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Pharmacology 1 > Cardiovascular System 2 > Flashcards

Cardiovascular System 2 Flashcards

1
Q

How many classes of antiarrhythmic drugs

A

4

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2
Q

What is Class 1 drugs of anti arrhythmia

A

Membrane stabilizing agent
Moderately decreasing dv/dt of o phase: quinidine, procainamide
Little decrease: lidocaine
Marked decrease: propafenone

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3
Q

What is Class 2 drugs of anti arrhythmia

A

Anti adrenergic drugs
Propanolol
Esmolol
Sotalol

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4
Q

What is Class 3 drugs of anti arrhythmia

A

Agents widening action potential
Amiodarone
Sotalol

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5
Q

What is Class 4 drugs of anti arrhythmia

A

Calcium channel blockers
Verapamil
Diltiazem

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6
Q

MOA of class 1 drugs of anti arrhythmia

A

Primary action is to block Na+ channels so there is limited conductance of Na+ and k+ across cell membrane
The bind to activated or inactivated Na+ channel

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7
Q

Lidocaine MOA and actions

A

Block Na+ channels more in inactivated state than open state and do not delay recovery time
Action is suppression of automaticity of ectopic foci.
Lidocaine has only effects on ventricular muscles not on atrial
It abbreviates action potential duration in ventricular fibers

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8
Q

Pharmacokinetics of lidocaine

A

Inactive orally due to high first pass metabolism
Proponolol prolongs T1/2 of lidocaine by reducing hepatic blood flow

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9
Q

ADR of lidocaine

A

Main toxicity is neurological effects
Drowsiness, nausea, disorientation

No proarrhythmic potential and is the least cardio toxic

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10
Q

Use of lidocaine

A

Ventricular tachycardia
Ventricular fibrillation
Can be used in MI but now contraindicated

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11
Q

Amiodarone MOA

A

Exert actions of class 1,2,3,4

Prolongs action potential duration and Q-T interval blocking K+ channels
Blocks inactivated Na+ channels
Partially inhibit ca2+ channels
Non competitive b blocking activity

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12
Q

Actions of Amiodarone

A

Conduction slowed
Ectopic foci depressed
Hypotension

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13
Q

Uses of Amiodarone

A

Ventricular arrhythmia
Supraventricular arrhythmia
PSVT
VT
Recurrent VF

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14
Q

Advantage of Amiodarone

A

Long acting hence suitable for chronic prophylactic therapy
Only anti arrhythmic found to reduce cardiac deaths
High and broad spectrum activity
Low pro arrhythmic potential

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15
Q

ADR of Amiodarone

A

Hypotension
Bradycardia
Myocardial depression
Nausea vomiting Gi upset
Photosensitization and sun burn
Corneal deposits
Pulmonary alveolitis and fibrosis
Peripheral neuropathy

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16
Q

What is Amiodarone

A

Iodine containing long acting anti arrhythmic drug

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17
Q

How many classes of drugs for angina

18
Q

Name the classes of drugs for angina

A

Nitrates- short acting and long acting
B blocker
Calcium channel blocker
K+ channel opener
Other anti anginal

19
Q

Name nitrates

A

Short acting: GTN, isosorbide dinitrate (SL)
Long acting: Isosorbide dinitrate (oral) isosorbide mononitrate

20
Q

Name potassium channel
Opener

A

Nicorandil

21
Q

Other antianginal drugs?

A

Dipyramidamol
Statins

22
Q

Actions of nitrates

A

Decrease preload
Decrease after load
Redistribution of coronary flow
Relief in angina
Peripheral vasodilation

23
Q

MOA of nitrates

A

Nitrates change to NO radical
Increases guanyl cyclase
Increased CGMP
Dephosphorylate MLCK
Lack of phospphorylated MLCK
No myosin activation
Smooth muscle relaxation

Decrease ca2+ in cells as well as

24
Q

ADR of nitrates

A

Fullness in head, throbbing head ache
Flushing, sweating, palpitations, weakness, dizziness
Methemoglobinemia at high dose

25
Uses of nitrates
Angina MI Acute coronary syndrome: UA and NSTEMI CHF and VF Biliary colic Oesophageal spasm Cyanide poisoning
26
How does nitrates help in cyanide poisoning
Nitrates increased methemoglobin Cyanide more affinity for methemoglobin Formation of cyanomethemoglobin We give sodium thiosulphate Formation of sodium thiocyanate
27
Classification of calcium channel blockers
Phenyl alkylamine: verapamil Benzothiazine: Diltiazem Dihydropyridine: Amlodipine, Nicardipine, nifedipine
28
Actions of CCB
Smooth muscle relaxation Negative ionotropic, chronotropic, dromotropic effect
29
MOA of CCB on smooth muscles
Ca2+ vital for excitation contraction coupling CCB cause relaxation by decreasing intracellular ca2+ DHP most marked action
30
MOA of CCB on heart
Negative ionotropic action as it decreases ca2+ stores Delayed recovery phase of the channels No delaying by dhp hence it has no negative chronotropic or dromotropic action
31
Features of verapamil
Dilates arterioles Has some alpha blocking activity so decreases tpr hence lowers bp HR decreases Constipation main ADR, hypotension, flushing, headache, ankle edema less common.
32
Features of nifedipine
Arteriolar dilation due to decrease in tpr Direct depressant action on heart Acts rapidly ADR are due to vasodilation- flushing, ankle edema, headache, palpitations
33
Uses of CCB
Angina pectoris Hypertension Cardiac arrhythmia Hypertrophic cardiomyopathy Premature labor
34
Drug combinations in angina
BB + Nitrates BB + CCB (DHPs, no verapamil and diltiazem) CCB + Nitrates CCB + BB + nitrates
35
What is the rationale of giving B blocker and nitrates/ B blocker and CCB
Tachycardia due to nitrates opposed by BB BB has tendency to reduce coronary flow that reduced by nitrates Tendency of BB to cause ventricular dilatation opposed by Nitrates
36
Rationale of giving nitrates, CCB and BB
Nitrates reduced preload CCB reduces after load BB reduces cardiac work by cardiac depression
37
Name a potassium channel opener
Nicorandil
38
Antagonist of nicorandil
Glibenclamide
39
MOA of nicorandil
Decrease pre load K+ loss leads to hyper polarization hence smooth muscle relaxation
40
Drug therapy in MI
1. GTN to terminate 2. Pain, anxiety and apprehension: morphine or diazepam 3. Oxygenation 4. Maintenance of blood volume/tissue perfusion: iv saline 5. Correction of acidosis: iv sodium bicarbonate infusion 6. Prevention and treatment: b blocker for prophylaxis Lidocaine or procainamide for tachyarrhythmias 7. Pump failure: diuretics, vasodilator, ionotropic 8. Prevention of thrombus extension, enobolism and venous thrombosis: aspirin 100mg, clopidogrel 100mg, Statins 70mg 9. Thrombolysis and reperfusion: fibrinolytic agents like tenecteplase/alteplase 10. Prevention of remodeling: ACE/ARB 11. Prevention of future attacks: Platelet inhibitors: asipirin/clopidogrel B Blockers Control of hyperlipidemia

Pharmacology 1 (14 decks)

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