Pharm - Arrythmias, IHD.

Question 1

What is an automatic arrythmia?

Answer 1

Impulse that’s formed from ectopic pacemaker or sinus disturbance

Question 2

What is a re-entry arrythmia?

Answer 2

When the propagating impulse persists after the refractory period has ended.

Question 3

What’s the difference between excitability and conductivity?

Answer 3

Excitability is the ability to RESPOND to an impulse

Conductivity is the ability to SEND an impulse.

Question 4

Is conductivity the same thing as automaticity?

Answer 4

No, automaticity means the cells can generate the signal spontaneously and pass it along.

Question 5

What phase of the AP cycle does Automaticity refer to?

Answer 5

Slope from RMP to threshold - actually phase 4 of the prior AP.

Question 6

What phase does conduction velocity correspond to?

Answer 6

Phase 0: the slope of the line that shoots straight upwards. This is when Na is entering the cells.

Question 7

What phase does the refractory period correspond with?

Answer 7

Phase 3: when the line is returning to the RMP. This is when the cells are repolarizing and K+ is entering the cells.

Question 8

What phases exist in nodal cells?

Answer 8

Phases 0, 3 and 4.

Question 9

Class II anti-arrythmics are what kind of drug?

Answer 9

Beta-blockers

Question 10

When would you not want to use Class II anti-arrythmics?

Answer 10

Shock

ADHF (Acute Decompensated heart failure)

Bradycardia

Heart block

Asthma (they block action of bronchodilators)

Question 11

What phases do beta blockers work on?

Answer 11

They:

Slow Phase 4 (automaticity):

Slow Phase 0
(Conduction velocity)

Increase phase 3
(Refractory period)

Question 12

If a pt has Ischemic heart disease, they probably have…

Answer 12

Increased cholesterol.

Question 13

What is the first manifestation of IHD in about half of patients?

Answer 13

CSA (chronic stable angina).

Question 14

Lifestyle modifications for IHD?

Answer 14

Quit Smoking. No exposure to env’t smoke.

30-60m of exercise daily.

BMI less than 25.

Immunizations.

Question 15

What medications are used to treat IHD?

Answer 15

B-blockers
CCBs
Nitrates
Ranolazine

Antiplatelet
Statins
ACEIs or ARBs
(These prevent remodeling).

Question 16

Why are BBlockers useful in IHD? What BPM is target?

Answer 16

Decrease O2 demand. 55-60bpm.

Question 17

Why are CCBs helpful in IHD?

Answer 17

Increases O2 supply in vasospastic angina pts. Dilates coronary vessels, relaxes smooth muscle.

Question 18

Why are Organic Nitrates helpful in IHD?

Answer 18

Increase NO and decrease O2 demand. Improves collateral flow to ischemic areas.

Question 19

What are the routes you can give nitroglycerin in?

Answer 19

tab, SL, spray, patch, paste, IV.

Question 20

What would you tell a pt who takes nitro who is complaining about HA and lightheadedness?

Answer 20

It’s d/t vasodilation. They’ll go away unless you keep nitro going all the time.

Question 21

When should you call 911 for chest pain, assuming the pt has a nitro prescription?

Answer 21

Right before the 2nd dose if chest pain is not relieved.

Question 22

How might a person unintentionally hurt themselves when they take SL nitro?

Answer 22

Falling - tell them to sit down.

Question 23

How likely is someone to have CAD if they have diabetes?

Answer 23

It’s almost 100%. Just assume, if they have DM, they also have CAD, IHD.

Question 24

Why are antiplatelet useful in IHD?

Answer 24

B/c the aggregation of platelets is a huge part of blockage formation. Prevents CAD and acute MI.

Question 25

What’s the difference between UA, NSTEMI and STEMI?

Answer 25

UA: partial blockage, ischemia.
NSTEMI: partial blockage, infarction.
STEMI: complete blockage, infarction.

Question 26

“Every pt with chest pain meets MONA B. In the ED.”

What does this mean?

Answer 26

Pts who present with chest pain to the ED will get:

Morphine
Oxygen
Nitro (SL)
Aspirin (325mg total). 
Beta-blocker.

Question 27

After the ED (in the cath lab) what agents are used for acute chest pain?

Answer 27

P2Y12 inhibitors (platelet inhibitors)
Anticoagulants
GPIs (glycoproteins inhibitors): “super aspirin”
Thrombolytic agents.

Question 28

How long can P2Y12 inhibitors be taken?

Answer 28

Up to 12mos post-MI if they had a stint placed. Up to 4 months if no stint.