Term
Class IA anti-arrhythmics
Mechanism & Use |
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Definition
Class IA anti arrhythmic - Fast Na channel blocker (raises threshold) + K+ blocker (prolongs AP & refractory period)
-Prolonged QRS & QT on EKG
Used for A-fib/flutter, PSVT, V-tach |
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Term
Quinidine
Use & Side Effects |
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Definition
Class IA anti-arrhythmic
Diarrhea, nausea, rash, torsade de pointe, Cinchonism, hepatotoxicity |
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Term
Procainimide
Use & side effects |
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Definition
Class IA anti-arrhythmic
NAPA metabolite can accumulate, ANA+, lupus like, agranulocytosis |
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Term
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Definition
Class IA anti-arrhythmic
Parasympatholytic effects (urinary retention, dry eyes, no accomodation), QT prolongation, Torsade |
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Term
Class IB anti-arrhythmics
Use & Mechanism |
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Definition
USE: V-tach / arrhythmias, Digitalis-induced arrhythmias
Mech: Fast Na channel blockade – mild block (decreased phase 4 raises threshold); shortened AP)
--Occasional decreased QT |
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Term
Lidocaine
Use & Side effects |
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Definition
Class IB anti-arrhythmic
tremors, seizures, paresthesias, delirium |
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Term
Tocainide
Use & Side effects |
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Definition
Class IB anti-arrhythmic
pulmonary fibrosis, GI sx |
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Term
Mexiletine (oral)
Use & side effects |
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Definition
Class IB anti-arrhythmic
ataxia, dizziness, tremors, GI sx |
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Term
Class IC Anti-arrhythmics
Use & mechanism |
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Definition
USE: Supraventricular arrhythmias in healthy people
Na blockade – Marked block (Big decrease in phase 0, no change in AP)
Prolong refractory period of AV node & bypass tracts
--> Prolonged PR; QRS & QT (not as prolonged as in IA) |
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Term
Flecainide
Use & side effects |
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Definition
Class IC anti-arrhythmic
Contraindicated in pts w CAD / structural heart dz; can exacerbate VT & heart failure |
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Term
Propafenone
Use & side effects |
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Definition
Class IC anti-arrhythmic
(also a beta blocker at high concentrations!)
depressed LV performance, exacerbates heart failure
dizziness, headache, nausea, vomiting |
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Term
Moricizine
Use & side effects |
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Definition
Class IC anti-arrhythmic
Proarrhythmia, especially post-MI; heart failure, dizziness, headache, nausea, vomiting |
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Term
Class II anti-arrhythmics
Use & mechanism |
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Definition
Beta blockers - prevents sympathetic increase in If
Increased refractory period of AV node
--> prolonged PR on EKG (sometimes)
Used for atrial & ventricular arrhythmias |
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Term
Class II anti-arrhythmic
side effects |
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Definition
Normal side effects of beta blockers
Hypotension, bradycardia, AV block
Hypoglycemia
Hyperkalemia
Bronchoconstriction
**contraindicated in WPW |
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Term
Class III anti-arrhythmics
Use & mechanism |
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Definition
USE: V-tach (amiodarone = first line, sotalol), A-fib/flutter, Bypass tract-mediated PSVT
K+ channel blockade (prolongs AP via phase 3)
Vasodilator
--> prolonged QT |
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Term
Sotalol
use & side effects |
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Definition
Class III antiarrhythmic (And beta blocker)
Used for V-tach
beta blockade side effects (see II) |
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Term
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Definition
Class III anti-arrhythmic (also has properties of Class I, II, and IV); very long half life
First line for V-tach & V-fib & cardiac arrest
Side effects: pulmonary fibrosis, GI, Neuro, hypotension
prolonged QT, QRS, PR |
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Term
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Definition
Class III anti-arrhythmic
Torsade de pointe, fatigue, bradycardia, SOB |
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Term
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Definition
Class III anti-arrhythmic
Torsade de pointe, fatigue, bradycardia, SOB |
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Term
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Definition
Class III anti-arrhythmic
Torsade de pointe, fatigue, bradycardia, SOB |
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Term
Class IV anti-arrhythmics
use & mechanism |
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Definition
L type Ca channel blocker; especially AV node
(only Verapamil & Diltiazem have cardiac effects -- not dihydropyridines)
--> Prolonged PR, slow HR
USES: PSVT, AV node reentrant tach, A-fib/flutter, Multifocal atrial tachycardia |
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Term
Class IV anti-arrhythmic
side effects |
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Definition
Hypotension, constipation
Contraindicated in WPW
Don't combine w beta blockers |
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Term
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Definition
Inhibits Na/K ATPase → [Na] increases → reduces Na/Ca exchange that normally pumps Ca out → increases Ca++ in cell
Arrhythmias: Adjuvant control of A-fib/flutter (contraindicated in WPW)
CHF: increases force of contraction |
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Term
| Nitroglycerine (sub-lingual) |
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Definition
Nitrate used primarily for angina
rapid onset, but tolerance develops quickly |
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Term
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Definition
Nitrate (used primarily for angina)
slower (30') onset but lasts 8+ hrs |
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Term
| Tridil - IV nitroglycerine |
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Definition
| Nitrate used primarily for angina |
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Term
| Isorbide dinitrate (Isordil) |
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Definition
sublingual nitrate, used for angina
longest duration of sublinguals (1 hr) |
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Term
| Isorbide mononitrate (Imdur) |
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Definition
| nitrate (sublingual) used primarily for angina |
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Term
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Definition
Headache - try to use smallest dose
