat LV systolic dysfunction?
organic nitrate (e.g. nitroglycerin)
- provides a mortality benefit for some patients with heart failure
- hydralazine is a vasodilator (decrease afterload), nitrates are venodilators (decrease preload)
Nitroprusside can ..
(“Nitro-pressure speedboat”)
-cause vasodilation via nitric oxide
(“nitrous oxide exahust”)→increasing cGMP (“grumpy old fart in the water”), which is useful during the treatment of hypertensive emergency
- causes arteriolar AND venous dilation
(“both shirt sleeves and pants are dilated “)
Nitroprusside side effect
cyanide poisoning especially with prolonged use or renal impairment
(“cyanide exhaust pipe gas”)
D1 receptor agonist that may be used to treat hypertensive emergency…
Fenoldopam
(“Old lady Pam)
Fenoldopam is a …
D1 receptor agonist that may be used to treat hypertensive emergency by increasing levels of cAMP, causing vasodilation in most arterial beds
- especially in renal arteries ,coronary, peripheral, and splanchnic vessels
- causes increased excretion of Na+ and water→natriuresis
Esmolol And Metoprolol are …
Beta-1 antagonists used for hypertensive emergencies.
- IV beta blockers administration treats hypertensive emergency
(“Muted beta bugle players surrounded by posion ivy”)
what are the subdivisions of Class I Antiarrhythmics?
IA
IB
IC
Name the Class I Antiarrhythmics and mention under which subdivision they fall
Class IA
Quinidine (“Dining prom queen”)
Procainamide (“Prom King”)
Dysopyramide (“Disapears!”)
Class IB
Lidocaine (“you lied ,your’e DEAD to me”)
Mexilitine (Mexican flag)
Phenytoin (“Friendly towing employee”)
Class IC
Flecainide (“blondy on 3rd floor eating cornFLAKES”)
Propafenone (“purple phone”)
Class I Antiarrhythmics MOA
-block open or inactivated Na+ channels
(“soloist holding open peanut butter jar with inactivating spoon in it “)
-affect the Na+ dependent cardiac action potential
(“Illuminated atria, ventricles, and His-perkinje system”)
**-“use dependence”** – class I antiarrhythmics have a **greater** effect on **rapidly depolarizing** tissues
("Heart tipping mic stand")
-decrease the slope of phase 0 upstroke (slows conduction of the cardiac AP) AP will almost look tipped over with a decreased slope
(“Soloist tipping mic stand”)
-widen the QRS complex on the ECG
(decreased AP conduction velocity)
(“Wide QRS shaped crack”)
**no action at the SA and AV nodes**
Class IA properties
-have an intermediate binding affinity to the Na+ channel
(“Prom queen lightly holding peanut butter jar”)
-block K+ channels prolonging phase 2 and 3 of the cardiac action potential prolonged refractory period
-
increased AP duration
(“prom queen pushing away the banana curtain”)
Class IA Antiarrhythmics can treat
-Supraventricular and Ventricular Arrhythmias
(“Illuminated top and bottom of IA heart:”)
-WPW syndrome
(“wpw highschool sign with 3 wolfs”)
Class IA Antiarrhythmics Side Effects
-quinidine toxicity can cause cinchonism
(syndrome of tinnitus, headache, dizziness)
(“tin cans around prom queen”)
-quinidine can cause thrombocytopenia
(“Broken plates around prom queen”)
-procainamide can cause a lupus–like syndrome raising an ANA titer
(“Prom king’s lupus wolf”)
-dysopyramide can exacerbate heart failure
(negative ionotrophy)
(“Darts in failing heart balloon”)
-can cause QT interval prolongation
(Precipitates torsades)
(“Twisted torsades streamer”)
Class IB properties
-have a low binding affinity for the Na+ channel
-
Decreased AP duration
(“Pulling the curtain”)
-shorten phase 2 and 3 of the cardiac action potential shortened refractory period so no chance for torsades de pointes
(“Pulling the curtain”)
-has a greater tendency to work with ischemic heart
(“Broken illuminated IB heart”)
[because of the reduced resting membrane potential delays sodium channel transition from inactive back into resting state resulting in increased drug binding]
(“Dropped peanut butter jar”)
Class IB Antiarrhythmics can treat…
-treat ventricular arrhythmias-especially in ischemic tissues
(“Illuminated and cracked bottom of heart”)
-treat ischemia induced ventricular arrhythmias one of the most common causes of death in the acute period following an MI
(sign says “you lied your’e “DEAD” to me”)
Class IB Antiarrhythmics Side Effects
-cause neurological problems-parasthesias, tremor, convulsions.
