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Pharmacology > The Heart > Flashcards

The Heart Flashcards

1
Q

Conduction System consists of what 4 things in what order/

A 
Sinoatrial node

Atrioventricular node

Bundle of His

Purkinje Fibers
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2
Q

Phase ___
• Rapid depolarization
• Na+ channels open

A

0

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3
Q

Phase ___
• Partial repolarization
• Na+ channels close

A

1

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4
Q

Phase __
• Plateau
• Ca2+ channels open

A

2

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5
Q

Phase ___
• Repolarization
• Ca2+ channels close
• K+ channels open

A

3

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6
Q 
Phase \_\_
• Pacemaker/resting
• Degradation of 
membrane potential 
slowly- Ca2+ channels
A

4

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7
Q

What ions act in phase 0?

A

Na open

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8
Q

What ions act in phase 1?

A

Na channels close

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9
Q

What ions act in phase 2?

A

Ca open

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10
Q

What ions act in phase 3?

A

Ca channels close

K channels open

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11
Q

What ions act in phase 4?

A

None active

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12
Q

_______ period

• Cannot be stimulated

A

Absolute refractory

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13
Q

_______ period
• Below the threshold
• Respond to greater-than-normal stimulus

A

Relative refractory

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14
Q

QT is rate dependent and

must be adjusted at a HR > ___ bpm

A

60 (QTc)

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15
Q

Do women or men generally have longer QT?

A

Women

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16
Q

____ arrhythmia:

Occurs in there is an additional ca influx in phase 4 that can result in ectopic beats

A

Delayed after-depolarization

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17
Q

Vaughn-Williams Classification
– Na+ Channel blockers
• Subgroups: Ia, Ib, and Ic

Phase 0

A

Class I

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18
Q

Vaughn-Williams Classification
- β-adrenoceptor blockers

Phase 2 and 4

A

Class II

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19
Q

Vaughn-Williams Classification

  • K+ Channel blockers

Phase 3

A

Class III

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20
Q

Vaughn-Williams Classification

  • Ca2+ Channel blockers

Phase 2

A

Class IV

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21
Q

Vaughn-Williams Classification

  • Miscellaneous
A

•Class V

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22
Q

Class ____ Na+ Channel blockers
• Moderate Na+ Channel blockade
• Eg. quinidine, procainamide, disopyramide

A

Class Ia

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23
Q

Class ____ Na+ Channel blockers
• Weak Na+ Channel blockade
• Eg. Lidocaine, Tocainide, Mexilitine, Phenytoin

A

Class Ib

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24
Q

Class ____ Na+ Channel blockers

  • Strong Na+ Channel blockade
  • Eg. Moricizine, Flecainide, Propafenone
A

Class Ic

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25
Q

______

  • MOA: Na+ channel blockade (moderate)
  • Use: Treatment of PVC and VT
  • ADRs: • Anticholinergic-Dry mouth (32%), constipation, urinary hesitancy
  • Cardiac- QT prolongation
  • Drug-Drug interactions:• Other anticholinergic medications (i.e. glycopyrrolate or atropine)
  • Increased risk of QT prolongation with macrolide antibiotics (i.e. erythromycin or clarithromycin)
A

Disopyramide

• Brand name: Norpace, Norpace CR

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26
Q

Is what type of drug?
Disopyramide
• Brand name: Norpace, Norpace CR

A

Class 1a antiarrhythmic meds

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27
Q
  • MOA: Na+ channel blockade (weak)
  • Use: Treatment of documented life-threatening ventricular dysrhythmias
  • ADRs: • GI- nausea, vomiting, heartburn
  • Neuro- dizziness, light-headedness, tremors, convulsion (toxic)
  • Drug-Drug interactions:• Use the lowest effective dose of local vasoconstrictor
A

Mexiletine

• Brand name: Mexitil

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28
Q

• MOA: Na+ channel blockade (strong)
• Use: Treatment of documented life-threatening dysrhythmias
• ADRs:
• GI: nausea, vomiting, altered taste, constipation
• Neuro- dizziness
• Drug-Drug interactions:
• Use the lowest effective dose of local vasoconstrictor
MOA= mechanism of action; GI= gastrointestinal; ADR= adverse drug reaction L

