Youel: Cardiac Pharm

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atropine: - belladonna anti-cholinergic
- mad as a hatter, red as a beet, blind as a bat, dry as a bone
- adrenaline rush, hyperdynamic, mydriasis, stop secretions
anticholinergic effect on AV node: open gateway to ventricles for unopposed sympathetic activity
what are organophosphates? what 2 drugs are antidotes?: cholinesterase inhibitor; use atropine or pralidoxime (new reactivator)
ipratropium: works like atropine on bronchi; bulky version so no penetration into CNS; used in COPD, not acute asthma
describe the 4 classes of anti-arrhythmic drugs: class I: cardiac anesthetic blocks fast Na+ channel; subclasses a, b, c

class II: beta blocker

class III: prolongs repolarization in phase 3 of action potential

class IV: calcium channel blocker
name 2 class Ia anti-arrhythmics; what other effect does this class have?: quinidine, procainimide; prolongs repolarization
name 2 class Ib anti-arrhythmics; what is the second effect of this drug on the AP?: lidocaine, tocainide; shortens repolarization
name 1 class Ic anti-arrhythmic; what is the second effect on the AP?: propafenone; no secondary effect; this class is the newest but has pro-arrhythmic effects and is considered least effective of the a,b,c
name 2 class III anti-arrhythmics: bretylium, amiodarone
name 3 class IV anti-arrhythmics: verapamil, diltiazem, nifedipine
which phases of the AP are missing in the SA and AV nodes?: phases 0 and 1
which 4 cardiac drugs are notable for causing heart block?: ABCD

Adenosine
Beta-blockers
Calcium channel blockers
Digoxin

don't give 2 of these at the same time!!
amrinone is a cardiac inotrope, causing + contractility...how does it do this?: poisons cAMP phosphodiesterase, as does Aminophylline, Anti-inflammatories, Asprin
can diuretics cause edema? vasodilators?: YES! decrease renal perfusion, triggering salt and water retention; YES! dilated vessels leak
what are the 11 categories of heart drugs?: AAA
ACE inhibitors
Anesthetics
Anti-coagulants

B
Beta-blockers

CCC
Calcium channel blockers
Clot busters
Cholesterol & triglyceride lowering drugs

DDDD
Diuretics
Digoxin and other inotropes
Delayed repolarizing drugs
Direct vasodilator
what is one cause of myxedema, ie. widespread mucopolysaccharide deposits: severe hypothyroidism
what are the 3 key features of angiotensin II?: - potent vasoconstrictor
- triggers aldosterone release
- sensitize tissues to epinephrine
name 4 test-relevant ACE inhibitors: Captopril
Enalapril/AT
Quinapril
Fosinopril
what are 4 side effects from ACE inhibitors?: hypotension
proteinuria
hyperkalemia
cough
what is the effect of ACE inhibitors on bradykinin?: increases
which ACE inhibitor is "tissue active"? what does that mean?: quinapril; hardens newly-formed soft atherosclerotic plaques to help avoid MI
which ACE inhibitor prolongs life in CHF? which is a pro-drug metabolized in the liver?: captopril; enalapril
name an angiotensin 1 receptor blocker; how is it better than an ACE inhibitor?: losartan; no cough side effect
when should ACE inhibitors be used?: high renin hypertension:
diabetes
CHF
COPD
peripheral vascular disease
explain the digoxin/quinidine reciprocal relationship: quinidine quickens AV transit
digoxin slows AV transit

quinidine depresses myocardium
digoxin stimulates myocardium
what 3 cardiac drugs can lead to Lupus-like syndrome?: procainamide (class Ia anesthetic)
hydralizine (direct vasodilator)
minoxidil (direct vasodilator)
how can quinidine increase serum digoxin levels?: bumps digoxin off skeletal muscle binding sites
first DOC in CHF?: ACE inhibitors
use beta blockers in CHF?: yes, but only in small doses and preferably beta1 selective; works by giving the heart a rest from constant adrenergic bombardment
what are the A,B,C,D's in CHF?: ACE inhibitors
Beta blockers
Causes
Diuretics/digitalis/dilators
describe the D's in CHF: Diuretics: thiazide diuretics for MILD CHF, furosemide for MODERATE and BOTH for SEVERE

Digitalis: improves life, but doesn't prolong

Dilators: nitroglycerine and isosorbide dinitrate, decrease pre-load and some decreased after-load
what is said about triamterene in CHF?: prolongs life; a diuretic only available with hydrochlorothiazide
what do you do in acute pulmonary edema? (paroxysmal nocturnal dyspnea): "FIND the answer"

Furosemide, morphine, nitroglycerine
Intravenous nitroglycerine
Nitroprusside, Dobutamine
pair and compare digitalis and quinidine: myocardial irritability and contractility, AV node conduction: digitalis: increases contractility, irritability, slows conduction through AV node

quinidine: decreases contractility and irritability, "quickens" AV node conduction (myocardial depression can lead to CHF)
what do you give in atrial flutter?: first digitalis, then quinidine; NEVER give quinidine alone; be careful of dosing: quinidine displaces digoxin from skeletal muscle binding sites
difference between aspirin and NSAIDs?: both inhibit cyclooxygenase, thus blocking prostaglandins; asprin binds irreversibly
heparin: anticoagulant

A: blocks conversion of fibrinogen to fibrin by anti-thrombin III

X: large polymer of disaccharide

I: DVT, TIA, PE, heart valve embolism, angina pectoris
warfarin (Coumarin): anti-clotting drug; "WEPT" = Warfarin Extrinsic Prothrombin Time

A: vitamin K analogue, so lowers availability of II, VII, IX, X

I: DVT, TIA, PE, heart valve embolism, angina pectoris
asprin, naproxen: anti-platelet drugs

A: aspirin inhibits COX permanently, naproxen does so temporarily

X: bleeding

I: DVT, TIA, PE, heart valve embolism, angina pectoris
risk factors for DVT: MS Estrogen

Malignancy
Stasis

Estrogen (increase factors II, VII, IX, X)
ticlopidine: anti-platelet

A: blocks platelet binding to factor I

X: neutropenia

I: DVT, TIA, PE, heart valve embolism, angina pectoris
what 3 vitamins are made in the body or gut, but still need dietary input?: vitamin D: steroid nucleus, UV light, liver and kidney hydroxylation

vitamin K: made by colonic bacteria and requires bile for absorption

niacin: made from tryptophan

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Number of cards 42