CARDIO TCOL SANA PUMASA NA AKO

PHASE 0

“upstroke”-Opening of Na channel

PHASE 2

“Plateau”-Sustained inward movement of Ca and outward movement of K-Can cause homeostasis

PHASE 1

“Early fast repola”-Closure of Na channel; opening of K channel (dec. AP)

PHASE 4

“Diastole or resting state”-All channels close

Type I drugs

Generally act by inhibiting fast sodium channel responsible for initial cardiac cell depolarization and impulse conduction.

Type II anti-arrhythmic drugs

Act by blocking beta-adrenergic receptors

Type III anti-arrhythmic drugs

Blocks potassium channels to prolong the duration of the action potential and the effective refractive period.

Type Ia agents

depress the fast sodium-dependent channel, slowing phase zero of the cardiac action potential.

disopyramide (Norpace)
quinidine
procainamide (pronestyl)

Type Ia drugs

Disopyramide and Quinidine

Type I agents also have anticholinergic activity

Quinidine and procainamide

Commonly used for suppression of

acute and chronic supraventricular

and ventricular arrhythmias

Quinidine

has alpha-adrenergic receptor-blocking activity

Quinidine

oldest anti-dysrrhythmic drugs

Procainamide

has ganglionic-and

neuromuscular-blocking activity

D 1 g
Q 1 g
P 5 g

Toxic dose of type Ia agents

Sinoatrial arrest
Sinus bradycardia

Type 1 toxic effects

SLE like symptoms

Procainamide can cause what

hypertonic NaHCO3

Antidote for Type Ia

hemodialysis

Quinidine can be remove by ____

hemoperfusion

Disopyramide can be remove through ____

Lidocaine
Mexiletine
Tocainide

Type Ib drugs

MEGX (monoethylglycinexylidide) and GX (glycine xylidide)

Lidocaine metabolizes in

Lidocaine

is an aminoacyl amide synthetic

derivative of cocaine.

It is an antidysrhythmic and local

Anesthetic agent

 

Moricizine
Flecainide
Propafenone
Encainide

Type IC drugs

Encainide

was withdrawn from US and Canadian markets

in Dec of 1991 due to increased mortality

in the cardiac dysrhythmia trial

Encainide

analog of lysergic acid, is at least 10 times more potent than procainamide.

Its absorption and hepatic metabolism is rapid; these metabolites are as active as

the original drug.

Type III drugs

Blocks potassium channels to prolong the duration of the action potential and the effective refractive period.

Bretylium

is a quaternary benzyl ammonium compound for treating

lidocaine-refractory arrhythmias.

catecholamine release

IV administration of bretylium initially causes release of catecholamines from nerve endings, followed by inhibition of ________

hypotension

Major toxic side effect is _____ caused by inhibition of catecholamine release.

rapid intravenous

After______ injection,

transient hypertension, nausea

and vomiting may occur.

Amiodarone

is a non-competitive beta-adrenergic blocker, which may

explain its tendency to cause

brady arrhythmias.

IODINE

Amiodarone may release____

and chronic use has resulted in

altered thyroid function.

40-50 days

Amiodarone half-life

BETA-ADRENERGIC BLOCKERS

Widely usedfor the treatment of hypertension, angina pectoris, migraine headaches and glaucoma

B–Betaxolol

B–Bisoprolol

E–Esmolol

A–Acebutolol

A–Atenolol

M–Metoprolol

Selective Beta blocker list

P–Propranolol

P–Pindolol

A–Acebutolol

L–Labetalol

M–Metoprolol

Membrane Stabilizing Activity list

L–Labetalol

C–Carvedilol

Mixed alpha and beta blocking effect

A–Acebutolol

B–Bisoprolol

C–Carteolol

P–Pindolol

P-Penbutolol

Intrinsic sympathomimetic activity

• Propranolol

• Nadolol

• Timolol

• Pindolol

• Sotalol

Non selective –β1and β2 blockers

lipid soluble

propranolol is a _____ that can cross BBB and can cause Seizures.

Pindolol

other agents with beta-agonist activity

Sotalol

Beta blocker that torsades de pointes and ventricular fibrillation

2-3 times

There are no clear

guidelines, but ingestion of only_____

times the therapeutic dose

Glucagon 0.1-0.3 mg/kg IV

Beta blockers antidote

hypertonic 1-2 mEq NaHCO3

other antidote for beta blocker

Isoproterenol/Magnesium

Sotalol poisoning treatment

phenoxybenzamine, phentolamine, tolazoline

Vasodilators have been in clinical practice since the 1940’s

Prazosin

1st selective α1 inhibitor was introduced in the early 1970’s

Doxazosin
Indoramin
Terazosin
Urapidil

Newer a1 drugs

Prazosin and other newer α1

specific agents are associated with little or no

reflex tachycardia

Indoramin

No fatalities have been

reported except with _____

-L-type Calcium Channel blockers

Calcium channel blockers blocks

hyperglycemia, lactic acidosis

Other physiologic responses include in CCB produce

chest radiograph

may be helpful to

determine heart size

abdominal radiography

If bowel obstruction is suspected what test ___

Troponin 1

_______ may help differentiate drug-induced bradycardia from

ischemic causes.

5-15 mg/IV

Prehospital dose of glucagon _____

Verapamil

the first clinically useful member of this group, was the result of attempts to synthesize more active analogs of papaverine, a vasodilator alkaloid found in the opium poppy

Verapamil

has the greatest depressant effect on the heart and may decrease

heart rate and cardiac output.

Diltiazem

CCB has intermediate actions

Inamrinone

a phosphodiesterase inhibitor with inotropic

activity, may be of additional benefit in profound cardiac

contractile failure

Glucagon

Acts via cAMP to increase cardiac

contractility and also may decrease heart

block.

50-100 mL

Minibag dose

Calcium gluconate

Moderates nerve and muscle performance,

and facilitates normal cardiac function

100 mg/mL ——> 10 mL

1 ampule = ____

3-12 g slow IV push

Adult dose calcium gluconate

100 mg (1 mL)/kg slow IV push

Pediatric dose calcium gluconate

Inamrinone (Inocor)

Phosphodiesterase inhibitor that acts by

inhibiting breakdown of cAMP, thus

prolonging effect on the release of calcium into

the cytosol

<10–20%

Nitrates & Nitrites bioavailability

Oxymetazoline and tetrahydrozoline

are nasal decongestants that may

cause toxicity identical to that of clonidine

adults 160-320 mg

Guanabenz MILD toxic dose ADULT

12 mg

Guanabenz MILD toxic dose3 year old

28 mg

Guanabenz SEVERE toxicity dose 19 month old

480 mg

Guanabenz SEVERE toxicity dose 3 year old

2g

Methyldopa. More than _____ in adults is

considered a toxic dose

25 g

Methyldopa death was reported in an adult after an ingestion of ____

Naloxone

_____ reverses signs and symptoms of clonidine overdose. Because the overdose mimics opioid intoxication,

Naloxone

_____ is indicated because narcotics may also have been ingested.

Cyanide poisoning

Na2S2O3

amyl nitrite

Because of its unpleasant odor and short duration of

action, is now obsolete for angina.

Nitroglycerin

may be considered the prototype of the group.