Module 1 Flashcards
(125 cards)
1
Q
Nonpharmacologic treatment for anti arrhythmia
A
Defibrillation
Pacemaker
2
Q
Miscellaneous anti arrhythmic drugs
A
Adenosine
Magnesium sulfate
3
Q
Class IV- Calcium Channel Blockers
A
Verapamil
Diltiazem
4
Q
Class III- Potassium Channel Blockers
A
Bretyllium
Sotalol
Ibutilide and Doletilide
Amiodarone
5
Q
Class II - Beta Blockers
A
Propranolol
Esmolol
6
Q
Class I - Sodium Channel Blockers
A
Procainamide
Quinidine
Disopyramide
7
Q
Involves a group of pharmacological agents that converts the existing arrhythmia to a normal rhythm
A
Cardiac Rhythm
8
Q
Uses of adenosine
A
PVST 1st line
Short duration (15 sec)
9
Q
Uses of Magnesium Sulfate
A
Torsade de point
10
Q
Uses of verapamil
A
AF 1st line
IV, oral
11
Q
Uses of bretyllium
A
Refractory post MI, VF
12
Q
Uses of amiodarone
A
Most efficacious
Block Na, Ca, K channels and B receptors
VT 1st line
13
Q
Side effects of adenosine
A
Flushing
Hypostension
14
Q
Side effect of verapamil
A
Hypotension
15
Q
Side effect of amiodarone
A
Corneal deposits
Hypothyroidism
Pulmonary fibrosis
16
Q
Side effects of ibutilide and doletilide
A
Torsades
17
Q
Side effect of sotalol
A
Torsades
Bradycardia
Asthma
18
Q
Side effect of bretyllium
A
Arrhythmia
Hypotension
19
Q
for patient with AF
A
Class II Beta Blocker
Propranolol and esmolol
20
Q
Side effects of Disopyramide
A
Antimuscarinic
Dry mouth
Blurred vision
Hot and flushed skin
Dry skin
Intra ocular pressure
21
Q
Side effects of Quinidine
A
Cinchonism ( headache, vertigo, tinnitus)
GI upset
Torsades de pointes
22
Q
side effect of procainamide
A
Hypotension
Lupus
23
Q
This is a specific type of abnormal heart rhythm that can lead to sudden cardiac death… a polymorphic ventricular tachycardia
A
Torsades de pointes
24
Q
The most serious arrhythmia, can result in cardiac arrest and death
A
Ventricular Fibrillation
25
Signs and symptoms of Ventricular Fibrillation
Palpitations
Irregular pulse
Dizziness
Syncope
Heart failure
Chest pain
26
Diagnosis for Ventricular Fibrillation
Electrocardiogram ECG
27
Classes of anti arrhythmic drugs
Class I- Sodium Channel Blockers
Class II - Beta Blockers
Class III- Potassium Channel Blockers
Class IV- Calcium Channel Blockers
Miscellaneous Antiarrhythmic Drugs
28
Types of Arrhythmia and commonly occurring Arrhythmia
Tachycardia (atrial or ventricular)
Atrial flutter
Atrial fibrillation
Ventricular fibrillation
Premature contraction of aorta
Premature contraction of the ventricles
Bradycardia
29
Characteristic rate of Tachycardia
150-250
30
Characteristic Rate of atrial flutter
200-350
31
Characteristic Rate of atrial fibrillation
Greater than 350
32
Characteristic Rate of ventricular fibrillation
Uncoordinated contraction
33
Characteristic Rate or premature contraction of aorta and premature contraction of the ventricles
Variable
34
Characteristic Rate of Bradycardia
Less than 50
35
A problem with the rate or rhythm of your heartbeat. It means your heart beats too quickly, too slowly, or with irregular pattern
Arrhythmia
36
Heart beats faster
Tachycardia
37
Heart beats slower
Bradycardia
38
Most common type arrhythmia, which causes an irregular and fast heartbeat
Atrial Fibrillation
39
Factors can affect your heart’s rhythm
Had a heart attack
Smoking
Congenital heart defects
Stress
40
A chronic progressive condition that affects the pumping power of your heart muscles
Congestive Heart Failure CHF
41
The stage which fluid builds up around the heart and cause it to pump inefficently
Congestive Heart Failure
42
Inability of the heart to pump sufficient blood to meet the metabolic needs of the body
Heart Failure
43
Common causes of CHF
Arteriosclerosis
Atherosclerosis
Myocardial Ischemia and Infarction
