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PAMercer Pharm1 - CV Review
Cardiovascular Review slides
119
Pharmacology
Graduate
08/02/2010

Additional Pharmacology Flashcards

 


 

Cards

Term

 

 

 

 

BP Goals for HTN treatment

Definition

 

 

 

 

< 140/90 mmHg

 

< 130/80 mmHg if DM or kidney disease

Term

 

 

 

 

 

Number of drugs required by most patients

to reach BP goals

Definition

 

 

 

 

> 2 drugs

Term

 

 

 

 

Initial treatment choice for Hypertension

Definition

 

 

 

Thiazide diuretics

 

Initial therapy in most patients

(monotherapy or in combination)

 

Use unless compelling indications for other antiHTN

 

Term

 

 

 

 

Compelling indication for use of BB

(Alternative: CCB)

Definition

 

 

 

 

 

HTN + stable angina pectoris

 

 

Term

 

 

 

 

Drug types to use Post MI with HTN

Definition

 

 

ACEI

BBs

Aldosterone Antagonists

 

Along with Lipid Management & Aspirin

 

 

Term

 

 

 

 

Drugs to use with Heart Failure & HTN

Definition

 

Asymptomatic ventricular dysfunction

ACEI or BB

 

 

Symptomatic Ventricular Dysfunction or

End-stage heart disease

ACEI, BB, ARBs, Aldosterone blockers

Loop Diuretic

Term

 

 

 

 

Drugs to use with Diabetes & HTN

Definition

 

 

ACEI or ARBs

Slow progression of diabetic neuropathy

& reduce albuminuria

 

Thiazides, BB, ACEI, ARBs, & CCBs

Reduce CVD & CVA

Term

 

 

 

 

Definition of Chronic Kidney Disease

Based on GFR & Albuminuria

Definition

 

 

 

GFR < 60 mL/min

 

Albuminuria (> 300 mg/day)

Term

 

 

 

 

Treatment of HTN with Chronic Kidney Disease

Definition

 

Aggressive BP management

 

ACEI & ARBs show benefit in renal disease

 

ACEI & ARBs may cause ↑ in Cr

(up to 35% above baseline)

 

Monitor for increases > 35% or Hyperkalemia

Term

 

 

 

 

Treatment of HTN with Cerebrovascular Disease

Definition

 

 

 

 

↓ Recurrent stroke rates with ACEI + Thiazide

Term

 

 

 

 

Special Considerations for African Americans with HTN

Definition

 

 

↓ response to monotherapy: BB, ACEI, ARBs

compared to diuretic or CCBs

 

ACEI - angioedema is more common

Term

 

 

 

 

Special Considerations for Elderly patients with HTN

Definition

 

 

 

 

 

Initiate at lower doses & titrate slowly

Term

 

 

 

 

Special considerations in treating

pregnant women with HTN

Definition

 

 

 

AVOID ACEI & ARBs

 

Methyldopa, Labetolol, & Vasodilators

should generally be used

Term

 

 

 

 

Special Considerations for Patient with Eclampsia/HTN

Definition

 

 

 

ONLY curative treatment is delivery

 

Manage with IV antihypertensives & magnesium sulfate

Term

 

 

 

 

Additional Considerations for Thiazide therapy for HTN

Definition

 

 

 

May slow progression of osteoporosis

 

May precipitate acute gout attacks

Term

 

 

 

 

Additional considerations for Beta Blocker therapy for HTN

Definition

 

 

Beneficial in the treatment/prophylaxis of migraine, tachyarrhythmias, essential tremor

 

Caution in reactive airway disease

 

Avoid in 2nd or 3rd degree heart block

Term

 

 

 

 

Additional considerations for HTN treatment

with alpha blockers

Definition

 

 

 

 

Beneficial in prostatic hyperplasia

Term

 

 

 

 

Additional considerations for treatment of HTN

using CCBs

Definition

 

 

 

 

Beneficial in Raynaud's syndrome

Term

 

 

 

Thiazide Diuretics Action Site & Characteristics

Definition

 

Action at DISTAL TUBULE

 

Mainly used for essential HTN

 

Caution in sulfa allergy

 

Ex: Hydrochlorothiazide (HCTZ)

Term

 