Postural hypotension
Tachycardia (cardiac reflex)
Do NOT take with PDE5 inhibitors (viagra - leads to severe hypotension) |
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Term
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Definition
Vasodilator used for hypertension treatment
mechanism not understood
Side effects: can cause lupus-like symptoms |
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Term
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Definition
Vasodilator - acts by opening K+ channels --> efflux --> muscle relaxation
Used in rx of hypertension
Side effects: hair growth (aka Rogaine) |
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Term
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Definition
Diuretic (DCT) --> decreases BV --> decreased preload --> decreased CO
One of the first line rx for hypertension
Angina: reduces CO (and O2 demand)
Reduces edema in CHF
Side effects: hypokalemia, increased uric acid, impotence |
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Term
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Definition
Loop Diuretic - K+ losing
Used for HTN, angina, CHF
Side effect: hypokalemia, hypomag, incr uric acid |
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Term
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Definition
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Term
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Definition
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Term
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Definition
K+ sparing diuretic (also an aldosterone antagonist)
used for htn, angina, chf
side effect: hyperkalemia |
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Term
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Definition
K+ sparing diuretic
used in chf, htn, angina
side effect: hyperkalemia |
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Term
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Definition
Lowers HR & force of contraction → decreases workload → increased EDV + decreased SV (Decreases O2 demand for angina)
Decreases mortality in CHF (unclear why)
HTN: Slow effect (best effect in young & white)
Arrhythmia: Class II anti-arrhythmic |
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Term
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Definition
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Term
beta blockers
Side effects |
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Definition
- Acute worsening of CHF
-Beta 2 block → bronchoconstriction & vasodilation (don't use in asthmatics)
-Lipid soluble → depression
-Decreases HDL & increases LDL + TGs
-contraindicated in periph vascular dz
-No use in diabetics: can’t maintain reflex |
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Term
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Definition
| beta 1 selective adrenergic blocker |
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Term
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Definition
| Beta 1 & alpha-1 blocker (blocks vasoconstriction) |
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Term
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Definition
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Term
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Definition
| beta 1 and beta 2 blocker |
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Term
| Nifedipine (Procardia, Adalat) |
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Definition
Dihydropyridine - Ca channel blocker --> vasodilation --> decreases afterload
Short half life
Also suppresses contractility and SA node (a little)
HTN: first line drug, all people
Angina: Increases O2 to heart + decreases after load |
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Term
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Definition
Dihydropyridine - Ca channel blocker --> vasodilation --> decreases afterload
intermediate half life
Also suppresses SA node (a little)
HTN: first line drug, all people
Angina: Increases O2 to heart + decreases after load |
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Term
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Definition
Dihydropyridine - Ca channel blocker --> vasodilation --> decreases afterload
Long half life
Also suppresses contractility and SA node (a little)
HTN: first line drug, all people
Angina: Increases O2 to heart + decreases after load |
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Term
| Ca channel blockers - side effects |
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Definition
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Term
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Definition
Benzothiasapine / ca channel blocker
short half life
vasodilation, primarily suppresses SA & AV nodes (Class IV anti-arrhythmic)
HTN: first line
Angina: increases O2 supply & decreases afterload |
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Term
| Verapamil (calan, Isoptin) |
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Definition
Phenylalkylamine (Ca channel blocker)
Intermediate half life
Good vasodilation, good contractility suppression, and suppresses SA & AV nodes (Class IV anti-arrhythmic)
HTN: first line
Angina: increases O2 supply & decreases afterload |
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Term
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Definition
- Blocks AT I → AT II → Decreases Na / H2O reabsorption (lowers BV → less afterload → less SV/CO)
- Blocks vasoconstriction of AT II (→ less preload + afterload → lower BP)
- May prevent cardiac remodeling |
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Term
ACE inhibitor
side effects |
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Definition
dry cough (due to bradykinin buildup)
postural hypotension |
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Term
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Definition
Hypertension: works best in young & white
CHF: lower BP blocks compensatory mechanism |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
ARB (blocks AT II receptors)
(similar to ACE-I but doesn't have cough)
Used for Htn & CHF |
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Term
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Definition
Renin inhibitor - blocks angiotensinogen --> AT I
Similar to ACE-I's but no cough side effect
Used for HTN & CHF |
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Term
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Definition
Aldosterone antagonist
K+ sparing diuretic (blocks Na/H2O reabsorption)
Lowers BV --> reduces preload --> relieves edema in CHF |
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Term
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Definition
Aldosterone antagonist
K+ sparing diuretic (blocks Na/H2O reabsorption)
Lowers BV --> reduces preload --> relieves edema in CHF |
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Term
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Definition
Low therapeutic index
Hypokalemia → a-fib / v-tac
Anorexia
Nausea / vomiting
Headache / fatigue |
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Term
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Definition
Beta1 receptor → inotropic
DA receptors → increases blood flow to kidney
(high dose activates alpha 1 → vasoconstriction)
--> vasodilation helps w CHF |
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Term
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Definition
Stimulates beta 1 / beta 2 → inotropic effect
Vasodilation?
