Pharm- Chf/ Antiarrhythmics/ Antianginals

Congestive heart failure (CHF) is a condition where the heart is unable to pump enough blood to meet the body's needs. This can lead to congestion in either the pulmonary (backward failure) or systemic (backward failure) circulation. Additionally, CHF can result in reduced blood flow and oxygen delivery to the body's tissues (forward failure). Therefore, the statement that CHF includes congestion of the pulmonary or systemic circulation (backward failure) and reduced output to body tissues (forward failure) is true.

Angina is a condition characterized by chest pain or discomfort that occurs when the heart muscle doesn't receive enough oxygen-rich blood. This happens when there is an imbalance between the demand for oxygen by the heart and the delivery of oxygen to the heart. Therefore, it is true that angina results from an imbalance between O2 demand and O2 delivery.

Nitroglycerine is a sublingual rescue drug for acute abortive angina. It is commonly used to relieve chest pain or angina attacks by relaxing and widening the blood vessels, allowing more oxygen-rich blood to flow to the heart. By placing a nitroglycerine tablet under the tongue, it can be quickly absorbed into the bloodstream, providing rapid relief from angina symptoms. Isosobide dinitrate, amlodipine, and acebutolol are not typically used as sublingual rescue drugs for acute abortive angina.

Bumetanide (Bumex) and Furosemide (Lasix) are classified as loop diuretics. Loop diuretics work by inhibiting the reabsorption of sodium and chloride ions in the loop of Henle in the kidneys, leading to increased urine production and removal of excess fluid from the body. They are commonly used to treat conditions such as edema, high blood pressure, and congestive heart failure. Thiazide diuretics, phosphodiesterase inhibitors, and cardiac glycosides are different classes of drugs with different mechanisms of action and therapeutic uses.

Beta blockers are a type of antiarrhythmic medication that work by blocking the effects of adrenaline on the heart. Class II antiarrhythmics, which include drugs like propranolol and metoprolol, are beta blockers. These medications are commonly used to treat arrhythmias by slowing down the heart rate and reducing the force of contractions. Therefore, the correct answer is II.

Class IV antiarrhythmic drugs are calcium (Ca++) blockers. These drugs work by blocking the calcium channels in the heart, which helps to slow down the conduction of electrical impulses and relax the smooth muscle in the heart. By blocking calcium, these drugs can help to control abnormal heart rhythms and prevent certain types of arrhythmias.

Digoxin (Lanoxin) is a cardiac glycoside. Cardiac glycosides are a class of medications that are used to treat heart failure and certain heart rhythm disorders. They work by increasing the force of the heart's contractions and slowing down the heart rate. Digoxin specifically is commonly used to treat atrial fibrillation and congestive heart failure. It helps to improve the heart's pumping ability and reduce symptoms such as shortness of breath and fluid retention. Furosemide (Lasix) is a loop diuretic, Carvedilol (Coreg) is a beta blocker, and Milrinone (Primacor) is a phosphodiesterase inhibitor, none of which are cardiac glycosides.

Lidocaine and Mexiletene belong to class Ib of antiarrhythmics. Class Ib antiarrhythmics are characterized by their ability to selectively block sodium channels in cardiac cells, which helps to stabilize the electrical activity of the heart and prevent abnormal heart rhythms. These drugs are particularly effective in treating ventricular arrhythmias, such as ventricular tachycardia.

Ascites, pleural effusion, and pericardial effusion are all fluid accumulations that can occur as a result of right heart failure. Right heart failure is characterized by the inability of the right side of the heart to effectively pump blood, leading to fluid backing up into the body's organs and tissues. Ascites refers to the accumulation of fluid in the abdominal cavity, pleural effusion is the buildup of fluid in the space around the lungs, and pericardial effusion is the accumulation of fluid in the sac surrounding the heart. Therefore, these three conditions are indeed signs of right heart failure.

Digoxin (Lanoxin) is conveniently available as intramuscular (IM), intravenous (IV), and oral (PO) formulations. However, it needs to be monitored for toxicity. This suggests that while it is easily accessible in different forms for administration, there is a risk of potential adverse effects or harmful reactions. Monitoring for toxicity is necessary to ensure the safe and effective use of the drug.

The statement is true because Propanolol (Inderal) is commonly administered orally at a dosage of 10-30mg, three to four times a day. However, in emergency situations, it can also be given intravenously at a lower dosage of 1-3mg, and repeated as necessary every 1-2 minutes. This allows for a faster onset of action and more immediate effects in emergency situations.

Most antianginals are used for prophylaxis, meaning they are taken to prevent angina attacks from occurring rather than to treat an ongoing attack. These medications work by relaxing and widening blood vessels, reducing the workload on the heart and improving blood flow to the heart muscle. By taking antianginals regularly, individuals with angina can reduce the frequency and severity of their symptoms and improve their overall quality of life. Therefore, the statement that most antianginals are for prophylaxis is true.