Hypertension
Valvular Stenosis and Regurgitation
44
Sign and Symptoms of CHF
Dyspnea
Orthopnea
Fatigue
Cough
45
First line therapies
Cardiac glycosides
46
4 Cardiac Glycosides
Digoxin
Digitoxin
Deslanoside
Ouabain
47
Cardiac Glycosides form Foxglove, Digitalis lanata, Digitalis Purpurea
Digoxin
48
For patient with Atrial Fibrillation
Target plasma concentration 0.5-1mg/ml
Steroid nucleus +5 membered lactone ring at C17 and sugar at C3
Digoxin
49
Very available in pharmacy because of its onset of action and also physician’s first choice
Digoxin
50
MOA of Digoxin
Therapeutic goal- to increase Myocardial Contraction
Inhibit Na-K ATPase pump — Increase Na—Na-Ca exchange
(Calcium increases the formation of Actinomycin, resulting the greater myocardial contraction)
51
Another cardiac glycoside na mas maganda and same with digoxin but delays onset of action
Digitoxin
52
Cardiac Glycoside Reserved drug
Deslanoside
Ouabin
53
Major side effect of cardiac glycoside
Hypokalemia
54
Digoxin:
Lipid solubility
Half- life
Excretion
Medium
Short
Renal
55
Digitoxin:
Lipid solubility
Half- life
Excretion
High
Long
Hepatic (liver)
56
Method of dosage with cardiac glycosides that rapidly produces effective drug level
Digitalization
57
Daily dosage of glycoside that maintains effective drug levels in the blood
Maintenance
58
Cardiac glycosides interactions
Diuretics- Arrhythmia
ACE inhibitors
Beta Blockers
Diuretics
59
Cardiac glycoside interactions
Beta blockers
Carvedilol
Metoprolol
Bisoprolol
60
Loop diuretics only for patients with fluid retention
Furosemide
Lumetanide
Torsemide
61
Is a chest pain due to decreased blood flow to the heart or due to an inadequate supply of oxygen to the heart muscle
Angina pectoris
62
2 types of Angina Pectoris
Exertional Angina
Vasospastic Angina
63
Caused by increased physical exertion
Also called chronic stable angina
Also called classic angina, typical and effect - induced
Most common type
Due to atherosclerosis of the coronary artery
Exertional Angina
64
Caused by vasospasm of the coronary artery
Also called Rest angina, Variant, Prinz metal
Vasospastic Angina
65
Strategy treatment for angina pectoris ( therapeutic goal)
Increase O2 delivery
Decrease O2 demand
66
Increase O2 delivery
Nitrates
Vasodilators
Ca blocker
67
Decrease O2 demand
Beta blockers
Ca blockers
68
Antianginal drugs
Nitrates
Beta blockers
Calcium channel blockers
69
The most widely used drug for nitrates
Routes are sublingual, buccal, spray, patch
Nitroglycerin
70
Nitrates
Nitroglycerin
Isosorbide dinitrate (ISDN)
Isosorbide mononitrate ( ISMN)
71
Route of Isosorbide Dinitrate ISDN
Sublingual and Oral
72
Route of Isosorbide Mononitrate ISMN
Oral
73
MOA of nitrate
Converted to Nitric Oxide (NO)
⬇️
Increase cGMP
⬇️
Smooth muscle relaxation
⬇️
Vasodilation
⬇️
Venodilation and atrial dilation
⬇️
Decrease oxygen demand
⬇️
Dilation of coronary artery
74
Nitrates for Acute attack
Nitroglycerin- Sublingual, buccal, spray
ISDN- sublingual
75
Nitrates for prophylaxis
Nitroglycerin- patch
ISDN- oral
ISMN- oral
76
Nitrates undergo extensive first pass metabolism
77
Tolerance time of nitrate
8-12 hrs free interval
78
Side effect of Nitrates
postural hypotension
reflex tachycardia
headache
flushing
79
-Also known as coronary artery disease (CAD)
-Lack of oxygen and decreased or no blood flow to the heart due to coyary alery around, nobat rigina, chronic stable angina or variant angina.
Ischemic Heart Disease IHD
80
Antianginal Beta blockers
Acebutolo!
Metoprolol
Atenolol
Betaxolol
Nadolol
Nebivolol
Bisoprolol
Carvedilol
Penbutolol
Pindolol
Esmolol
Propranolol
Labetalol
Timolol
81
beta blocker most widely used in the treatment of angina.