 

 

Loop Diuretics Action Site & Characteristics

Definition

Action: LOOP OF HENLE

 

MOST EFFECTIVE diuresis

 

Mainly used for edematous conditions (HF, cirrhosis with ascites, renal failure w/ volume overload)

 

Caution in sulfa allergy

 

Ex: Furosemide (Lasix®)

Term

 

 

 

 

K-sparing diuretics Action Site & Characteristics

Definition

 

 

Action: DISTAL TUBULE, COLLECTING TUBULE

 

Mainly used in combo with other diuretics for HTN or ascites

 

Ex: Spironolactone (Aldactone®)

Triameterene

Term

 

 

 

 

Most frequent problem with use of Thiazide Diuretics

Definition

 

Hypokalemia


May predispose to digoxin toxicity & arrhythmias

 

K supplementation - dietary, K salts, K-sparing diuretics: typically useful in countering the effects of aldosterone

Term

 

 

 

 

Adverse Effects of Thiazide Diuretics

Definition

Hypokalemia

Hyponatremia

Hyperuricemia

Hyperlipidemia

Volume depletion

Hypercalcemia

Skin - photosynsitivity, SJS

Hyperglycemic

Hypersensitivity - potential of sulfa-allergic 

patientsto react to thiazides

Rare - Bone marrow supressior vasculitis, dermatitis

Term

 

 

 

 

 

How Hyperuricemia occurs with Thiazide Diuretics

Definition

 

 

 

Serum uric acid is increased by decreasing

the amount of uric acid lost in the urine

 

May precipitate acute gout attacks

Term

 

 

 

 

Use/Action of Loop Diuretics

Definition

 

 

High Ceiling: highest efficacy in mobilizing Na & Cl from the body & most efficacious of all diuretics

 

Results in large amounts of urine

 

Some are sulfonamide derivatives

Term

 

 

 

 

Adverse Effects of Loop Diuretics

Definition

Ototoxicity


Hyperuricemia


Hypocalcemia


Hypomagnesemia


Acute Hypovolemia/CV

Substantial rapid ↓ blood volume may cause

hypovolemia, tachycardia arrhythmias

Term

 

 

 

MoA of Spironolactone

(Aldosterone Antagonist K-Sparing diuretic)

Definition


  • Synthetic diuretic with hormone effects that antagonize aldosterone
  • Prevention of Na reabsorption (leading to ↓ K secretion)

Term

 

 

 

Actions of Spironolactone

(K-sparing diuretic/Aldosterone Antagonist)

Definition

 

 

↓ aldosterone - diuretic of choice in cirrhosis

 

Causes retention of K & excretion of Na

 

Renal function for diuretic effects

Term

 

 

 

 

Use of Non-aldosterone antagonist K-sparing diuretics

Definition

 

 

 

Typically used only for k-sparing properties

 

Frequently used in combination with other diuretics (Triametrene/HCTZ)

Term

 

 

 

 

Non-aldosterone antagonist K-sparing Diuretics

Definition

 

 

 

Triamterene

 

Amiloride

Term

 

 

 

 

Adverse Effects of K Sparing Diuretics

Definition

 

 

GI: GI upset, peptic ulcers

 

Hormonal (spironolactone) - Gynecomastia,

menstrual irregularities

 

Hyperkalemia

Term

 

 

 

 

Drug interactions with K Sparing Diuretics

 

Definition

 

 

Other medications that may cause hyperkalemia - ACEI, ARBs, NSAIDs

 

Medications with hormonal effects

Term

 

 

 

 

Therapeutic Uses of K-Sparing Diuretics

Definition

 

 

Diuretic: low efficacy in mobilizing NaCl (compared to other diuretics)

 

Secondary hyperaldosteronism

 

Heart failure: prevention of remodeling

Term

 

 

 

 

Actions of Beta Blockers for HTN Treatment

Definition

 

 

 

Reduction of BP occurs primarily through reduction of cardiac output

 

Secondary effects - inhibition of renin release

Term

 

 

 

 

Therapeutic Uses of Beta Blockers in Treatment of HTN

Definition

 

 

Population subsets - More effective in Caucasians 

and in young to middle-age patients

 

