Cardiovascular II Flashcards
digoxin
cardiac glycoside
digoxin MOA
inhibit Na/K ATPase
- indirect inhibition Na/Ca exchanger
- increased Ca - positive inotropy
stimlate vagus nerve - decreased HR
clinical use digoxin
HF - increased contractility
A-fib - decreased conduction at AV and suppression SA node
adverse digoxin
cholinergic - N/V, diarrhea, blurry yellow vision, arrythmia, AV block
hyperK - indicator of poor prognosis
antidote for digoxin
normalize K
cardiac pacer
anti-digoxin Fab fragments
Mg
class I antiarrhythmics
sodium channel blockers
slow phase 0 depolarization
-state dependent
quinidine
class IA antiarrhythmic
procainamide
class IA antiarrhythmic
disopyramide
class IA antiarrhythmic
class IA antiarrhythmic MOA
increased AP duration
increased effective refractorr period in ventricular action potential
increased QT interval
tx re-entrant and ectopic SVT and VT
class IA antiarrhythmic
adverse class IA antiarrhythmic
HA, tinnitus
reversible SLE syndrome
HF
thrombocytopenia
torsades - with long QT
lidocaine
class IB antiarrhythmic
mexiletine
class IB antiarrhythmic
class IB antiarrhthmic MOA
decrease AP duration
preferentially affect ischemic or depolarized purkinje fibers and ventricular tissue
tx ventricular arrythmia post MI
class IB antiarrhythmic
adverse class IB antiarrhythmic
CNS stimulant/depressant
cardiovasc depression
flecainamide
class IC antiarrhythmic
propafenanone
class IC antiarrhythmic
class IC antiarrhythmic MOA
prolong effective refractory period in AV node
no effect in purkinje and ventricular tissue
minimal effect AP duration
decreased slope of phase 0 depolarization
sodium channel blockers - class I antiarrhythmics
adverse class IC antiarrhythmic
proarrhythmic
CI post MI and structural heart disease
class II antiarrhythmic
beta-blocker
metoprolol
class II antiarrhythmic
propranolol
class II antiarrhythmic
esmolol
class II antiarrhythmic
atenolol
class II antiarrhythmic
timolol
class II antiarrhythmic
carvedilol
class II antiarrhythmic
MOA class II antiarrhythmic
beta-blocker
- decreased SA and AV node activity
- decreased cAMP, decreased Ca current
decrease slope phase 4 pacemaker
esmolol
short acting beta blocker
dyslipidemia
with metoprolol
exacerbate prinzmetal angina vasospasm
propranolol
unopposed alpha1 agonist
if give beta-blocker alone with pheochromocytoma or cocaine toxicity
tx beta-blocker overdose
saline, atropine, glucagon
class III antiarrhythmic
potassium channel blocker
amiodarone
class III antiarrhythmic
ibutilide
class III antiarrhythmic
dofetilide
class III antiarrhythmic
sotalol
class III antiarrhythmic
class III antiarrhythmic MOA
K channel blocker
increased AP duration
increased effective refractory period
increased QT interval
adverse sotalol
torsades
excessive beta-blockade
adverse ibutilide
torsades
adverse amiodarone
pulmonary fibrosis hepatotoxic hypothyroid/hyperthyroid - 40% iodine hapten - corneal deposit - skin deposits neuro effects constipation CV effects - brady, heart block HF
monitor pulmonary, liver, thyroid function tests
class IV antiarrhythmic
calcium channel blocker
verapamil
class IV antiarrhythmic
diltiazem
class IV antiarrhythmic
class IV antiarrhythmic MOA
calcium channel blocker
- decreased conduction velocity
- increased effective refractory period
- increased PR interval
adverse class IV antiarrhythmics
constipation
flushing
edema
CV effects - HF, AV block, sinus node depression
adenosine MOA
more K out of cell
-hyperpolarize and decreased Ca in cell
DOC for abolishing SVT
adenosine
very short acting
blunt effects of adenosine
theophylline and caffeine
adverse of adenosine
flushing, hypotension, chest pain, sense impending doom, bronchospasm
tx of torsades
Mg2+