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Name two calcium channel blockers that slow heart rate and decrease conractility? Diltiazem Verapamil
What is the drug of choice to decrease oxygen demand? Beta Blocker
How does Ranolazine (non-dihydropyridine)work? Improves efficiency of oxygen utilization
What are three things Ranolazine does not do? Decrease heart rate or blood pressure and reduce contractility
What are the side effects of Ranolazine (non-dihydropyridine)? Dizziness, headache, constipation, QT prolongation
When taking Ranolazine what are some contraindications? Do not use with antifungals, or grapefruit juice
Ranolazine dosage (non-dihydropyridine) 500 mg BID initially Can titrate to 1000mg BID second or third line agent for angina
What is drug of choice for acute angina? Nitroglycerine
What are nitrate side effects? headache, hypotension (causes venous dilation than arterial), nausea/vomiting, dry mouth, **TOLERANCE**
True or False, Ranolazine is a 3A4 substrate and grapefruit juice will cause an increase of buildup of this medication? True
After which dose of nitrate do you call 911? Take first dose and wait 5 minutes, take second dose and wait 5 minutes, if still having CP after 10 minutes, take 3rd dose and call 911
What is brand name of Isosorbide mononitrate Extended Release? Imdur
How do you take Imdur? This is a long acting nitrate, taken once a day in the morning. Runs out after 12-14 hours to give you that nitrate free interval.
How do you take Isosorbide dinitrate? Once in the morning and then in afternoon at least 7 hours apart, do not take evenly spaced to give you the nitrate free period needed.
Use nitrates cautiously in patients with? Glaucoma, severe anemia, hyperthyroidism, hypovolemia, hyperthyroidism
What is the shelf life of nitroglycerine? 6 months, it is sensitive to light and oxygen
What is dosage for Isosorbide mononitrate? 30-120mg once daily
What is phase 4 of the cardiac action potential? The reset phase, where Na-K-ATPase puts cations where they are supposed to be
What happens in phase 0? Na rushes into the cell and becomes very positive.
What happens in phase 1 and 2? Calcium rushes in and Potassium goes out of the cell, plateau phase
What happens in phase 3? Potassium continues to rush out of the cell and produces a hypernegative charge.
Mechanism of antiarrhythmics: what phase decreases automaticity? Phase 4
Mechanism of antiarrhythmics: what phase increases the refractory period? Phase 2 and 3
Mechanism of antiarrhythmics: what phase slows conduction velocity? Phase 0
Mechanism of antiarrhythmics: what phase limits reentry? Phase 1,2,3,and 4
What is the resting phase of ion channels? Closed but ready to go
What is the active phase of ion channels? Open
What is the inactive phase of ion channels? Closed and can't be opened
Which medications affect the Na Channel? Ia. Procainamide, quinidine Ib. Lidocaine, mexilitine Ic. Propafenone, flecainide
Which medications affect the nodal channel? Beta blockers (SA and AV node)
Which medications affect the K channel? Amiodarone, sotalol,...
Which medications affect the nodal Ca Channel? Calcium channel blockers
Class Ia agents affect which two channels? Na and K- slow down initial depolarization and lengthen phase 2 and 3 by slowing down K release
Class Ib agents have? Rapid on-off kinetics, have little effect on normal heart rate(work well on tachy arrhytmias in phase 0)
Class Ic agents have? Slow on-off kinetics result in greater effects on phase 0. More pronounced slowing of conduction.
Class II and IV Beta and Calcium channel blockers slow which phase? Phase 4, most specifically at the AV and SA nodes.
Which medication effects K to increase refractory period, has beta blocker properties and decreases automaticity, and Na channel blockers to decrease repolarization. Amiodarone
Used for supraventricular and ventricular arrhythmias Class Ia and Ic
Used for ventricular arrythmias Class Ib
Used for supraventricular rate Class II and IV
How do high K levels effect digoxin? Digoxin won't work as well.
How do low K levels effect digoxin? Digoxin levels can become toxic.
What are toxicity signs of digoxin? Nausea, vomiting, weakness, and altered mental status. May see green halos but not common.
Which two drugs can be used with impaired cardiac function for rhythm control? Amiodarone and Dofetilide
When treating atrial fibrillation, which is more important: rate or rhythm control Rate control
What is the half life of amiodarone? 7 weeks- requires loading dose for sooner steady state.
Amiodarone pharmacodynamic drug interactions? Beta blockers, Ca Channel blockers, digoxin, most other antiarrhythmics, and anything with QT prolongation. Additive effect of bradycardia.
Amiodarone pharmacokinetic drug interactions? Warfarin (increases INR levels), digoxin, cyclosporine, opiates, statins, phenothiazines, triptans, anti-epileptics.
Adverse Drug reactions with chronic use of amiodarone Pulmonary toxicity, pneumonitis, fibrosis, hepatoxicity, optic neuropathy/corneal deposits, hypo/hyperthyroid, peripheral neuropathy paresthesias, ataxia, weakness tremor, photosensitivity, skin discoloration, Stevens-Johnson, blood dyscrasias
Important monitoring for amiodarone? EKG and CXR, electrolytes (esp K and Mg)baseline TSH, LFT and PFTs, Visual exam 6-12 months.
Half-life of amiodarone 7 weeks long
Created by: 1096147201



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