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CVPR Cardiovascular pharmacology 3 Flashcards

1
Q

Adverse effects of Niacin

A

Red flushed face which is ↓ by NSAIDs or long-term use Hyperglycemia Hyperuricemia

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2
Q

What is Hyperuricemia?

A

Excess uric acid in the blood

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3
Q

PCSK9 inhibitors effect on LDL

A

↓↓↓

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4
Q

PCSK9 inhibitors effect on HDL

A

↑

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5
Q

PCSK9 inhibitors effect on triglycerides

A

↓

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6
Q

PCSK9 inhibitors MOA

A
  • Inactivation of LDL-receptor degradation
  • Increasing amount of LDL removed from bloodstream
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7
Q

Adverse effects of PCSK9 inhibitors

A
  • Myalgias
  • Delirium
  • Dementia
  • Other neurocognitive effects
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8
Q

Examples of PCSK9 inhibitors

A
  • Alirocumab
  • Evolocumab
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9
Q

Cardiac glycosides

A

Digoxin

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10
Q

Digoxin MOA

A

Direct inhibition of Na/K ATPase → indirect inhibition of Na/Ca exchanger ↑[Ca] → (+) ionotropy

Stimulates vagus nerve → ↓ HR

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11
Q

Clinical use of Digoxin

A
  • HF (↑ contractility)
  • Atrial fibrillation (↓ conduction at AV node and depression of SA node)
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12
Q

Adverse effects of digoxin

A

Cholinergic: NVD Blurry yellow vision (think Van Gogh) Arrhythmias AV block Can lead to hyperkalemia which is a poor prognostic indicator

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13
Q

Factors predisposing to Digoxin toxicity

A
  • Renal failure (↓ excretion)
  • Hypokalemia (permissive for Digoxin binding at K-binding site on Na/K/ATPase)
  • Drugs that displace digoxin from tissue-binding sites ↓ clearance (eg verapamil, amiodarone and quinidine)
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14
Q

Antidote to Digoxin

A

Slowly normal K Cardiac pacer Anti-digoxin Fab fragments Mg2+

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15
Q

Digoxin diagram

A

314

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16
Q

Class I sodium channel blockers

A

Slow or block (↓) conduction (especially in depolarized cells) ↓ slope of phase 0 depolarization Are state dependent (selectively depress tissue that is frequently depolarized [tachycardia]

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17
Q

Antiarrhythmics Class IA

A

Quinidine Procainamide Disopyramide “The Queen Proclaims Diso’s pyramid”

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18
Q

Class IA Antiarrhythmics MOA

A

Sodium channel blockers ↑ AP duration ↑ effective refractory period (ERP) in ventricular action potential ↑ QT interval Some potassium channel blocking effects

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19
Q

Clinical uses of Class IA Antiarrhythmics

A

Both atrial and ventricular arrhythmias Especially re-entrant and ectopic SVT and VT

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20
Q

Adverse effects of Class IA Antiarrhythmics

5 listed

A
  • Cinchonism (headache, tinnitus with quinidine)
  • Reversible SLE-like syndrome (procainamide)
  • HF (disopyramide)
  • Thrombocytopenia
  • Torsades du Pointes due to ↑ QT interval
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21
Q

Class IA Antiarrhythmics AP effects

A

Pg 315

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22
Q

Class IB Antiarrhythmics mnemonic

A

Lidocaine MexileTine I’d buy Liddy’s Mexican Tacos

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23
Q

Class IB Antiarrhythmics MOA

A
  • ↓AP duration
  • Preferentially affect ischemic or depolarized Purkinje and ventricular tissue
  • Phenytoin can also fall into the IB category
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24
Q

Phenytoin Class of Antiarrhythmics

A

Can also fall into the IB category

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25
Q

Clinical uses of Class IB Antiarrhythmics

A
  • Acute ventricular arrhythmias (especially post-MI)
  • Digitalis-induced arrhythmias
  • IB- is Best post-MI
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26
Q

Adverse effects of Class IB Antiarrhythmics

A
  • CNS
  • stimulation/depression
  • Cardiovascular depression
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27
Q

Class IB Antiarrhythmics AP

28
Q

Class IC Antiarrhythmics Mnemonic

A

Class IC Flecainide Propafenone Can I have Fries, Please

29
Q

Class IC Antiarrhythmics MOA

A
  • Significantly prolongs ERP in AV node and accessory bypass tracts
  • No effect on ERP in Purkinje and ventricular tissue
  • Minimal effect on AP duration
30
Q

Clinical use of Class IC Antiarrhythmics

A
  • SVTs (including atrial fibrillation)
  • Only as a last resort in refractory VT
31
Q

Adverse effects of Class IC Antiarrhythmics

A
  • Proarrhythmic, especially Post-MI (contraindicated)
  • Class IC is Contraindicated in structural and ischemic heart disease
32
Q

Class IC Antiarrhythmics contraindicated in?

