Favorite questions by Dr. Bella Merkely Flashcards
(4 cards)
Pt. with huge extensive ant. STMI, BP 100mmHg systolic, O2 saturation 80%, with dyspnea, HR of 130 bpm. (In acute cardiogenic shock), with sinus tachycardia on ECG. Which drugs do we give to lower the HR?
DON’T say beta blockers! The cause of this sinus tachycardia is a reflex. Pt is in cardiogenic shock in acute MI, meaning his LV function is severely depressed (LAD is occluded in most extensive ant. MI) the beta blocker negative inotropic, will kill pt.) Give oxygen, Morphine, heparin to treat shockNot the reflex, and open occlusion as fast as possible.
Which good drug therapy for diastolic heart failure? (there isn’t one!)
Apparently there isn’t one.
Should try to maintain rhythmicity because ventricles will be filled by atria more efficiently. βblockers may help as well because they decrease the HR and allow more time for ventricular filling.
Which 3 drugs to use in stable systolic heart failure?
Diuretics (furosemide, thiazide), ACE inhibitors (or ARB), βblockers.
Antiarrhythmic drugs.
The Vaughan Williams classification was introduced in 1970.
With regards to management of atrial fibrillation, Class I and III are used in rhythm control as chemical cardioversion agents while Class II and IV are used as rate control agents.
There are five main classes in the Vaughan Williams classification of antiarrhythmic agents:
● Class I agents interfere with the sodium (Na+) channel and include Quinidine, Lidocaine and Propafenone.
● Class II agents are antisympathetic nervous system agents (mostly βblockers) and include Carvedilol, Esmolol, Propranolol, Metoprolol and Atenolol.
● Class III agents affect potassium (K+) efflux and include Amiodarone (although it has class IIV activity) and Sotalol (βblockers).
● Class IV agents affect calcium channels and the AV node and include Verapamil and Diltiazem.
● Class V agents work by other or unknown mechanisms and include Adenosine, Digoxin and Magnesiumsulphate.
