Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology > The Heart > Flashcards

The Heart Flashcards

1
Q

conduction system

A

SA node
AV node
bundle of his
purkinje fibers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

phase 0
(2)

A

rapid depolarization
Na channel sopen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

phase 1
(2)

A

partial repolarization
Na channels close

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

phase 2
(2)

A

plateau
Ca channels open

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

phase 3 (3)

A

repolarization
Ca channels close
K channels open

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

phase 4
(2)

A

pacemaker/resting
degradation of membrane potential slowly- Ca channels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q
  • Absolute refractory period
A
  • Cannot be stimulated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q
  • Relative refractory period
A
  • Below the threshold
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q
  • Respond to greater-than-normal stimulus
A
  • Supernormal excitatory period
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

QT vs. QTc
QT is rate dependent and
must be adjusted at a HR — bpm

A

> 60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Prolonged QT
≥ – msec in women
≥ – msec in men

A

460
450

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Cardiac Arrhythmias
Site
(3)

A
  • Atrial
  • Junctional
  • Ventricular
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Cardiac Arrhythmias
Rate
(2)

A
  • Tachycardia (HR > 100 bpm)
  • Ex. Atrial Fibrillation,
    SVT, Ventricular
    tachycardia, and
    ventricular fibrillation
  • Bradycardia (HR < 60 bpm)
  • Ex. Heart block and
    asystole
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Cardiac Arrhythmias
Mechanism
(4)

A
  • Delayed after-
    depolarization
  • Re-entry
  • Ectopic pacemaker
    activity
  • Heart block
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Antiarrhythmic Medications
Vaughn-Williams Classification
* Class I –
* Class II-
* Class III-
* Class IV-
* Class V-

A

Na+ Channel blockers
* Subgroups: Ia, Ib, and Ic
β-adrenoceptor blockers
K+ Channel blockers
Ca2+ Channel blockers
Miscellaneous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Class I Antiarrhythmic Medications
USE-

A

DEPENDENT CHANNEL BLOCKADE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Na+ Channel blockers
* Class Ia
(2)

A
  • Moderate Na+ Channel blockade
  • Eg. quinidine, procainamide, disopyramide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Na+ Channel blockers
* Class Ib
(2)

A
  • Weak Na+ Channel blockade
  • Eg. Lidocaine, Tocainide, Mexilitine, Phenytoin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Na+ Channel blockers
* Class Ic
(2)

A
  • Strong Na+ Channel blockade
  • Eg. Moricizine, Flecainide, Propafenone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Mnemonic
* Class IA- “Double Quarter Pounder”
* Class IB- “Lettuce, Tomato, Mayo, Pickles”
* Class IC- “More Fries Please”

A
  • Disopyramide, Quinidine, Procainamide
  • Lidocaine, Tocainide, Mexiletine, Phenytoin
  • Moricizine, Flecainide, Propafenone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Class Ia Antiarrhythmic medications
Disopyramide, Quinidine, Procainamide
Disopyramide
* Brand name:
* MOA:
* Use:

A

Norpace, Norpace CR
Na+ channel blockade (moderate)
Treatment of PVC and VT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Class Ia Antiarrhythmic medications
Disopyramide, Quinidine, Procainamide
Disopyramide
ADRs:
(2)

A
  • Anticholinergic-Dry mouth (32%), constipation, urinary hesitancy
  • Cardiac- QT prolongation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Class Ia Antiarrhythmic medications
Disopyramide, Quinidine, Procainamide
Disopyramide
Drug-Drug interactions:
(2)

A
  • Other anticholinergic medications (i.e. glycopyrrolate or atropine)
  • Increased risk of QT prolongation with macrolide antibiotics
    (i.e. erythromycin or clarithromycin)
24
Q

Class Ib Antiarrhythmic medications
Lidocaine, Tocainide, Mexiletine, Phenytoin
Mexiletine
* Brand name:
* MOA:
* Use:

A

Mexitil
Na+ channel blockade (weak)
Treatment of documented life-threatening ventricular
dysrhythmias

