Cardiovascular and Renal Drugs Flashcards
(121 cards)
1
Q
digoxin MOA
A
-inhibits Na+/K+ ATPase -
( “knocked over banana vending machine”)
-leads to increased intracellular Na+
(“offwhite man holding salty peanuts, salty peanuts in floor”)
-increase intracellular Na+ promotes Calcium inlfux through the Na+/Ca+2 exchanger
(“salty peanuts guy opens the door for the Calci-YUM guy”)
-results in increased contractillity
(“blue shirt guy flexes his arm “)
2
Q
what is Digoxin used for ?
A
- Anti-arrhythmic effect (“turntable”)
- symptomatic treatment of chronic systolic HF (“deflated balloon”)
-direct stimulation of the Vagal nerve can treat Atrial arrhythmias
(“las VAGas”)
3
Q
side effects of Digoxin
A
-hyperkalemia as a result of acute toxicity
(“pile of bananas”)
-induce various Arrhythmias
(“various dancers on heart shaped dancing floor”)
-chronic use of Digoxin may cause scooped concave ST segment on ECG
(scooped ice cream can says :”taSTy”)
-Bradycardia due to parasympathetic activation of SA node
(“Dangling heart watch” , “SA music note”)
- Heart block in case of toxicity (“AV music note”)
- GI symptoms (“nauseated dancer”)
- Xanthopia (“yellow spotlight”)
4
Q
Digoxin is contraindicated in …
A
-SA node heart block
(**use with caution in beta blockers**)
5
Q
what may exacerbate digoxin toxicity ?
A
Hypokalemia
- loop diuretics may cause hypokalemia , diarrhea , vomiting
Renal insufficiency
can make digoxin toxicity worse and will precipitate digoxin rise, the long flag indicates the long 1⁄2 life of digoxin, and increasing susceptibility to toxicity
- many arrhythmics inhibit renal clearance of digoxin, increasing susceptibility to toxicity
6
Q
what can reverse digoxin Toxicity ?
A
immune fab (“FAB uolous las vegas” sign)
7
Q
which drugs can treat Acute heart failure ?
A
Milirinone
(donkey sign says “hes One in a million”)
Nesiritide
(elephant sign says “necessary to turn the tide”)
8
Q
Milirinone MOA
A
-inhibits phosphodiesterase
(“don’t phoster disinterest”)
-decreases CAMP breakdown
(sign says “join the CAMPaign”)
-increases cardiac contractility
(“red donkey flexing arms”)
-causes arteriolar dilation in HF, but watch for hypotension
(“dilated red donkey ears”)
9
Q
Nesiritide MOA
A
-BNP analog that increases cGMP
-Nesiritide causes arteriolar AND venous dilation, reducing afterload and preload→natiuresis
(“elephant has dilated red ears and blue legs”)
(“BuMP the GruMP”)
10
Q
Name the ACE inhibitors
A
- *-PRIL**
- *CAPTO/**pril
- *ENALA/**pril
- *RAMI/**pril
- *LISINO/**pril
11
Q
ACE inhibitors MOA
A
inhibit ACE ⇒ATI is not converted to ATII
→ counteracts ATII effects
- dilate efferent arteriole → decrease GFR
- decrease Aldosterone Release →decrease Na+ reabsorption (natiuresis)
- decrease pressor effects of ATII
(“floppy red suspenders”)
12
Q
ACE inhibitors are used to treat …
A
-1st line treatment for CHF
(“failing heart balloon”)
-used in myocardial infarction
(“mandolina player playin dem Broken heart strings”)
-1st line agents used for HTN
(“High pressure candy pipes”)
-slow the progression of diabetic nephropathy
(“Diasweeties Candy shop”)
- ACEi reduce Mortality
(“Angel above le cross”)
13
Q
which patients should be started on ACEi therapy ?
A
-patients with albuminuria and BP > 130/80
(“albums in diasweeties candy shop”)
14
Q
what side effects might ACEi cause ?
A
-can cause significant hypotension and syncope in patients with high renin levels (in heart failure)
(“fainting poker player with floppy red suspenders”)
-can cause hyperkalemia due to decreased aldosterone levels
(“raised banana daquiri”)
-dry cough due to an increase of bradykinin
(“coughing dealer”)
-ACE increases the risk of fetal hypotension
(“Tarantula on mama’s back”)
15
Q
when are ACEi contraindicated and why ?
