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CVS > L05: Drugs And The Heart > Flashcards

L05: Drugs And The Heart Flashcards

1
Q

How can drugs act to affect the heart function

A

Directly

Indirectly

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2
Q

What does the direct action of drugs affect

A

Rate

Force of contraction in myocytes

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3
Q

What does indirect action of drugs do to affect the heart function

A

Affect the vasculature

Affect blood volume

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4
Q

Why do we need drugs that affect the rate of the heart

A

To treat arrhythmia

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5
Q

What is arrhythmia

A

A disorder where the area is disturbed

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6
Q

Why is the rate disturbed in arrhythmia

A

Generation and conduction being abnormal

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7
Q

What do anti arrhythmic drugs affect

A

The ion current which affect the AP

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8
Q

How many classes of drugs does anti arrhythmic drugs have

A

4

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9
Q

What are the classes of anti arrhythmic drugs dependent on

A

Which channels they work on

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10
Q

Which channels does class 1 anti arrhythmic drugs work on

A

Voltage gated sodium channels

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11
Q

What are class 1 anti arrhythmic drugs

A

Voltage gated sodium channel blockers

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12
Q

Give an example of a class 1 anti arrhythmic drug

A

Lidocaine

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13
Q

What is the role of class 2 anti arrhythmic drugs by blocking voltage gated sodium channels

A

Slows depolarisation and increases the refractory period

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14
Q

What channels do class 2 anti arrhythmic drugs work on

A

Beta 1 adrenoceptors

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15
Q

What are class 2 anti arrhythmic drugs

A

Beta blockers

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16
Q

What is the role of class 2 anti arrhythmic drugs

A

Reduce the effect of the sympathetic ns on the SAN

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17
Q

Give an example of a class 2 anti arrhythmic drug

A

Metropol

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18
Q

Which channels do class 3 anti arrhythmic drugs work on

A

Potassium channels

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19
Q

What are class 2 anti arrhythmic drugs

A

Potassium channel blockers

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20
Q

What is the effect of the class 2 anti arrhythmic drugs

A

Prolong action potential

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21
Q

Give an example of a class 3 anti arrhythmic drug

A

Amiodarone

Solalol

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22
Q

Which channels do class 4 anti arrhythmic drugs work on

A

L type (voltage gated calcium channels)

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23
Q

What are class 4 anti arrhythmic drugs

A

Voltage gated calcium channel blockers

24
Q

What is the effect of class 4 anti arrhythmic drugs

A

Reduce depolarisation in SAN and AVN

25
What are non classified drugs
Drugs that do not get into classifications
26
Name 2 non classified drugs involved in the heart
Adenosine | Cardiac glycosides
27
Name an example of cardiac glycosides
Digoxin
28
Which receptors do adenosine binds to
Adenosine receptors
29
Where are adenosine receptros found
In the cells of SAN and AVN
30
What happens when adenosine binds to adenosine receptors
It opens potassium channels
31
What does opening of potassium channels cause
Hyperpolarisaton
32
What does hyper-polarisation mean in terms of refractory period
Increases the refractory period and the cell become further away from reaching threshold after hyperpolarisation
33
What is the role of cardiac glycosides
Increases vagal activity
34
What does increase in vagal activity do
Decrease AVN conduction rate due to activation of the parasympathetic NS
35
Why do we need drugs that affect force of contraction
To treat Anaphylaxis Heart failure
36
What happens to cardiac output in cardiac failure
Insufficient for metabolic needs of the body
37
How do we get cardiac myocytes contraction
Voltage gated calcium channels open due to depolarisation This causes calcium influx Calcium influx causes the release of other calcium from the sarcoplasmic reticulum Calcium release moves regulatory complex from the actin binding site so myosin head binds to actin binding site to form a cross bridge and contraction
38
If drugs want to affect the force of contraction what do they need to effect
The intracellular calcium levels
39
Which drugs increase the intracellular calcium
Positive ionotrophic
40
What are the 3 inotrophic drugs
Sympothomimetics Cardiac glycosides Phosphodiesterase inhibitors
41
Give an example of cardiac glycosides
Digoxin
42
What is the mechanism of action of cardiac glycosides
Partial inhibition of sodium/potassium ATPase
43
How does the partial inhibition of sodium/potassium ATPase lead to the increase in intracellular calcium
1) after contraction some calcium will become stored back in the sarcoplasmic reticulum and some will be exchanged by sodium 2) calcium will leave out by a calcium/sodium transporter 3) another channel of sodium/potassium ATPase maintains the sodium concentration 4) dioxin partially acts on the sodium/potassium ATPase which causes a rise in sodium inside the cell 5) this makes the calcium/sodium exchanger less efficiency as there is lots of sodium in side the cell 6) this causes a rise in intracellular calcium
44
What are the side effects of cardiac glycosides
- Ionic disturbance which can cause excitability and therefore arrhythmia’s - gynaecomastia- breast growth in both sexes
45
What are the other issues with using digoxin
Digoxin can interact with other drugs such as diuretics
46
Give an example of phosphodiesterase inhibitors
Milrinone
47
What is the mechanism of action of phosphodiesterase inhibitors
Inhibits the enzyme phosphodiesterase
48
What is the normal role of phosphodiesterase
Break 2nd messenger CAMP
49
How does calcium levels increase with phosphodiesterase inhibitors
Inhibiting phosphodiesterase increases CAMP CAMP open calcium channels Intracellular calcium therefore increases as calcium influx occurs
50
What channel does verapamil effect
Voltage gated calcium channels
51
What channel does lidocaine affect
Voltage gated sodium channel
52
What channel does metropol affect
Beta 1 adrenoceptors
53
What channel does amiodrone affect
Voltage gated potassium channel
54
What are the 2 roles digoxin
Increase vagal activity | Partially inhibit sodium/potassium ATPase
55
What channel does adenosine affect
Potassium channel

CVS (19 decks)

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