Hypertension with comorbid disease -

Previous MI, CHF, Migraines, Angina, SVT

Term

 

 

 

 

Common Adverse Effects of Beta Blockers

in HTN treatment

Definition

 

 

Cardiovascular: Bradycardia, hypotension

 

CNS: fatigue, insomnia

 

Other: sexual dysfunction

Term

 

 

 

 

Uncommon Adverse Effects of Beta Blockers

in HTN treatment

Definition

 

 

 

 

May adversely effect cholesterol

Term

 

 

 

 

Cautions with use of Beta Blockers

Definition

 

Asthma/COPD: bronchoconstriction (esp. non-selective)

 

Unstable HF: may cause decompensation

 

PVD: potential to cause some vasoconstriction

 

Withdrawal: abrupt cessation of BBs may cause angina, MI, or sudden death (patients w/ ischemic heart disease)

Term

 

 

 

 

Nonselective Beta Blockers

Definition

 

 

 

Propranolol (Inderal®)

 

Nadolol (Corgard®)

Term

 

 

 

 

Cardioselective Beta Blockers

Definition

 

 

 

Atenolol (Tenormin®)

 

Metoprolol (Toporol XL, Lopressor)

Term

 

 

 

 

Actions of ACE Inhibitors for HTN treatment

Definition

↓ BP by reduction of peripheral vascular resistance


Prevents conversion of Angiotensin I to Angiotensin II

(it is a potent vasoconstrictor)


↓ Aldosterone


Slows progression of diabetic nephropathy, ↓ proteinuria


Prevents cardiac remodeling after MI

 

Term

 

 

 

 

Relationship of ACE & Bradykinin

Definition

 

 

 

Responsible for the breakdown of bradykinin

 

With use of inhibitor, bradykinin levels increase, which causes vasodilation & may be involved in the cough associated with ACEI treatment

Term

 

 

 

 

Therapeutic uses of ACE Inhibitors

Definition

HTN

Population subsets: most effective in young, Caucasian patients - Gains effectiveness in African Americans when combined with a diuretic

 

Heart failure (helps prevent remodeling)

 

Diabetic nephropathy

Especially useful in patients with diabetes & HTN

Term

 

 

 

 

Adverse Effects of ACE Inhibitors

Definition

 

Dry cough

Hypotension

Hyperkalemia

Angioedema

Renal Failure

Other: fever, rash

TERATOGENIC:

Black Box Warning

Term

 

 

 

 

Renal Failure with ACE Inhibitor Use

Definition

 

 

 

Caused in patients with bilateral renal stenosis

 

Usually reversible upon discontinuation

Term

 

 

 

 

ACE Inhibitors for HTN

Definition

 

 

Lisinopril (Prinivil, Zestril®)

 

Benzapril (Lotensin®)

 

Captopril (Capoten®)

 

(Most end with "-pril")

Term

 

 

 

 

Actions of Angiotensin Receptor Blockers

Definition

 

 

 

 

Effects similar to ACE inhibitors - ↓ BP - Vasodilation

↓ aldosterone secretion but doesn't increase bradykinin l

Term

 

 

 

 

Therapeutic Uses of Angiotensin Receptor Blockers

Definition

 

 

 

 

Alternative to ACE inhibitors -

HTN, HF, diabetic nephropathy

Term

 

 

 

 

Adverse effects of Angiotensin Receptor Blockers

Definition

 

 

 

 

Similar to ACEI:

↓ risk of cough & angioedema

TERATOGENIC

Term

 

 

 

 

 

Angiotensin Receptor Blockers for HTN treatment

Definition

 

 

 

Valsartan (Diovan®)

 

Losartan (Cozaar®)

 

(typically end with "-sartan")

Term

 

 

 

 

Actions of Renin Inhibitors for HTN Treatment

Definition

 

 

 

 

 

Direct inhibitors of renin

Term

 

 

 

 

 

Adverse Effects of Renin Inhibitors

Definition

 

 

Hypotension

Diarrhea

Cough

Angioedema

TERATOGENIC

Hyperkalemia

Term

 

 

 

 

Renin Inhibitors for HTN treatment

Definition

 

 

 

Aliskiren (Tekturna®)

 

(Ending of -iren is helpful - i = inhibit, ren = renin)

