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N929: Advanced Pharmacology > Cardiovascular Week 1 > Flashcards

Cardiovascular Week 1 Flashcards

1
Q

Class I anti-arrhythmics

A

Sodium channel blockers
- depression of Phase 0, depolarization
Class Ia, Ib, Ic

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2
Q

Class II anti-arrhythmics

A

Beta adrenergic antagonist

- Atenolol, Acebutolol, Carvedilol, Esmolol, metoprolol, pindolol, propranolol, timolol

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3
Q

Class III anti-arrhythmics

A

Potassium channel blockers

- Amiodarone, Bretylium, Dofetilide, Ibutilide, Sotalol

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4
Q

Class IV anti-arrhythmics

A

Calcium channel blockers

  • Diltiazem
  • Verapamil
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5
Q

Class V anti-arrhythmics

A

Unclassified

Adenosine, Adenosine triphosphate, Atropine, Digoxin,

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6
Q

Class Ia anti-arrhythmic

A

Moderate sodium channel blockers;

moderate depression; prolonged depolarization (slower upstroke) & longer refractory period

  • disopyramide
  • procainamide
  • qinidine
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7
Q

Class Ib anti-arrhythmic

A

Weak sodium channel blockers;

weak depression; shortened depolarization (shortened phase 2)

  • lidocaine, mexiletine, phenytoin, tocainide
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8
Q

Class Ic anti-arrhythmic

A

Strong sodium channel blocker;

Strong depression; minimal effect on repolarization

  • flecainide, propafenone, moricizine
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9
Q

What occurs in phase 0 of cardiac AP

A

rapid depolarization

  • Fast Na channels open, Na rushes in
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10
Q

What occurs in phase 1 of cardiac AP

A

begin repolarization

  • Fast Na channels begin to close
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11
Q

What occurs in phase 2 of cardiac AP

A

plateau

  • SLOW Ca channels open,
    Ca inward
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12
Q

What occurs in phase 3 of cardiac AP

A

repolarization

  • Ca channels close
  • K channels open, slow K eflux
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13
Q

What occurs in phase 4 of cardiac AP

A

RMP

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14
Q

What occurs in phase 0 of cardiac PACEMAKER AP

A

upstroke

  • critical firing threshold -40mV
  • slower & Ca mediated
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15
Q

What occurs in phase 3 of cardiac PACEMAKER AP

A

repolarization

  • Ca & Na channels close
  • K channels open; slow outward K
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16
Q

What occurs in phase 4 of cardiac PACEMAKER AP

A

gradual depolarization

  • slow inward Na & Ca
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17
Q

4 ways to classify arrhythmia

A
  1. site of origin
  2. Narrow or broad complexes
  3. Regular or Irregular
  4. ↑ or ↓ HR
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18
Q

Underlying factors that may contribute to arrhythmia development (8)

A
  • Arterial hypoxemia
  • Electrolyte imbalance
  • Acid-base abnormalities
  • Myocardial ischemia
  • Altered SNS activity
  • Bradycardia
  • Administration of certain drugs
  • Enlargement of failing ventricle
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19
Q

4 mechanisms of arrhythmia/electrical disturbance initiation & production in the heart

A
  1. altered automaticity
  2. delayed after-depolarization
  3. Re-entry
  4. conduction block
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20
Q

When does an arrhythmia require treatment? (3)

A
  1. can’t be corrected by removing cause
  2. hemodynamic instability
  3. disturbance predisposes more serious arrhythmia or co-morbidities
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21
Q

What are 3 non-pharmacological treatments to arrhythmias?

A
  1. pacing (external, temporary, permanent)
  2. prophylaxis (ablation)
  3. acute (vagal down, cardiovert)
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22
Q

Antiarrhythmic medications are administered to ___, ___, or ____ arrhythmias.

