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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

A

5

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
Q

Uses of nitrates

A

Angina
MI
Acute coronary syndrome: UA and NSTEMI
CHF and VF
Biliary colic
Oesophageal spasm
Cyanide poisoning

26
Q

How does nitrates help in cyanide poisoning

A

Nitrates increased methemoglobin
Cyanide more affinity for methemoglobin
Formation of cyanomethemoglobin
We give sodium thiosulphate
Formation of sodium thiocyanate

27
Q

Classification of calcium channel blockers

A

Phenyl alkylamine: verapamil
Benzothiazine: Diltiazem
Dihydropyridine: Amlodipine, Nicardipine, nifedipine

28
Q

Actions of CCB

A

Smooth muscle relaxation
Negative ionotropic, chronotropic, dromotropic effect

29
Q

MOA of CCB on smooth muscles

A

Ca2+ vital for excitation contraction coupling
CCB cause relaxation by decreasing intracellular ca2+
DHP most marked action

30
Q

MOA of CCB on heart

A

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
Q

Features of verapamil

A

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
Q

Features of nifedipine

A

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
Q

Uses of CCB

A

Angina pectoris
Hypertension
Cardiac arrhythmia
Hypertrophic cardiomyopathy
Premature labor

34
Q

Drug combinations in angina

A

BB + Nitrates
BB + CCB (DHPs, no verapamil and diltiazem)
CCB + Nitrates
CCB + BB + nitrates

35
Q

What is the rationale of giving B blocker and nitrates/ B blocker and CCB

A

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
Q

Rationale of giving nitrates, CCB and BB

A

Nitrates reduced preload
CCB reduces after load
BB reduces cardiac work by cardiac depression

37
Q

Name a potassium channel opener

A

Nicorandil

38
Q

Antagonist of nicorandil

A

Glibenclamide

39
Q

MOA of nicorandil

A

Decrease pre load
K+ loss leads to hyper polarization hence smooth muscle relaxation

40
Q

Drug therapy in MI

A
  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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