A
- ACE inhibitors are contraindicated inhereditary angioedema ( to C1 esterase deficiency) due to increased Bradykynin activity .
- ACE inhibitors are contraindicated in bilateral renal artery stenosis due to further decrease in GFR
- use of ACEi can precipitate acute renal failure charachterized by persistent increase in creatinine levels-azotemia
16
Q
which drugs should be avoided during ACEi therapy ?
A
NSAIDs should be avoided since they inhibit the actions of prostaglandins and bradykynin , causing vasoconstriction of afferent arteriole→GFR decrease
- can precipitate acute kidney injury
20
Q
Possible side effects of ARBs
A
- Hyperkalemia (“banana daquiri on taken chair”)
21
Q
Name a drug which can directly inhibit renin
A
Aliskiren
(“high limit-high risk slots”)
22
Q
name a possible side effect of Aliskiren ?
A
Hyperkalemia
(“slot machine showing 3 bananas”)
25
Q
in case of Hereditary angioedema , which drugs can replace ACEi therapy ? why ?
A
ARBs can be used as a replacement therapy since they don’t affect bradykynin serum levels
26
Q
Name the ARBs
A
-SARTAN (chair says “SoRry TAkeN”)
LO/ sartan
CANDE/ sartan
VAL/ sartan
27
Q
MOA OF ARBs
A
Angiotensin II receptor blockers
28
Q
which drugs act on the Proximal Convoluted Tubule ?
A
**Acetazolamide
Mannitol**
29
Q
Acetazolamide MOA
A
Inhibits Carbonic Anhydrase enzyme
- less H+ into the interstitium
- Na+/H+ exchanger inhibited
-cause bicarbonate (HCO3-) to stay in the tubular lumen leading to urine alkalization
(“Spilled alkaline substance on inside track”)
-prevent sodium reabsorption leading to natiuresis
(“Dropping salty peanuts on the inside of track”)
(“Acid from battery breaks car battery”)
30
Acetazolamide can be used to treat ...
-managment of **glaucoma
-**
managment of **idiopathic intracranial hypertension**
-treats **mountain sickness
-**
prevents formation of **uric acid kidney stones** due to increase in pH
31
Acetazolamide **side effects**
- normal anion gap **metabolic acidosis-type II RTA
- hypokalemia
-**
promote formation of **calcium phosphate stones
-**
Sulfa drug
33
Mannitol is used to treat ...
-increased **intracranial** pressure
("High pressure head balloon")
-increased **intraocular** pressure
("Spilled eyeball cups")
34
Mannitol Side Effects
- can cause **pulmonary edema**
- exacerbate **heart failure**
- **hypo/hyper** natremia
37
Mannitol Moa
**Osmotic Diuretic**
38
Name the Loop Diuretics
_THE MOST EFFICIENT DIURETICS EVA !_
**Furosemide** (SULFA)
**Ethacrynic acid** (NON-SULFA)
39
Loop Diuretics **MOA**
Site of action : **TAL**
* impermeable to water -diluting segment
("secured water in car")
- Blocks **NKCC** transporter and cancels positive luminal charge
* K+ no longer effluxes from cells thus promote excretion of Mg+2 and Ca+2
- induce expression of **COX-2** which synthesizes **prostaglandins**
* prostaglandins dilate afferent arteriole, increase RBF and enhance diuretic action
40
Loops diuretics are used for ...
- **1st line** for the symptomatic treatment of **acute decompensated heart failure**
- **1st line** treat symptoms of **pulmonary edema** in an **acute heart failure** exacerbation
- loop diuretics treat **ascites** in liver failure
- can be useful in the treatment of **HTN**
41
which group of drugs may interfere with the actions of Loop Diuretics and why ?
**NSAIDs -** decrease prostaglandins synthesis ,thus interfere with the actions of loop diuretics
42
**Side Effects** of Loop Diuretics
- loop diuretics may cause **hypokalemia**
- prolonged use of loop diuretics can cause **hypomagenesmia**
- Loop diuretics can cause **hypocalcemia (rare)**
- can cause dose related **hearing loss**
- **Interstitial nephritis** can be caused by loop diuretics
- loop diuretics can cause **hyperuricemia,** may lead to **gouty arthritis**
- can cause **contraction alkalosis**
43
which group of drugs may interfere with the actions of Loop Diuretics and why ?