(“friendly towing trucker has brain hat”)
Class IC Antiarrhythmics Properties
-strong binding affinity for the Na+ channel
(“blonde dude in bed tightly holding peanut butter jar”)
(strong use dependence, drastic slowing of the phase 0 upstroke)
- dramatic effect on QRS duration, , no change in AP Duration
(prolongs ERP in AV node)
(“3rd floor has untouched potassium curtain”)
-do not affect the cardiac action potential duration
(“3rd floor has untouched potassium curtain”)
Class IC Antiarrhythmics treat …
-treat supraventricular (A.Fib) and ventricular arrhythmias
(“Illuminated top and bottom of heart”)
-treat atrial fibrillation (and flutter)
(“Irregularly Irregular signal”)
-can restore and maintain normal sinus rhythm in A. Fib and Flutter
(“blonde dude uses remote controller to convert the signal”)
Class IC Antiarrhythmics are contraindicated when …
-contraindicated in patients with history of structural or ischemic heart disease
(proarrhythmic effects)
(“box next to cornflakes box says “Healthy Hearts Only”!”)
Class II Antiarrhythmics are …
Beta Blockers
(“muted Beta Bugle”)
Non Selective
- *Proprano**lol
- *Sota**lol
- *Timo**lol
- *Nado**lol
Selective
“A-BEAM”
- *Acebuto**lol
- *Bisopro**lol
- *Esmo**lol
- *Ateno**lol
- *Metopro**lol
Beta Blockers MOA
(“muted Beta Bugle”)
-blocking sympathetic input to SA and AV nodes
(“SA , AV Notes”)
-decrease cAMP , leads to closure of membrane calcium channels, preventing the upstroke of AV nodal action potential
(“Torn Band Camp poster”)
(“Crushed calci-yum ice cream cartons on the floor”)
-prolong phase 4 of the nodal action potential decreased pacemaker activity, prolonged conduction time and refractory period
(“Ella Fitzgerald sliding up the piano keys”)
-decrease atrioventricular conduction
(“disconnected bottom of heart shaped lamp”)
Class II Antiarrhythmics can be used to treat …
-supraventricular arrhythmias (Afib and RVR)
(“upper part of heart shaped lamp is lit”)
-useful in atrial fibrillation (and flutter)
(“Irregularly irregular static signal”)
-prevent rapid ventricular response in atrial fibrillation and flutter-“rate control”
[does not fix the atrial fibrillation]
(“heart shaped metronome”)
Acute supraventricular arrhythmias can be treated with …
IV Beta blokcer e.g. - Esmolol
(“poison ivy”)
Class II Antiarrhythmics Side effects
-Beta blockers can cause heart block
- heart block manifests as a prolonged PR interval on EKG
(“suited reporter interviewed by Public relations”)
(“louie’s hat shielding heart”)
Names of Class III Antiarrhytmics
-Amiodarone
(“tres AMIGOs”)
-Tilide suffix (blue chica holding “till i die” sign )
- DOFE tilide
- IBU tilide
-Sotalol (“Soda on table”)
Class III Antiarrhytmics MOA
-block K+ channels prolonging phase 2 and 3 of the cardiac action potential→prolonged refractory period
(“Singer pushing away the Banana curtain”)
-*_Amiodarone_* shares properties of **class I, II, III,** and **IV** antiarrhythmics. (grafiiti on wall says "uno, dos, tres, quattro”)
-Sotalol is also a beta blocker
(“Muted beta bugle and soda bottles”)
Class III Antiarrhytmics can be used to treat …
-treat both supraventricular arrhythmias and also ventricular arrhythmias
(“Heart candles illuminated on top and bottom”)
-treat atrial fibrillation and flutter
(“Irregularly irregular signal on TV”)
-can restore and maintain normal sinus rhythm in atrial fibrillation and flutter
(“green shirt old fart converting the signal using remote control “)
Amiodarone Side Effects
-many neurologic side effects -tremor, ataxia, peripheral neuropathy, sleep disturbances
(“sombrero with Skulls”)
-can cause grey corneal deposits
(“singer with Gray sunglasses”)
-can cause hyper or hypo-thyroidism
(“band members wear Big and small bowties
-can cause pulmonary fibrosis