A

Propafenone

• Brand name: Rythmol/Rythmol SR

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29
Q

Is what type of drug?
Mexiletine
• Brand name: Mexitil

A

Class 1b antiarrhythmic meds

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30
Q

Is what type of drug?
Propafenone
• Brand name: Rythmol/Rythmol SR

A

Class 1c antiarrhythmic meds

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31
Q

Class _____ Antiarrhythmic medications Dental Implications
• Monitor vital signs (pulse to irregularity)
• Consider stress reduction protocol
• Xerostomia- assess salivary flow as a factor in caries,
periodontal disease, and candidiasis
(most significant with Ia medications)
• After supine positioning, have patient sit upright
for at least 2 minutes before standing to avoid
orthostatic hypotension
• Avoid or limit dose of vasoconstrictor

A

I Antiarrhythmic medications Na+ Channel blockers-

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32
Q 
Class\_\_\_\_ Antiarrhythmic medications
• Block sympathetic stimulation to the heart
• Decrease heart rate
• Decrease automaticity 
• block NE’s effects on Ca2+ channels
• Slow conduction through AV node (increase 
refractory period)
• Prevent ischemia
AV nodal blocking agent
A

Class II β-adrenoceptor blockers

33
Q

____ drug:
• MOA: selective β1-adrenoceptor blocker
• Use: hypertension, CAD, angina, HF, supra-ventricular arrhythmias
• ADRs:
• Common: hypotension, bradycardia, fatigue, sexual dysfunction, drowsiness
• Drug-Drug interactions:
• Increased hypotension with fentanyl and inhaled anesthetics
• Decreased effect of vasoconstrictors (i.e. epinephrine)
• NSAIDS may reduce the efficacy (> 3 weeks of treatment)

A

Metoprolol

• Brand name: Lopressor (tartrate) Toprol XL (succinate)

34
Q

Metoprolol
• Brand name: Lopressor (tartrate) Toprol XL (succinate)
is a Class __ Antiarrhythmic medications

A

II; β-adrenoceptor blockers

35
Q

Class __ Antiarrhythmic medications dental implications

• Monitor vital signs
• Consider stress reduction protocol
• Shorter appointments
• After supine positioning, have patient sit upright
for at least 2 minutes before standing to avoid
orthostatic hypotension
• Use vasoconstrictors and inhaled anesthetics with caution

A

Class 2

36
Q

Class __ Antiarrhythmic medication
• K+ channel blockers
• Delay repolarization (prolong action potential)
• QT prolongation→→→ risk of TdP
• Agents
• Amiodarone (exhibits all antiarrhythmic classes activity)
• Dofetilide (pure class III activity)
• Dronedarone (amiodarone analog- less toxic)
• Sotalol (exhibits class III and class II activity)
• Ibutilide (pure class III activity- only available IV)

A

Class 3

37
Q

____ drugs
• MOA: K+ channel blocker, also blocks Na+ and Ca2+ channels, b
receptors
• Use: supraventricular and ventricular arrhythmias
• ADRs:
• Effects seven organ systems: eyes, lungs, heart, thyroid, liver, GI, skin
• Drug-Drug interactions:
• Bradycardia and hypotension with vasoconstrictors and inhaled anesthetics
• Increased photosensitivity with tetracycline
• Many interactions secondary to CYP3A4 inhibition

A

Amiodarone (most effective and most toxic)

• Brand name: Cordarone or Pacerone

38
Q

Amiodarone (most effective and most toxic)
• Brand name: Cordarone or Pacerone
Is what type of drug?

A

Class III Antiarrhythmic medications K+ channel blockers

39
Q

Class ____ Antiarrhythmic medications
MOA: Block calcium from entering cell through voltage
sensitive “slow” L-type channels
• Slow conduction in SA and AV node (non-dihydropyridine)
•  heart rate
• AV block
• Shorten plateau (phase 2) of action potential
• Deceased delayed after-depolarization (DAD)
•  ectopic beats

A

IV Calcium Channel Blockers

40
Q

What are the 2 types of Class IV Antiarrhythmic meds?

