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SBM > SBM: Pharmacology & therapeutics - Cardiology > Flashcards

SBM: Pharmacology & therapeutics - Cardiology Flashcards

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1
Q

name 4f factors controlling coronary circulation

A

Arterial pressure Cardiac cycle Heart Rate Direct sensitivity of arterioles to anaerobic metabolites`

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2
Q

Compare coronary flow of a normal patient to one with coronary artery disease

A

Normal Pt: Flow can increase 8 fold in response to demand Disease: increase in flow is LIMITED

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3
Q

Angina What are the two types of angina

A

Stable + Unstable

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4
Q

Describe a patient with UNSTABLE angina

A

Unexpected usually occurs @ rest discomfort may be more severe and prolonged that typical angina

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5
Q

Describe a patient with STABLE angina

A

Episodes of chest discomfort Predictable - e.g. on exertion/stress

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6
Q

What is angina?

A

symptom of Myocardial Ischaemia myocardium does not get enough oxygen –> heart poorly supplied its blood wrt metabolic needs

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7
Q

list 6 (SIX) Anti-anginals

A

Nitrates Beta Blockers CCB Potassium channel activators metabolic manipulators Opiates

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8
Q

Name two types of nitrates used?

A

Nitroglycerin + Isosorbide dinitrate

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9
Q

What is Nitroglycerin used for?

A

Stable Angina

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10
Q

Explain the mechanism of nitroglycerin

A

Acts of vascular smooth muscle –> vasodilation Primarily works on veins (modest dilation of arterioles) Decrease myocardial oxygen demand

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11
Q

How does nitroglycerin decrease myocardial oxygen demand? (Ppt Notes)

A

it was first thought that GTN worked by dilating coronary vessels. However due to atherosclerosis - they believe it limits the dilation. therefore GTN works by dilating in the periphery. the reduction in PRELOAD and then the AFTERLOAD subsequently decreases the workload of the heart –> decreasing oxygen demand

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12
Q

Side effects of nitroglycerin

A

headaches, tachycardia, hypotension

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13
Q

Why would you use isosorbide dinitrate instead?

A

more stable that nitroglycerol longer lasting effect

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14
Q

What problem can arise with Isosorbide dinitrate?

A

Tolerance can occur - therefore give lowest dose

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15
Q

Beta blockers are used for what diseases? (How do you know they are B-blockers)

A

Hypertension, IHD, arrhythmias, hyperthyroidism, gluacoma (- olol)

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16
Q

How do B-Blockers work?

A

Competitive Beta receptor blockade - reduction in heart rate - increases diastolic filling time therefore reduces force of contraction

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17
Q

Put these in order of selective to non selective starting with NON SELECTIVE to selective metoprolol - atenolol - nebivolol - propranolol - bisoprolol - esmolol

A

propranolol - atenolol - metoprolol - bisoprolol - nebivolol - - esmolol

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18
Q

What are the common side effects of B blockers

A

Bronchospam, hypotension, severe bradycardia,. cardiac failure

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19
Q

How do dihydropyridine CCB work?

A

Vasodilation NO CARDIAC SLOWING

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20
Q

What can dihydropyridine CCB be used for

A

IHD Hypertension

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21
Q

name 3 dihydropyridine CCB (how do you know a drug is a CCB)

A

Nefedipine, amlodipine, delodipine (- dipines)