**NSAIDs -** decrease prostaglandins synthesis ,thus interfere with the actions of loop diuretics
44
Loop Diuretics **MOA**
Site of action : **TAL**
* impermeable to water -diluting segment
("secured water in car")
- Blocks **NKCC** transporter and cancels positive luminal charge
* K+ no longer effluxes from cells thus promote excretion of Mg+2 and Ca+2
- induce expression of **COX-2** which synthesizes **prostaglandins**
* prostaglandins dilate afferent arteriole, increase RBF and enhance diuretic action
45
Name the Loop Diuretics
_THE MOST EFFICIENT DIURETICS EVA !_
**Furosemide** (SULFA)
**Ethacrynic acid** (NON-SULFA)
49
can loop diuretics prolong the the life of the heart ?
No.
50
Names of the Thiazide Diuretics
**-Hydrochloroathiazide** ("Chloro-thighs" )
-**Chlorothalidone** ("thiodore roosevelt")
52
Thiazides **MOA**
-block **NaCl Transporter**
* intracellular levels of Na+ drops → Ca+2/Na+ exchanger on basolateral membrane is enhanced
* more Ca+2 is reabsorbed
53
Thiazides are used to treat ...
-one of the *_1st line_* treatments for **mild-moderate hypertension**
("high pressure pipes")
**-**useful in treatment of **symptomatic heart failure**
("balloon guy holding lithium and floppy heart balloon")
* \*\*\*Loop Diuretics are 1st Line\*\*\*
-thiazides may treat **nephrogenic diabetes insipidus**
and reduce polyuria and polydypsia
-thiazides can prevent **Calcium stones**
("worker removing stones from tube slide")
-patients with **osteoporosis** may benefit from thiazide treatment
("life guard holding new calcium chalk")
54
what are the **side effects** seen with Thiazide diuretics treatment ?
**_HYPER_**
Glycemia ("elevated candy jar")
Lipidemia ("elevated butter stick")
Calcemia ("elevated Calci-YUM ice cream")
Uricemia - may precipitate **gout** ("yellow knitting needles")
**_HYPO_**
Kalemia ("Banana peel on floor")
Natremia ("salty peanuts on floor")
--------------------------------------------------------------------------------
-can cause **contraction/metabolic alkalosis**
- may decrease the amount of Lithium cleared from the kidney , thus **increase serum Lithium**
- **Sulfa** drugs
55
Site of Action of Thiazide Diuretics
**Distal Convoluted Tubules**
59
what is the difference between Ca+2 Reabsoprtion in PCT and DCT ?
_PCT_- **passive** , paracellular
_DCT_- **active** , controlled by PTH
60
what is the **site of action** of K+ sparing Diuretics ?
**Collecting Duct**
61
what are the two types of cells found in the collecting ducts ?
**_Principal cells_**
the main **Na+ reabsorbing cells** and the site of action of aldosterone, K+-sparing diuretics, and spironolactone.
they **secrete K+** through an apical membrane potasium channel.
**_α-intercalated cells_**
cells which contain apical **H+ ATPase**, explaining its ability to secrete protons.
62
Name the K+ sparing Diuretics
**Amiloride**
("Almonds")
**Triamterene**
("Tangerines")
**Eplerenone**
("apple with the teacher")
**Spironolactone**
("inspector with spiral bound notebook")
63
Aldosterone MOA
- upregulates **ENaCs** on the apical membrane
- upregulates **Na+/K+ ATPse** on the basolateral membrane
- upregulates **K+ channels** on the apical membrane
- upregulates **H+ ATPase** apical membrane
64
K+ sparing Diuretics MOA
**_Amiloride , Triamterene_**
ENaC inhibition
**_Spironolactone , Eplerenone_**
Aldosterone receptor antagonists
65
what are Amiloride and Triamterene used for ?
-useful in treatment of **Li+ induced nephrogenic Diabetes insipidus**
("inspidus fountain in the background")
**-**Amiloride and Triamterene are useful in the treatment of **Liddles syndrome** (overactive ENaCs)
("Little midget blocked by tangerines and almonds carts")
66
at higher doses Spironolactone can ..
-is a **synthetic steroid** inhibit **Androgen** receptors , more specifically **17-alpha Hydroxylase enzyme** thus lowers testosterone levels in the body
("17 alpha-fry-droxylase" "fried male symbol)
* may treat symptoms of androgen excess in **PCOS** such as **Hirsutism** ("bubbling ovary fryers")
67
what are the **side effects** seen with K+ sparing diuretics therapy ?