A

Dihydropyridine

Non-Dihydropyridine

41
Q

Class IV Antiarrhythmic

  • Selective for smooth muscle
  • End in “dipine”
  • Nifedipine
  • Amlodipine
  • etc….
  • Common side effects:
  • Reflex tachycardia
  • Hypotension
  • Peripheral edema
  • Gingival Hyperplasia

INcrease HR

A

Dihydropyridine

42
Q

Class IV Antiarrhythmic

  • Selective for myocardium
  • Two agents
  • Diltiazem
  • Verapamil
  • Common side effects:
  • Bradycardia/AV block
  • Hypotension
  • Edema
  • Gingival Hyperplasia

Decrease HR

A

Non-Dihydropyridine

43
Q

What drug?
• MOA: Non-dihydropyridine calcium channel blocker
• Use: Angina, atrial fibrillation, hypertension
• ADRs:
• Constipation, dizziness, lightheadedness, hypotension, bradycardia,
gingival enlargement
• Drug-Drug interactions:
• Bradycardia and hypotension with general and inhaled anesthetics
• Many interactions secondary to CYP3A4 inhibition

A

Verapamil

• Brand name: Calan, Isoptin, or Verlan

44
Q 
What class of drug is verapamil
• Brand name: Calan, Isoptin, or Verlan
A

Class IV Antiarrhythmic Ca channel blocker

45
Q
  • Produced endogenously
  • Binds to the A1 receptor in the AV node causing AV node block
  • Used to terminate SVT
  • Half-life is  20-30 seconds
  • Metabolized by red blood cells and vascular endothelium
  • ADRs= flushing, chest pain, shortness of breath
  • No dental implications
A

Adenosine

46
Q

Adenosine is what type of drug?

A

Class V antiarrhythmic

47
Q

What ion is needed for actin and myosin contraction?

A

Ca

48
Q
  • amount of blood in left ventricle at the end of diastole

= Preload

A

LV End Diastolic Volume (EDV)

49
Q
  • pressure heart has to overcome to eject blood

about equal to Systemic blood pressure

A

Afterload

50
Q
  • amount of blood in left ventricle at the end of systole
A

LV End Systolic Volume (ESV)

51
Q

= EDV – ESV (mL)

A

Stroke Volume (SV): SV

52
Q

= SV/EDV X 100% (%)

A

Ejection Fraction (EF): EF

53
Q

= HR X SV (mL/min)

A

Cardiac Output (CO): CO

54
Q

ability of

the heart to contract

A

Inotropy-

55
Q

If SV is low, how is EDV affected?

A

Low too

56
Q

What is the point where SV and EDV are working as efficiently as possible? Can you go past this point and cause better or worse SV?

A

Optimal sarcomere length

57
Q

_____ is a :
Positive Inotropic medications
•Cardiac glycosides
•Digoxin- inhibits Na-K ATPase

A

Digotoxin

58
Q

_____ drug:
• MOA: inhibition of Na+-K+ ATPase/ vagal tone to heart
• Use: heart failure, atrial fibrillation (rate-control)
• ADRs (narrow therapeutic index medication):
• Nausea, vomiting, diarrhea
• Bradycardia/ heart block
• Visual disturbances (green-yellow halo)
• Drug-Drug interactions:
• Other drugs that cause bradycardia or hypokalemia
• Increased levels with macrolide antibiotic
• Increase risk of arrhythmia with adrenergic agonists or succinylcholine

A

Digoxin

• Brand name: Digitek, Lanoxicaps, Lanoxin (available IV/PO)

59
Q

______ Dental Implications
• Monitor vital signs
• Increased gag reflex may make dental procedures,
such as taking radiographs or impressions difficult
• After supine positioning, have patient sit upright
for at least 2 minutes before standing to avoid
orthostatic hypotension (bradycardia)
• Use vasoconstrictors with caution (adrenergic stimulation)
• Avoid dental light in patient’s eye/offer dark glasses
• Stress reduction protocol

A

Digoxin-

60
Q
  • MOA: b1- adrenergic receptor agonist
  • Use: acute decompensated heart failure, cardiogenic shock
  • ADRs:
  • Increased heart rate and blood pressure
  • Arrhythmias
  • Chest pain
  • Drug-Drug interactions: none of significance
  • Dental Implications: none
A

DOBUTamine

• Brand name: Dobutrex (only available IV)

61
Q
  • MOA: Phosphodiesterase-3 enzyme inhibitor
  • Use: acute decompensated heart failure, cardiogenic shock
  • ADRs:
  • Arrhythmias (ectopic beats, NSVT, VT)
  • Hypotension
  • Chest pain
  • Drug-Drug interactions: none of significance
  • Dental Implications: none
A

Milrinone

• Brand name: Primacor (only available IV)

62
Q

• MOA: Sensitize troponin to Ca2+ (inotropy) and KATP channel activation
in smooth muscle (vasodilation)
• Use: acute decompensated heart failure
• ADRs:
• Arrhythmias (ectopic beats, NSVT, VT)- supposedly less than DOBUTamine
• Hypotension
• Headache
• Drug-Drug interactions: none of significance
• Dental Implications: none

A

Levosimendan

• Brand name: Simdax (not available in the U.S.)