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22
Q

What are rate slowing CCB

A

Vasodilator Cardiac slower

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23
Q

Name 2 Rate Slowing CCB

A

Verapamil Diltiazem

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24
Q

What are rate slowing CCB used for

A

IHD Hypertension Atrial arrhythmias

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25
Name a potassium channel activator
Nicorandil
26
Action of Nicorandil?
Similar to nitrates Acts of vascular smooth muscle --\> vasodilation Primarily works on veins (modest dilation of arterioles) Decrease myocardial oxygen demand
27
name 3 metabolic manipulators
perhexiline trimetazadine ranolazine
28
Describe the cardiac electrical activity
1) Beat initiated by spontaneous depolarisation of pacemaker cells in SAN 2) these cells trigger neighbouring cells to depolarise by DIRECT electrical contacts. A wave of depolarisation spreads across atria - contracts. 3) The signal eventaully excites the AVN 4) AVN to ventricle by Bundle of His (conducting tissues - derived from modified cardiac muscle - Purkinje fibers) 5)
29
What is the Bundle His made from?
derived from modified cardiac muscle - Purkinje fibers
30
When do arrhythmias occur? (3)
1) when the hearts NATURAL pacemaker develops an abnormal rate/rhythm 2) when normal conduction path is interrupted 3) ???? When another part of the heart takes over as pacemaker (UNDERSTAND?)
31
What does Tachycardia mean?
fast
32
What does Bradycardia mean?
slow
33
what qualifies as a tachyarrhythmias?
\>100bpm
34
What tachyarrhythmias is Supraventricular?
AF Atrial flutter 'SVT'
35
What does SVT mean?
Supraventricular ttachyarrhythmias - that is NOT AF/Atrial flutter
36
What tachyarrhythmias are Ventricular
VT VF Torsade de Pointes
37
What does VT mean?
Means there is an arrhythmia in theventricle, which started by an ectopic and then developing a short circuit of depolarisation and depolarisation within the ventricle.
38
What is shown in this ECG?
VT
39
What is shown in this ECG?
VF
40
What is the aim of antiarrhythmic drugs?
Reduce ectopic pacemaker activty + modify critically impaired conduction.
41
what makes an ideal anti-arrhythmic drug?
Work on ectopic pacemaker and depolarised tissue more than on normal depolarising tissues
42
How do anti-arrhytmic drugs work?
Altering ion flxues (Na,Ca,K) within excitable tissues in the myocardium.
43
what is used to classify anti-arrythmic drugs?
Singh-Vaugn Williams system
44
What are the 4 classes of anti arrythmic drugs?
Class 1: Na channel blockers Class 2: B blockers Class 3: K Channel Blockers Class 4; Ca Channel Blockers
45
Where do each of the classes work?
46
How do Class One anti-arrythmic drugs work?
block the Fast inward sodium channel
47
How are class 1 anti arrythmic drugs subdivided? based on what?
IA, IB, IC Based on potency towards blocking teh sodium channel and effects on repolarisation
48
What does IA classify for? Examples?
High/Intermediate potency Prolong Repolarisation - prolong QT interval Quinidine, disopyramide
49
What does IB classify for? Example?
Lowest potency shorten repolarisation Decrease QT interval E,g Lidocaine, Mexiletine
50
What does IC classify for? Example?
Most potent sodium channel blocking agents Prolong QRS interval Little effect on repolarisation - NO EFFECT ON QT interval E.g. Flecainide, propafenone.
51
What is Disopyramide? What is it used for?
Disomyrapide is a sodium channel blocker Used for Supraventricular arrythmias And in ventricular arrythmias BUT only in pt with good ventricular fucntion because of its negative inotrophic effects. Has anti-cholinergic effects.
52
# trick... What is dipyridamole?
Antiplatelet used in stroke
53
What is Lidocaine / Mexiletine
Sodium Channel blockers Lidocaine - It is used IV only - because of its first pass metabolism mexiletine is orally active
54
Propafenone is what class of anti-arrythimic drug?
Class IC used to treat supraventricular arrythmias used to suppress life threatening ventricular arrhythmias Structurally similar to propranolol and has beta blocking activity aswell. THEREFORE CONSIDER WHEN GIVING IN HEART FAILURE PATIENTS
55
How do Class 2 Anti arrhythmias work? What are class 2?
acts indircetly by blocking beta-adrenergic receptors. Slow sinus rhythm, prolong PR interval Beta Blockers - olols
56
What are class 3 anti arrhythmic drugs? Examples?
K channel blockers prolongs reploarization Prolong QT interval No effect on QRS interval Little effect on rate of depolarisation Block fast outward K+ - Amiodarone, Sotalol Block slow INward Na+ current: Ibutilide
57
What are class 4 anti-arrhythmic drugs? Example
CCB relatively selective AV nodal CCB Slow sinus rhythm Prolong QR interval Verapamil, diltiazem
58
How do class 3 anti arrhythmic drugs work?
K Channel blockers prolong repolarisation by blocking outward K.
59
What do you treat intractable ventricular arrhythmias with?
Amiodarone Sotalol
60
Amiodarone is used to treat what? Whats its mechanism of action?
treat intractable ventricular arrhythmias. mechanism: block fast outward K current.
61
What does amiodarone do to the QT interval?
Prolong it
62
What is used to treat ventricular arrhythmias?
IV Amiodarone Which is superior to IV lidocaine.
63
What is Mexiletine used for?
it is the orally active form of lidocaine. It is a class 1 B anti arrythmic drug
64
With the best of your ability, describe the Dynamics of amiodarone. (Half life?)
It can take several weeks to months for amiodarone to achieve stready state plasma levels. Takes months to clear with an elimination half life from 26-107
65
Side effects of amiodarone? ## Footnote
Pulmonary fibrosis Hepatotoxcity Hyper/Hypothryoidism (amiodarone is structually similar to thyroid hormone + has lots of iodine) peripheral neuropathy Skin reactions,
66
What is class 4 anti arrhythmic drugs? Example?
CCB Prolong repolarisation by blocking inward calcium (therefore keeping cell more +ve than it should be) prolong QT Example: verapamil, ditiazem
67
Talk about Verapamil.
useful in supraventricular arrhythmias more effective than digoxin for Ventricular rate control in AF High doses can cause AV or SA block
68
What is Adenosine
An anti arrythmic drug For paroxysmal SVT Used to terminate arrhythmias (blocks reentrant pathway).
69
How should you give Adenosine
IV only It has a short half life
70
What is the half life of adenosine
extremely short half life
71
What do you use Digoxin for?
AF
72
What is epinephrine used for?
bradycardia
73
why do you give adenosine?
Given as a rapid IV bolus to acutely treat paroxysmal SVT
74
How does adenosine work?
potently block AV nodal conduction within 10-30 seconds of administration
75
How long is the half life of adenosine?
extremely short 1.5-10seconds
76
What is digoxin? and how does it work?
cardiac glycoside acts by inhibiting the Na/K ATPase Increase vagal tone, thus inhibiting AV nodal conduction.
77
What is digoxin used for?
Control ventricular rate in patients with atrial tachycardias.
78
what drugs would you give in VF
IV Lidocaine IV Amiodarone
79
What drugs would you give in VT
Amiodarone Class 1, Class 3
80
What drug would you give to Atrial arrythmias to control ventricular response?
Digoxin IV Adenosine Class 2 Class 4
81
What does high doses of verapamil do?
Cause AV block or suppression of SA Node.
82
To treat the atrial arrythmias what drugs would you give?
Class 3, Class 1A, Class1C
83
to treat torsades de pointes: acute: Chronic:
to treat torsades de pointes: acute: magnesium, isoproterenol Chronic: Class 2
84
What is torsade de pointes?
polymorphic arrhythmia which can rapidly develop into VF
85
Recognise this ECG?
Torsade de pointes
86

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