USMLE Cardiology Pharmacology
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shunpisut's
version from
2016-08-25 16:10
Mnemonics
| Class | Drugs | Mnemonic |
|---|---|---|
| IA | Disopyramide/Quinidine/Procainamide | ดริปพบคิว |
| IB | Lidocain/Tocainide/Mexiletine/Phenytoin | ลิลลี่มีฝีโต |
| IC | Moricizine/Flecainide/Propafenone | โม่โปรฟรี |
| III | Ibutilide/Sotalol/Bretylium/Amiodarone/Dofetilide | แอม โดฟ ไอ้บู๋ เบ็ด สด |
Arrhythmias
| Arrythmia | Mechanism of Treatment | Drugs to Use |
|---|---|---|
| Atrial Flutter Step 1 | Slow ventricular rate with AV block | II/IV/Digoxin |
| Atrial Flutter Step 2 | Restore sinus rate with slow conduction or prolonging AP (QT) | Ia/Ic/III |
| Atrial Flutter Maintenance | Continue slowing conduction or prolonging AP (QT) | Ia/Ic/III |
| Atrial Fibrillation Step 1 | Slow ventricular rate with AV block | II/IV |
| Atrial Fibrillation Step 2 | Restore sinus rate with slow conduction or prolonging AP (QT) | Ia/Ic/III |
| Atrial Fibrillation Maintenance | Prevent thrombosis | Anticoagulant |
| AVNRT if infrequent | Vagal Maneuver | None |
| AVNRT if frequent | Restore sinus rate with slow conduction or prolonging AP (QT) | II/IV/Digoxin |
| AVRT/WPW nonpreferred | Slow normal pathway/speed accessory pathway | II/IV/Digoxin |
| AVRT/WPW preferred | Slow all pathways | Ia/Ic/III (some) |
| Ventricular Tachycardia Sustained | If hemodynamically stable | Amiodarone/procainamide/lidocaine |
| Ventricular Tachycardia Idiopathic | Control symptomatic episodes | II/IV |
| Torsades de Pointes drug/electrolyte | Shorten QT | I.V. Mg/Beta stimulating |
| Torsades de Pointes long QT syndrome | Sympatholytic | II |
| Ventricular Fibrillation | Defibrillation/treate precipitant of underlying arrhythmia | Varies |
Drugs
| Drug | Category | Electrical Mechanism | Number | Mechanical Mechanism | Number |
|---|---|---|---|---|---|
| Quinidine | Ia | Reduce Phase 0 slope/slows Phase 3 repolarization/lengthens AP | 3 | Slow and block conduction/increase threshold for firing/widen QRS/increase ERP (QT) | 4 |
| Procainamide | Ia | Reduce Phase 0 slope/slows Phase 3 repolarization/lengthens AP | 3 | Slow and block conduction/increase threshold for firing/widen QRS/increase ERP (QT) | 4 |
| Disopyramide | Ia | Reduce Phase 0 slope/slows Phase 3 repolarization/lengthens AP | 3 | Slow and block conduction/increase threshold for firing/widen QRS/increase ERP (QT) | 4 |
| Lidocaine | Ib | Reduce Phase 0 slope/speeds Phase 3 repolarization/shortens AP | 3 | Slow and block conduction/increase threshold for firing/widen QRS/decrease ERP (QT) | 4 |
| Tocainide | Ib | Reduce Phase 0 slope/speeds Phase 3 repolarization/shortens AP | 3 | Slow and block conduction/increase threshold for firing/widen QRS/decrease ERP (QT) | 4 |
| Mexiletine | Ib | Reduce Phase 0 slope/speeds Phase 3 repolarization/shortens AP | 3 | Slow and block conduction/increase threshold for firing/widen QRS/decrease ERP (QT) | 4 |
| Phenytoin | Ib | Reduce Phase 0 slope/speeds Phase 3 repolarization/shortens AP | 3 | Slow and block conduction/increase threshold for firing/widen QRS/decrease ERP (QT) | 4 |
| Flecainide | Ic | Reduce Phase 0 slope | 1 | Slow and block conduction/increase threshold for firing/widen QRS | 3 |
| Propafenone | Ic | Reduce Phase 0 slope | 1 | Slow and block conduction/increase threshold for firing/widen QRS | 3 |
| Moricizine | Ic | Reduce Phase 0 slope | 1 | Slow and block conduction/increase threshold for firing/widen QRS | 3 |
| Propranolol | II | Reduce Phase 4 slope/prolong SA/AV node repolarization | 3 | Reduce rate/increase ERP (QT)/block external pacemakers | 3 |
| Esmolol | II | Reduce Phase 4 slope/prolong SA/AV node repolarization | 3 | Reduce rate/increase ERP (QT)/block external pacemakers | 3 |
