Cardiovascular Pharm Flashcards
(21 cards)
Antiarrhythmic Drugs Affect what
Affect the various ion channels underlying the cardiac action potential
Antiarrhythmic Drugs 4 classes and what they block
- Class I: NA+ channel blockers
- Class II: beta-adrenergic receptor blockers
- Class III: K+ channel blockers
- Class IV: Ca++ channel blockers
Class I: Na channel blockers
Tx3
dont want to…
- Used to tx -
- Atrial fibrilation
- Tachycardia
- Ventricular arrhythmias
- Dont want to completely block the Nav channels, just decrease their activity
Class I Subtypes
Class 1A: Na channel blockers
Affect on cardiac cycle
- Reduce automaticity
- Decrease conduction velocity
- Increase refractory period
- Inc overall action potential duration
Class IA examples 2 and side effects
- Quinidine
- can cause cinchonism (quinone poisoning), hypotension, torsades de pointes
- Procainamide
- Can cause mental changes, lupus, torsades de pointes
Class IB Na channel blockers
Affect on cardiac cycle
1 ex and side effescts
- Reduces automaticity at abnormal pacemakers
- His-Purkinje system and or ventricular myocardium
- Lidocaine
- can cause convulsions
Class IC Na channel blockers
Affect on cardiac cycle
2 ex
- Reduces automaticity
- Dec conduction velocity
- Flecainide
- Can cause convulsions, dizziness, blurred vision, cardiac risk with recent myocardial infarction
- Propafenone
- Can cause chest pain, edema, nausea, altered taste, anxiety, dyspnea
Class II Beta-adrenergic receptor blockers MoA
- Bluck sympathetic stimulation of heart
- reduces automaticity
- Dec conduction velocity
Class II Beta-adrenergic receptor blockers
Tx
2 ex MoA contraindication in, can also cause
- Tx hypertension, post myocardial infarction, angina, and to prevent tachyarrhythmias
- Propranolol (blocks both beta1 and beta2)
- Esmolol a lil more specific for beta-1
- contraindicated in asthmatics (bronchoconstriction)
- Can also cause heart block
Class III: K+ channel blockers
MoA
- Reduces automaticity
- Prolongs ventricular depolarization
- Inc the refractory period (slows repolarization)
Class III:K+ channel blockers
2 Ex and side effects
- Amiodarone
- Can cause many serious side effects
- pulmonary fibrosis, thyroid abnormalities, skin discoloration, cornea deposits, peripheral neuropathy
- Dronedarone and Sotalol
- Fewer side effects but still serious
Class IV:Ca++ channel blockers
Tx3
2 ex, can act on both
MoA
can cause
- Used to tx
- hypertension
- angina
- atrial arrythmias
- Verapamil, Diltiazem
- Can act on both smooth muscle and cardiac muscle
- Dec automaticity
- Dec contractility
- Dec conduction velocity in AV node
- Dec peripheral resistance
- Can cause flushing, AV node conduction defects
Other antiarrhythmic drug not in classes1-4
Adenosine
Tx
MoA
can cause
- Given IV, usually in advanced cardiac life support situation
- MoA
- Red automaticity
- Dec conduction velocity in AV node
- Can cause flushing, asthma, dyspnea, SA nodal arrest, AV nodal block
Cardiac Glycosides
Tx by
2 ex and MoA
- Tx congestive heart failure
- Inc strength of myocardial contraction
- Also slows ventricular rate
- Ex Disoxin, Digitalis
- Blocks Na/K ATPase
- Co-administration with epi can inc risk of ventricular arrhythmias
- Drugs that lower plasma K levels (thiazide, diuretics) inc toxicity
- Can cause
- Heart block
- ventricular arrhythmias
- Visual and mental disturbances
- Nausea and vomiting
Acute tx of heart failure
5 and what they are
- Dobutamine
- beta-1 agonist
- Dopamine
- catecholamine
- Phosphodiesterase III Inhibitors
- Inamrinone, Milrinone, Vesnarinone
- Atrial natriuretic peptide agonists
- Nesiritide
- Vasopressin receptor antagonists
- Tolvaptan
Antianginal drugs
what is angina pectoris
drug mech 4
- Angina pectoris= pain from hypoxic heart tissue
- Drug mechanisms
- Reduca cardiac rate
- Reducae cardiac force
- Reduce peripheral resistance
- Dilate coronary arteries
Antianginal Drugs include 7
adverse affects
- Clacium channel blockers
- Beta blockers
- Vasodilators
- Paticularly nitrates and nitrites
- Antiplatelet drugs
- Lipid lowering drugs
- Ranolazine (blocks late Na and Kir currents, prolonging ventricular AP, improves contractile dysfunction)
- Nitroglycerine and Amyl nitrite
- generate NO
- Adverse effects: headache, syncope, tachycardia, tolerance, methemoglobinemia (low O2 carrying capacity in the blood)
Drugs that Reduce Risk of Myocardial Infarction
6
- Antiplatelet drugs
- Aspirin
- Clopidogrel, Prasugrel- block activation of platelets by inhibiting ADP receptor
- Abciximab, Eptifibatide, Tirofiban- GPIIb-IIIa glycoprotein receptor inhibitors (block platelet aggregation)
- Ranolazine
- Lipid lowering drugs (statins)
Dyslipidemia
Type
elevated lipo
drug
- IIa
- LDL
- Statin
- IIb
- LDL VLDL
- Statin fibrate
- III, IV, V
- LDL VLDL
- Fibrate