Term

 

 

 

 

 

Actions of Calcium Channel Blockers for HTN treatment

Definition

 

 

 

 

Block the entrance of Ca into the cells, causing vascular smooth muscles to relax and dilation of arterioles

Term

 

 

 

 

 

Therapeutic uses of Calcium Channel Blockers

Definition

 

 

HTN

 

Angina

 

SVT

Term

 

 

 

 

Adverse Effects of Calcium Channel Blockers

Definition

 

Constipation (esp. with verapamil)

 

Dizziness

 

Headache

 

Fatigue

Term

 

 

 

 

Adverse effects of Verapamil, CCB for HTN

Definition

 

 

 

(-) inotropic

 

Avoid in CHF or AV block

Term

 

 

 

 

Non-Dihydropyridine Calcium Channel Blockers

for HTN Treatment

 

Examples

Definition

 

 

Block Ca channels of myocardial & vascular smooth muscle

 

Slow automaticity/AV nodal conduction

 

Verapamil

 

Diltiazem

Term

 

 

 

 

Dihydropyridine Calcium Channel Blockers

for HTN treatment

 

Examples

Definition

 

vascular resistance: most useful for HTN

Less drug interactions

 

Amlodipine (Norvasc®)

Nifedipine (Adalat, Procardia®)

 

(Most end with "-pine")

Term

 

 

 

 

Actions of Alpha Blockers for HTN treatment

Definition

 

 

 

Competitive blockade of α1-receptors

 

Relaxation of arterial & venous smooth muscle

Term

 

 

 

Therapeutic Uses of Alpha-Blockers

Definition

 

 

HTN

 

BPH

Term

 

 

 

 

Adverse effects of Alpha-Blockers for HTN Treatment

Definition

 

Postural hypotension

 

Tachycardia (reflex)

 

Edema

 

Syncope (esp. w/ 1st dose)

 

Tolerance to antiHTN effects

Term

 

 

 

 

Alpha-Blockers for HTN Treatment

Definition

 

 

Doxazosin (Cardura®)

 

Terazosin (Hytrin®)

 

(most end with "-zosin")

Term

 

 

 

 

Centrally acting adrenergics for HTN treatment

Definition

 

 

 

α2-agonist (↓ central adrenergic outflow)

 

Do not typically ↓ blood flow to the kidneys

(useful with renal disease)

Term

 

 

 

 

Centrally Acting Adrenergics for HTN Treatment

Definition

 

 

 

Clonidine (Catapress®)


Methyldopa (Aldomet®)

Term

 

 

 

 

Clonidine (Catapress®)

Definition

 

 

 

Centrally Acting Adrenergic

 

Urgent: 0.1mg QH with max of 0.6mg PO

 

Used for HTN (2nd line)

 

 

Term

 

 

 

 

Adverse effects of Clonidine (Catapress®)

Definition

 

 

 

Dry mouth/nasal mucosa

 

Sedation

 

Rebound HTN with abrupt withdrawal

Term

 

 

 

 

Methyldopa (Aldomet®)

Definition

 

 

 

Used in:

 

HTN in pregnancy

Hypertensive emergency

Hypertensive urgency

Term

 

 

 

 

Action of Vasodilators for HTN treatment

Definition

 

 

 

Direct-acting smooth muscle relaxants

 

Reflex stimulation of the heart

(Some reflexive actions can be

blocked with the β-blockers)

Term

 

 

 

 

Action & Uses of Hydralazine (Apresoline®)

Definition

 

 

Vasodilator - Arterial & venous dilation

 

Predominant dilation of arterioles & arteries

 

Used in HTN & HTN in Pregnancy

Term

 

 

 

 

Adverse effects of Hydralazine (Apresoline®)

Definition

Headache


Tachycardia


Nausea


Sweating


Arrythmia


Lupus-like syndrome

Term

 

 

 

 

Action & Uses of Minoxidil

Definition

 

 

Vasodilator - Dilation of arterioles

 

Severe/refractory HTN

 

Topically to treat male-pattern baldness

Term

 

 

 

 

Adverse Effects of Minoxidil

Definition

 

 

Reflex tachycardia

 

Fluid retention

 

Hypertrichosis

Term

 

