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Questions and Answers
What common gastrointestinal symptoms may indicate digitalis toxicity?
What common gastrointestinal symptoms may indicate digitalis toxicity?
- Blood in stools
- Anorexia, nausea, vomiting, and diarrhea (correct)
- Sharp abdominal pain
- Severe constipation
Which electrolyte imbalance facilitates the enzyme-inhibiting actions of cardiac glycosides?
Which electrolyte imbalance facilitates the enzyme-inhibiting actions of cardiac glycosides?
- Hypokalemia (correct)
- Hyperkalemia
- Hypercalcemia
- Hyponatremia
Which class of drugs is effective for treating atrial and ventricular arrhythmias but has potential lupus-related side effects?
Which class of drugs is effective for treating atrial and ventricular arrhythmias but has potential lupus-related side effects?
- Class 3
- Class 4
- Class 1A (Procainamide) (correct)
- Class 1B
Which drug class decreases ventricular filling pressures while increasing cardiac output?
Which drug class decreases ventricular filling pressures while increasing cardiac output?
What is a common adverse effect associated with using Class 1A antiarrhythmic agents like prcainamide and quinidine?
What is a common adverse effect associated with using Class 1A antiarrhythmic agents like prcainamide and quinidine?
Which of the following adverse effects is most commonly associated with digoxin therapy?
Which of the following adverse effects is most commonly associated with digoxin therapy?
What effect does hypercalcemia have in relation to digoxin therapy?
What effect does hypercalcemia have in relation to digoxin therapy?
Which of the following strategies is NOT commonly used for managing heart failure?
Which of the following strategies is NOT commonly used for managing heart failure?
What is the primary mechanism of action of Milrinone in heart failure management?
What is the primary mechanism of action of Milrinone in heart failure management?
Which of the following adverse effects is characteristic of disopyramide?
Which of the following adverse effects is characteristic of disopyramide?
What is the most significant adverse effect associated with Amiodarone?
What is the most significant adverse effect associated with Amiodarone?
Which Class 1B antiarrhythmic drug is primarily used for termination of ventricular tachycardia?
Which Class 1B antiarrhythmic drug is primarily used for termination of ventricular tachycardia?
Which of the following statements is true regarding beta-blockers like Propranolol?
Which of the following statements is true regarding beta-blockers like Propranolol?
What is the primary action of Verapamil in treating arrhythmias?
What is the primary action of Verapamil in treating arrhythmias?
Which adverse effect is associated with Class 3 antiarrhythmic agents such as Amiodarone?
Which adverse effect is associated with Class 3 antiarrhythmic agents such as Amiodarone?
Which drug is specifically noted for its selective blocking of If current?
Which drug is specifically noted for its selective blocking of If current?
Which of the following drugs is known for causing heart block in patients with preexisting conditions?
Which of the following drugs is known for causing heart block in patients with preexisting conditions?
What is a key characteristic of dihydropyridine calcium channel blockers?
What is a key characteristic of dihydropyridine calcium channel blockers?
Which adverse effect is most commonly associated with Digoxin?
Which adverse effect is most commonly associated with Digoxin?
What is the primary mechanism of action of Digoxin in heart failure treatment?
What is the primary mechanism of action of Digoxin in heart failure treatment?
Which of the following is a goal of heart failure treatment?
Which of the following is a goal of heart failure treatment?
Why is therapeutic drug monitoring crucial for patients on Digoxin?
Why is therapeutic drug monitoring crucial for patients on Digoxin?
Which drug is primarily used to manage intermittent claudication in patients with peripheral artery disease?
Which drug is primarily used to manage intermittent claudication in patients with peripheral artery disease?
What distinguishes high-output heart failure from low-output heart failure?
What distinguishes high-output heart failure from low-output heart failure?
What is a common side effect when using Ranolazine?
What is a common side effect when using Ranolazine?
Which type of drug is Ivabradine classified as?
Which type of drug is Ivabradine classified as?
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Study Notes
Class 1: Sodium Channel-Blocking Drugs
- Lidocaine: Preferred for ventricular tachycardia termination and fibrillation prevention post-cardioversion in acute ischemia; low toxicity and effective for myocardial infarction-related arrhythmias; acts by blocking sodium channels with rapid kinetics.
- Mexiletine, Flecainide, Propafenone, Moricizine: Reading assignment focused on additional sodium channel blockers.
- Procainamide: Effective for most atrial and ventricular arrhythmias; associated with frequent dosing and lupus-like side effects; prolongs action potential duration and QRS interval; can cause hypotension, torsade de pointes, and syncope.
- Quinidine: Similar actions to procainamide; rarely used due to adverse effects like cinchonism.
- Disopyramide: Similar actions but with significant antimuscarinic effects; adverse effects include urinary retention and dry mouth.
Class 2: Beta-Adrenoreceptor Blocking Agents
- Propranolol: Provides antiarrhythmic effects through β-receptor blockade; prevents recurrent infarction and sudden death after myocardial infarction recovery.
- Esmolol: Used for managing intraoperative and acute arrhythmias.
Class 3: Drugs that Prolong Action Potentials
- Amiodarone: Treats serious ventricular arrhythmias and atrial fibrillation; widely used; side effects include vasodilation, potential bradycardia, heart block, pulmonary toxicity, liver dysfunction, skin discoloration, and visual disturbances.
- Dronedarone, Sotalol: Additional class 3 agents listed for reading.
Class 4: Calcium Channel Blockers
- Verapamil and Diltiazem: Exhibit antiarrhythmic properties; dihydropyridine CCBs do not share antiarrhythmic efficacy and may worsen arrhythmias.
- Verapamil: Blocks activated and inactivated L-type calcium channels; used for supraventricular tachycardias and controlling ventricular rates in atrial fibrillation; rarely converts atrial flutter to sinus rhythm.
Miscellaneous Antiarrhythmic Drugs
- Ivabradine: Selectively blocks If current.
- Digoxin: Increases cardiac contractility through calcium concentration modulation; adverse effects include gastrointestinal issues, hyperkalemia, hypokalemia, and hypercalcemia which can lead to arrhythmias.
BIPYRIDINES
- Milrinone: Phosphodiesterase-3 inhibitor; enhances myocardial contractility via calcium influx and intracellular calcium movements.
Beta-Agonists
- Dobutamine: Raises cardiac output while decreasing ventricular filling pressure; carries risks of angina and arrhythmias, especially in coronary artery disease patients.
Drugs Without Positive Inotropic Effects Used in Heart Failure
- Diuretics: Spironolactone and eplerenone aid fluid management;
- ACE Inhibitors: Captopril reduces afterload and improves long-term outcomes.
- Beta Blockers: Reduce mortality in stable severe heart failure patients, excluding bucindolol.
Arrhythmias Overview
- Caused by abnormal pacemaker activity or impulse conduction; categorized into:
- Class 1: Sodium channel blockade (subdivided into 1A, 1B, 1C);
- Class 2: Beta-blockers;
- Class 3: Prolong APD and block IKr;
- Class 4: Calcium channel blockade.
Heart Failure
- Characterized by inadequate cardiac output; can be systolic or diastolic; symptoms include tachycardia, diminished exercise tolerance, and edema.
- Goals of Treatment: Symptom relief, progression slowing, and acute decompensation management.
Digoxin as Heart Failure Therapy
- Derived from Digitalis lanata; has a half-life of 36-40 hours; functions by inhibiting Na+/K+-ATPase; narrow therapeutic window; may not reduce mortality in chronic failure cases.
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