Lidocaine is indeed given intravenously (IV) with a starting dose of 150-200mg administered over a period of 15 minutes. This method of administration allows for a rapid onset of action and is commonly used for various medical purposes, such as local anesthesia, cardiac arrhythmias, and pain management.

c= Sotalol (betapace) and all Class III drugs have the potential to induce arrhythmia

Metolazone (Zaroxolyn) is less likely to be used in CHF because of its low level of effectiveness. Diuretics are commonly used in CHF to reduce fluid buildup and relieve symptoms. Furosemide (Lasix) and Bumetanide (Bumex) are more commonly used diuretics in CHF due to their higher effectiveness in promoting diuresis. However, Metolazone has a weaker diuretic effect compared to these drugs, making it less effective in managing fluid overload in CHF patients.

Propafenone (Rythmol) is classified as a Class Ic antiarrhythmic medication. This class of drugs works by blocking sodium channels in the heart, which helps to stabilize the heart's electrical activity and prevent abnormal heart rhythms. Quinidine, Lidocaine, and Mexiletene are also antiarrhythmic medications, but they belong to different classes (Class Ia, Ib, and Ib respectively).

Other answers are contraindications...other indications include post MI, Migraine prophylaxis, and performance anxiety

Spironolactone is a direct aldosterone antagonist, meaning it blocks the action of aldosterone in the body. Aldosterone is a hormone that regulates sodium and potassium levels, so by inhibiting its effects, spironolactone can prevent hyperkalemia (high potassium levels) and Na+ (sodium) retention. It does not, however, reverse cardiac remodeling.

The correct answer is AV Junction 40-60. The AV Junction is responsible for transmitting electrical signals from the atria to the ventricles. A normal heart rate for the AV Junction is between 40 and 60 beats per minute. This range ensures proper coordination between the atria and ventricles, allowing for efficient blood flow.

Disopyramide (Norpace) is classified as a Class Ia antiarrhythmic medication. Class Ia antiarrhythmics work by blocking sodium channels in the heart, which slows down the conduction of electrical impulses and helps to stabilize abnormal heart rhythms. Flecainide (Tambocor) and Mexiletene are both Class Ic antiarrhythmics, which have a similar mechanism of action but are not classified as Class Ia. Therefore, the correct answer is Disopyramide (Norpace).

only administered as rapid IV bolus

unstable angina = unpredictable, comes at anytime, even at rest, stable angina only comes with exertion

Class I antiarrhythmic drugs are divided into three sections based on their effects on the sodium concentration of the cell membrane. These drugs can alter both the potassium and sodium concentrations of the cell membrane. Therefore, the correct answer is A & C.

Pregnancy, bacterial endocarditis, myasthenia gravis, and a history of Torsades des Pointes are contraindications for Quinidine.

Leg and GI edema is not seen in left-sided CHF. Left-sided heart failure typically causes pulmonary edema, which results in symptoms such as shortness of breath, coughing, and wheezing. Right-sided heart failure, on the other hand, can cause peripheral edema, including edema in the legs and gastrointestinal tract.

not first line PO, side effect: life threatening V-Tach, effective PVC supressor, last ditch drug b/c high toxicity

Class Ia

Dosage is PO 400-1600mg/day and IV 150mg then increase to 360
may cause worse dysrhythmias and pulmonary fibrosis

first line includes ACE inhibitors and ARBs

Direct Vasodilators are not a class of Antianginal drugs. Antianginal drugs are used to treat angina, a condition characterized by chest pain or discomfort caused by reduced blood flow to the heart. Organic Nitrates, Beta Blockers, and Calcium Channel Blockers are all classes of Antianginal drugs commonly used to relieve angina symptoms. Direct Vasodilators, on the other hand, are a separate class of drugs that work by directly relaxing the blood vessels, but they are not specifically indicated for the treatment of angina.

beta blockers may actually worsen heart failure even though they have these positive effects

Propanolol (Inderal) is not a selective beta-1 antagonist used for Antiarrhythmatic therapy. It is a non-selective beta blocker that blocks both beta-1 and beta-2 receptors. Esmolol (brevibloc), Motoprolol (Lopressor), and Acebutolol (Sectral) are all selective beta-1 antagonists that are commonly used for Antiarrhythmatic therapy.

this is the the Ventricular arrythmia dose. SVT is 50mg and increase to a max of 300mg/day

Angina pain is caused by reduced blood flow to the heart muscle. It typically presents as a discomfort or pain in the chest, but can also radiate to other areas. The pain commonly radiates to the left shoulder, left arm, spine, and jaw due to the nerve pathways that connect these areas to the heart. However, it does not typically radiate to the abdomen. This is because the nerves that supply sensation to the abdomen are not directly connected to the heart, therefore making it an exception in terms of angina pain radiation.

increase in CHF patients only

Adenosine (Adenocard) is the correct answer because it is known to cause transient asystole, facial flushing, dyspnea, hypotension, and palpitations. Adenosine is commonly used in the treatment of supraventricular tachycardia, and these side effects are expected due to its mechanism of action. It works by slowing down the electrical conduction in the heart, which can briefly stop the heart (asystole) before it restarts in a normal rhythm. The facial flushing, dyspnea, hypotension, and palpitations are all common side effects of adenosine administration.