A
  • Proarrhythmic, especially post-MI (contraindicated)
  • IC is Contraindicated in structural and ischemic heart disease
33
Q

Class IC Antiarrhythmics AP

34
Q

Class II Antiarrhythmics and examples

A

β-blockers

Metoprolol

Propranolol

Esmolol

Atenolol

Timolol

Carvedilol

35
Q

Class II Antiarrhythmics MOA

A
  • Decrease SA and AV nodal activity by ↓ cAMP which ↓Ca currents
  • Suppress abnormal pacemakers by ↓ slope of phase 4 AV node is particularly sensitive - ↑PR interval
36
Q

Esmolol duration of action

A

Very short acting

37
Q

Very short acting β-blockers

38
Q

Class II Antiarrhythmics affinity

A

AV node is particularly sensitive - ↑PR interval

39
Q

Class II Antiarrhythmics AP

40
Q

Class II Antiarrhythmics Clinical uses

A
  • SVT
  • Ventricular rate control for atrial fibrillation and atrial flutter
41
Q

Adverse effects of Class II Antiarrhythmics

A
  • Impotence
  • Exacerbation of COPD and asthma
  • Cardiovascular effects (Bradycardia, AV block, HF)
  • CNS effects (sedation, sleep alterations)
  • May mask the signs of hypoglycemia (caution in diabetes)
  • Metoprolol can cause dyslipidemia
  • Propranolol can exacerbate vasospasm in Prinzmetal angina
  • β-blockers (except non-selective α- and β-antagonists carvedilol and labetalol) cause unopposed α1 agonism if given alone for pheochromocytoma or cocaine toxicity
42
Q

Treatment of β-blocker OD

A
  • Saline
  • Atropine
  • Glucagon
43
Q

Class III Antiarrhythmics Mnemonic and main action

A

Potassium channel blockers

AIDS

  • Amiodarone
  • Ibutilide
  • Dofetilide
  • Sotalol
44
Q

Class III Antiarrhythmics MOA

A
  • ↑AP duration
  • ↑ERP
  • ↑QT interval
45
Q

Class III Antiarrhythmics AP

46
Q

Clinical use of Class III Antiarrhythmics

A
  • Atrial fibrillation
  • Atrial flutter
  • Ventricular tachycardia (amiodarone, sotalol)
47
Q

Adverse effects of Class III Antiarrhythmics

A

Sotalol - torsades de pointes, excessive β-blockade

Ibutilide - torsades de pointes

Amiodarone - pulmonary fibrosis, hepatotoxicity, hypothyroidism or hyperthyroidism (amiodarone is 40% iodine by weight) acts as a hapten (corneal deposits, blue/gray skin deposits resulting in photodermatitis), neurologic effects, constipation, cardiovascular effects (bradycardia, heart block, HF)

48
Q

Considerations when using amiodarone?

A

Remember to check PFTs, LFTs and TFTs when using amiodarone Amiodarone is lipophilic and has class I, II, III and IV effects

49
Q

Class IV Antiarrhythmics main action and examples

A

Ca channel blockers Verapamil Diltiazem

50
Q

Class IV Antiarrhythmics MOA

A

↓ conduction velocity ↑ ERP ↑ PR interval

51
Q

Clinical uses of Class IV Antiarrhythmics

A
  • Prevention of nodal arrhythmias (eg SVT)
  • Rate control in atrial fibrillation
52
Q

Adverse effects of Class IV Antiarrhythmics

A

Constipation Flushing Edema Cardiovascular effects (HF, AV block, sinus node depression)

53
Q

Class IV Antiarrhythmics AP

54
Q

Other antiarrhythmics

A
  • Adenosine
  • Mg2+
55
Q

Adenosine as an antiarrhythmic

A

↑K efflux out of cells → hyperpolarizing the cell and ↓ Ica, ↓AV node conduction

56
Q

Adenosine clinical uses for antiarrhythmia

A

Drug of choice in diagnosin/terminating certain forms of SVT

57
Q

Adenosine duration of action

A

Very short acting (≈ 15 seconds)

58
Q

Adenosine effects are blunted by?

A

Caffeine and theophylline (both are adenosine receptor antagonists)

59
Q

Adverse effects of adenosine

A
  • Flushing
  • Hypotension
  • Chest pain
  • Sense of impending doom
  • Bronchospasm
60
Q

Mg2+ as an antiarrhythmic

A

Effective in torsades de pointes and digoxin toxicity

61
Q

Ivabradine MOA

A

Selective inhibition of funny Na channels (If) prolonging slow depolarization phase 4 ↓ SA node firing: Negative chronotropic effect without ionotropy Reduces cardiac O2 requirement

62
Q

Clinical uses of Ivabradine

A
  • Chronic stable angina in patients who cannot take β-blockers
  • Chronic HF with reduced Ejection fraction
63
Q

Adverse effects of Ivabradine

A

Luminous phenomena/visual brightness HTN bradycardia

64
Q

Adverse effects of quinidine

A

Cinchonism (headache, tinnitus with quinidine)

65
Q

Adverse effects of procainamide

A

Reversible SLE-like syndrome (procainamide)

66
Q

Adverse effects of disopyramide

A

HF (disopyramide)

67
Q

Digoxin drug interactions

A
  • verapamil
  • amiodarone
  • quinidine

CVPR (93 decks)

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