CHF: Reduces afterload --> Heart contracts more forcefully→greater organ perfusion |
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Term
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Definition
PDE inhibitor → prevents cAMP breakdown → increases active protein kinase → Ca channels phosphorylated → Ca enters cell → stronger contraction
- Vascular dilation (venous & arterial)
CHF: stronger contraction, reduces preload & afterload
(increases mortality w longterm use though) |
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Term
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Definition
PDE inhibitor → prevents cAMP breakdown → increases active protein kinase → Ca channels phosphorylated → Ca enters cell → stronger contraction
- Vascular dilation (venous & arterial)
CHF: stronger contraction, reduces preload & afterload
(increases mortality w longterm use though) |
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Term
Statins
(Resuvastatin, Atorvastatin, Simvastatin, Pravastatin) |
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Definition
HMG-CoA inhibitor blocks cholesterol synth
Lowers LDL 25-55%
Side effects: GI distress, hepatotoxicity, myopathy, CNS effects |
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Term
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Definition
Inhibits VLDL secretion (and then LDL production) --> reduces Non-HDL's & TG's + increases HDL
Side Effects (common): Flushing, Heart palpitations, Itching, Hypouricemia (less common)
Diabetes = strong contraindication |
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Term
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Definition
bile acid binding resin (BARB)
Stop reabsorption of bile acid → converts more cholesterol to bile acid (less negative feedback) → LDL receptors upregulated --> lowers LDL by 20%
-Used in pts w fxnl LDL receptors
Side effects: constipation, bloating, vit K deficiency |
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Term
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Definition
bile acid binding resin (BARB)
Stop reabsorption of bile acid → converts more cholesterol to bile acid (less negative feedback) → LDL receptors upregulated --> lowers LDL by 20%
-Used in pts w fxnl LDL receptors
Side effects: constipation, bloating, vit K deficiency |
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Term
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Definition
elevates LPL enzyme --> Increases TG lipolysis -->lowers TGs (+ some LDL decreases + HDL increase)
Used for hypertriglyceremia
Side effects: Rashes, GI distress, Myopathy, Hypokalemia, Arrhythmias
Contraindicated if renal/liver disease |
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Term
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Definition
Blocks intestinal cholesterol absorption (dietary)
--> reduces LDL
MOST EFFECTIVE LDL LOWERING = ezetimibe + statins
Contraindicated in pregnant women |
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Term
| Heparin / Enoxaparin / Daletparin |
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Definition
Catalyzes AT-3 → inactivates clotting factors (X, II, IX, XI)
inhibits thrombus formation, prevents DVTs & PEs |
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Term
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Definition
Blocks vitamin K --> blocks synth of X, IX, VII, II
--> inhibits thrombus formation
can be given orally
Teratogenic |
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Term
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Definition
Anticoagulant
Irreversible Factor II (thrombin) inhibitor
DOes not affect platelets |
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Term
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Definition
Anticoagulant
Irreversible Factor II (thrombin) inhibitor
DOes not affect platelets |
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Term
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Definition
Fibrinolytic, increases plasminogen --> plasmin
Used in STEMI's w beta blockers / ACEI's to reduce mortality
Also used for PE, DVTs, Stroke |
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Term
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Definition
Irreversible COX I & II inhibitor --> prevents thromboxane synthesis --> blocks platelet aggregation
Daily use in CHD to prevent MI's
Useful in transient ischemia |
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Term
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Definition
ADP receptor antagonist on plaelets --> blocks platelet aggregation
synergystic w aspirin
Used in many stents
Side effects: N/D, hemorrhage, leukopenia, TTP |
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Term
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Definition
ADP receptor antagonist on plaelets --> blocks platelet aggregation
synergystic w aspirin
Used in many stents
Side effects: N/D, hemorrhage, leukopenia, TTP |
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Term
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Definition
antibody against GP IIb/IIIa --> prevents platelet aggregation
Used in ACS |
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Term
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Definition
antibody against GP --> prevents platelet aggregation
Used in ACS |
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Term
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Definition
antibody against GP --> prevents platelet aggregation
Used in ACS |
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Term
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Definition
| used for CHF - dilates both arteries & veins |
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