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IPAP > Pharm Block 2 Anti-As and Angina > Flashcards

Pharm Block 2 Anti-As and Angina Flashcards

1
Q

What are the 3 ions that regulate the heart?

A

Na K Ca

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2
Q

What are the names of the five AP phases?

A 
Upstroke
Early-fast repolarization
Plateau
Repolarization
Diastole
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3
Q

Arrhythmias can result from one of what three issues?

A 
Abnormal Automaticity (impulse formation)
Abnormal Impulse Conduction- development of short-circuit pathway
Re-Entry Phenomenon- impaired conduction
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4
Q

How do antiarrhythmics exert their effect on the heart?

A

Inhibits K channels to widen AP causing prolonged QT interval

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5
Q

Excessive prolongation of QT interval can results in ?

A

Torsades de Pointes- ventricular tachyarrhthmia

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6
Q

QT interval prolongation is usually caused by ? but can be caused by what three things?

A

Drug induced

Can be from ischemia, hypoK, genetics

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7
Q

Torsades de Pointes typically occurs when QT intervals exceed what time and can be caused by ?

A

> 500 milliseconds

Hypo K, Mag, drugs

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8
Q

Define Supraventricular arrhythmias

A

Originate in Atria and AV nodes

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9
Q

What type of arrhythmia can lead to HF or ischemic stroke?

A

A-Fib

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10
Q

Define Re-Entrant rhythm

A

Atrial flutter- signals travel in circle and not across the atria

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11
Q

Define PSVT

A

HR above 100 bpm originating superior to ventricles when atria contract prematurely

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12
Q

Define PACs and what type of arrhythmia are they?

A

Transient ryhthm when extra beat originates in atria

PSVT

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13
Q

What can cause PVCs to develop?

A

Structural HD
Electrolyte imbalance
ETOH
Stimulants

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14
Q

CAST was tested with what two meds?

A

Encainide

Flecainide

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15
Q

What is the most common classification of antiarrhythmic drugs and what are they based upon?

A

Vaughn-Williams System

Effect on Purkinje fibers

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16
Q 
Supra/Ventricular arrhythmias are treated with what class of drugs?
Ventricular arrhythmias are treated with what class of drugs?
A

Class 3
Class 1A
Class 1C

Class 1B

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17
Q

Supraventricular arrhythmias are treated with what drugs?

A

Adenosine
Digoxin
Verapamil

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18
Q

Stress induced arrhythmias are treated with what class of drugs?

A

Class 2: BBs, propranol, atenolol

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19
Q

What classes of drugs are used for Rate, Rhythm or Both control?

A

Class 1- rhythm
Class 2- rate
Class 3- both (rate- Am, So, Dr)
Class 4- rate

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20
Q

What drug was the prototype of Class 1A drugs?

What is the most frequently used 1A drug?

A

Quinine

Procainamide

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21
Q

What happens if Quinidine is given in high doses?

A

Cinchonism

Can exacerbate myasthenia gravis

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22
Q

Procainamide is the 2/3 choice drug for ventricular arrhythmias associated with MI after what two drugs have been used?

A

Lidocaine

Amiodarone

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23
Q

What two drugs can produce the Lupus macular-like rash?

A

Hydralazine

Procainamide

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24
Q

Disopyramide has what added benefit on top of it’s Class 1A effects?

A

Class 3- K blocking, prolong repolarization

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25
Q

Disopyramide is reserved for treatment of what type of PT?

A

Ventricular arrhythmia that are refractory/intolerant to Quinidine or Procainamide

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26
Q

Class 1B drugs have what effect on the electrical process?

A

Shortens Phase 3 repolarization

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27
Q

What are the 3 uses of Lidocaine?

When must the dose be adjusted?

A

Shortens V-tach with pulse
Prevents V-tach after conversion
Alternate for PVT/VF if amiodarone is not available

Hepatic Dz and/or CHF

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28
Q

What is the least cardio toxic Na Channel blocker?
When is it contraindicated?
What can it interact with?

