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Heart drugs Flashcards

1
Q

quinidine

A

Class 1a antiarrhythmic
blocks Na+ channels (use-dependent) slowed upstorke
blocks K+ channels –> delay repolarization

vagal inhibitor (anti-cholinergic) 
a-receptor antagonist 
use treat:
re-entrant arrhythmias 
atrial flutter
Atrial fibrillation
Atrial tachycardia(30% success rate)
Ventricular tachycardias/fibrillation (frequent)
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2
Q

procainamide

A

Class 1a antiarrhythmic
blocks Na+ channels (use-dependent) slowed upstorke
blocks K+ channels –> delay repolarization

use treat:
re-entrant arrhythmias 
atrial flutter
Atrial fibrillation
Atrial tachycardia(30% success rate)
AV reentrant Tachycardia
Ventricular tachycardias/fibrillation (frequent)
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3
Q

lidocaine

A 
Class 1b antiarrhythmic
blocks Na+ channels (use-dependent) slowed upstorke (milder effect than 1a and 1c) 
Purest form of class 1 drugs

use treat:
re-entrant arrhythmias 
atrial flutter
Atrial fibrillation
Atrial tachycardia(30% success rate)
Ventricular tachycardias/fibrillation (frequent)
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4
Q

phenytoin.

A

Class 1b antiarrhythmic
blocks Na+ channels (use-dependent) slowed upstorke (milder effect than 1a and 1c)

use treat:
re-entrant arrhythmias
atrial flutter
Atrial fibrillation
Atrial tachycardia(30% success rate)
Ventricular tachycardias/fibrillation (frequent)
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5
Q

propafenone

A

Class 1c antiarrhythmic
blocks Na+ channels (use-dependent) and prolongs phase 2
powerful prolongation of tissue refractory period

use treat:
re-entrant arrhythmias 
atrial flutter
Atrial fibrillation
Atrial tachycardia(30% success rate)
Ventricular tachycardias/fibrillation(frequent)
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6
Q

flecainide

A

Class 1c antiarrhythmic
blocks Na+ channels (use-dependent) and prolongs phase 2
powerful prolongation of tissue refractory period

use treat:
re-entrant arrhythmias 
atrial flutter
Atrial fibrillation
Atrial tachycardia(30% success rate)
Ventricular tachycardias/fibrillation (frequent)
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7
Q

propranolol

A

class II antiarrhythmic drug B-blocker

reduce If, L-type Ca2+, Ks current –>reduces the upstroke rate and slows repolarization particuarly in AV nodal myocytes. —-> pacing and refractory period is prolonged in SA and AV nodal cells.

Used to treat
atrial flutter (slow conduction in 1:1 situation)
atrial fibrillation (controlling ventricular rate)
Atrial tachycardia(30% success rate)
AV nodal reentrant tachycardia (acute and chronic)
Ventricular tachycardias/fibrillation (frequent)
long QT syndrome(prevent Torsades)
hypertrophic obstructive cardiomyopathy(decrease contractility)

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8
Q

metoprolol

A

class II antiarrhythmic drug B-blocker

reduce If, L-type Ca2+, Ks current –>reduces the upstroke rate and slows repolarization particuarly in AV nodal myocytes. —-> pacing and refractory period is prolonged in SA and AV nodal cells.

Used to treat
atrial flutter (slow conduction in 1:1 situation)
atrial fibrillation (controlling ventricular rate)
Atrial tachycardia(30% success rate)
AV nodal reentrant tachycardia (acute and chronic)
Ventricular tachycardias/fibrillation (frequent)
long QT syndrome(prevent Torsades)
hypertrophic obstructive cardiomyopathy(decrease contractility)

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9
Q

esmolol

A

class II antiarrhythmic drug B-blocker

reduce If, L-type Ca2+, Ks current –>reduces the upstroke rate and slows repolarization particuarly in AV nodal myocytes. —-> pacing and refractory period is prolonged in SA and AV nodal cells.

