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L2 - CV Pharm 2
Clin Pharm Ex 1
| Question | Answer |
|---|---|
| Heart contractions start... | @ apex & squeeze up towards base |
| P-wave | deflection of the SA node firing |
| Positive Deflection | wave moving towards electrode |
| Negative Deflection | wave moving away from electrode |
| Q-wave | deflection of the AV node firing = atrial contraction |
| RS-wave | contraction of ventricles (larger than atrial contr) |
| T-wave | depolarization & repolarization (resetting the system) |
| Bradycardia | slower than normal HR |
| Tachycardia | faster than normal HR (supraventricular or ventricular) |
| Automaticity | HR is self-propelling |
| What areas does the automaticity of the heart originate? | SA node, AV node, & ventricular cells (each slower than the last) |
| Re-entry arrhythmia | when signal moves backwards in the conduction pathway |
| Ventricular Fibrillation | uncoordinated signal = random ventricular contractions = can't pump blood |
| Atrial Fibrillation | uncoordinated signal = random atrial contractions = much less severe at REST than V-Fib (common in horse) |
| A-Fib is less severe at rest bc... | ventricular filling is mostly passive and doesn't NEED the contraction of the ventricles |
| When is A-fib in horses dangerous? | during exercise - the ventricles do need proper contraction of the atria then |
| What secondary arrhythmia can be caused by fibrillation? | triggered beats |
| What is the benefit of having 3 origins of automaticity in the heart? | if one fails, there is a backup to keep the heart pumping, just at a slower rate |
| What is an example of a benign arrhythmia? | Premature Ventricular Contraction (PVC) |
| Premature Ventricular Contraction (PVC) | when the ventricles contract too early for a beat = next beat is delayed & CO is momentarily ↑ |
| Arrhythmias that compromise CO, BP, & Coronary perf can cause... | myocardial ischemia, pump fxn deterioration, or sudden death |
| Arrhythmias affect the perfusion of the Coronary aa bc... | Coronary aa fill during diastole - doesn't happen properly in arrhyth. |
| Class I arrhythmia medications are... | Na-channel blockers & hv membrane stabilizing effects, ↓ conduction, & ↓ automaticity |
| Class II arrhythmia medications are... | B-blockers (adrenergic antagonists) |
| Class III arrhythmia medications are... | K-channel blockers & prolong effective refractory period of heart AP |
| Class IV arrhythmia medications are... | Ca-channel blockers (CCB) |
| What is a potential SE of arrhythmia medications? | can induce a different arrhythmia w/the wrong dose... |
| Which cells make up the AV node? | myocytes & perjinke fibers |
| Which cells make up the SA node? | pacemaker cells |
| Are cells in SA or AV node faster responders to electrical signals? | AV node |
| Which class of arrhythmia drugs results in slower rate of rise & can keep induction in refractory prd longer? | Class I |
| Quinidine is a... | use dependent block = more effective @ ↑ rates |
| Which Class I drug has good bioavailability by PO or IM routes? | Quinidine |
| Procainamide has similar activity as which other drug? | Quinidine |
| Which Class I drug has good bioavail by PO route & can be delivered via IV infusion? | Procainamide |
| Procainamide is good for tx of... | PVCs - just be careful not to overdose |
| Which Class I drug suppresses automaticity in Purkinje fibers & diseased myocardial tissue? | Lidocaine |
| What are some other Class I drugs? | Mexiletine, Flecainide, Propafenone |
| Pairing Class I agents with which other drugs can hv better arrhythmia control in dogs? | B-blockers or Class II agents |
| Class II drugs are indicated to tx... | supraventricular tachyarrhythmias |
| What are the effects of Class II drugs on the heart? | ↓HR, ↓myocardial O2 demand, & ↑AV conduction time |
| Class II B-blockers are first choice drug for both supra- & ventricular tachycardias in which animal? | cats |
| Class III agents inhibit the repolarizing K-channel (IKr), which causes what effects? | prolonged AP & effective refractory period |
| What is unique about the Class II agent Sotalol? | both L & D isoforms are active (L = B-blocker & D = IKr-blocker) |
| Sotalol is primarily used in dogs with... | ventricular tachyarrhythmia |
| Which arrhythmia tx agent has properties of Class I, II, & IV? | Amiodarone |
| B-blockers are good for... | long term therapy |
| Class IV dihydropyridine agents cause arterial vasodilation w/minimal CV effects. Example? | Amlodipine |
| Class IV non-dihydropyridine agents have anti-arrhythmic effects. Examples? | Verapamil & Diltiazem |
| Class IV nonselective agents have both vascular and heart specific effects. Example? | Bepridil |
| Which drugs should not be used in conjunction with B-blockers? | Class IV agents |
| Which Class IV agent has the most potent cardiac effects? | Verapamil |
| Which Class IV agent ↓sinus node, ↑AV refractory period, & blocks some automaticity & re-entry patterns? | Diltiazem |
Created by:
Dr_B.Phillips22
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