A

Lidocaine
3* block
Amiodarone inc lidocaine levels

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29
Q

What is Mexiletine used in the treatment of?

What is it contraindicated in?

A

Ventricular arrhythmias associated with previous MI
Off label- diabetic neuropathy
3* block

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30
Q

What is the MOA of Class 1C agents?

A

Slows conduction velocity w/ little effect on refractory period of Supraventricular/Ventricular arrhythmia

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31
Q

When are Class 1C drugs used?

A

PTs with normal hearts but have supraventricular arrhythmia

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32
Q

Avoid Class 1C drugs in what PTs?

A

Post MI

HF

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33
Q

Class 1C drugs have what effect on the electrical process?

A

Slows conduction velocity with little effect on refractory period

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34
Q

What Class 1C drug possesses negative ionotropic effects and can exacerbate HF?

A

Flecainide

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35
Q

What are the two uses of Flecainide?

A

Sinus rhythm maintenance of A-fib w/out structural HD

Life threatening V-tach, refractory

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36
Q

What are the 3 contraindications for Felainide?

A

HF
VD
CAD

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37
Q

What are the three uses of Propafenone?

A

Supraventricular arrhythmia w/out structural HD
Rhythm control of A-fib/flutter
Life threatening V-tach

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38
Q

What are the DOC in A-fib/flutter?

A

BBs

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39
Q

A-fib PTs should be started on what additional medication on top of the BB?

A

Anticoagulation

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40
Q

Of the anti-arrhythmic BBs, which one is non-selective?

A

Propranolol

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41
Q

What is Esmolol used for?

A

Intraoperative BP/HR control and acute arrhythmia

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42
Q

What drug has zero drug interactions due to being metabolized in RBCs?

A

Esmolol

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43
Q

What is the MOA of Class 3 drugs?

A

Prolong phase 3, refractory period in ventricle/supraventricle tissue

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44
Q

Amiodarone has what three effects?

A

BB
Anti-angina
Vasodilation

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45
Q

What is the DOC of PVT/VF

A

Amiodarone

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46
Q

What type of PTs is Amiodarone used in?

A

A-fib conversion
Suppression of arrhythmias in PTs with implanted defibrilators
Preferred agent for PTs with LVD/HF

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47
Q

What is the derivative of Amiodarone that doesn’t contain iodine?

A

Dronedarone

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48
Q

What is the clinical use of Dronedarone

How is it’s bioavailability increased?

A

Maintain sinus rhythm in A-fib/flutter w/ history of paroxysmal/persistent A-fib
Taken with food

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49
Q

What is Sotalol used for?

A

Treatment of Supra/Ventricular arrhythmias in Peds

Maintenance of sinus rhythm in PTs with A-fib

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50
Q

What is the MOA of Ibutilide?

A

Class 3 that prolongs AP duration that slows sinus rat and AV conduction velocity

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51
Q

What is Ibutailide used for?

A

Rapid conversion of A-fib/flutter to normal sinus

More effective if onset is less than 90 days

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52
Q

What is Dofetilide used for?

A

Conversion of A-fib/flutter

Maintenance of sinus in PTs with arrhythmias lasting greater than a week

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53
Q

What effect do Class 4 drugs have on the SA and AV nodes?

A

Slows Ca conduction in AV (most important)

SA- Slow depolarization and decrease HR

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54
Q

What are Class 4 drugs beneficial against?

A

Atrial arrhythmias

Re-entrant supraventricular tachy

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55
Q

Which Non-DHP has grater action on the heart?

A

Verapamil

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56
Q

Which Non-DHP is more potent vasodilator than Verapamil?

A

Diltiazem

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57
Q

What is the MOA of Digoxin?

A

Cardiac glycoside, inhibits Na/K pump in cardiac membrane dec K and inc Na/Ca

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58
Q

What is the clinical effect of taking Digoxin?

A

Inc contractions

Stims Vagus nerve to slow SA/AV node and HR w/out increasing O2 demand

59
Q

What drug is used to control ventricular rate with A-fib/flutter?

