USMLE Cardiology Pharmacology


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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