63
Q

Cardiac myocytes supplied with blood during ______

A

diastole

64
Q

Increase in Heart rate leads to less time in diastole leading to _____ blood flow

A

Decreased blood flow to heart muscle

65
Q

______ Nervous System
b1 adrenoceptors
•  force of contraction (positive inotropic effect)
•  heart rate (positive chronotropic effect)
•  automaticity
• Repolarization
• Reduced cardiac efficiency

A

SYMPATHETIC

66
Q 
\_\_\_\_\_\_ Nervous System
Muscarinic (M2) receptors
• Cardiac slowing
•  automaticity 
• Inhibition of AV node 
conduction
A

PARASYMPATHETIC

67
Q

Increase myocardial O2 supply

A

Organic nitrates

68
Q

Increase myocardial O2 supply and Decrease O2 demand

A

Calcium channel blockers-

69
Q

Decrease myocardial O2 demand

A

b-adrenocepter antagonists-

70
Q

improves angina w/o changing BP or HR

A

Ranolazine-

71
Q

What class of antianginal drug is the best agent to use for angina?

A

B blockers

72
Q 
Major side effects
• Contraindicated with PDE-5 Inhibitors
• Headache • Syncope/hypotension
• Tachycardia • Tolerance
• Methemoglobinemia
  • Nitroglycerin
  • Isosorbide dinitrate/mononitrate
  • Sodium Nitroprusside

• Contraindicated with PDE-5 Inhibitors

A

• Organic nitrates

73
Q
  • MOA: Stimulate production of intracellular cGMP
  • Use: Angina and heart failure
  • ADRs:
  • Headache (common), flushing, dizziness, postural hypotension
  • Drug-Drug interactions:
  • Increased effects with other vasodilator type medications
A

Isosorbide Mononitrate

• Brand name: Imdur, Ismo

74
Q

Antianginal Medications _______-:
MOA: Block calcium from entering cell through voltage
sensitive “slow” L-type channels
• Slow conduction in SA and AV node (non-dihydropyridine)
•  heart rate
• AV block
• Vasodilatation of arterioles
• Decrease arterial pressure and wall tension
• Decrease myocardial contractility
• Increase flow through areas of fixed coronary obstruction

A

Calcium Channel Blockers

75
Q

• MOA: Dihydropyridine calcium channel blocker
• Use: Angina, hypertension, also vasospastic angina
• ADRs:
• Edema (common), dizziness, lightheadedness, hypotension, flushing,
gingival enlargement (rare- but more common than non-DHP)
• Drug-Drug interactions:
• Hypotension with sedatives, opioids, general and inhaled anesthetics
• NSAIDS reduce blood pressure lowering effect

A

Amlodpine

• Brand name: Norvasc

76
Q 
Antianginal medications \_\_\_\_\_\_\_:
• Block sympathetic stimulation to the heart
• Decrease heart rate
• Decrease automaticity       
• block NE’s effects on Ca2+ channels
• Slow conduction through AV node (increase 
refractory period)
• Prevent ischemia
• Decrease myocardial oxygen demand
•   HR,  contractility,  SBP
A

β-adrenoceptor blockers

77
Q

What are the following drugs used for?
Metoprolol
Atenolol
Carvedilol

A

B Blockers for antiangina

78
Q

• MOA:
• inhibits late inward sodium current (Ina) in ischemic myocardium  reduced
myocardial wall tension and O2 consumption
• At higher concentrations inhibits rapid delayed rectifier potassium current (Ikr) 
prolonged action potential and QT interval

A

Ranolazine

79
Q

• MOA: Inhibition of late inward sodium current (Ina)
• Use: Angina
• ADRs:
• Bradycardia, hypotension, dizziness, QT prolongation, TdP, xerostomia
• Drug-Drug interactions:
• Many due to CYP 450 3A4 metabolism
Dental implications:
• Assess salivary flow as a factor in caries, periodontal disease, and candidiasis
• Use vasoconstrictors and inhaled anesthetics with caution

A

Ranolazine

• Brand name: Ranexa

Pharmacology (12 decks)

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