Propranolol
82
Antianginal Calcium Channel blocers
Nifedipine
Verapamil
Diltiazem
83
-Agents of choice for variant or Prinz metal angina
-Arteriolar dilator, depress myocardial contractility
Antianginal Calcium Channel blocker
84
Primary Agents for the Treatment of Hypertension
Diuretics
Beta blocker
Angiotensin Converting Enzyme inhibitors
Angiotensin II Receptor Blockers
Calcium Channel Blocker
a1- receptor blockers
Centrally acting / a2 agonist
Reserpine
Vasodilator
Post ganglionic sympathetic inhibitors
85
Diuretics used for hypertension
-thiazides
86
Thiazide
Hydrochlorothiazide
Chlorthalidone
Indapamide
Metolazone
Microside
87
Thiazide
Hydrochlorothiazide
Chlorthalidone
Indapamide
Metolazone
Microside
88
Side effects of diuretics
Hypokalemia
Hypomagnesemia
Hypercalcemia
Hyperuricemia
Hyperglycemia
Hyperlipidemia
89
Side effects of diuretics
Hypokalemia
Hypomagnesemia
Hypercalcemia
Hyperuricemia
Hyperglycemia
Hyperlipidemia
90
Beta blockers MOA
Negative inotropic, chronotropic action
91
Beta blockers MOA
Negative inotropic, chronotropic action
92
Beta blockers cardio selective at low dose
Atenolol
Betaxolol
Bisoprolol
Metoprolol
93
Beta blocker intrinsic sympathomimetic actvity
Acebutolol
Carteolol
Penbutolol
Pindolol
94
extensive first pass metabolism
Propranolol
metoprolol
95
long half-life, renal excretion
Atenolol
nadolol
96
Side effect of beta blockers
hypotension
bradycardia
heart failure
heart block
bronchospasm (asthma, COPD patients)
peripheral vasoconstriction
intermittent claudication
97
blocks conversion of angiotensin I to angiotensin Il
-blocks the degradation of bradykinin--angioedema
-given once daily except captopril (2-3x a day)
ACE inhibitors (Angiotensin converting enzyme) inhibitors
98
ACE inhibitors
captopril
ramipril
enalapril
imidapril
99
-blocks angiotensin type (AT 1) receptor
-lack of cough as side effect
-S/E: hyperkalemia, renal insufficiency
-contraindicated in pregnancy
Angiotensin Il receptor blockers
100
Angiotensin II receptor blocker
losartan
valsartan
candesartan
irbesartan
valsartan
101
blocks voltage sensitive calcium channels in cardiac and smooth muscle
Calcium channel blockers
102
Calcium Channel blocker 2 classes
1. non dihydropyridine
2. dihydropyridine
103
non dihydropyridine
verapamil
diltiazem
104
dihydropyridine
nifedipine
felodipine
amlodipine
105
Side effect of Non-dihydropyridine
bradycardia
Av block
heart failure
constipation
106
Side effects of Dihydropyridine
dizziness
headache
107
-reserved for patients with BPH
a1-receptor blockers
108
A1 receptor blocker
prazosin
terazosin
doxazosin
109
Side effect of a1 receptor blockers
first-dose phenomenon-Orthostatic hypotension (dizziness, faintness, syncope), Sodium and water retention
110
-presynaptic a2 agonist.-negative feedback---Decrease NE release
- activity of methyldopa is due to the stimulation of central aplha adrenoreceptor by methyldopamine and methyl norepinephrine
Centrally acting / a2 agonists
111
Centrally acting/a2 agonist
methyldopa
clonidine
guanabenz
guanfacine
112
Side effect of centrally acting/ a2 agonist
-Sedation, dry mouth, depression
-Sodium and water retention (esp. methyldopa)
-rebound hypertension (esp. clonidine)
113
MOA: depletes NE and blocks transport of NE into its storage vesicles.
Reserpine
114
Side effects if Reserpine
-Sodium and fluid retention
-parasympathetic effect (nasal congestion, diarrhea, bradycardia),
-depression
115
Vasodilators
Hydralazine
Minoxidil
116
Increase heart rate and renin release ( should be given with beta blocker and a diuretic)
Vasodilators
117
Hydralazine for
Eclampsia
118
Methyldopa for
Chronic HTN in pregnant patients
119
Side effect of hydrazaline
Lupus like (rash, arthralgia, reversible)
120
Side effect of minoxidil
Hypertrichosis (overgrowth of hair)
121
Postganglionic sympathetic inhibitors
Guanethidine
Guanadrel
122
Deplete and inhibit the release of NE
Post ganglionic sympathetic inhibitors
123
Side effect of post ganglionic sympathetic inhibitors
Orthostatic hypotension
124
Hypertensive urgency
Clonidine
Captopril
Labetalol
125
Hypertensive emergency
Nitroprusside
Nitroglycerin
Nicardipine
Felodopam
Labetalol
Hydrazaline