 

 

 

Definition of Hypertensive Emergency

Definition

 

 

 

Usually BP > 210/150

 

Lower if there is evidence of end-organ damage or patients with other cardiovascular risk factors

Term

 

 

 

 

Treatment of Hypertensive Emergency

Definition

 

Sodium Nitroprusside


Labetolol

 

Nicardipine (CCB)

 

Fenoldopam

Term

 

 

 

 

Sodium Nitroprusside in Treatment of HTN Emergency

Definition

 

 

 

IV: causes prompt vasodilation (arterial & venous)

Rapid metabolism (requires continuous infusion to maintain actions)

 


AE (mostly associated with very high doses or prolonged administration) - Cyanide ion production, Hypotension

 

Term

 

 

 

 

Labetolol in treatment of HTN emergency

Definition

 

 

α & β non-selective β blockade

 

 

Given as IV bolus or IV infusion in HTN emergencies,

no reflex tachycardia

Term

 

 

 

 

Fenoldopam in treatment of HTN emergency

Definition

 

 

Parenteral antiHTN with different MoA

 

Dopamine-1 agonist

 

Lowers BP but maintains or ↑ renal perfusion

Term

 

 

 

 

Treatment of Ischemic Heart Disease

Definition

 

Antiplatelet Agents

 

ACE Inhibitors

 

Statins

 

Beta Blockers

 

Calcium Channel Blockers

Term

 

 

 

 

Antiplatelet Agents used in Treatment of

Ischemic Heart Disease

Definition

Aspirin

Inhibition of cyclooxygenase

Reduces risk of acute CV events

Doses of 75-235 mg/day are CV protective

Contraindicated with aspirin allergy or active PUD

 

Clopidogrel (Plavix®)

Alternative antiplatelet for patients who can't take aspirin

Term

 

 

 

 

ACE Inhibitors in Treatment of Ischemic Heart Disease

Definition

 

 

↓ risk of CV events in patients with chronic,

stable angina, or significant IHD risk factors

 

ARBs can be used as substitutes

Term

 

 

 

 

Statins for Treatment of Ischemic Heart Disease

Definition

 

 

 

↓ mortality/morbidity associated with IHD

 

Primary & secondary prevention of CV events

Term

 

 

 

 

Beta Blockers in Treatment of Ischemic Heart Disease

Use/Actions

Definition

 

 

Part of 1st line treatment for ↓ symptoms in IHD

 

↓ myocardial oxygen demand

 

ISA activity: less reduction of HR but less effective for angina



Term

 

 

 

Beta Blockers in Treatment of Ischemic Heart Disease

Contraindications/Cautions

Definition

 

 

 

Contraindicated in patients with severe bradycardia, AV conduction defects (without a pacemaker)


Caution with other agents that ↓ AV nodal conduction


Relative contraindications: bronchospastic disease, severe depression, PVD

 

Term

 

 

 

 

Calcium Channel Blockers in treatment of

Ischemic Heart Disease

Definition

 

 

 

Indicated in IHD when BB cannot be used or in combination with BB for refractory symptoms

Term

 

 

 

 

Use of Short-Acting Nitrates

Definition

1st line treatment for termination of acute episodes of angina


Convert to nitric oxide and cause venodilation

 

↓ myocardial O2 demand & ↑ myocardial O2

Supply, resolution of vasospasm


Angina treatment: 0.3-0.4 mg SL, repeat x 5 min until resolution of sx; unimproved after 1-2 doses, call EMS

 

Prophylaxis: use 5 min prior to activity (effective for ~30 min)

 

Term

 

 

 

 

 

Distinction of Isosorbide dinitrate (Isordil®)

Definition

 

 

 

 

 

Longer half life of the short-acting nitrates

Term

 

 

 

 

Short-acting nitrates as monotherapy

Definition

 

 

 

Useful for patients with angina symptoms every few days

 

 

If more frequent attacks -

Use long-acting anti-anginal therapy

Term

 

 

 

 

Long-acting anti-anginal therapies

Definition

 

 

 

 

BB, CCB, long-acting nitrates

Term

 

 

 

 

Drug interactions with short acting nitrates

Definition

 

 

 

 