| Metoprolol | II | Reduce Phase 4 slope/prolong SA/AV node repolarization | 3 | Reduce rate/increase ERP (QT)/block external pacemakers | 3 |
| Atenolol | II | Reduce Phase 4 slope/prolong SA/AV node repolarization | 3 | Reduce rate/increase ERP (QT)/block external pacemakers | 3 |
| Amiodarone | III | Prolong Phase 3 repolarization (flattens slope) | 1 | Increase ERP (QT) | 1 |
| Dronedarone | III | Prolong Phase 3 repolarization (flattens slope) | 1 | Increase ERP (QT) | 1 |
| Sotalol | III | Prolong Phase 3 repolarization (flattens slope) | 1 | Increase ERP (QT) | 1 |
| Ibutilide | III | Prolong Phase 3 repolarization (flattens slope) | 1 | Increase ERP (QT) | 1 |
| Dofetilide | III | Prolong Phase 3 repolarization (flattens slope) | 1 | Increase ERP (QT) | 1 |
| Bretylium | III | Prolong Phase 3 repolarization (flattens slope) | 1 | Increase ERP (QT) | 1 |
| Verapamil | IV | Increase SA threshold/decrease AV velocity/increase ERP | 3 | Reduce rate/conduction velocity (lengthen PR interval)/increase ERP (QT) | 3 |
| Diltiazem | IV | Increase SA threshold/decrease AV velocity/increase ERP | 3 | Reduce rate/conduction velocity (lengthen PR interval)/increase ERP (QT) | 3 |
| Adenosine | N/A | Activates K channels/hyperpolarizes SA node/slows AV conduction | 3 | Slows SA firing/decreases AV conduction | 2 |
| Digoxin | N/A | Na/K/ATPase blocker/increases threshold/vagal effect | 3 | Decreases rate conduction/increases ERP | 2 |
| Atropine | N/A | Reduces threshold | 1 | Anticholinergic | 1 |
Side Effects
| Drug | Side Effects | Mnemonic |
|---|---|---|
| Quinidine | Torsade (long QT)/Thrombocytopenia/Tinnitus (cinchonism)/hypotension w/cardiac arrest | 4 3T's plus one |
| Procainamide | Torsade (long QT)/Reversible drug induced lupus/agranulocytosis | 3 |
| Disopyramide | Torsade (long QT)/Anticholinergic (blurry vision/urinary retention/dry mouth)/heart failure | 3 |
| Lidocaine | Local anesthetic/confusion/paresthesias/dizziness/seizures | 4 |
| Mexiletine | Dizziness/tremor/slurred speech/nausea/vomiting | 4 |
| Phenytoin | Drug interactions/protein bound | 2 |
| Flecainide | Torsade/drug interactions | 2 |
| Propafenone | Granulocytopenia/hypersensitivity | 2 |
| Propranolol | Bradycardia/AV block/CHF/Impotence/Broncho-vasospasm/metabolism (TG up/HDL down) | 5 |
| Esmolol | Bradycardia/AV block/CHF/Impotence/Broncho-vasospasm/metabolism (TG up/HDL down) | 5 |
| Metoprolol | Bradycardia/AV block/CHF/Impotence/Broncho-vasospasm/metabolism (TG up/HDL down) | 5 |
| Atenolol | Bradycardia/AV block/CHF/Impotence/Broncho-vasospasm/metabolism (TG up/HDL down) | 5 |
| Amiodarone | Torsade (long QT)/Pulmonary fibrosis (PFT)/thyroid (TFT)/hepatotoxic (LFT)/bradycardia/corneal deposits | 6 |
| Dronedarone | Torsade (long QT)/nausea/vomiting/diarrhea | 4 |
| Sotalol | Torsade (long QT)/over beta blocking | 2 |
| Ibutilide | Torsade (long QT) | 1 |
| Dofetilide | Torsade (long QT) | 1 |
| Verapamil | CHF/AV block/facial flushing/headache/gingival hyperplasia/constipation/edema | 7 |
| Diltiazem | CHF/AV block/facial flushing/headache/gingival hyperplasia/constipation/edema | 7 |
| Adenosine | Flushing/hypotension/chest pain | 3 |
| Digitalis | AV block/Vtach/Vfib/GI (nausea/vomiting/diarrhea)/yellow halos/hyperkalemia | 6 |
| Digoxin | AV block/Vtach/Vfib/GI (nausea/vomiting/diarrhea)/yellow halos/hyperkalemia | 6 |
| Digitoxin | AV block/Vtach/Vfib/GI (nausea/vomiting/diarrhea)/yellow halos/hyperkalemia | 6 |
| Digoxin | Renal clearance | Clearance |
| Digitoxin | Hepatic clearance | Clearance |
| Glycosides | Lidocaine/anti digoxin Fab/Mg2+/Potassium reduction | 4 Antidote (LAMP) |
| Glycosides | Renal failure/hypokalemia (and hypokalemic drugs)/quinidine (decreases clearance) | 3 Toxicity increasing factors |
