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Cardiology - Pharmacology

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welejofo's version from 2017-04-28 01:49

Mechanisms

Question Answer
Calcium channel blockersBlock voltage-dependent L-type Ca channels in cardiac and smooth muscle tissue → ↓ muscle contractility
Hydralazine↑ cGMP → smooth muscle relaxation of arteries>veins → ↓ afterload
Nitroprussideshort acting; ↑ NO → ↑ cGMP
FenoldopamDopamine D1 receptor agonst → ↓ BP and ↑ natriuresis
Nitroglycerin, isosorbide dinitrateVenodilator - ↓ preload by: ↑ NO in smooth muscle → ↑ cGMP and relaxation
Dilates veins>>arteries → ↓ preload
HMG-CoA reductase inhibitorsInhibit conversion of HMG-CoA to mevalonate, a cholesterol precursor
NiacinInhibits lipolysis in adipose tissue
Reduces hepatic VLDL secretion
Cholestyramine, colestipol, colesevelamPrevent intestinal reabsorption of bile acids → liver must use cholesterol to make more
EzetimibePrevent cholesterol reabsorption at small intestine brush border
FibratesUpregulate LPL → ↑ TG clearance
Cardiac glycosides (digoxin)Direct inhibition of Na/K ATPase → indirect inhibition of Na/Ca exchanger/antiport
↑ [Ca] → positive inotrophy
Stimulates vagus nerve → ↓ HR
Quinidine, Procainamide, DisopyramideClass IA antiarrhythmics
Blocks Na channels
↑ AP duration
↑ effective refractory period (ERP)
↑ QT interval
Lidocaine, Mexiletine, TocainideClass IB antiarrhythmics
Blocks Na channels only in very rapidly depolarizing cells
↓ AP duration
Flecainide, propafenoneNo effect on AP duration
Blocks Na channels
Slows phase 0 depolarization
B-blockers (anti-arrhythmics class II)Dec. SA/AV nodal activity by ↓ cAMP & ↓ Ca currents (↓ slope of phase 4)
AV node is particularly sensitive → ↑ PR interval
Amiodarone, Ibutilide, Dofetilide, SotalolClass III anti-arrhythmics
↓ K efflux
↑ AP duration, ↑ ERP, ↑ QT interval
Verapamil, diltiazemClass IV antiarrhythmics
↓ conduction velocity, ↑ ERP, ↑ PR interval
Adenosine↑ EK → hyperpolarizing the cell + ↓ ICa
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Uses

Question Answer
Nifedipine, verapamil, diltiazem, amlodipineHTN
angina
arrhythmias (not nifedipine)
Prinzmetal's angina (at rest or cyclic, d/t coronary a angiospasm)
Raynaud's
HydralazineSevere HTN
CHF
First-line for htn in pregnancy, with methyldopa
coadministered with B-blocker to prevent reflex tachy
Nitroprussidemalignant htn
Fenoldopammalignant htn
Nitroglycerin, isosorbide dinitrateAngina
pulmonary edema
HMG-CoA reductase inhibitorsdecrease LDL
increase HDL
Niacindecrease LDL
Increase HDL
Cholestyramine, colestipol, colesevelamdecrease LDL
Ezetimibedecrease LDL
FibratesDec triglycerides
Cardiac glycosides (digoxin)CHF (↑ contractility)
a fib (↓ conduction at AV node and depression of SA node)
Quinidine, Procainamide, Disopyramideatrial & vent arrhythmias, esp. reentrant and ectopic supraventricular and ventricular tachy
Lidocaine, Mexiletine, TocainideAcute vent arrhythmias (post-MI) and in digitalis-induced arrhythmias
Flecainide, propafenoneSVTs, including a-fib. Only a last resort in refractory VT
For pts without structural abnormalities
B-blockers (anti-arrhythmics class II)SVT
slowing vent rate during a fib and a flutter
Amiodarone, Ibutilide, Dofetilide, SotalolUsed when other antiarrhythmics fail
Verapamil, diltiazemPrevention of nodal arrhythmias (SVT)
AdenosineDiagnosing/abolishing SVT
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something else

Question Answer
Nifedipine, verapamil, diltiazem, amlodipine
Hydralazine
Nitroprusside
Fenoldopam
Nitroglycerin, isosorbide dinitrate
HMG-CoA reductase inhibitors
Niacin
Cholestyramine, colestipol, colesevelam
Ezetimibe
Fibrates
Cardiac glycosides (digoxin)
Quinidine, Procainamide, Disopyramide
Lidocaine, Mexiletine, Tocainide
Flecainide, propafenone
B-blockers (anti-arrhythmics class II)
Amiodarone, Ibutilide, Dofetilide, Sotalol
Verapamil, diltiazem
Adenosine
memorize