25
Q

Class Ib Antiarrhythmic medications
Lidocaine, Tocainide, Mexiletine, Phenytoin
Mexiletine
* ADRs:
(2)

A
  • GI- nausea, vomiting, heartburn
  • Neuro- dizziness, light-headedness, tremors, convulsion (toxic)
26
Q

Class Ib Antiarrhythmic medications
Lidocaine, Tocainide, Mexiletine, Phenytoin
Mexiletine
* Drug-Drug interactions:
(1)

A
  • Use the lowest effective dose of local vasoconstrictor
27
Q

Class Ic Antiarrhythmic medications
Moricizine, Flecainide, Propafenone
Propafenone
* Brand name:
* MOA:
* Use:

A

Rythmol/Rythmol SR
Na+ channel blockade (strong)
Treatment of documented life-threatening dysrhythmias

28
Q

Class Ic Antiarrhythmic medications
Moricizine, Flecainide, Propafenone
Propafenone
* ADRs:
(2)

A
  • GI: nausea, vomiting, altered taste, constipation
  • Neuro- dizziness
29
Q

Class Ic Antiarrhythmic medications
Moricizine, Flecainide, Propafenone
Propafenone
* Drug-Drug interactions:
(1)

A
  • Use the lowest effective dose of local vasoconstrictor
30
Q

Class I Antiarrhythmic medications
Na+ Channel blockers-Dental Implications
* Monitor …
* Consider …
* Xerostomia-
* After supine positioning, have patient
* Avoid or limit dose of —

A

vital signs (pulse to irregularity)
stress reduction protocol

assess salivary flow as a factor in caries,
periodontal disease, and candidiasis
(most significant with Ia medications)

sit upright
for at least 2 minutes before standing to avoid
orthostatic hypotension

vasoconstrictor

31
Q

Class II Antiarrhythmic medications
β-adrenoceptor blockers
* Block sympathetic stimulation to the heart
(3)

A
  • Decrease heart rate
  • Decrease automaticity
  • block NE’s effects on Ca2+ channels
  • Slow conduction through AV node (increase
    refractory period)
32
Q

Class II Antiarrhythmic medications
β-adrenoceptor blockers
* Prevent —
— blocking agent

A

ischemia
AV nodal

33
Q

Medication: Metoprolol, Betaxolol, Acebutolol*,
Esmolol, Atenolol, Nebivolol
Receptor Affinity:

A

β1&raquo_space;> β2

34
Q

Medication: Propranolol, Carteolol, Penbutolol,
Pindolol, Timolol
Receptor Affinity:

A

β1 = β2

35
Q

Medication: Butoxamine
Receptor Affinity:

A

β2&raquo_space;> β1

36
Q

Medication: Labetalol & Carvedilol
Receptor Affinity:

A

β1 = β2 ≥ α1 > α2

37
Q

β1-Selective Antagonist Mnemonic
* “Beta blockers Acting Exclusively At Myocardium”

A
  • Betaxolol
  • Acebutelol
  • Esmolol
  • Atenolol
  • Metoprolol
38
Q

Class II Antiarrhythmic medications
β-adrenoceptor blockers
Metoprolol
* Brand name:
* MOA:
* Use:

A

Lopressor (tartrate) Toprol XL (succinate)
selective β1-adrenoceptor blocker
hypertension, CAD, angina, HF, supra-ventricular arrhythmias

39
Q

Class II Antiarrhythmic medications
β-adrenoceptor blockers
Metoprolol
ADRs:
* Common: (5)

A

hypotension, bradycardia, fatigue, sexual dysfunction, drowsiness

40
Q

Class II Antiarrhythmic medications
β-adrenoceptor blockers
Metoprolol
Drug-Drug interactions:
(3)

A
  • Increased hypotension with fentanyl and inhaled anesthetics
  • Decreased effect of vasoconstrictors (i.e. epinephrine)
  • NSAIDS may reduce the efficacy (> 3 weeks of treatment)
41
Q

Class II Antiarrhythmic medications
β-adrenoceptor blockers- Dental Implications
* Monitor …
* Consider …
* – appointments
* After supine positioning, …
* Use (2) with caution