60
Q

When is Digoxin used as an add on therapy for HF?

A

PTs failed to achieve Sx control

61
Q

What is the MOA of Adenosine?

A

Inc K efflux
Dec Ca influx
Slows HR and AV conduction

62
Q

What is Adenosine the drug of choice for?

A

Conversion of regular rhythm paroxysmal supraventricular tachycardia to sinus rhythm

63
Q

What must every Adenosine administration be followed with?

What is the starting dose?

A

NaCl flush

6mg

64
Q

PTs taking what drug may not be responsive to Adenosine?

A

Theophylline

65
Q

What is the most common arrhythmia?

Where is it a common comorbidity?

A

AFib

Valve HD or HF

66
Q

For Torsades de Points, if they have it give ?

If they don’t have it give?

A

Magnesium

BB

67
Q

Define Atrial Flutter

A

Atrial rate 300

68
Q

Define Atrial Fibrillation

A

Atrial muscles writhering dure to ectopic areas

Ventricle rate +140bpm

69
Q

What are the five classifications fo A-Fib?

A 
Paroxysmal
Persistent
Long standing
Permanent
Recurrent
70
Q

_____ control is at least as good as _____

____ have more risk than ____ drugs

A

Rate, Rhythm

Rhythm more than rate

71
Q

How are Rhythm control drugs chosen?

A

Based on disease state

72
Q

Avoid Class __ and __ in HF PTs

73
Q

What three Class 3 drugs have a neutral effect on mortality in PTs with LVD post-MI?

A

Amiodarone
Dofetilide
Sotalol

74
Q

Dronedarone is contraindicated in PTs with ___?

A

SxHF with recent decompensation requiring admission

NYHA Class 4

75
Q

Avoid Class __ and ___ in acute MI

What two Class 3s can be used?

A

1A and 1C

Amiodarone and dofetilide

76
Q

Avoid Class __ in PTs with structural HD?

77
Q

What is the goal of ventricular rate control?

A

Reduce Sx and prevent tachy-induced cardiomyopathy

78
Q

What therapies have an effect on cardioconversion of AF?

A

BB
CCBs
Digoxin
Amiodarone

79
Q

Which BBs can be considered for PTs with stable HF?

A

Carvedilol
Metoprolo
Bisoprolol

80
Q

Avoid BBs for ventricular rate control in PTs with what syndrome?

A

Wolff-Parkinson-White

81
Q

Avoid Non-DHPs in ventricular rate control if what is present?

A

Concomitant Systolic dysfunction

82
Q

Non-DHP CCB use for ventricular rate control may be preferred over BB in PTs with ?

A

COPD

Asthma

83
Q

___ is ineffective for monotherpay for controlling ventricular rate in AF

84
Q

When can Amiodarone be used for rate control in PTs with HF?

A

No accessory pathway

85
Q

Amiodarone is not considered first or second line options for rate control after ?

A

BBs
Non-DHPs
CCBs
Digoxin

86
Q

PTs with any form of A-fib need to be evaluated on what criteria?

A 
Anti-Coagulation Therapy
Dabigatran
Rivaroxaban
Apixaban
Warfin
Edoxaban
87
Q

When is aspirin use for angti-coagulation therapy?

A

No other problems and under 60y/o

88
Q

What is considered first line for cardioconversion in AF for stable PTs?

A

Electrical

89
Q

If PT is experiencing AF for more than 48hrs what needs to be considered/added?

A

Anticoagulation
Less than 48hrs=1%
More than 48= 15%
More than 72= 30% rate of thrombus

90
Q

What must be verified before converting a PT with a-fib?
What is needed for pre-conversion care?
What is needed for post-conversion care?

A

Absence of atrial thrombi
Anticoagulation x 3wks
Anticoagulation x 4wks

91
Q

Cardioconversion of PTs with A-fib is contraindicated in PTs with what heart issue?

A

Structural HD

92
Q

What Class 3 agent is used during cardioconversion for AF?