Phosphodiesterase 5 inhibitors: serious HYPOTENSION due to combined vasodilatory effects (avoid taking PD5 inhibitors for 24-48 hours after taking nitrates)

Term

 

 

 

 

Adverse effects with Short-Acting Nitrates

Definition

 

 

Dizziness

 

Headache

 

Hypotension

Term

 

 

 

 

Use of Long-acting Nitrates

Definition

 

PO & transdermal dosage forms

Nitroglycerin ER

Isosorbide mononitrate or dinitrate SR formulations

 

 

Development of tolerance is common

Nitrate-free interval each day for 8-12 hours

Term

 

 

 

 

Caution with Use of Long-acting Nitrates

Definition

 

 

Avoid monotherapy due to reflex tachycardia

 

 

Adverse effects: same as short-acting nitrates

(dizziness, headache, hypotension)

Often resolve with continued treatment

 

 

Term

 

 

 

 

Treatment summary for IHD

Definition

 

 

Lifestyle modifications

ACEI or ARB

BB or CCB for prevention of ischemic events

Nitrates (Short or long acting)

Statins for CV protection

Antiplatelets for CV event prophylaxis

Interventional treatments for severe or refractory disease

Term

 

 

 

 

Compensatory Physiology of HF

Definition

 

3 major responses

 

↑ SNS activity

 

Activation of RAAS

 

Myocardial hypertrophy

Term

 

 

 

 

Classes of drugs used for Heart Failure Treatment

Definition

 

ACE Inhibitors

 

β-blockers

 

Diuretics

 

Vasodilators

 

(+) inotrope

Term

 

 

 

 

ACE Inhibitors & ARBs used for HF treatment

Definition

 

 

 

 

Prevent activation of RAAS & remodeling

Term

 

 

 

 

β-blockers for HF treatment

Definition

 

 

↓ workload of heart

Caution with initiation due to possible exacerbation

from ↓ CO (initiate when pt is stable)

 

Secondary action of inhibiting renin

 

Inhibits myocardial remodeling

Term

 

 

 

 

Use of diuretics for HF treatment

Definition

 

 

 

 

↓ plasma volume (↓ cardiac workload & oxygen demand) & reduction of symptoms of volume overload

Term

 

 

 

 

Use of vasodilators for HF treatment

Definition

 

 

 

 

↓ preload & afterload

Term

 

 

 

Use of (+) inotropic drugs for HF treatment

Definition

 

 

 

Enhancement of cardiac muscle contractility leading to better ejection fraction & ↑ cardiac output

 

Digitalis/Digoxin

Term

 

 

 

 

Use of Digitalis/Digoxin for HF treatment

 

Definition

 

 

 

Indicated in severe left ventricular systolic dysfunction after initiation of a ACE & diuretic

 

HF with atrial fibrillation

 

 

 

 

Term

 

 

 

Adverse Effects of Digitalis/Digoxin

Definition

 

Narrow TI - requires labs

 

Cardiac effects - Slowing of AV conduction (arrhythmias)

 

GI effects - anorexia, N/V

 

CNS effects - HA, fatigue, confusion, blurred vision, alteration of color perception & halos on dark objects

 

Toxicity with enhanced hypokalemia

Term

 

 

 

 

Drug interactions with Digitalis/Digoxin

Definition

 

 

 

 

Protein Binding

 

Renal elimination

Term

 

 

 

 

Class I Antiarrhythmics

Definition

 

 

 

Blockade of fast Na channels: 

conduction velocity in non-nodal tissue

Term

 

 

 

 

Class IA Antiarrhythmics

Definition

Direct effect on AP is modified by anticholinergic actions


Anticholinergic - ↑ in SA & AV conduction

(may cancel other effects).


Procainamide - Used for ventricular & supraventricular tachycardias; weak anticholinergic actions; short half life, lupus-like syndrome


Quinidine - used for atrial & ventricular tachycardia, anticholinergic actions; Toxicity - Cinchonism (blurred vision, tinnitus, HA, psychosis); enhanced Digitalis toxicity

 

Term

 

 

 

 

 

Class IB Antiarrhythmics

Definition


Lidocaine-IV; efficacious in ischemic myocardium.  Useful for ventricular tachycardias-can convert to normal rhythm & maintain normal rhythm in ischemic myocardial tissue.