(“Fibrotic lung embroidery on singer’s blazer “)
-lung fibrosis causes restrictive lung diseases
(“singer has tight button in his blazer”)
-can induce heart failure
(“Trampled failing heart balloon”)
-can cause hypersensitivity hepatitis
(“Liver spot on cow”)
-can cause gray blue skin discoloration
(“Mariachi band wearing Grey blue outfits”)
-inhibits the cytochrome P450 - drugs like warfarin and statins may increase
(“Broken chrome bumper”)
Sotalol , Dofetilide , Ibutilide (Also Amiodarone)
Side Effects
-can induce dose related torsade’s
(“twisted torsades streamer”)
(although all type III antiarrhythmics can widen the QT interval)
Names Class IV Antiarrhythmics
Non dihydropyridine calcium channel blockers
Verapamil
(“very Vanilla”)
Diltiazem
(“Delicious dark choclate”)
Class IV Antiarrhythmics MOA
Non-Dihydropyridine Calcium Channel Blockers
-Block L-type voltage gated Calcium channels in the heart thus block calcium current in the SA and AV nodes
(“L shaped nozzles on wall”)
(“Notes on music sheet”)
- Exert a greater effect on tissues that fire more frequently that use a calcium current
-non-dihydropyridine CCB’s prolong phase 4 of the nodal action potential decreased pacemaker activity, prolonged conduction time and refractory period
(“pianist sliding up the keys”)
-non-dihydropyridine CCB’s decrease atrioventricular conduction
(“Disconnected bottom of heart shaped lamp”)
Class IV Antiarrhythmics can treat …
-treat supraventricular arrhythmias (A.FIB with RVR)
(“Illuminated top of the heart shaped lamp”)
-useful in atrial fibrillation and flutter
(“tv showing Irregularly irregular signal”)
-prevents rapid ventricular response in A Fib and Flutter
(“heart shaped metronome on piano”)
Digoxin MOA
-digoxin exerts direct parasympathomimetic effects via direct stimulation of the vagus nerve → AV nodal inhibition
(“welcome to las VEGAS” sign)
Digoxin may be used to treat ..
-useful in atrial fibrillation and flutter, not first line
(“many tv screens showing irregularly irregular rythm”)
-prevents rapid ventricular response in atrial fibrillation and flutter (rate control)
(“las vegas” sign shaped like metronome )
Magnesium Can treat …
(“magnets”)
-useful for the treatment of certain arrhythmias (torsades)
- magnesium treats torsades de pointes
(״Torn twisted torsades streamers״)
Hyperkalemia can …
-induce arrhythmias
(“Banana dancer pointing up”)
-causes peaked T waves on ECG
(“Peaked streamer”)
Hypokalemia can …
-induce arrhythmias, severe muscle weakness, and glucose abnormalities
(“female Banana dancer pointing down”)
-can induce U waves at the end of the T wave on EKG
(“Streamer with extra bump”)
Adenosine MOA
-adenosine is a purine nucleoside
(“Purine shaped gate”)
-adenosine activates A1 (Gi) receptors on the myocardium and at the SA and AV nodes
(“A1 swing”)
-increases outward K+ current→hyperpolarization
(“Banana flying out of the cup”)
-suppress inward Ca2+ current
(“Falling calci-YUM ice cream”)
-decreases atrioventricular conduction
(“disconnected bottom of heart shaped lamp”)
-inhibits AV nodes
(“Note shaped dance floor”)
Adenosine can treat ..
-first line agent for acute treatment of supraventricular arrhythmias (PVST)
(“Illuminated top of heart shaped lamp”)
Side effects of Adenosine
-causes transient high grade heart block (direct av node inhibition for about 10s)
(“Hat blocking heart”)
-causes coronary dilation (mediated by A2 receptors)
(“Dilated coronary crown”)
-can cause cutaneous flushing
(“Flushed dancer”)
-can cause shortness of breath, chest pain, and impending sense of doom
(“Dancer clutching his chest)
-can cause fainting, headache, and hypotension
(“fainting female dancer”)
the actions of adenosine are inhibited by…
-caffeine and theophylline (methylxanthines)
(“Energy drink blocking A1 gate”)
