Intro Cardiovascular Drugs Flashcards
Metoprolol
A. Often used as a rate-control antiarrhythmic, caution should be used with this agent in a patient with a reactive airway disease (asthma)
B. This drug has the longest half-life of the calcium channel blockers discussed in class
C. This drug slows action potential upstroke in phase 0 in nodal tissues, decreases the excitability of the SA node and prolongs the AV nodal conduction
D. Often used as a rate-control antiarrhythmic, caution should be used with this agent in a patient with left ventricular dysfunction
E. This drug decreases the slope of phase 4 depolarization and prolongs repolarization in nodal tissues
F. This agent exhibits use-dependent block in nodal tissues
G. Preferred for use in hypertension over other drugs in this list
H. This agent exerts its pharmacological effect at beta receptors
I. This agent exerts its pharmacological effect at T- type calcium channels
J. This agent exerts its pharmacological effect at L- type calcium channels
K. This agent is available for IV administration, and works as a calcium channel blocker
Metoprolol – A, C and H
A. Often used as a rate-control antiarrhythmic, caution should be used with this agent in a patient with a reactive airway disease (asthma)
C. This drug slows action potential upstroke in phase 0 in nodal tissues, decreases the excitability of the SA node and prolongs the AV nodal conduction
H. This agent exerts its pharmacological effect at beta receptors
Amlodipine
A. Often used as a rate-control antiarrhythmic, caution should be used with this agent in a patient with a reactive airway disease (asthma)
B. This drug has the longest half-life of the calcium channel blockers discussed in class
C. This drug slows action potential upstroke in phase 0 in nodal tissues, decreases the excitability of the SA node and prolongs the AV nodal conduction
D. Often used as a rate-control antiarrhythmic, caution should be used with this agent in a patient with left ventricular dysfunction
E. This drug decreases the slope of phase 4 depolarization and prolongs repolarization in nodal tissues
F. This agent exhibits use-dependent block in nodal tissues
G. Preferred for use in hypertension over other drugs in this list
H. This agent exerts its pharmacological effect at beta receptors
I. This agent exerts its pharmacological effect at T- type calcium channels
J. This agent exerts its pharmacological effect at L- type calcium channels
K. This agent is available for IV administration, and works as a calcium channel blocker
Amlodipine – B, G and J
B. This drug has the longest half-life of the calcium channel blockers discussed in class
G. Preferred for use in hypertension over other drugs in this list
J. This agent exerts its pharmacological effect at L- type calcium channels
Nicardipine
A. Often used as a rate-control antiarrhythmic, caution should be used with this agent in a patient with a reactive airway disease (asthma)
B. This drug has the longest half-life of the calcium channel blockers discussed in class
C. This drug slows action potential upstroke in phase 0 in nodal tissues, decreases the excitability of the SA node and prolongs the AV nodal conduction
D. Often used as a rate-control antiarrhythmic, caution should be used with this agent in a patient with left ventricular dysfunction
E. This drug decreases the slope of phase 4 depolarization and prolongs repolarization in nodal tissues
F. This agent exhibits use-dependent block in nodal tissues
G. Preferred for use in hypertension over other drugs in this list
H. This agent exerts its pharmacological effect at beta receptors
I. This agent exerts its pharmacological effect at T- type calcium channels
J. This agent exerts its pharmacological effect at L- type calcium channels
K. This agent is available for IV administration, and works as a calcium channel blocker
Nicardipine – J and K
J. This agent exerts its pharmacological effect at L- type calcium channels
K. This agent is available for IV administration, and works as a calcium channel blocker
The same patient from question 8 returns to the clinic with reports of palpitations; “feels like my chest is racing”. Which would be the best agent to add to his therapy to treat his presenting symptoms?
a. Amlodipine
b. Nicardipine
c. Diltiazem
d. Metoprolol
e. Verapamil
Learning objective: appropriate medication for reflex tachycardia
Answer: D
Use of beta blockade for SNS reflex tachycardia is appropriate here.
Nifedipine
A. Often used as a rate-control antiarrhythmic, caution should be used with this agent in a patient with a reactive airway disease (asthma)
B. This drug has the longest half-life of the calcium channel blockers discussed in class
C. This drug slows action potential upstroke in phase 0 in nodal tissues, decreases the excitability of the SA node and prolongs the AV nodal conduction
D. Often used as a rate-control antiarrhythmic, caution should be used with this agent in a patient with left ventricular dysfunction
E. This drug decreases the slope of phase 4 depolarization and prolongs repolarization in nodal tissues
F. This agent exhibits use-dependent block in nodal tissues
G. Preferred for use in hypertension over other drugs in this list
H. This agent exerts its pharmacological effect at beta receptors
I. This agent exerts its pharmacological effect at T- type calcium channels
J. This agent exerts its pharmacological effect at L- type calcium channels
K. This agent is available for IV administration, and works as a calcium channel blocker
Nifedipine – G and J
G. Preferred for use in hypertension over other drugs in this list
J. This agent exerts its pharmacological effect at L- type calcium channels
A 56-year-old man presents for his regular checkup where his BP is measured at 156/94. This is the third visit where his systolic BP has measured above 150 and although he has changed his diet, the physician decides to treat his BP with medication. Which of the following would be appropriate medications to start this patient on for the treatment of hi hypertension?
a. Amlodipine
b. Nicardipine
c. Diltiazem
d. Metoprolol
e. Verapamil
Learning objective: appropriate medication for hypertension
Answer: A
Amlodipine is a very commonly employed antihypertensive agent. Its long half-life helps prevent “spikes” in the SNS reflex as the drug levels rise and fall slowly, so there is less impact at the baroreceptors.