A
  1. Prevent
  2. Supress
  3. Treat
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23
Q

Medication used to treat:

sinus bradycardia

A

Class V: Atropine (IV)

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24
Q 
Medications (2) & class used to treat:
Ventricular rhythms
A

Class Ib (sodium channel blockers)

  • Lidocaine (IV)
  • Mexiletine

**NOT Class IV Ca Channel blockers

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25
Q

Medications used to treat:
Supraventricular rhythms

2 classes
3 medications

A

Class V:

  • Adenosine (IV)
  • Digoxin

Class IV:
- Verapamil

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26
Q

Medications used to treat:
Ventricular & Supraventricular

3 classes
2 medications in each class

A

Class Ia:

  • Procainamide
  • Disopyramide

Class Ic:

  • Flecainide
  • Propafenone

Class III:

  • Amiodarone
  • Sotalol
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27
Q

Medications used to treat:
stress induced arrhythmias

1 class
3 medications
A

Class II:

  • Atenolol
  • Propranolol
  • Sotalol

(beta blockers)

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28
Q

Atropine class

A

Class V;

muscarinic receptor antagonist

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29
Q

Atropine indication

A

symptomatic bradycardia

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30
Q

Atropine dose

A

0.4-1mg

repeat as necessary

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31
Q

Use caution with atropine doses _____

A

Under 0.4mg d/t paradoxical response

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32
Q

Atropine onset

A

<1min

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33
Q

Atropine duration

A

30-60 minutes

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34
Q

Magnesium is Class ___ anti-arrhythmic

A

Class V

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35
Q

Magnesium has effects on which channels?

A
  1. sodium channels
  2. potassium channels
  3. calcium channels
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36
Q

Magnesium can be given during ____

A

Torsades de Pointe

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37
Q

Magnesium dose

A

1gm over 20 minutes; can repeat

38
Q

Digoxin class/categorization & MOA

A

cardiac glycoside

  • increases vagal activity - - leads to decreased activity of the SA node & prolongs conduction through AV node
39
Q

Digoxin dose

A

0.5-1mg divided over 12-24 hours

**reduce dose in elderly & renal

40
Q

Digoxin onset

A

30-60 minutes

41
Q

What kind of inotrope is digoxin?

A

positive inotrope, can use to treat CHF

42
Q

Digoxin will decrease a person’s :

3 cardiovascular values

A
  1. HR
  2. preload
  3. afterload
43
Q

Digoxin is good for

A

management of a-fib or a-flutter (especially in peds

44
Q

Digoxin protein binding

A

weak

45
Q

Digoxin elimination

A

1/2t is 36 hours

46
Q

CON of digoxin

A

narrow therapeutic window

0.5-1.2ng /mL

47
Q

Excretion of digoxin

A

90% excreted by kidneys

48
Q

Adverse effects of Digoxin

Cardiovascular

A

arrhythmias, heart block

49
Q

Procainamide class

A

Class Ia - Intermediate Sodium channel blockers

50
Q

Lidocaine class

A

Class Ib - Fast dissociation Sodium channel blockers

51
Q

Amiodarone class

A

Class III - Potassium channel blockers

  • have many MOA/targets
52
Q

Diltiazem class

A

Class IV - Calcium channel blockers

53
Q

Verapamil class

A

Class IV - Calcium channel blockers

54
Q

Adenosine class

A

Class V - unclassified

55
Q

Procainamide dose

A

100mg IV Q5M (max 15mg/kg) until rate controlled

infusion 2-6mg/min

56
Q

Procainamide used to treat

A

Ventricular arrhythmias (not useful in atrial)

57
Q

Procainamide protein binding

A

15%

58
Q

Procainamide E1/2t

A

2 hours

59
Q

Procainamide therapeutic level

A

4-8mcg/mL

60
Q

Procainamide adverse effects (2)