-can cause mild or even dangerous **hyperkalemia**
("Elevated banana’s in stand")
-may cause a normal anion gap **metabolic acidosis**
(by decreasing the function of the H+ATPase)
- K+ sparing diuretics inhibit the effects of aldosterone in the collecting duct causing a **type 4 renal tubular acidosis → \*\*only one associated with hyperkalemia\*\*.
- **
68
What are **two classes** of diuretics which **prevent** cardiac **remodeling** and **improve outcomes** in heart failure?
**(1) Aldosterone receptor antagonists**
* Spironolactone
* Eplerenone
**(2) ACE Inhibitors**
* Capto , Lisino, Rami , Enala - PRIL
69
possible **side effects** of Spironolactone
- inhibits androgen receptors and 17-alpha hydroxylase enzyme
- **Gynecomastia** ("hairy dudismo with lids on chest")
- **impotence** and **decreased libido** ("Droopy churro")
70
what is the **site of action** of K+ sparing Diuretics ?
**Collecting Duct**
77
what can Spironolactone and Eplerenone be used for ?
-useful in the treatment of **primary** and **secondary Hyperaldosteronism**, **Conn syndrome**, **ACTH**
("Crumbling Mineral Mountain in the background")
- useful in the treatment of **heart failure** to prevent K+ wasting
- **prevent myocardial remodeling** induced by high level of aldosterone
78
Calcium Channel Blockers MOA
Block **L-type** voltage gated **calcium channels**
| ("L-Shaped handle")
79
what are the 2 main groups of CCBs? what is the main difference between the two ?
**_1) Dihydropiridines_**
Blocks calcium channels in **Smooth Muscle
_2)Non-Dihydropiridines_**
Blocks calcium channels in **Cardiac Muscle**
80
Name the Non-Dihydropiridines
**Verapamil**
("very vannilla" flavor)
**Diltiazem**
("Delicious dark choclate" flavor)
81
Non-Dihydropiridines MOA
| ("Non-Dairy" section")
-Block **L-type** voltage gated calcium channels in **Cardiac muscle**
* decrease **cardiac contractility**
("weak kid trying to squeeze out some ice cream from the nozzle")
* decrease activity of **SA** and **AV** nodes
("Music notes on non-dairy sign")
⇒ may cause **bradycardia**
("Low dangling heart pocket watch")
* act as a negative ionotrope and chronotrope thus decrease **myocardial oxygen demand**
("discarded oxygen line")
* Verapamil → very minimal _dilatory_ activity
("Small sized ice-cream nozzle")
Diltiazem → has some _vasodilatory_ activity
("Medium sized ice-cream nozzle")
82
Dihydropiridines MOA
_Block **L-type** Calcium Channels found in **cardiac muscle**_
- **vasodilate coronary** arteries. ("dilatd coronary crown")
* Reduce coronary resistance, increase coronary blood flow and may enhance development of collaterals
-**increased** peripheral **vasodilation**
* lower systemic blood pressure
* decrease myocardial **oxygen demand**
("discarded oxygen line")
* reduce **afterload**
("reducued navil load because no ice-cream inside")
83
Calcium Channel Blockers Can Treat ...
-CCB’s **treat hypertension**
("High pressure pipes")
-CCB's **treat stable angina**
("angina anvil")
-CCB’s treat **prinzmetal angina**
("Anvil medal on red crown lady")
84
what can **Non-Dihydropiridines** be used for?
-Verapamil can be used for **Migraine Prophylaxis**
("pounding headbell")
-they have **antiarrhythmic properties**, this will help with A .Fib and A .Flutter
("Jukebox with records")
85
what can **Dihydropiridines** be used for ?
-IV dihydropyridines such as Clevidipine and Nicardipine can **treat hypertensive emergency**
("Emergency shut off switch")
-Nifedipine is used to treat **hypertension in pregnancy** or post-partum
("Pregnant knife lady")
-Nifedipine and Amlodipine can treat **raynaud’s syndrome-**an exaggerated response to cold temperature or stress
("guy in toppings stand has blue fingertips")
-can be used to treat **subarachnoid hemorrhages** commonly associated with berry aneurysms
("brain shaped ice-cream with berries")
* Nimodipine prevents vasospasms after a subarachnoid hemorrhage, vasodilates cerebral vessels (berry brain ice-cream "need Mo'dippin")
86
Dihydropiridines **Side Effects**
- CCB’sc an **worsen heart failure** due to hypotension, and can increase sympathetic activity
- Short acting Nifedipine has a high chance of side effects because of how active it is.