CGF
| Question | Answer | Column 3 |
|---|---|---|
| NYHA I | Usually asymptomatic/vigorous activity | Definition |
| NYHA II | Prolonged moderate exertion | Definition |
| NYHA III | ODA | Definition |
| NYHA IV | At rest | Definition |
| NYHA I-II | Na restriction/loop diuretic/ACE-ARB | 3 |
| NYHA II-III | Na restriction/loop diuretic/ACE-ARB/BB | 4 |
| NYHA III-IV | Na restriction/loop diuretic/ACE-ARB/BB/Digoxin/spironolactone | 6 |
Misc
| Question | Answer | Column 3 |
|---|---|---|
| CCB | Nifedipine/verapamil/diltiazem/amlodipine | 4 ID |
| CCB | Block voltage dependent L type Ca channel on SM to reduce contractility | MoA |
| CCB | Amlodipine=nifedipine>diltiazem>verapamil | Strength at vascular smooth muscle |
| CCB | Verapamil>diltiazem>amlodipine=nefedipine | Strength at heart |
| CCB | HTN/angina/arrhythmias (not nifedipine)/Prinzmetal's angina/Raynaud's | 5 Use |
| Hydralazine | Increased cGMP relaxes smooth muscle (artioles>veins)/afterload reduction | MoA |
| Hydralazine | HTN/CHF/HTN in pregnancy (w/methyldopa) | 4 Use |
| Hydralazine | Compensatory tachycardia (contraindicated in CAD/angina/use BB to prevent)/fluid retention/nausea/headache/angina/Lupus like syndrome | 6 SE |
| Nitroprusside | Direct NO release increases cGMP (veins>arteries) reduces preload | MoA |
| Nitroprusside | Short acting malignant HTN | Use |
| Fenoldopam | D1 agonist (coronary/peripheral/renal/splanchnic vasodilation) | MoA |
| Fenoldopam | malignant HTN/causes natriuresis | Use |
| Nitroglycerin | Direct NO release increases cGMP (veins>arteries) reduces preload | MoA |
| Isosorbide dinitrate | Direct NO release increases cGMP (veins>arteries) reduces preload | MoA |
| Nitroglycerin | Angina/pulmonary edema | 2 Use |
| Isosorbide dinitrate | Angina/pulmonary edema | 2 Use |
| Nitroglycerin | Reflex tachycardia/hypotension/flushing/headache | 4 SE |
| Isosorbide dinitrate | Reflex tachycardia/hypotension/flushing/headache | 4 SE |
Lipid Lowering
| Question | Answer | Column 3 |
|---|---|---|
| Statins | Lova/atorva/rosuva/prava/simva | 5 ID (LARPS) |
| Statins | Decrease significant (>large) | LDL effect |
| Statins | Increase | HDL effect |
| Statins | Decrease | TG effect |
| Statins | Inhibits HMG-CoA reductase/blocks mevalonate synthesis (cholesterol precursor) | MoA |
| Statins | Hepatotoxicity (LFTs)/rhabdomyolysis | 2 SE |
| Niacin (B3) | Decrease large | LDL effect |
| Niacin (B3) | Increase large | HDL effect |
| Niacin (B3) | Decrease | TG effect |
| Niacin (B3) | Inhibits lipolysis in adipose/TG synthesis in liver | 2 MoA |
| Niacin (B3) | Facial flushing (reduced by aspirin/long term use)/hyperglycemia (acanthosis nigricans)/hyperuricemia (exacerbates gout) | 3 SE |
| Bile acid resins | Cholestyramine/colestipol/colesevelam | 3 ID |
| Bile acid resins | Decrease large | LDL effect |
| Bile acid resins | Increase slight | HDL effect |
| Bile acid resins | Increase slight | TG effect |
| Bile acid resins | Prevents intestinal bile-cholesterol reabsorption | MoA |
| Bile acid resins | Bad taste/GI discomfort/decrease fat soluble vitamin absorption/cholesterol gallstones | 4 SE |
| Ezetimibe | Decrease large | LDL effect |
| Ezetimibe | Prevent cholesterol absorption at small intestine brush border | MoA |
| Ezetimibe | Rare LFTs/diarrhea | 2 SE |
| Fibrates | Gemfibrozil/clofibrate/bezafibrate/fenofibrate | 4 ID |
| Fibrates | Decrease | LDL effect |
| Fibrates | Increase | HDL effect |
| Fibrates | Decrease significant (>large) | TG effect |
| Fibrates | Upregulate lipoprotein lipase/increase TG clearance | 2 MoA |
| Fibrates | Myositis/hepatotoxicity (LFTs)/cholesterol gallstones | 3 SE |
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