A

Amiodarone initiated for out-pt use after anti-coagulation

93
Q

Amiodarone is useful for cardioconversion in PTs with A-fib and what two underlying issues?

A

Worlf-Parkinsons after 1C drugs have failed

Safe in HF

94
Q

What two Class 3 drugs are safe for use in cardioconversion of A-fib in PTs with HF?

A

Amiodarone and Dofetilide

95
Q

What is the DOC for Symptomatic Bradyarrhythmia?

96
Q

What is the DOC for Paroxysmal Supraventricular Tachy?

A

Adenosine, fastest onset and shortest duration of action

97
Q

What is the sequence of DOCs for Acute Ventricular Tachy/Pulseless Fib?

A 
Epi, followed by:
1st line antiarrhythmic- amiodarone
Lidocaine
Procainamide
Empiric Magnesium
98
Q

What is the DOC for Torsades de Pointes?

A

Magnesium IV in PTs with TdP and digitalis toxicity and hypomagnesium is present

99
Q

Ischemic HD is AKA?

A

Coronary Heart Disease

Sx from imbalance of O2 demand and supply

100
Q

What are the phases of Ischemic Heart Disease?

A 
Asymptomatic
Stable angina
Progressive angina
Unstable angina
Non-STEMI
STEMI
101
Q

Define STEMI and what it indicates

A

Persistent ST elevations and release of biomarkers of necrosis
Elevation indicates full thickness injury to muscle

102
Q

Define Non-SEMI and what it’s associated with?

A

Usually caused by atherosclerosis and associated with increased risk of cardiac death/MI
Absence of elevation indicates lack of full thickness

103
Q

Priority of Stable Plaque phase of Acute Coronary Syndrome

Priority of Unstable angina phase?

A

Control anginal Sx

Prevent total occlusion

104
Q

What is the priority during N/STEMI phases of ACS?

A

Prevent total occlusion, limit infarct size

Restore patency of infarcted artery, prevent arrhythmia/death

105
Q

Define Chronic Stable Angina, it’s AKA and treatment

A

Exertional/Classic angina
Most common fro reduced coronary perfusion
Rest, nitro, BB/CCB

106
Q

Define Unstable Angina, it’s AKA and treatment

A

Crescendo/Pre-Infarction Angina
Episodes of small clots, PT may present with angina at rest
Admit and treat

107
Q

Define Variant Angina, it’s AKA and treatment

A

Prinzmetal/Vasospasitc
Coronary artery spasm caused by decreased blood flow to heart from coronary artery
Nitro and CCB

108
Q

What treatment plan applies to all PTs with chronic coronary artery disease and chronic stable angina?

A 
ABCDE
Aspirin/anti-anginal 
BB/BP
Cigarette/cholesterol cessation
Diet/Diabetes
Education/exercise
All to decrease cardiac load and inc blood flow
109
Q

What treatment classes are available for angina?

A 
BBs- first line for stable IHD
Nitrates
CCBs
Na blockers (BB alternative)
ACEI/ARB in PT with CV comorbidities
Lipid lowering agents
Anti-platelet
110
Q

All angina PTs should be treated with ? or the alternative

A

Aspirin

Clopidogrel

111
Q

How do BB help in angina PTs?

A

Dec O2 demand by decreasing catecholamines

112
Q

What is the clinical use for BB with angina PTs?

What can be combined with it?

A

Long term chronic angina w/ Sx occurring more than once a day or during exertion
Used with nitrates, avoid ISAs

113
Q

____ class of drug is detrimental in rest or severe angina

114
Q

BBs should be avoided in what type of angina PT?

A

Prinzmetal, use CCBs

115
Q

CCBs can be used for what type of angina PT?

A

Stable

Or those who can’t tolerate BB/Nitrates due to adverse effects

116
Q

What DHPs can be used in angina PTs?