* Nifedipine can **exacerbate myocardial ischemia** due to reflex tachycardia – avoid in patients with unstable angina or MI
("Knife cutting heart shaped apple")
* Dihydropiridines can cause **reflex tachycardia**, especially with Nifedipine
(female doctor holding "Heart reflex hammer")
-can cause **lightheadedness, Headache,** flushing,
("lightheaded monkey customer")
-**Peripheral edema** due to preferential dilation from precapillary vessels from the arterioles increased capillary hydrostatic pressure
(" monkey customer wearing Baggy pants")
| ("failing heart balloon")
87
Non-Dihydropiridines Side effects
-verapamil can cause **constipation**
("Clogged toilet)
-verapamil can cause **gingival hypertrophy**
("toilet plummer has expanding gum in his mouth")
-verapamil and diltiazem care relatively **contraindicated** in patients with **heart block**
("remain unblocked" sign next to door)
-Verapamil or diltiazem combined with a **beta blockers** may produce **excessive AV block**
("remain un**_B_**locked" sign next to door)
88
Name the Dihydropiridines
_**-DIPINE -**suffix_
* *Nife**/ DIPINE
* *Amlo**/ DIPINE
* *Nicar/** DIPINE
* *Clevi**/ DIPINE
89
a Diuretic used as a **first line** agent for treating primary hypertension
**Hydrochlorothiazide**
(may be less effective than chlorthalidone )
90
What four drug classes are used in the treatment of **primary hypertension**?
1. Thiazide diuretics
2. ACE inhibitors
3. Angiotensin II receptor blockers (ARBs)
4. Dihydropyridine Ca2+ channel blockers
91
Black and elderly patients respond well to which drugs for treatment of **primary hypertension ?**
**1) hydrochlorothiazide**
2) long-acting _dihydropyridine_ **Ca2+ channel blockers**
92
**first line** treatment for **hypertension** in patients with _heart failure_, _MI,_ and/or _diabetes_
-**ACEi**
("ACE casino tables")
-**angiotensin II receptor** blockers
93
**Hypertensive emergency** occurs when ...
**systolic BP \>180** or **diastolic BP \>120** with **end-organ** damage
94
an **α- and β-antagonist,** can be used for **hypertensive emergency**
**Labetalol**
| ("Alpha and beta organ stops")
95
Many agents used in hypertensive emergencies are potent...
**Potent Vasodilators**
| ("Dilated red smoke stack")
96
Potent vasodilation (e.g. following hypertensive therapy) may cause ...
**hypotension** followed by reflex **tachycardia** and increased **renin** levels
97
Vasodilation (e.g. following hypertensive therapy) reduces...
**Afterload**
| (sailor unloads scale)
98
**IV Ca2+ channel blockers** that may be used in hypertensive emergency
**Clevidipine**
("clover on nice card")
**Nicardipine**
("nice card")
99
Hydralazine can ..
**dilate** arterioles, and decreased **after-load** via increasing **cGMP**
* \*\*has little effect on venous circulation\*\*
cause **hypotension**, which may induce a reflex **tachycardia** that can worsen **angina**
100
Hydralazine is often **co-administered** with a ...
**β-blocker** to minimize the reflexive sympathetic activation and tachycardia
101
Hydralazine can rarely cause...
**drug-induced lupus,** which may manifest as myalgias, arthralgias, and joint swelling
102
what can be **combined with Hydralazine** in order to treat LV systolic dysfunction?
**organic nitrate** (e.g. nitroglycerin)
* provides a **mortality benefit** for some patients with heart failure
* _hydralazine_ is a **vasodilator** (decrease afterload), _nitrates_ are **venodilators** (decrease preload)
103
**Nitroprusside** can ..
| ("Nitro-pressure speedboat")
-cause **vasodilation via nitric oxide**
("nitrous oxide exahust")**→increasing cGMP** ("grumpy old fart in the water"), which is useful during the treatment of hypertensive emergency
* causes **arteriolar** *_AND_* **venous** dilation
("both shirt sleeves and pants are dilated ")
104
Nitroprusside **side effect**
**cyanide poisoning** especially with prolonged use or renal impairment
("cyanide exhaust pipe gas")
105
**D1 receptor agonist** that may be used to treat hypertensive emergency...
**Fenoldopam**
| ("Old lady Pam)
106
Fenoldopam is a ...