Choice B: Nicardipine is available as an oral agent, but is not commonly used as a first line for HTN due to short half-life. The IV formulation would be inappropriate.
Choice C and E: Dilt and Verap are non-DHP, and would not be a good first choice in HTN unless the patient has concomitant AFib
Choice D: Metoprolol (and all beta-blockers) are not first line for HTN
Verapamil
A. Often used as a rate-control antiarrhythmic, caution should be used with this agent in a patient with a reactive airway disease (asthma)
B. This drug has the longest half-life of the calcium channel blockers discussed in class
C. This drug slows action potential upstroke in phase 0 in nodal tissues, decreases the excitability of the SA node and prolongs the AV nodal conduction
D. Often used as a rate-control antiarrhythmic, caution should be used with this agent in a patient with left ventricular dysfunction
E. This drug decreases the slope of phase 4 depolarization and prolongs repolarization in nodal tissues
F. This agent exhibits use-dependent block in nodal tissues
G. Preferred for use in hypertension over other drugs in this list
H. This agent exerts its pharmacological effect at beta receptors
I. This agent exerts its pharmacological effect at T- type calcium channels
J. This agent exerts its pharmacological effect at L- type calcium channels
K. This agent is available for IV administration, and works as a calcium channel blocker
Verapamil-C, D, F and J
C. This drug slows action potential upstroke in phase 0 in nodal tissues, decreases the excitability of the SA node and prolongs the AV nodal conduction
D. Often used as a rate-control antiarrhythmic, caution should be used with this agent in a patient with left ventricular dysfunction
F. This agent exhibits use-dependent block in nodal tissues
J. This agent exerts its pharmacological effect at L- type calcium channels
Diltiazem
A. Often used as a rate-control antiarrhythmic, caution should be used with this agent in a patient with a reactive airway disease (asthma)
B. This drug has the longest half-life of the calcium channel blockers discussed in class
C. This drug slows action potential upstroke in phase 0 in nodal tissues, decreases the excitability of the SA node and prolongs the AV nodal conduction
D. Often used as a rate-control antiarrhythmic, caution should be used with this agent in a patient with left ventricular dysfunction
E. This drug decreases the slope of phase 4 depolarization and prolongs repolarization in nodal tissues
F. This agent exhibits use-dependent block in nodal tissues
G. Preferred for use in hypertension over other drugs in this list
H. This agent exerts its pharmacological effect at beta receptors
I. This agent exerts its pharmacological effect at T- type calcium channels
J. This agent exerts its pharmacological effect at L- type calcium channels
K. This agent is available for IV administration, and works as a calcium channel blocker
Diltiazem–C, D, F and J
C. This drug slows action potential upstroke in phase 0 in nodal tissues, decreases the excitability of the SA node and prolongs the AV nodal conduction
D. Often used as a rate-control antiarrhythmic, caution should be used with this agent in a patient with left ventricular dysfunction
F. This agent exhibits use-dependent block in nodal tissues
J. This agent exerts its pharmacological effect at L- type calcium channels
A 62-year old man was diagnosed with atrial fibrillation.He was prescribed a medication that works through blockade of L-type calcium channels. Which of the following are the ECG changes that would be expected to be caused by the use this drug in this patient?
a. PR interval: decrease, QRS duration: unchanged, QTinterval: increased
b. PRinterval: increase, QRSduration: unchanged, QTinterval: unchanged
c. PR interval: increase, QRS duration: decreased, QT interval: increased
d. PRinterval: decrease, QRSduration: unchanged, QTinterval:unchanged
e. PRinterval: increase, QRSduration: unchanged, QTinterval: decreased
Learning objective: describe the effect of non-DHP CCBs on the ECG
Answer: B
Diltiazem and Verapamil are the non-DHPs used for control of Afib. As they have significant impact on the rate of the SA node, and the conductance of the AV node, they will lengthen the PR interval. They will have no clinically relevant effect on the other parts of the ECG
Class IV - Ca2+ blockers
vasodilators
DHPs: nifedipine & nicardipine
Non-DHPs: verapamil & diltiazam (increase ventricular filling)
molecular –> block L-type Ca2+ channels & inhibit Ca2+ influx of vascular SM and cardiac myocytes
DECREASED AFTERLOAD
decrease vascular resistance
increase coronary blood flow
increase PVR in HTN
risks: bradycardia, hypotension, worsened HF
AVOID IN HF!!!! alternative to beta blocker
Class II - Metoprolol
beta1 blocker
–> inhibit receptor in SA node –> decrease If –> decreased rate of phase 4 depolarization –> less frequent firing
–> inhibit AV node –> decrease Ca2+ and K+ currents –> decreased conduction velocity –> increased nodal refractory period
ECG: decreased conduction –> stronger AV node –> PR increased
Phase 4 decreased: SA node
risks: bradycardia, hypotension, bronchospasm
1st line
molecular effect vs pharm effect
molecular: what happens in the cell
pharm: what that does to the body
