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Theraputics > Cardiovascular Therapeutics- Anti-Arrhythmic Drugs > Flashcards

Cardiovascular Therapeutics- Anti-Arrhythmic Drugs Flashcards

1
Q

What are the four classes of anti-arrhythmic drugs?

A

Class 1- Sodium Channel Blocker (e.g. lidocaine, flecanide)
Class 2- Beta Blocker (e.g. metoprolol)
Class 3- Potassium Channel Blocker (e.g. amiodarone)
Class 4- Calcium Channel Blocker (e.g. verapamil)

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2
Q

What is the treatment for SVT?

A

This is a shockable rhythm- put on defib pads
Vagal manoeuvres- aim to stimulate the vagus nerve and reduce HR
Carotid sinus massage- Interpreted as HTN and so HR is reduced
Large bore cannula- give adenosine to reduce HR
If ineffective give verapamil
Shock if no improvement or haemodynamically compromised (hypotensive, going into cardiogenic shock)

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3
Q

How does adenosine work?

A

Acts on adenosine receptors to slow the heart rate
Causes hyperpolarisation
Transient AV block

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4
Q

What is a side effect of adenosine?

A

Feeling of death

Chest tightness, flushing

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5
Q

What is a contra-indication to adenosine?

A

Asthma

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6
Q

What are the three types of AF?

A

Paroxysmal- intermittent
Persistent- up to 7 days
Permanent - over 7 days

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7
Q

What is the treatment for AF?

A

Anticoagulation- Warfarin, dabigatran, apixabam
Rate control- Beta blockers
Rhythm control- amiodarone, flecainide
(It is either rate or rhythm control)

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8
Q

What are the two types of rhythm control?

A

Pharmacological- amiodarone, flecanide

Non pharmacological- DC cardioversion, catheter ablation

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9
Q

How does digoxin work?

A

Inhibits sodium potassium ATPase in cardiac myocyte enzyme
This causes intracellular sodium to increase
Causes decreased activity of sodium-calcium exchanger which normally extrudes calcium
Increases in intracellular calcium causes increase in contractility
Also enhances vagal inhibition of SAN rate and AVN conduction

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10
Q

Which drug can cause digoxin toxicity?

A

Furosemide

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11
Q

What are some side-effects of digoxin?

A 
Arrhythmias
Nausea and vomitting
Fatigue
Confusion
Reduced colour vision- xanthopsia
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12
Q

What should be given in digoxin overdose?

A

Atropine

Digoxin specific antibody

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13
Q

What are some side effects of amiodarone?

A 
Lung fibrosis
Hepatitis
Thyroid dysfunction
Photosensitivity
Dark grey/blue skin
Tremors 
Ataxia
Corneal microdeposits
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14
Q

How does flecanide work?

A

Slows conduction in the atria, his-purkinje system, acccesory pathways and ventricles
Sodium channel blocker

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15
Q

What is the mechanism of warfarin?

A

Inhibits synthesis of vitamin K dependent clotting factors

Anti-coagulant effect takes several days to develop and is initially pro-coagulant

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16
Q

What is the target INR for someone with AF?

A

2-3 (Normal is 1)

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17
Q

What is the antidote to warfarin?

A

Give vitamin K

18
Q

What juice should be avoided with warfarin therapy?

A

Cranberry juice should be avoided as it inhibits cytochrome p-450 which metabolises warfarin. Therefore causes INR to increase.
So does clarithyromycin, metronidazole and ciprofloxacin

19
Q

What does DOAC stand for?

A

Direct Oral Anti-coagulant

20
Q

Give an example of a DOAC

A

Dobigatran

21
Q

How is dobigatran reversed?

A

This requires a monoclonal antibody called idarucizumab which is very expensive

22
Q

How do statins work?

A

HMG CoA reductase inhibitors

Cause up-regulation of LDL cholesterol receptors and therefore remove it from the serum

23
Q

What is a side effect of statin therapy?

A

Myalgia
Myositis
Raised LFTs
Rhabdomyolysis (rare)

24
Q

What is ezetimibe?

A

Drug used to treat hyperlipidaemia
Blocks NPC1L1 transport protein in the brush border of enterocytes and so prevent intestinal absorption of cholesterol
Use if satins not tolerated

25
Q

What are fibrates?

A

Lipid lowering drugs that largely reduce circulating VLDL and so triglyceride
Examples include benzafibrate, fenofibrate
Not for routine use

26
Q

How do PCSK9 inhibitors work?

A

PCSK9 binds to the receptor for LDL receptor causing it to be broken down. This causes up-regulation of LDL receptors on hepatocytes resulting in increased LDL uptake from blood
Monoclonal Ab that is an SC injection
Example - Alirocumab and Evolocumab
Expensive and only recommended by NICE for certain high risk patients

27
Q

What re the four targets to treat angina?

A

Reduce the HR and so cardiac work
Reduce TPR and so reduce the after-load
Reduced venous return and so reduce preload
Vasodilation of the coronary artery to increase blood supply to myocardium

28
Q

How does Ivabradine work?

A

Slows the heart rate through inhibition of the funny current

Ivabradine is an alternative to beta-blockers if not tolerated

29
Q

What is the mechanism through which nitrates work?

A

Decompose to NO which causes vasodilation

Increases coronary flow and reduces preload and afterload

30
Q

What is a side effect of nitrates?

A

Headache

Postural hypotension

31
Q

What conditions are included in acute coronary syndrome?

A

STEMI
NSTEMI
Unstable Angina (No trop rise)

32
Q

What is the primary management for ACS?

A 
Morphine
Oxygen- Maintain 94-98% O2 Sat
Nitrates- GTN
Aspirin (300mg) and Clopidogrel 
Beta-blocker
ACEi/ARB
Statins
H- Low molecular weight Heparin
Also give anti-emetic metoclopramide
33
Q

What is the treatment for MI?

A 
PCI
Or Thrombolysis (Alteplase)- if PCI not available
34
Q

What is alteplase?

A

Alteplase is used for thrombolysis
It is a tissue plasmingoen acitvator
Also used for stroke and massive PE

Note- Streptokinase is no longer used as it is derived from streptococcus and antibodies develop after first use. Alteplase is not antigenic

35
Q

What is fondaparinux?

A

Unfractionated heparin- prolongs the APTT

36
Q

How is fondaparinux given?

A

IV bolus/infusion and so acts immediately

37
Q

Give an example of a low molecular weight heparin

A

Enoxaparin
Tinazaprin
Do not prolong the APTT

38
Q

Give two examples of antiplatelet therapy

A

Aspirin
Clopidogrel
Tricagrelor

39
Q

What is the mechanism of action of aspirin?

A

Inhibits COX-1 which reduces TXA2 synthesis
Effects last as long as platelet lifespan
Reduces platelet activation and aggregation

40
Q

What are some side effects of apirin?

A

Upper GI bleeding

Peptic ulcers

41
Q

How does clopidogrel work?

A

Adenosine P2Y12 inhibitor- irreversibly inhibits ADP induced platelet aggregation

42
Q

How does ticagrelor work?

A

Inhibits ADP induced platelet aggregation

Allosteric inhibition of P2Y12 receptor

Theraputics (12 decks)

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