**D1 receptor agonist** that may be used to treat hypertensive emergency by increasing levels of **cAMP**, causing **vasodilation** in most arterial beds
* especially in **renal** arteries **,coronary,** peripheral, and splanchnic vessels
* causes increased excretion of **Na+** and **water→natriuresis**
107
**Esmolol** And **Metoprolol** are ...
**Beta-1 antagonists** used for hypertensive emergencies.
* **IV** beta blockers administration treats hypertensive emergency
("Muted beta bugle players surrounded by posion ivy")
108
what are the subdivisions of **Class I Antiarrhythmics?**
IA
IB
IC
109
Name the **Class I Antiarrhythmics** and mention under which subdivision they fall
**_Class IA_**
Quinidine ("Dining prom queen")
Procainamide ("Prom King")
Dysopyramide (“Disapears!”)
**_Class IB_**
Lidocaine ("you lied ,your'e DEAD to me")
Mexilitine (Mexican flag)
Phenytoin ("Friendly towing employee")
**_Class IC_**
Flecainide ("blondy on 3rd floor eating cornFLAKES")
Propafenone ("purple phone")
110
Class I Antiarrhythmics **MOA**
-block **open** or **inactivated Na+** channels
("soloist holding open peanut butter jar with inactivating spoon in it ")
-affect the Na+ dependent **cardiac action potential**
("Illuminated atria, ventricles, and His-perkinje system")
```
**-“use dependence”** – class I antiarrhythmics have a **greater** effect on **rapidly depolarizing** tissues
("Heart tipping mic stand")
```
-**decrease** the slope of **phase 0** upstroke (slows conduction of the cardiac AP) AP will almost look tipped over with a decreased slope
("Soloist tipping mic stand")
-**widen the QRS** complex on the ECG
(decreased AP conduction velocity)
("Wide QRS shaped crack")
\*\*no action at the SA and AV nodes\*\*
111
**Class IA** properties
-have an **intermediate** binding affinity to the Na+ channel
("Prom queen lightly holding peanut butter jar")
-**block K+** channels prolonging phase **2** and **3** of the cardiac action potential **prolonged refractory period**
* **increased AP** duration
("prom queen pushing away the banana curtain")
112
**Class IA** Antiarrhythmics can **treat**
-**Supraventricular** and **Ventricular** Arrhythmias
("Illuminated top and bottom of IA heart:")
-**WPW** syndrome
("wpw highschool sign with 3 wolfs")
113
**Class IA** Antiarrhythmics **Side Effects**
-quinidine toxicity can cause **cinchonism**
(syndrome of tinnitus, headache, dizziness)
("tin cans around prom queen")
-quinidine can cause **thrombocytopenia**
("Broken plates around prom queen")
-procainamide can cause a **lupus–like syndrome** raising an ANA titer
("Prom king's lupus wolf")
-dysopyramide can **exacerbate heart failure**
(negative ionotrophy)
("Darts in failing heart balloon")
-can cause **QT interval prolongation**
(Precipitates torsades)
("Twisted torsades streamer")
114
**Class IB** properties
-have a **low binding affinity** for the Na+ channel
* **Decreased AP** duration
("Pulling the curtain")
-**shorten phase 2** and **3** of the cardiac action potential shortened refractory period so no chance for torsades de pointes
("Pulling the curtain")
-has a **greater tendency** to work with **ischemic heart**
("Broken illuminated IB heart")
[because of the reduced resting membrane potential delays sodium channel transition from inactive back into resting state resulting in increased drug binding]
| ("Dropped peanut butter jar")
115
**Class IB** Antiarrhythmics can **treat**...
-treat **ventricular arrhythmias-**especially in ischemic tissues
("Illuminated and cracked bottom of heart")
-treat **ischemia induced ventricular arrhythmias** one of the most common causes of death in the acute period following an MI
(sign says "you lied your'e "DEAD” to me")
116
**Class IB** Antiarrhythmics **Side Effects**
-cause **neurological problems**-parasthesias, tremor, convulsions.