Used to treat:
atrial flutter (slow conduction in 1:1 situation)
atrial fibrillation (controlling ventricular rate)
Atrial tachycardia(30% success rate)
AV nodal reentrant tachycardia (acute and chronic)
Ventricular tachycardias/fibrillation (frequent)
long QT syndrome(prevent Torsades)
hypertrophic obstructive cardiomyopathy(decrease contractility)

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10
Q

amiodarone

A

class III antiarrhythmic drug (long half-life)

blocks cardiac K+ channels —> prolongation of fast response phase 2 –> prominent prolongation of refractory period
blocks Na+ channels reduces conduction velocity and increases refractory period
decreases the rate of diastolic depolarizaton in autonomic cells —> reduces firing rate

used to treat:
re-entrant arrhythmias  
atrial flutter
Atrial fibrillation
Atrial tachycardia(30% success rate)
Ventricular tachycardias/fibrillation (acute and chronic)
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11
Q

sotalol

A

class III antiarrhythmic drug

blocks cardiac K+ channels —> prolongation of fast response phase 2 –> prominent prolongation of refractory period
B-blocker

used to treat:
re-entrant arrhythmias  
atrial flutter
Atrial fibrillation
Atrial tachycardia(30% success rate)
Ventricular tachycardias/fibrillation (frequent)
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12
Q

ibutilide

A

class III antiarrhythmic drug

blocks cardiac K+ channels —> prolongation of fast response phase 2 –> prominent prolongation of refractory period
Specifically blocks Kr

used to treat:
re-entrant arrhythmias  
atrial flutter
Atrial fibrillation
Atrial tachycardia(30% success rate)
Ventricular tachycardias/fibrillation (frequent)
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13
Q

dofetilide

A

class III antiarrhythmic drug

blocks cardiac K+ channels —> prolongation of fast response phase 2 –> prominent prolongation of refractory period
Specifically blocks Kr

used to treat:
re-entrant arrhythmias
atrial flutter
Atrial fibrillation
Atrial tachycardia(30% success rate)
Ventricular tachycardias/fibrillation (frequent)
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14
Q

bretylium

A

class III antiarrhythmic drug

blocks cardiac K+ channels —> prolongation of fast response phase 2 –> prominent prolongation of refractory period

used to treat:
re-entrant arrhythmias
atrial flutter
Atrial fibrillation
Atrial tachycardia(30% success rate)
Ventricular tachycardias/fibrillation (frequent)
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15
Q

verapamil

A

class IV antiarrhythmic drug

slow down Ca2+ dependent upstoke in slow response tissue –> slows condcution velocity (principal effect)
prolong refractory period —> suppress re-entrant arrhythmias, particularly in the AV node.

Used to treat:
atrial flutter (slow conduction in 1:1 situation)
Atrial tachycardia(30% success rate)
AV nodal reentrant tachycardia (acute and chronic)
Ventricular tachycardias/fibrillation(frequent)
hypertrophic obstructive cardiomyopathy(decrease contractility)

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16
Q

diltiazem

A

class IV antiarrhythmic drug

slow down Ca2+ dependent upstoke in slow response tissue –> slows condcution velocity (principal effect)
prolong refractory period —> suppress re-entrant arrhythmias, particularly in the AV node.

Used to treat:
atrial flutter (slow conduction in 1:1 situation)
Atrial tachycardia(30% success rate)
AV nodal reentrant tachycardia (acute and chronic)
Ventricular tachycardias/fibrillation(frequent)
hypertrophic obstructive cardiomyopathy(decrease contractility)

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17
Q

Adenosine

A

Antiarrhythmic drug
acts on A1 adenosine receptor –> Gi coupled antagonizes sympathetic action in nodal cells

Activates K+ channel activates by Ach (parasympathetic)

reduction in SA and AV node firing rate + reduced conduction rate in AV node.

Used to treat:
AV nodal reentrant tachycardia (acute)

18
Q

digoxin

A

Inotrope
Half life 38 hours
Na/K ATPase inhibitor:
Increases Ca2+ load via NCX

p-glycoprotein substrate (narrow therapeutic window)

Increases Baroreceptor sensitivity
Slows the sinus rate (SA node effect) 
slowed conduction (AV node effect)
decreased norepeniphrine serum concentration 
decresed RAAS activation

Recommended for:
Patients with HFrEF in sinus rhythm or atrial fibrillation
All patients with sever symptoms EF <25%, big heart on X-ray
Paroxysmal supraventricular tachycardia

