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Y2 Cardiovascular > Cardiovascular pharmacology 1 > Flashcards

Cardiovascular pharmacology 1 Flashcards

1
Q

What is inotropy?

A

Contractility of the cardiac muscle

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2
Q

What is lusitropy?

A

Relaxation of the ventricles

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3
Q

Affecting preload will have which affect which 2 things?

A

Circulating volume

Vascular resistance

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4
Q

Affecting afterload will affect the…?

A

Vascular resistance

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5
Q

What are the overall effects of the following drugs on the heart:

  1. Positive inotropes
  2. Lusiotropes
  3. Positive chronotropes
  4. Negative inotropes
  5. Negative chronotropes
A
  1. Increase contractility
  2. Change relaxation
  3. Increase heart rate
  4. Decrease contractility
  5. Decrease heart rate
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6
Q

Which drug is used in the case of atrioventricular block?

A

Positive choronotropes

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7
Q

Which drug is used in dilated cardiomyopathy cases?

A

Positive inotropes

  • it is disease of the heart muscle that causes the ventricle to stretch and dilate
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8
Q

Rate is determined and altered by which 2 factors?

A
  • CV centre in the medulla oblongata

- Autonomic NS

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9
Q

Conduction of the action potential is reliant on which 3 factors?

A
  • Normal activity of Na+, K+ and Ca++ channels
  • Normal intracellular and extracellular levels of these ions
  • Correct function of intercalated discs
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10
Q

What may cause control of heart rate and rhythm to go wrong?

A
  • Ectopic pacemakers
  • Damage to conducting tissue
  • Depression of the CV centre
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11
Q

What is a tacharrhythmia?

A

A heart rate that exceeds the normal resting rate

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12
Q

What is the problem with tacharrhythmias?

A
  • ↓diastolic filling time = ↓EDVV = ↓SV = ↓CO
  • Can be severe and cause fainting and sudden death
  • Increased cardiac work leads to myocardial hypertrophy
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13
Q

What factors can we change to slow heart rate?

A
  • Reduce firing rate

- Slow conduction of impulses

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14
Q

Which group of drugs do we use to slow the heart down?

A

Antidysrhythmics

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15
Q

What is the overall function of each of the 4 classes of antidysrhythmics?

A 
I = drugs which block fast sodium channels
II = β blockers
III = drugs which prolong the AP by blocking some K channels
IV = Drugs which block calcium channels
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16
Q

Out of class I A,B and C, which is a weak, moderate and strong sodium ion channel blockade?

A 
B = weak
A = moderate
C = strong
17
Q

How do class I A, B and C each effect the effective refractory period?

A

A - increases the ERP
B - decreases the ERP
C - doesn’t change the ERP

18
Q

How does the type of sodium channel effect the drugs?

What is the importance of this?

A

They are more likely to act on an active sodium channel than an inactive channel.
Reduce heart rate in tachyarrhythmias while not significantly affecting normal heart rates.

19
Q

What are class I antidysrhythmics dependant on?

A

Normal extracellular potassium for function

20
Q

What is the effect of hyper- and hypo- kalaemia on class I antodysrhytmics?

A

Hyperkalemia increases their function

Hypokalemia reduces their function

21
Q

Name the Class Ia and Class Ib antidysrhythmic used in practice

A 
Ia = Quinidine 
Ib = Lidocaine
22
Q

What are the adverse effects of using quinidine?

A
  • Various rhythm disturbances as blockade persists
  • Negative inotropy & vasodilation –> Congestive heart failure
  • GI signs, Nervousness, depression
  • Need 24 hour monitoring
23
Q

How are quinidine and lidocaine administered?

A 
Quinidine = Oral route preferred 
Lidocaine = slow IV parental
24
Q

What are the predicted effects of Class II antidysrhythmics (Beta blockers)?

A
  • Slow the pacemaker potential by slowing the calcium influx
  • Slow conduction through the AV bundle as increases the refractory period
  • Also negative inotropy and reduced lusitropy
25
Q

Where might beta blockers be useful?

A
  • Supraventricular or ventricular tachycardias

- Hypertension

26
Q

What is the Class II antidysrhythmic used in practice?

A

Atenolol

27
Q

What are the mechanisms of action of class III antidysrhythmic?

A
  • Prolong the cardiac AP
  • Block potassium ion channels which slows repolarisation (so cells are depolarised for longer, slowing the HR) and increases the refractory period
28
Q

What is the Class III antidysrhythmic used in practice?

A

Sotalol

29
Q

What makes up Sotalol?

A

A mixture of two isomers:
I-isomer which is a non-selective beta blocker
D-isomer which inhibits potassium ion channels

30
Q

What are the effects of Class IV antidysrhythmics?

A
  • Block Ca channels
  • Shorten the plateau phase
  • Slows conduction in the SA and AV nodes
  • Cause partial AV block
31
Q

What effect do Class IV antidysrhythmics have on inotropy and lusitropy?

A

Negative inotropes

Positive lusitropes

32
Q

Describe the Class IV antidysrhythmic is used in practice?

A

Diltiazem

  • administered orally and parentally
  • coronary and systemic vasodilator
33
Q

Which class does Digoxin belong to?

A

Class V -miscellaneous

34
Q

What is digoxin used for?

A
  • Negative chronotropic effects (decreases HR)
  • Enhances the action of the vagus nerve in the heart, mimicking the action of the parasympathetic NS
  • Slows conduction through the AV node by increasing the refractory period
35
Q

What do most bradyarrhythmias require if they are causing clinical signs?

A

Pacemaker implantation

36
Q

Which 2 groups of autonomic drugs can be used to treat bradyarrhythmias?

A
  • Sympathomimetics

- Anticholinergics

Y2 Cardiovascular (5 decks)

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