("friendly towing trucker has brain hat")
117
**Class IC** Antiarrhythmics **Properties**
-**strong binding affinity** for the Na+ channel
("blonde dude in bed tightly holding peanut butter jar")
(strong use dependence, drastic slowing of the phase 0 upstroke)
* dramatic effect on QRS duration, , **_no change in AP Duration_**
(prolongs ERP in AV node)
("3rd floor has untouched potassium curtain")
-**do not affect** the cardiac _action potential duration_
("3rd floor has untouched potassium curtain")
118
**Class IC** Antiarrhythmics treat ...
-treat **supraventricular** (A.Fib) and **ventricular** arrhythmias
("Illuminated top and bottom of heart")
-treat **atrial fibrillation (and flutter)**
("Irregularly Irregular signal")
-can restore and maintain **normal sinus rhythm in A. Fib** and Flutter
("blonde dude uses remote controller to convert the signal")
119
**Class IC** Antiarrhythmics are **contraindicated** when ...
-contraindicated in patients with **history of structural** or **ischemic** heart disease
(proarrhythmic effects)
("box next to cornflakes box says “Healthy Hearts Only”!")
120
Class II Antiarrhythmics are ...
**Beta Blockers**
("muted Beta Bugle")
_Non Selective_
* *Proprano**lol
* *Sota**lol
* *Timo**lol
* *Nado**lol
_Selective_
"A-BEAM"
* *Acebuto**lol
* *Bisopro**lol
* *Esmo**lol
* *Ateno**lol
* *Metopro**lol
121
Beta Blockers **MOA**
("muted Beta Bugle")
-blocking **sympathetic input** to **SA** and **AV** nodes
("SA , AV Notes")
-**decrease cAMP** , leads to **closure** of membrane **calcium channels**, preventing the upstroke of AV nodal action potential
("Torn Band Camp poster")
("Crushed calci-yum ice cream cartons on the floor")
-**prolong phase 4** of the nodal action potential decreased pacemaker activity, prolonged conduction time and refractory period
("Ella Fitzgerald sliding up the piano keys")
-**decrease** atrioventricular conduction
("disconnected bottom of heart shaped lamp")
122
**Class II** Antiarrhythmics can be used to treat ...
-supraventricular **arrhythmias (Afib and RVR)**
("upper part of heart shaped lamp is lit")
-useful in **atrial fibrillation** (and flutter)
("Irregularly irregular static signal")
-**prevent rapid ventricular response** in atrial fibrillation and flutter-**“rate control”**
[does not fix the atrial fibrillation]
("heart shaped metronome")
123
**Acute** supraventricular arrhythmias can be treated with ...
**IV** Beta blokcer e.g. - **Esmolol**
| ("poison ivy")
124
**Class II** Antiarrhythmics **Side effects**
-Beta blockers can cause **heart block**
* heart block manifests as a **prolonged PR** interval on **EKG**
("suited reporter interviewed by Public relations")
| ("louie's hat shielding heart")
125
Names of Class III Antiarrhytmics
**-Amiodarone**
("tres AMIGOs")
-**Tilide suffix** (blue chica holding "till i die" sign )
* **DOFE** tilide
* **IBU** tilide
-**Sotalol** ("Soda on table")
126
Class III Antiarrhytmics **MOA**
-**block K+ channels** prolonging phase 2 and 3 of the cardiac action potential→prolonged refractory period
("Singer pushing away the Banana curtain")
```
-*_Amiodarone_* shares properties of **class I, II, III,** and **IV** antiarrhythmics.
(grafiiti on wall says "uno, dos, tres, quattro”)
```
-Sotalol is also a **beta blocker**
("Muted beta bugle and soda bottles")
127
Class III Antiarrhytmics can be used to treat ...
-treat both **supraventricular** arrhythmias and also **ventricular** arrhythmias
("Heart candles illuminated on top and bottom")
-treat **atrial fibrillation and flutter**
("Irregularly irregular signal on TV")
-can restore and **maintain normal sinus rhythm** in atrial fibrillation and flutter
("green shirt old fart converting the signal using remote control ")
128
**Amiodarone** Side Effects
-many **neurologic side effects** -tremor, ataxia, peripheral neuropathy, sleep disturbances
("sombrero with Skulls")
-can cause **grey corneal deposits**
("singer with Gray sunglasses")
-can cause **hyper** or **hypo-thyroidism**
("band members wear Big and small bowties
-can cause **pulmonary fibrosis**
("Fibrotic lung embroidery on singer's blazer ")
-lung fibrosis causes **restrictive lung diseases**
("singer has tight button in his blazer")
-can induce **heart failure**
("Trampled failing heart balloon")
-can cause **hypersensitivity hepatitis**
("Liver spot on cow")
-can cause **gray blue skin discoloration**
("Mariachi band wearing Grey blue outfits")
-inhibits the **cytochrome P450 -** drugs like warfarin and statins may increase
("Broken chrome bumper")
129
Sotalol , Dofetilide , Ibutilide (Also Amiodarone)
**Side Effects**
-can induce **dose related torsade’s**
("twisted torsades streamer")
(although all type III antiarrhythmics can widen the QT interval)
135
which **lab tests** should be preformed when starting **Amiodarone** therapy ?