19
Q

Hydralazine

A

direct arterial vasodilation
decrease in afterload

combination Hydralazine and Isosorbite dinitrate:
reduce mortality and morbidity in African-Americans with HFrEF
also to patients who can’t be give ACE inhibitor or ARBS

20
Q

Isosorbite dinitrate

A

venous dilation
decrease in preload

combination Hydralazine and Isosorbite dinitrate:
reduce mortality and morbidity in African-Americans with HFrEF
also to patients who can’t be give ACE inhibitor or ARBS

21
Q

Captopril

A

ACE inhibitor:(short half-life)
prevents formation of Angiotensin II
prevents breakdown of Bradykinin

Blocks action of Angiotenisn II:
arterial constriction
increased sympathetic output (cardiac output)
Aldosterone secretion (Na+ resorption)
ADH secretion(increase water absorption)
Direct kidney effects (Na+ resorption + water retention)

Side effects:
cough (bradykinin) 
hyperkalemia 
angioedema
hypotension
renal dysfunction(NSAID make it worse)

Recommended in patients with HFrER and currret or priop symptoms.

22
Q

Enatopril

A

ACE inhibitor: (6h half life)
prevents formation of Angiotensin II
prevents breakdown of Bradykinin

Blocks action of Angiotenis II:
arterial constriction
increased sympathetic output (cardiac output)
Aldosterone secretion (Na+ resorption)
ADH secretion(increase water absorption)
Direct kidney effects (Na+ resorption + water retention)

Side effects:
cough (bradykinin) 
hyperkalemia 
angioedema
hypotension
renal dysfunction(NSAID make it worse)

Recommended in patients with HFrER and currret or priop symptoms.

23
Q

Lisonopril

A

ACE inhibitor:(12 h half life)
prevents formation of Angiotensin II
prevents breakdown of Bradykinin

Blocks action of Angiotenis II:
arterial constriction
increased sympathetic output (cardiac output)
Aldosterone secretion (Na+ resorption, fibrosis, hypertrophy)
ADH secretion(increase water absorption)
Direct kidney effects (Na+ resorption + water retention)

Side effects:
cough (bradykinin) 
hyperkalemia 
angioedema
hypotension
renal dysfunction(NSAID make it worse)

Recommended in patients with HFrER and currret or priop symptoms.

24
Q

Losartan

A

Angiotensin II receptor blocker: ARB

block angiotensin receptor 1

prevent: 
aldosterone secretion(Na+ retention, fibrosis, hypertrophy) 
vascular constriction 
dyspogenic response (drinking) 
renal/inotropic response
angiotensiongen gene expression

Recommended
Patients with HFrEF, intolerant to ACE inhibitors (reduce mortality)
Maybe addition to ACE inhibitors, intolerant to aldosterone antagonist

