DRUGS CARDIO Flashcards
what is lidocaine used for for arrhythmia
VT/VF
what drugs can increase the levels of serum digoxin?
verapamil and diltiazem
what is amiodarone used for?
mechanism?
anti-arrhythmia - VT and VF (off-label Afib)
unknown - but class 3 - inhibits K channels - thought to prolong the action potential
what antiarrhythmics can prolong the QT interval
K channel blockers
amiodarone
quinidine
norepinephrine
receptors
effect on HR, BP
alpha-1, alpha-2, beta-1
Increase BP, bradycardia (reflex - the beta-1 stimulation is not strong enough to overcome the relfex)
nicotine:
mechanism effects (heart, GI, vessels)
nicotinic agonist
tachycardia, vasoconstriction, increased GI motility
what type of stable angina drug increases coronary flow?
calcium channel blockers (verapamil and diltiazem)
phenylephrine
receptors
what does it do to BP? HR?
alpha-1 agonist
hypertension, bradycardia (reflex)
prazosin
receptors
effect on BP
competitive alpha-1 blocker
decrease BP, orthostatic hypotension (“first-dose syncope”)
when an agonist binds to an alpha-2 receptor, what is the intracellular pathway?
usually Gi –> decrease cAMP
presynaptic, regulate the reslease of NE, really.
main hemodynamic goal of antiischemic (antiangina) drugs
restore dynamic balance between O2 supply and O2 demand
propranolol
receptors
what does it do to HR? BP? lungs?
beta blocker (1 and 2)
increases HR, decreases BP, bronchoconstriction
_________, if give after an MI, have been shown to increase survival
beta-blockers
class one antiarrhythmic drugs
general mechanism
example
sodium channel blockers
lidocaine
dobutamine
receptors
what does it do to HR?
beta-1 direct agonist
increases HR
atropine
mechanism
what does it do to HR? pupils? mouth?
muscarinic receptor antagonist
tachycardia, dilated pupils, dry mouth
what drug would you give to treat out-of-hospital show-resistant ventricular fibrillation?
amiodarone
downside of nitroglycerin -
headache and tolerance to the drug
how are beta blocker successful at treating stable angina?
decrease myocardial oxygen demand (limit HR
what antipsychotics can prolong the QT interval
haloperidol
chlorpromazine
as an antiarrhythmic, what does metoprolol treat?
mechanism
A-fib, atrial flutter, SVTs
unknown - automaticity decreased, cardiac slowing
isoproterenol
receptors
effect on lungs, HR, BP?
beta 1 and beta 2 agonist
bronchodilator, increase HR, decrease BP (reflex)
what are the calcium channel blockers that can help treat arrhythmias?
verapamil and diltiazem
describe muscarinic receptor activation in the heart:
decrease c_______, decrease _______
decrease cAMP, decrease PKA
- increases K+ effluc
- Decreases Na pacemaker activity
(just kind of goes against everything NE did)
class three anriarrhythmic drugs
general mechanism
example
potassium channel blockers
amiodarone
atropine
mechanism
side effects
muscarinic receptor antagonist
dry mouth, urinary retention, constipation, dilated pupils, tachycardia, dilated pupils
class two anriarrhythmic drugs
general mechanism
example (2)
beta blockers
metoprolol
propranolol
when an agonist binds to an alpha-1 receptor, what is the intracellular pathway?
Gq –> IP3 –> Ca++ (contraction)
side effect of adenosine:
flushing, may cause asthma attacks
________________ are the first line therapy for stable angina (along with mitroglyerin)
beta-blockers
what antibiotics can prolong the QT interval
Macrolides (erythromycin, azithromycin)
Fluoroquinolones (ciprofloxacin, levofloxacin)
metoptrolol
receptors
what does it do to HR? BP? lungs?
beta-1 selective ANTAGONIST
decreases BP, bradycardia
bethanechol
receptors
what does it do to blood vessels?
muscarinic agonist
vasodilation
mechanism of verapamil and diltiazem as antiarrhythmics
Slow SA and AV nodal conduction –> cardiac slowing
what arrhythmias should you use verapamil and diltiazem for?
SVT
a-fib
atrial flutter
what opioids can prolong the QT interval
methadone
side effects of amiodarone?
could cause more VT/VF (exacerbation of present arrhythmia)
skin changes - blue (chronic) pulmonary fibrosis (chronic)
what is nitroglycerin used for sublingually?
mechanism (sublingual)? increase flow or decrease demand?
stable
NO –> venous relaxation (sublingual), increases coronary flow
decreases oxygen demand (decreases preload)
what drugs can you give for a-fib?
beta blockers
verapamil, diltiazem
amiodarone (off-label)
sildenafil
what is it used for?
Mechanism
erectile dysfunction
inhibits phosphodiesterase type 5, which degrades cGMP (allows for more vasodilation)
class four antiarrhythmic drugs
general mechanism
examples (2)
calcium channel blockers
verapamil and diltiazem
the ________________ serve as initial therapy for stable angina when ________ ________ can’t be used (along with nitroglycerin)
calcium channel blockers
beta-blockers
adenosine is an _____________ drug
mechanism of action:
antiarrhythmic
agonist at adenosine A1 receptor (purinergic) –> K+ efflux, hyperpolarization –> cardiac slower (decreased AV node conduction)
INHIBITS AV NODE CONDUCTION
side effects with verapamil and diltiazem
hypotension, bradycardia, headache, AV block
what is amiodarone used for
VT and VF not responding to other medications
off-label for Afib
side effects of lidocaine as an antiarrhythmic
CNS simulation - seizures
the main way nitrates decrease angina -
reduction of cardiac work (venous relaxation –> reduced preload) and thus reduce oxygen demand
who should not be given beta-blockers?
asthmatics/COPD (causes bronchospasm in them)
people with unstable HF (can aggravate)
__________ _________ is the primary determinant of myocardial oxygen consumption
tension generation
what calcium channel blockers can be used to treat stable angina?
verapamil and diltiazem
norepinephrine
receptors
what is it used for?
alpha-1, alpha-2, beta-1
treatment of hypotension, shock
use of adenosine:
SVT
when an agonist binds to a beta-1 receptor, what is the intracellular pathway?
Gs –> increase cAMP
increase heart rate, force, renin release
epinephrine
receptors
effect on HR, BP
alpha-1, alpha-2, beta-1, beta-2
increase in BP (alpha-1), and an increase in HR (Beta-1 is stronger than the reflex)
nitroglycerine
sublingual is used for
IV is used for
sublingual - prophylaxis and treatment of stable angina
IV - heart failure
drug interactions of amiodarone?
uses CP450 for metabolism
interacts with warfarin and digoxin
hemodynamics of how verapamil and diltiazem relieve stable angina?
specific –> general
decrease rate (AV, SA node AP)
decreased contractility
increase on coronary blood flow (dilation)
increase myocardial oxygen supply and decrease demand
what drug slows the ventricular contractions to see the P wave morphology more clearly
adenosine
main mechanism (in one sentence) of verapamil and diltiazem
slow AV node conduction
the main effect of nitroglycerin on hemodynamics is that it reduces __________
preload (venous dilation)
therefore, reduces O2 demand
what classes of drugs can be used for stable angina?
calcium channel blockers
beta-blockers
organic nitrates
(statins for underlying problem)