* *Pulmonary** Function Test
* *Thyroid** Function Test
* *Liver** Function Test
136
Names Class IV Antiarrhythmics
**_Non dihydropyridine calcium channel blockers_**
Verapamil
("very Vanilla")
Diltiazem
("Delicious dark choclate")
137
Class IV Antiarrhythmics **MOA**
_Non-Dihydropyridine Calcium Channel Blockers_
-Block **L-type** voltage gated **Calcium channels** in the **heart** thus **block** calcium current in the **SA** and **AV** nodes
("L shaped nozzles on wall")
("Notes on music sheet")
* Exert a **greater effect** on tissues that **fire more** frequently that use a calcium current
-non-dihydropyridine CCB’s **prolong phase 4** of the nodal action potential decreased pacemaker activity, **prolonged conduction time** and **refractory period**
("pianist sliding up the keys")
-non-dihydropyridine CCB’s **decrease atrioventricular conduction**
("Disconnected bottom of heart shaped lamp")
138
Class IV Antiarrhythmics can treat ...
-treat **supraventricular arrhythmias** (A.FIB with RVR)
("Illuminated top of the heart shaped lamp")
-useful in **atrial fibrillation** and **flutter**
("tv showing Irregularly irregular signal")
-prevents **rapid ventricular response** in A Fib and Flutter
("heart shaped metronome on piano")
139
Digoxin MOA
-digoxin exerts **direct parasympathomimetic** effects via direct stimulation of the **vagus nerve → AV nodal inhibition**
("welcome to las VEGAS" sign)
140
Digoxin may be used to treat ..
-useful in **atrial fibrillation and flutter**, _not first line_
("many tv screens showing irregularly irregular rythm")
-prevents **rapid ventricular response** in atrial fibrillation and flutter (rate control)
("las vegas" sign shaped like metronome )
141
Magnesium Can treat ...
| ("magnets")
-useful for the treatment of certain **arrhythmias** (torsades)
- magnesium treats **torsades de pointes**
(״Torn twisted torsades streamers״)
142
Hyperkalemia can ...
-induce **arrhythmias**
("Banana dancer pointing up")
-causes **peaked T waves** on ECG
("Peaked streamer")
143
Hypokalemia can ...
-induce **arrhythmias**, severe **muscle weakness**, and **glucose** abnormalities
("female Banana dancer pointing down")
-can induce **U waves** at the **end of the T** wave on EKG
("Streamer with extra bump")
144
Adenosine **MOA**
-adenosine is a **purine nucleoside**
("Purine shaped gate")
-adenosine **activates A1 (Gi) receptors** on the myocardium and at the SA and AV nodes
("A1 swing")
-**increases outward K+** current→hyperpolarization
("Banana flying out of the cup")
**-suppress inward Ca2+** current
("Falling calci-YUM ice cream")
-decreases **atrioventricular conduction**
("disconnected bottom of heart shaped lamp")
-**inhibits AV** nodes
("Note shaped dance floor")
145
Adenosine can treat ..
**-first line** agent for **acute** treatment of **supraventricular arrhythmias (PVST)**
("Illuminated top of heart shaped lamp")
146
Side effects of **Adenosine**
-causes **transient high grade heart block** (direct av node inhibition for about 10s)
("Hat blocking heart")
-causes **coronary dilation** (mediated by A2 receptors)
("Dilated coronary crown")
-can cause **cutaneous flushing**
("Flushed dancer")
-can cause **shortness of breath**, **chest pain**, and impending **sense of doom**
("Dancer clutching his chest)
-can cause **fainting**, **headache**, and **hypotension**
("fainting female dancer")
147
the actions of **adenosine** are **inhibited** by...
**-caffeine** and **theophylline** (methylxanthines)
("Energy drink blocking A1 gate")