A
  1. myocardial depression leading to hypotension

2. syndrome resembling LUPUS ERYTHEMATOUS

61
Q

Lidocaine used to treat

A

ventricular arrhythmias

*Not pro-arrhythmic

Also in:
re-entry rhythms, v-tach, v-fib, PVCs

62
Q

POSITIVE characteristic of lidocaine

A

*not Pro-arrhythmic

63
Q

MOA of lidocaine

A
  1. delayed rate Phase 4

2. ↑ ventricular fibrillation threshold

64
Q

Lidocaine dose

bolus & infusion

A

bolus 1-1.5mg/kg IV

infusion: 1-4mg/min (max dose 3mg/kg)

65
Q

Lidocaine protein binding

A

50%

66
Q

Lidocaine metabolism

A

hepatic; CYP450

active metabolite

67
Q

Lidocaine elimination

A

10% renal

68
Q

Lidocaine adverse effects

A

CV: hypotension, bradycardia, lightheadedness, myocardial depression, sinus arrest, heart block, cardiac arrest

Neuro: Sz, CNS depression, drowsiness, dizziness, confusion

Resp: apnea, ventilatory depression

Misc: tinnitus

**Can augment pre-existing NMB

69
Q

if patient is taking Mexiletine; check ___

A

cardiac clearance

70
Q

Phenytoin AKA Dilantin can cause;

A

Steven Johnson Syndrome

71
Q

pro-arrhythmic agents

A

Class Ic

Class III

72
Q

non-selective beta blocker

A

propranolol

73
Q

patient’s on Class III; must monitor their ____ closely

A

potassium

74
Q

Amiodarone class & site of action

A

Class III ;

K channels
Na channels
Ca channels
Alpha & beta receptors

75
Q

Amiodarone is FIRST LINE

A

in VT/VF when resistant to electrical defibrillation

76
Q

Amiodarone dose

bolus & gtt

A

bolus 150-300mg IV over 2-5 minute

gtt 1mg/hr x6H, 0.5mg/hr x18 hours

77
Q

Amiodarone protein binding

A

96%

78
Q

Amiodarone metabolism

A

Hepatic; CYP450

INHIBITS CYP450; WILL PROLONG coumadin/warfarin/NMBD

79
Q

Amiodarone therapeutic level

A

1-3.5mcg/mL

80
Q

Adverse effects of Amiodarone

A

CV: PRO-ARRHYTHMIC effects, heart block, hypotension

Neuro: disturbances

Resp: pulmonary toxicity, pulmonary edema, ARDS

GI: disturbances

MISC: photosensitive rash, grey/blue skin discoloration, corneal deposits, sleep disturbances, abnormal LFTs (20%)

81
Q

Amiodarone contains ___-

A

iodine; monitor for thyroid issues

82
Q

MUST monitor ___ when pt is taking Amiodarone

A

POTASSIUM; HIGH risk of TdP

83
Q

Class IV agent primary target

A

AV node

84
Q

Calcium channels found in:

A
  • neurons
  • skeletal muscles
  • vascular smooth muscles
  • glandular cells
  • blood coagulation
85
Q

3 classifications of Class IV

A
  1. phenyl-alkyl-amines
  2. benzothiazepines
  3. 1,4- dihydropyridines
86
Q

Classification of verapamil

A

phenyl-alkyl-amine

87
Q

classification of diltiazem

A

benzothiazepine

88
Q

2 categories of Class IV (calcium channel blocker) use

A
  1. vascular

2. non-vascular

89
Q

What are vascular Class IV medications used for

A
  • angina
  • systemic HTN
  • pulm HTN
  • cerebral arterial spasm (post-bleed)
  • Raynaud’s disease
  • migraine
90
Q

what are non-vascular Class IV medications used for?

A
  • bronchial asthma
  • esophageal spasm
  • dysmenorrhea
  • premature labor
91
Q

Class IV anti-arrhythmic are used for

A

**VASOSPASTIC ANGINA PECTORIS; CAD

N929: Advanced Pharmacology (6 decks)

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