A

Nifedipine- added HTN/Sx control, oldest/best studied and used agent in class
Felodipine- HTN/Sx control
Amlodipine- HTN Sx control when HF is present

117
Q

NO dependent relaxation of vascular smooth muscle leads to ?

A

Endothelium dependent vasodilation

Inhibits coronary artery spasm

118
Q

Spironolactone is more effective diuretic in what type of PTs?

A

2* Hyperaldosteronism- Hepatic Cirrhosis, Nephrotic syndrome
Ascites
PCOS

119
Q

What is a benefit of using Milrinone?

A

Inhibits PDE3

No direct adrenergic effect so safe for use in PTs on BBs

120
Q

Using Nitrates for stable angina is useful in conjunction with what other two classes?

A

Non-DHP

BB

121
Q

What form of nitrates are stable from hepatic breakdown and allow for long duration?

A

Isosorbide mononitrate

122
Q

What are the adverse reactions of nitrates?

A

HA
Inc ICP
Methemoglobinemia

123
Q

What is nitrates contraindicated to use with?

A

PDE5 inhibitors- can cause hypertrophic obstructive cardiomyopathy
Inferior wall MI
Aortic valve stenosis

124
Q

WHat is the max dose of SL Nitro?

Don’t use nitro tabs if they’re older than ?

A

.4mg
Max is 3 tabs in 15min, lasting more than 20min
6mon

125
Q

Nitro is the DOC for what type of PT heart issue?

A

Preload reduction in PTs with pulmonary congestion

126
Q

Transdermal patches are used for what types of angina and in conjunction with?

A

Chronic stable but must have nitrate free period daily

BBs

127
Q

What form of nitrate is reserved for inpatient use when PTs require variable doseages?

128
Q

What is the clinical use of Isosorbide Dinitrate?

A

Prevent angina pectoris Sx in chronic stable angina w/ BBs

Approved combo of ISDN/hydralazide in HF

129
Q

What form of nitrate has the best bioavailability?
What is this form used for?
What step must be taken by the PT?

A

Mononitrate- ISMO at 100%
Treating chronic stable angina w/ BBs BUT is not FDA approved
7hrs in between dose to prevent tolerance

130
Q

What is the clinical use of Ranolazine?

A 
Monotherapy for chronic stable angina if BBs were adverse/ineffective
#3 in line added to CCBs, BBs or nitrates when traditional management is not effective
131
Q

What are the adverse reaction of Ranolazine?

A

QT prolongation

Limit dose to 500mg BID

132
Q

What are the three clues that indicate unstable angina?

A

Longer than 20min
New onset/inc of angina
Sudden development of SOB

133
Q

How is NSTEMI angina medically managed?

A

Antiplatelets w/ aspirin and P2Y12 inhibitor +- glycoprotein 2b/3a inhibitor

134
Q

What are the two types of inhibitors used in NSTEMI?

A

P2Y12- Clopidogrel- inhibits platelet activation/aggregation

Glycoprotein 3a/2b Inhib- prevents formation/aggregation

135
Q

All PTs with NSTEMI ACS receive anticoagulation therapy with includes what four things?

A 
Unfract. Heparin
Low weight Heparin
Foondaprinux
Bivalirudin
All prevent formation of fibrin and thrombus
136
Q

How is PCI performedin PTs with UNSTEMI?

A

PIC w/ fibrinolytics

137
Q

When are BB the first line drug?

A

PT after MI to dec PVCs

138
Q

When are Non-DHPs the first line drug?

A

PT w/ Inc HR for rate

Rate control for A-Fib and can’t tolerate a BB

139
Q

A-Fib PTs need what two drugs?

A

BB

Anti-Coagluant

140
Q

What is the first line drug for PVT/Fib?

A

Amiodarone

141
Q

What is the first line drug for PSVT?

142
Q

What is the DOC for Pinzmetal Angina?

143
Q

What is the first line drug for lithium induced nephrogenic diabetes insipidous?

A

Triamterene

Thizide for only D Insip.

144
Q

All HFrEF PTs get what class of drug unless CI?

IPAP (212 decks)

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