Cardiovascular Pharm

Question 1

Antiarrhythmic Drugs Affect what

Answer 1

Affect the various ion channels underlying the cardiac action potential

Question 2

Antiarrhythmic Drugs 4 classes and what they block

Answer 2

• Class I: NA+ channel blockers
• Class II: beta-adrenergic receptor blockers
• Class III: K+ channel blockers
• Class IV: Ca++ channel blockers

Question 3

Class I: Na channel blockers

Tx3

dont want to…

Answer 3

• Used to tx -
  
  • Atrial fibrilation
  • Tachycardia
  • Ventricular arrhythmias
• Dont want to completely block the Nav channels, just decrease their activity

Question 4

Class I Subtypes

Answer 4

Question 5

Class 1A: Na channel blockers

Affect on cardiac cycle

Answer 5

• Reduce automaticity
• Decrease conduction velocity
• Increase refractory period
  
  • Inc overall action potential duration

Question 6

Class IA examples 2 and side effects

Answer 6

• Quinidine
  
  • can cause cinchonism (quinone poisoning), hypotension, torsades de pointes
• Procainamide
  
  • Can cause mental changes, lupus, torsades de pointes

Question 7

Class IB Na channel blockers

Affect on cardiac cycle

1 ex and side effescts

Answer 7

• Reduces automaticity at abnormal pacemakers
  
  • His-Purkinje system and or ventricular myocardium
• Lidocaine
  
  • can cause convulsions

Question 8

Class IC Na channel blockers

Affect on cardiac cycle

2 ex

Answer 8

• Reduces automaticity
• Dec conduction velocity
• Flecainide
  
  • Can cause convulsions, dizziness, blurred vision, cardiac risk with recent myocardial infarction
• Propafenone
  
  • Can cause chest pain, edema, nausea, altered taste, anxiety, dyspnea

Question 9

Class II Beta-adrenergic receptor blockers MoA

Answer 9

• Bluck sympathetic stimulation of heart
  
  • reduces automaticity
  • Dec conduction velocity

Question 10

Class II Beta-adrenergic receptor blockers

Tx

2 ex MoA contraindication in, can also cause

Answer 10

• Tx hypertension, post myocardial infarction, angina, and to prevent tachyarrhythmias
• Propranolol (blocks both beta1 and beta2)
• Esmolol a lil more specific for beta-1
  
  • contraindicated in asthmatics (bronchoconstriction)
  • Can also cause heart block

Question 11

Class III: K+ channel blockers

MoA

Answer 11

• Reduces automaticity
  
  • Prolongs ventricular depolarization
  • Inc the refractory period (slows repolarization)

Question 12

Class III:K+ channel blockers

2 Ex and side effects

Answer 12

• Amiodarone
  
  • Can cause many serious side effects
  • pulmonary fibrosis, thyroid abnormalities, skin discoloration, cornea deposits, peripheral neuropathy
• Dronedarone and Sotalol
  
  • Fewer side effects but still serious

Question 13

Class IV:Ca++ channel blockers

Tx3

2 ex, can act on both

MoA

can cause

Answer 13

• Used to tx
  
  • hypertension
  • angina
  • atrial arrythmias
• Verapamil, Diltiazem
  
  • Can act on both smooth muscle and cardiac muscle
  • Dec automaticity
  • Dec contractility
  • Dec conduction velocity in AV node
  • Dec peripheral resistance
• Can cause flushing, AV node conduction defects

Question 14

Other antiarrhythmic drug not in classes1-4

Adenosine

Tx

MoA

can cause

Answer 14

• Given IV, usually in advanced cardiac life support situation
• MoA
  
  • Red automaticity
  • Dec conduction velocity in AV node
• Can cause flushing, asthma, dyspnea, SA nodal arrest, AV nodal block

Question 15

Cardiac Glycosides

Tx by

2 ex and MoA

Answer 15

• Tx congestive heart failure
• Inc strength of myocardial contraction
• Also slows ventricular rate
• Ex Disoxin, Digitalis
  
  • Blocks Na/K ATPase
  • Co-administration with epi can inc risk of ventricular arrhythmias
  • Drugs that lower plasma K levels (thiazide, diuretics) inc toxicity
  • Can cause
    
    • Heart block
    • ventricular arrhythmias
    • Visual and mental disturbances
    • Nausea and vomiting

Question 16

Acute tx of heart failure

5 and what they are

Answer 16

• Dobutamine
  
  • beta-1 agonist
• Dopamine
  
  • catecholamine
• Phosphodiesterase III Inhibitors
  
  • Inamrinone, Milrinone, Vesnarinone
• Atrial natriuretic peptide agonists
  
  • Nesiritide
• Vasopressin receptor antagonists
  
  • Tolvaptan

Question 17

Antianginal drugs

what is angina pectoris

drug mech 4

Answer 17

• Angina pectoris= pain from hypoxic heart tissue
• Drug mechanisms
  
  • Reduca cardiac rate
  • Reducae cardiac force
  • Reduce peripheral resistance
  • Dilate coronary arteries

Question 18

Antianginal Drugs include 7

adverse affects

Answer 18

• Clacium channel blockers
• Beta blockers
• Vasodilators
  
  • Paticularly nitrates and nitrites
• Antiplatelet drugs
• Lipid lowering drugs
• Ranolazine (blocks late Na and Kir currents, prolonging ventricular AP, improves contractile dysfunction)
• Nitroglycerine and Amyl nitrite
  
  • generate NO
• Adverse effects: headache, syncope, tachycardia, tolerance, methemoglobinemia (low O2 carrying capacity in the blood)

Question 19

Drugs that Reduce Risk of Myocardial Infarction

6

Answer 19

• Antiplatelet drugs
• Aspirin
• Clopidogrel, Prasugrel- block activation of platelets by inhibiting ADP receptor
• Abciximab, Eptifibatide, Tirofiban- GPIIb-IIIa glycoprotein receptor inhibitors (block platelet aggregation)
• Ranolazine
• Lipid lowering drugs (statins)

Question 20

Dyslipidemia

Type

elevated lipo

drug

Answer 20

• IIa
  
  • LDL
  • Statin
• IIb
  
  • LDL VLDL
  • Statin fibrate
• III, IV, V
  
  • LDL VLDL
  • Fibrate