The answer "none of the above" is correct because all of the given options are consistent with the goals of antiarrhythmic therapy. Restoring and maintaining normal sinus rhythm, suppressing excitable areas outside the normal pathway, and controlling ventricular rate and optimizing cardiac output are all important objectives in the treatment of arrhythmias. Therefore, none of the options are inconsistent with the goals of antiarrhythmic therapy.

Cardiac glycosides are medications used to treat heart failure and certain arrhythmias. They have positive inotropic effects, meaning they increase the force of contraction of the heart muscle. They also have negative chronotropic effects, which means they decrease the heart rate. However, cardiac glycosides are not indicated for ventricular fibrillation (VFib) or tachycardia. They are typically used for atrial fibrillation and atrial flutter. Additionally, cardiac glycosides should be used cautiously in pregnancy due to their potential effects on the fetus.

A decrease in myocardial oxygen demand would not be an indication for pharmacotherapy in arrhythmia patients because it does not directly address the abnormal heart rhythm. Pharmacotherapy is typically used to treat arrhythmias by either controlling the heart rate or restoring the normal heart rhythm. A decrease in myocardial oxygen demand may be beneficial for patients with heart disease or angina, but it does not specifically target the arrhythmia itself.

Dronedarone (Multaq) is the correct answer because it has properties of all the antiarrhythmic classes, meaning it can be used to treat different types of arrhythmias. However, it also has a black box warning for heart failure, which means that it can potentially worsen heart failure symptoms or even cause heart failure in some patients. This warning indicates that caution should be exercised when prescribing this drug to patients with a history of heart failure or those at risk for developing heart failure.

Flecainide (Tambocor) = high toxicity, and is a last ditch drug
lidocaine is very effective in MI associated arrhythmias and has a low risk of toxicity

contraindicated in WPW syndrome

Flecainide (Tambocor) is a strong sodium channel blocker. Class Ia drugs, including Flecainide, work by blocking sodium channels in the heart, which helps to stabilize the heart's electrical activity and prevent abnormal heart rhythms. Lidocaine and Amiodarone are also antiarrhythmic drugs, but they belong to different classes and have different mechanisms of action. Lidocaine is a Class Ib drug that primarily blocks sodium channels in damaged or ischemic tissues, while Amiodarone is a Class III drug that affects multiple ion channels in the heart. Therefore, Flecainide is the correct answer as it is specifically classified as a strong sodium channel blocker.

A long p-r interval is inconsistent with a WPW Syndrome patient because WPW Syndrome is characterized by a shortened p-r interval due to an abnormal accessory pathway. This pathway allows for rapid conduction of electrical impulses, resulting in a shortened p-r interval. Therefore, a long p-r interval would be inconsistent with this condition.

Nitroglycerine is a medication used to treat angina, and it has an acute abortive effect on angina attacks. It is available in various routes of administration, including topical application. It is contraindicated in patients with inferior wall myocardial infarction (MI) and during pregnancy. However, nitroglycerine does not induce bradycardia with prolonged use.

Class IV antiarrhythmics are better for supraventricular arrhythmias than ventricular arrhythmias because they specifically target and block the calcium channels in the heart's conduction system. This action helps to slow down the electrical conduction in the atrioventricular (AV) node, which is responsible for transmitting electrical signals from the atria to the ventricles. By inhibiting the AV node conduction, class IV antiarrhythmics can effectively treat supraventricular arrhythmias, such as atrial fibrillation or atrial flutter, without significantly affecting the ventricular conduction.

DOC for stable angina

this describes direct vasodilators

dosage is q.i.d/every 6 hrs

Phosphodiesterase inhibitors, including Milrinone (Primacor) and Inamrinone (Inocor), are usually used for long-term therapy. These medications work by inhibiting the enzyme phosphodiesterase, which increases the levels of cyclic adenosine monophosphate (cAMP) in the cells. This leads to smooth muscle relaxation and vasodilation, improving cardiac output and reducing afterload. While they do not directly prevent ventricular dysrhythmias, their positive inotropic effects can help stabilize the heart's rhythm and improve overall cardiac function. Therefore, the correct answer is "includes Milrinone (Primacor) and Inamrinone (Inocor)."