Toxicity-CNS (Seizures, drowsiness, etc).  Avoid in high grade heart block-suppressed ventricular automaticity may be lethal by preventing alternative rhythms in complete heart block.

Term

 

 

 

 

Class IC Antiarrhythmics

Definition

Slow conduction velocity; used for ventricular arrhythmias.  Extremely effective for prevention of premature ventricular contractions & slowing ventricular response to A.fib/flutter.
Adverse effects-Precipitation of arrhythmias, CNS stimulation, Cardiovascular depression, Allergic reactions,Toxicity is worsened by electrolyte abnormalities
Flecainide

 

Term

 

 

 

Class II Antiarrhythmics - Beta Blockers

Definition

sinus rate, ↓conduction velocity (which can block re-entry mechanisms), & inhibit aberrant pacemaker activity ; also affect non-pacemaker action potentials by ­ APD & ERP
Propranolol (Inderal®): Non-selective B-blocker, Indicated for post-MI mortality reduction (mortality associated with post-MI arrhythmias)
Metoprolol (Lopressor®): B1-selective B-blocker
Esmolol (Breviblock®): very SHORT acting B1 selective B-blocker -IV for acute arrhythmias 

Term

 

 

 

Class III Antiarrhythmics:

K-channel blockers

Definition

MoA: block K channels (phase 3 repolarization), slowing repolarization leads to ­APD.  Also ­ ERP
ECG changes-increased QT interval (Common effect of all Class III antiarrhythmic drugs). By ­the ERP, these drugs are very useful in suppressing tachyarrhythmias caused by reentry mechanisms
Adverse Effects-(Similar toxicity to Class IA drugs)
Precipitation of arrhythmias (including Torsades), Caution with other drugs that may cause QT prolongation (Some antibiotics, TCAs, antipsychotics)

Term

 

 

 

Class III Antiarrhythmics:

Amiodarone

Definition


Used for many different types of arrhythmias due to actions of classes I-IV

1st line for supraventriculartachycardias

Toxicity-pulmonary fibrosis, thyroid dysfunction

Term

 

 

 

 

Class III Antiarrhythmics:

Ibutilide

Definition

 

 

 

Used for A.fib; helps convert to normal sinus rhythm

Term

 

 

 

 

Class IV Ca Channel Blockers

(Non-dihydropyridines)

Definition


Bind to L-type Ca channels on vascular smooth muscle, cardiac myocytes, & cardiac nodal tissue

Blocking Ca entry into the cells causes vasodilation, negative inotropy, negative chronotropy, and negative dromotropy

Term

 

 

 

 

Antiarrhythmic Properties of CCBs

Definition

 

↓ conduction velocity & prolong repolarization (especially at the AV node

 

Help block re-entry mechanisms, ↓ the firing rate of aberrant pacemaker

 

Cautions - excessive bradycardia, impaired conduction or contractility

Term

 

 

 

Drugs in Class IV CCB Antiarrhythmics

 

AEs

Definition

 

Verapamil & Diltiazem

 

Used for re-entrant SVT, ↓ ventricular rate in

a.flutter & fibrillation

 

AEs: inotropic effects, hypotension, avoid use with Class II (could lead to complete heart block)

Term

 

 

 

 

Digoxin as antiarrhythmic

Definition

 

 

Shortens ERP in atrial & ventricular cells, while prolonging the refractory period in the AV node

 

Therapeutic uses: to control the ventricular response rate in a. fib or flutter

Term

 

 

 

 

Adenosine as antiarrhythmic

Definition

Marked, immediate ↓ in AV node conduction

 

In IV form, the drug of choice for aborting acute SVT

 

When given IV in large doses: slows or completely blockss conduction in the AV node

 

Extremely short DoA

 

AEs: flushing, CP, hypotension

Term

 

 

 

 

Potassium as antiarrhythmics

Definition

 

 

 

 

Depresses ectopic pacemakers

(too much can cause re-entry arrhythmias)

Term

 

 

 

 

Magnesium as antiarrhythmic

Definition

 

 

 

Shortens QT duration

 

Sometimes effective in arrhythmias caused by digoxin toxicity or Torsades

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