A

vital signs
stress reduction protocol
Shorter
have patient sit upright
for at least 2 minutes before standing to avoid
orthostatic hypotension
vasoconstrictors and inhaled anesthetics

42
Q

Class III Antiarrhythmic medication
(3)

A
  • K+ channel blockers
  • Delay repolarization (prolong action potential)
  • QT prolongation→→→ risk of TdP
43
Q

Class III Antiarrhythmic medication
Agents
(6)

A
  • 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)
  • Bretylium (no longer available)
44
Q

Mnemonic
Class III- “A Big Dog Is Darn Scary”

A
  • Amiodarone, Bretylium, Dofetilide, Ibutilide,
    Dronedarone, Sotalol
45
Q

Class III Antiarrhythmic medications
K+ channel blockers
Amiodarone (most effective and most toxic)
* Brand name:
* MOA:
* Use:

A

Cordarone or Pacerone
K+ channel blocker, also blocks Na+ and Ca2+ channels, b receptors
supraventricular and ventricular arrhythmias

46
Q

Class III Antiarrhythmic medications
K+ channel blockers
Amiodarone (most effective and most toxic)
ADRs:
* Effects seven organ systems:

A

eyes, lungs, heart, thyroid, liver, GI, skin

47
Q

Class III Antiarrhythmic medications
K+ channel blockers
Amiodarone (most effective and most toxic)
Drug-Drug interactions:
(3)

A
  • Bradycardia and hypotension with vasoconstrictors and inhaled anesthetics
  • Increased photosensitivity with tetracycline
  • Many interactions secondary to CYP3A4 inhibition
48
Q

Class III Antiarrhythmic medications
K+ channel blockers- Dental Implications
* Monitor …
* Consider …
* — appointments
* Delay appointment if patient in —
* After supine positioning,
* Use (2) with caution
* Avoid …

A

vital signs
stress reduction protocol
Shorter
distress
have patient sit upright
for at least 2 minutes before standing to avoid
orthostatic hypotension
vasoconstrictors and inhaled anesthetics
dental light in patient’s eye/offer dark glasses (Amiodarone)

49
Q

Class IV Antiarrhythmic medications
Calcium Channel Blockers
MOA:

A

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

50
Q

Dihydropyridine
Selective for —
* End in —
* Common side effects:
(4)

A

smooth muscle
“dipine”
* Nifedipine
* Amlodipine
* etc….

  • Reflex tachycardia
  • Hypotension
  • Peripheral edema
  • Gingival Hyperplasia
51
Q

Non-Dihydropyridine
Selective for —
* Two agents
(2)
* Common side effects:
(4)

A

myocardium

  • Diltiazem
  • Verapamil
  • Bradycardia/AV block
  • Hypotension
  • Edema
  • Gingival Hyperplasia
52
Q

Class IV Antiarrhythmic medications
Calcium channel blockers
Verapamil
* Brand name: (3)
* MOA:
* Use: (3)

A

Calan, Isoptin, or Verlan
Non-dihydropyridine calcium channel blocker
Angina, atrial fibrillation, hypertension

53
Q

Class IV Antiarrhythmic medications
Calcium channel blockers
Verapamil
ADRs:
(6)

A
  • Constipation, dizziness, lightheadedness, hypotension, bradycardia,
    gingival enlargement
54
Q

Class IV Antiarrhythmic medications
Calcium channel blockers
Verapamil
Drug-Drug interactions:
(2)

A
  • Bradycardia and hypotension with general and inhaled anesthetics
  • Many interactions secondary to CYP3A4 inhibition
55
Q

Class IV Antiarrhythmic medications
Dental Implications
* Monitor …
* Consider…
* — appointments
* After supine positioning,
* Use (2) with caution
* Place on frequent recall to monitor for —

A

vital signs
stress reduction protocol
Shorter
have patient sit upright
for at least 2 minutes before standing to avoid
orthostatic hypotension
vasoconstrictors and inhaled anesthetics
gingival hyperplasia

56
Q

Class V Antiarrhythmic medications
Unclassified agent
Adenosine

A
  • 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

Pharmacology (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions