Create
Learn
Share

USMLE Cardiology Pharmacology

rename
shunpisut's version from 2016-08-25 16:10

Mnemonics

ClassDrugsMnemonic
IADisopyramide/Quinidine/Procainamideดริปพบคิว
IBLidocain/Tocainide/Mexiletine/Phenytoinลิลลี่มีฝีโต
ICMoricizine/Flecainide/Propafenoneโม่โปรฟรี
IIIIbutilide/Sotalol/Bretylium/Amiodarone/Dofetilideแอม โดฟ ไอ้บู๋ เบ็ด สด
memorize

Arrhythmias

ArrythmiaMechanism of TreatmentDrugs to Use
Atrial Flutter Step 1Slow ventricular rate with AV blockII/IV/Digoxin
Atrial Flutter Step 2Restore sinus rate with slow conduction or prolonging AP (QT)Ia/Ic/III
Atrial Flutter MaintenanceContinue slowing conduction or prolonging AP (QT)Ia/Ic/III
Atrial Fibrillation Step 1Slow ventricular rate with AV blockII/IV
Atrial Fibrillation Step 2Restore sinus rate with slow conduction or prolonging AP (QT)Ia/Ic/III
Atrial Fibrillation MaintenancePrevent thrombosisAnticoagulant
AVNRT if infrequentVagal ManeuverNone
AVNRT if frequentRestore sinus rate with slow conduction or prolonging AP (QT)II/IV/Digoxin
AVRT/WPW nonpreferredSlow normal pathway/speed accessory pathwayII/IV/Digoxin
AVRT/WPW preferredSlow all pathwaysIa/Ic/III (some)
Ventricular Tachycardia SustainedIf hemodynamically stableAmiodarone/procainamide/lidocaine
Ventricular Tachycardia IdiopathicControl symptomatic episodesII/IV
Torsades de Pointes drug/electrolyteShorten QTI.V. Mg/Beta stimulating
Torsades de Pointes long QT syndromeSympatholyticII
Ventricular FibrillationDefibrillation/treate precipitant of underlying arrhythmiaVaries
memorize

Drugs

DrugCategoryElectrical MechanismNumberMechanical MechanismNumber
QuinidineIaReduce Phase 0 slope/slows Phase 3 repolarization/lengthens AP3Slow and block conduction/increase threshold for firing/widen QRS/increase ERP (QT)4
ProcainamideIaReduce Phase 0 slope/slows Phase 3 repolarization/lengthens AP3Slow and block conduction/increase threshold for firing/widen QRS/increase ERP (QT)4
DisopyramideIaReduce Phase 0 slope/slows Phase 3 repolarization/lengthens AP3Slow and block conduction/increase threshold for firing/widen QRS/increase ERP (QT)4
LidocaineIbReduce Phase 0 slope/speeds Phase 3 repolarization/shortens AP3Slow and block conduction/increase threshold for firing/widen QRS/decrease ERP (QT)4
TocainideIbReduce Phase 0 slope/speeds Phase 3 repolarization/shortens AP3Slow and block conduction/increase threshold for firing/widen QRS/decrease ERP (QT)4
MexiletineIbReduce Phase 0 slope/speeds Phase 3 repolarization/shortens AP3Slow and block conduction/increase threshold for firing/widen QRS/decrease ERP (QT)4
PhenytoinIbReduce Phase 0 slope/speeds Phase 3 repolarization/shortens AP3Slow and block conduction/increase threshold for firing/widen QRS/decrease ERP (QT)4
FlecainideIcReduce Phase 0 slope1Slow and block conduction/increase threshold for firing/widen QRS3
PropafenoneIcReduce Phase 0 slope1Slow and block conduction/increase threshold for firing/widen QRS3
MoricizineIcReduce Phase 0 slope1Slow and block conduction/increase threshold for firing/widen QRS3
PropranololIIReduce Phase 4 slope/prolong SA/AV node repolarization3Reduce rate/increase ERP (QT)/block external pacemakers3
EsmololIIReduce Phase 4 slope/prolong SA/AV node repolarization3Reduce rate/increase ERP (QT)/block external pacemakers3
MetoprololIIReduce Phase 4 slope/prolong SA/AV node repolarization3Reduce rate/increase ERP (QT)/block external pacemakers3
AtenololIIReduce Phase 4 slope/prolong SA/AV node repolarization3Reduce rate/increase ERP (QT)/block external pacemakers3
AmiodaroneIIIProlong Phase 3 repolarization (flattens slope)1Increase ERP (QT)1
DronedaroneIIIProlong Phase 3 repolarization (flattens slope)1Increase ERP (QT)1
SotalolIIIProlong Phase 3 repolarization (flattens slope)1Increase ERP (QT)1
IbutilideIIIProlong Phase 3 repolarization (flattens slope)1Increase ERP (QT)1
DofetilideIIIProlong Phase 3 repolarization (flattens slope)1Increase ERP (QT)1
BretyliumIIIProlong Phase 3 repolarization (flattens slope)1Increase ERP (QT)1
VerapamilIVIncrease SA threshold/decrease AV velocity/increase ERP3Reduce rate/conduction velocity (lengthen PR interval)/increase ERP (QT)3
DiltiazemIVIncrease SA threshold/decrease AV velocity/increase ERP3Reduce rate/conduction velocity (lengthen PR interval)/increase ERP (QT)3
AdenosineN/AActivates K channels/hyperpolarizes SA node/slows AV conduction3Slows SA firing/decreases AV conduction2
DigoxinN/ANa/K/ATPase blocker/increases threshold/vagal effect3Decreases rate conduction/increases ERP2
AtropineN/AReduces threshold1Anticholinergic1
memorize

Side Effects

DrugSide EffectsMnemonic
QuinidineTorsade (long QT)/Thrombocytopenia/Tinnitus (cinchonism)/hypotension w/cardiac arrest4 3T's plus one
ProcainamideTorsade (long QT)/Reversible drug induced lupus/agranulocytosis3
DisopyramideTorsade (long QT)/Anticholinergic (blurry vision/urinary retention/dry mouth)/heart failure3
LidocaineLocal anesthetic/confusion/paresthesias/dizziness/seizures4
MexiletineDizziness/tremor/slurred speech/nausea/vomiting4
PhenytoinDrug interactions/protein bound2
FlecainideTorsade/drug interactions2
PropafenoneGranulocytopenia/hypersensitivity2
PropranololBradycardia/AV block/CHF/Impotence/Broncho-vasospasm/metabolism (TG up/HDL down)5
EsmololBradycardia/AV block/CHF/Impotence/Broncho-vasospasm/metabolism (TG up/HDL down)5
MetoprololBradycardia/AV block/CHF/Impotence/Broncho-vasospasm/metabolism (TG up/HDL down)5
AtenololBradycardia/AV block/CHF/Impotence/Broncho-vasospasm/metabolism (TG up/HDL down)5
AmiodaroneTorsade (long QT)/Pulmonary fibrosis (PFT)/thyroid (TFT)/hepatotoxic (LFT)/bradycardia/corneal deposits6
DronedaroneTorsade (long QT)/nausea/vomiting/diarrhea4
SotalolTorsade (long QT)/over beta blocking2
IbutilideTorsade (long QT)1
DofetilideTorsade (long QT)1
VerapamilCHF/AV block/facial flushing/headache/gingival hyperplasia/constipation/edema7
DiltiazemCHF/AV block/facial flushing/headache/gingival hyperplasia/constipation/edema7
AdenosineFlushing/hypotension/chest pain3
DigitalisAV block/Vtach/Vfib/GI (nausea/vomiting/diarrhea)/yellow halos/hyperkalemia6
DigoxinAV block/Vtach/Vfib/GI (nausea/vomiting/diarrhea)/yellow halos/hyperkalemia6
DigitoxinAV block/Vtach/Vfib/GI (nausea/vomiting/diarrhea)/yellow halos/hyperkalemia6
DigoxinRenal clearanceClearance
DigitoxinHepatic clearanceClearance
GlycosidesLidocaine/anti digoxin Fab/Mg2+/Potassium reduction4 Antidote (LAMP)
GlycosidesRenal failure/hypokalemia (and hypokalemic drugs)/quinidine (decreases clearance)3 Toxicity increasing factors
memorize

CGF

Question Answer Column 3
NYHA IUsually asymptomatic/vigorous activityDefinition
NYHA IIProlonged moderate exertionDefinition
NYHA IIIODADefinition
NYHA IVAt restDefinition
NYHA I-IINa restriction/loop diuretic/ACE-ARB3
NYHA II-IIINa restriction/loop diuretic/ACE-ARB/BB4
NYHA III-IVNa restriction/loop diuretic/ACE-ARB/BB/Digoxin/spironolactone6
memorize

Misc

Question Answer Column 3
CCBNifedipine/verapamil/diltiazem/amlodipine4 ID
CCBBlock voltage dependent L type Ca channel on SM to reduce contractilityMoA
CCBAmlodipine=nifedipine>diltiazem>verapamilStrength at vascular smooth muscle
CCBVerapamil>diltiazem>amlodipine=nefedipineStrength at heart
CCBHTN/angina/arrhythmias (not nifedipine)/Prinzmetal's angina/Raynaud's5 Use
HydralazineIncreased cGMP relaxes smooth muscle (artioles>veins)/afterload reductionMoA
HydralazineHTN/CHF/HTN in pregnancy (w/methyldopa)4 Use
HydralazineCompensatory tachycardia (contraindicated in CAD/angina/use BB to prevent)/fluid retention/nausea/headache/angina/Lupus like syndrome6 SE
NitroprussideDirect NO release increases cGMP (veins>arteries) reduces preloadMoA
NitroprussideShort acting malignant HTNUse
FenoldopamD1 agonist (coronary/peripheral/renal/splanchnic vasodilation)MoA
Fenoldopammalignant HTN/causes natriuresisUse
NitroglycerinDirect NO release increases cGMP (veins>arteries) reduces preloadMoA
Isosorbide dinitrateDirect NO release increases cGMP (veins>arteries) reduces preloadMoA
NitroglycerinAngina/pulmonary edema2 Use
Isosorbide dinitrateAngina/pulmonary edema2 Use
NitroglycerinReflex tachycardia/hypotension/flushing/headache4 SE
Isosorbide dinitrateReflex tachycardia/hypotension/flushing/headache4 SE
memorize

Lipid Lowering

Question Answer Column 3
StatinsLova/atorva/rosuva/prava/simva5 ID (LARPS)
StatinsDecrease significant (>large)LDL effect
StatinsIncreaseHDL effect
StatinsDecreaseTG effect
StatinsInhibits HMG-CoA reductase/blocks mevalonate synthesis (cholesterol precursor)MoA
StatinsHepatotoxicity (LFTs)/rhabdomyolysis2 SE
Niacin (B3)Decrease largeLDL effect
Niacin (B3)Increase largeHDL effect
Niacin (B3)DecreaseTG effect
Niacin (B3)Inhibits lipolysis in adipose/TG synthesis in liver2 MoA
Niacin (B3)Facial flushing (reduced by aspirin/long term use)/hyperglycemia (acanthosis nigricans)/hyperuricemia (exacerbates gout)3 SE
Bile acid resinsCholestyramine/colestipol/colesevelam3 ID
Bile acid resinsDecrease largeLDL effect
Bile acid resinsIncrease slightHDL effect
Bile acid resinsIncrease slightTG effect
Bile acid resinsPrevents intestinal bile-cholesterol reabsorptionMoA
Bile acid resinsBad taste/GI discomfort/decrease fat soluble vitamin absorption/cholesterol gallstones4 SE
EzetimibeDecrease largeLDL effect
EzetimibePrevent cholesterol absorption at small intestine brush borderMoA
EzetimibeRare LFTs/diarrhea2 SE
FibratesGemfibrozil/clofibrate/bezafibrate/fenofibrate4 ID
FibratesDecreaseLDL effect
FibratesIncreaseHDL effect
FibratesDecrease significant (>large)TG effect
FibratesUpregulate lipoprotein lipase/increase TG clearance2 MoA
FibratesMyositis/hepatotoxicity (LFTs)/cholesterol gallstones3 SE
memorize