25
Candesartan
Angiotensin II receptor blocker: ARB block angiotensin receptor 1 ``` prevent: aldosterone secretion(Na+ retention, fibrosis, hypertrophy) vascular constriction dyspogenic response (drinking) renal/inotropic response angiotensiongen gene expression ``` Recommended Patients with HFrEF, intolerant to ACE inhibitors (reduce mortality) Maybe addition to ACE inhibitors, intolerant to aldosterone antagonist
26
Valsartan
block angiotensin receptor 1 ``` prevent: aldosterone secretion(Na+ retention, fibrosis, hypertrophy) vascular constriction dyspogenic response (drinking) renal/inotropic response angiotensiongen gene expression ``` Recommended Patients with HFrEF, intolerant to ACE inhibitors (reduce mortality) Maybe addition to ACE inhibitors, intolerant to aldosterone antagonist
27
Carvedilol
Beta-blocker: ``` prevents down regulation of B-1 receptor prevents apoptosis/oxidative stress prevents hypertrophy/fibrosis prevents increased arrhythmia potential vasodilation ``` recommended for patients with current or prior symptoms of HFrEF to reduce mobritdiy and mortality
28
Bisoprolol
Beta-blocker: ``` prevents down regulation of B-1 receptor prevents apoptosis/oxidative stress prevents hypertrophy/fibrosis prevents increased arrhythmia potential vasodilation ``` recommended for patients with current or prior symptoms of HFrEF to reduce mobritdiy and mortality
29
LC2696
combinatin of neprilysin inhibitor + ARB neptrilysin degrades BNP
30
Dobutamine
Inotrope B1 agonist Increases cardiac output Used in patients: Cold and wet/dry
31
Milrinone
Inotrope phosphodiaesterase inhibitors prevents breakdown of cAMP Increases cardiac output Used in patients: Cold and wet/dry advanced heart failure and low out syndrome
32
Dopamine
endogenous precursor of norepinephrine directly simulates adrenergic receptors release norepinephrine from nerves renal, inotrope, pressor
33
furosemide
Loop Diuretic inhibit Na-K-2Cl- transporter (NKCC2) ---> decrease water reabsorption effected augmented with Na restricted diet ``` adverse reactions: decrease Mg+ and Ca2+ reabsroption hypokalemic metabolic alkalosis(ectopic pacemaker and arrhythmias) hypouricemia (same transport) Ototoxicity ```
34
bumetanide
``` Loop Diuretic (more reliable bioavailability) inhibit Na-K-2Cl- transporter (NKCC2) ---> decrease water reabsorption effected augmented with Na restricted diet ``` ``` adverse reactions: decrease Mg+ and Ca2+ reabsroption hypokalemic metabolic alkalosis(ectopic pacemaker and arrhythmias) hypouricemia (same transport) Ototoxicity ```
35
torsemide
``` Loop Diuretic (more reliable bioavailability) inhibit Na-K-2Cl- transporter (NKCC2) ---> decrease water reabsorption effected augmented with Na restricted diet ``` ``` adverse reactions: decrease Mg+ and Ca2+ reabsroption hypokalemic metabolic alkalosis(ectopic pacemaker and arrhythmias) hypouricemia (same transport) Ototoxicity allergic sulfa reaction. ```
36
Hydrochlorothiazide
Na/Cl contransporter inhibitor --> increasing urinary excretion of NaCl prototype thiazide, 2x daily dose increase Ca2+ reabsorption clinical uses: congestive heart failure in combination with loop diuretics. hypertension hypocalcuria. Adverse reactions/toxicities: ``` hypokalemia ---> ectopic pacemkaers impaired carbohydrate tolerance (hyperglycemia) hyperuricemia hyperlipidemia (long term) allergic sulfa reaction. ```
37
Metolazone
Na/Cl contransporter inhibitor --> increasing urinary excretion of NaCl 1x daily dose (longer duration, acts well with loop diuretics) increase Ca2+ reabsorption clinical uses: congestive heart failure in combination with loop diuretics. hypertension hypocalcuria. Adverse reactions/toxicities: ``` hypokalemia ---> ectopic pacemkaers impaired carbohydrate tolerance (hyperglycemia) hyperuricemia hyperlipidemia (long term) allergic sulfa reaction ```
38
Spironolactone
Potassium-Sparing Diurectic aldosterone receptor antagonist poor oral absorption prevent increased activity and number of Na+ (ENaC leak) channels, K+ leak channels and Na-K ATPase ---> less Na+ absorobed more K+ and H+ excreted. Clinical uses: congestive heart failure ---> anti remodeling action + raising serum potassium to counter the action of K+ wasting diuretics. Hypertension in combination with thiazides Adeverse reactions: hyperkalemia ---> EKG changes, conduction abnormalitis, arrhythmias. gynecomastia
39
Eplerenone
Potassium-Sparing Diurectic aldosterone receptor antagonist good oral absorption metabolized by CYP3A4 prevent increased activity and number of Na+ (ENaC leak) channels, K+ leak channels and Na-K ATPase ---> less Na+ absorobed more K+ and H+ excreted. Clinical uses: congestive heart failure ---> anti remodeling action + raising serum potassium to counter the action of K+ wasting diuretics. Hypertension in combination with thiazides Adeverse reactions: hyperkalemia ---> EKG changes, conduction abnormalitis, arrhythmias.
40
Triamterene
Potassium-Sparing Diurectic direct effect to block the Na+ channels on the collecting duct ---> decrease Na+ reabsorption ---> decrease coupled K+ excretion.
41
Amiloride
Potassium-Sparing Diurectic direct effect to block the Na+ channels on the collecting duct ---> decrease Na+ reabsorption ---> decrease coupled K+ excretion

heart drugs (2 decks)

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