Exam 3; Cardiovascular Drugs Flashcards
What is an arrhythmia
alternation in the normal impulse pathway
What can be two causes of an arrhythmia
alteration in the pacemaker
alteration in the transmission pathway
This is the source of the start of a rhythm
ectopic focus
Which is worse, ventricular or atrial fibrillation
ventricular; life threatening
What can result from ventricular fibrillation
decreased CO
clots may form
What is a major cause of sudden cardiac death
ventricular arrhythmias
Why is a non-drug treatment preferred for an arrhythmia
drug treatments may further cause arrhythmias
What are four types of non-drug treatments of arrhythmia
pacemaker implantation
cardioversion
automatic defibrillator implantation
surgical removal of an ectopic signal
This family of drugs are Na channel blockers that decrease the rate of depolarization
local anesthetics
This Na channel blocker can be used for all arrhythmias; depresses muscle function and anticholinergic effects
La-quinidine
What are three symptoms of La-quinidine
GI upset
vomiting
anorexia
What are two CNS effects of la-quinidine
tinnitus
altered color vision
This Na blocker does not enter the CNS, so no CNS effects and has a lupus like effect in low acetylators
procainamide
This Na channel blocker has strong anti-vagal effects; anti-muscarinic effects or oppostie of DUMBELLS
disopyramide
This Na channel blocker is give IV due to the first pass effect has low toxicity and is useful for treating ventricular tachycardia
Lb-lidocaine
What are two symptoms of lb-lidocaine
tremors and seizures
This Na channel blocker is given orally, has low toxicity and is useful for treating ventricular tachycardia; can result in tremors and seizures
mexiletine
What are the 5 Na channel blockers (anti-arrhythmia)
la-quinidine procainamide disophyamide lb-lidocaine mexiletine
These three drugs are anti-arrhythmia beta blockers
propranolol
metaprolol
esmolol
What is the mechanism behind the beta blockers
block the beta1 receptors in the heart
effectively slows the heart rate
This beta blocker decreases the pacemaker firing rate
propranolol
This beta blocker is more selective and has less beta 2 effects
metaprolol
This beta blocker has a more rapid onset
esmolol
What are three symptoms of beta blockers
bradycardia
hypotension
if there is a beta2 effect, asthma
What are the three potassium channel blockers
sotalol
amiodarone
dronedarone
This is a beta blocker that also blocks K channels
sotalol
This is a Na, K, and beta blockader
amiodarone
This is the most effective anti-arrhythmic; DOC in cases of cardiac arrest
amiodarone
This is an analog of amiodarone, with fewer side effects and less efficacy
dronedarone
This drug has symptoms such as potentially fatal pulmonary fibrosis, liver damage, blue-grey skin coloration, and GI upset
amiodarone
Where are two places on the body that amiodarone can be deposited and what are its effects
can be deposited in the cornea; optic neuritis
can be deposited in the skin; iodine containing
What are three Ca channel blockers
verapamil
diltizaem
nifedpine
What is the mechanism behind the Ca channel blockers
blocks Ca transport into cardiac cells; increasing the refractory period
This anti-arrhythmic is given IV and binds to the adenosine receptor which decreases the firing rate of the AV node
adenosine
What is the half life of adenosine
very short; 10 seconds
What is adenosine most useful for
atrial tachycardia
coronary vasodilator
This is when there is not enough blood flow to the heart muscles
angina
When is angina the most severe
if there is chest pain at rest and not solely after exercise
What are the two ways in which we can treat angina
increasing blood flow to the heart or decreasing oxygen demand
behavior modifications
This drug rapidly dilates all blood vessels; arteries and veins, including the coronary arteries
glyceryl trinitrate (nitroglycerin)
What is the mechanism of nitroglycerin
activates cGMP which leads to vascular dilation
How long do the effects of nitroglycerin last
30 mins to an hour
What are three side effects of nitroglycerin
hypotension
skin flushing
headache
This becomes of nitroglycerin if you take it continuously within a day
rapid tolerance; after even a day there will be no effect
nitroglycerin is given which method
patch or paste
in order to divert the 1st pass metabolism
This drug is a slow release nitrate formulation and can be given orally
isosorbide dinitrate
This family of drugs is used to decrease heart rate via being a beta blocker
-olol’s
This family of drugs is used to decrease heart rate via being a Ca channel blocker
-ipine
What is the concept behind congestive heart failure
cardiac muscles are not contracting as much
blood comes to the heart but doesn’t leave fast enough
heart enlarges
tissues become anoxic
The blood back up from congestive heart failure can go to wear and lead to what
can back up into the lungs and lead to pulmonary congestion, decreasing the ability to breathe
What happens to the kidney during congestive heart failure
the kidney is not well perfused; causing retention of Na and fluids leading to peripheral edema
The heart responds to congestive heart failure in what way
release of EPI, NE, and angiotension II
What effects do EPI, NE, and angiotension II have on the heart during congestive heart failure
increases blood pressure
increases heart rate
vasoconstriction
Angiotension II causes an increase in what
blood volume; increased Na retention and increased aldosterone secretion leads to increased Na/K exchanger
This occurs in response to the force of contraction due to stretching of cardiac muscles
enlargement of the heart
The heart will work harder to compensate for its failing mechanisms which is bad, why?
its already damaged so working harder makes it even more damaged
What is the mechanism behind digoxin
inhibits the Na/K ATPase which results in Na remaining high in the cardiomyocyte thus preventing Ca from leaving the cell increasing the contractility
What are two toxic effects of digtoxin
cardiac arrhthymia
CNS effects
What are the three CNS effects of digtoxin
vision; yellow/green tinting (VanGogh)
hallucinations
activation of chemoreceptor trigger zone; nausea
The effects of digoxin are associated with what condition
hypokalemia
How would you treat digoxin poisoning
with anti-digoxin antibodies
What is the mechanism behind dobutamine
it is a beta1 agonist and also increases the amount of Ca in the heart muscle
Dobutamine may increase the force of contraction but may not necessarily increase what
the rate
These four drugs are the best treatment of CHF; the use of agents that inhibit the body’s compensatory changes in heart failure
ACE inhibitors
beta blocketers
vasodilators
diuretics
This drug decreases blood pressure and fluid retention
ACE inhibitors
This drug decreases heart rate
beta blockers
This drug decreases blood pressure
vasodilators
What are four agents that increase blood flow to selected organs (penis)
sildenafil vardenafil tadalafil avanafil "-fil's"
What is the mechanism behind the drugs that increase blood flow to the penis
inhibitors of type 5 cGMP phosphodiesterases; strong vasodilator
What should you not take with the drugs that increase blood flow to the penis
nitrates they also increase cGMP leading to vasodilation
alpha-1 blockers
can lead to a severe decrease in blood pressure
What are two side effects of the drugs that increase blood flow to the penis
stroke or myocardial infarction
How can drugs that increase blood flow to the penis cause visual disturbances
impaired blue/green color discrimination
NAION; damage to the retina; induced by cGMP phosphodiesterase inhibitors
What are the drugs that increase blood flow to the penis metabolized by
P450
What other condition can drugs that increase blood flow to the penis treat
pulmonary hypertension
This is injectable prostaglandin E1 which leads to vasodilation when injected directly into the penis
alprostadil
