My achy breaky heart
What is the drug of choice in acute angina and what route?
Nitroglycerin, sublingual
Name all the drugs in class 1. What is the MOA?
1a – Quinidine, Procainamide, disopyramide
1b – Lidocaine, Mexiletine, Tocainide, Phenytoin
1c – Flecainide, Propafenone
Na Channel blockers
What's the difference between a migraine (classic vs common), tension headache, and cluster headache?
Classic migraine: has an aura
Common migraine: lacks the aura + severe throbbing unilateral headache that lasts for a few hours to 1-2 days.
Tension: non throbbing, bilateral occipital head pain not associated with nausea, vomiting or prodromal visual disturbance. "tight band around the head"
Cluster: brief, very severe, unilateral, constant, headache that last from 15 mins-3 hours. It may begin as a burning sensation over the lateral aspect of the nose or as pressure behind the eye. Ipsilateral conjunctival injection, lacrimation, nasal stuffiness and Horner syndrome.
1. Too much excitation (glutamate) or 2. Too little inhibition (GABA)
Explain the MOA of Nitroglycerin.
Why do we recommend drug holidays?
-Metabolized to release NO --> NO activates guanylyl cyclase --> cGMP forms --> dephosphorylation of MLC --> SM relaxation
-major action on capacitance vessels (veins) to reduced cardiac preload
-dilate collateral coronary vessels
To avoid postural hypotension
Name two ADEs of quinidine
Two ADEs of Procainamide
Two ADEs of Dispyramide
Quin – diarrhea, cinchonism (lightheadedness, tinnitus, blurry vision, palpitations), torsades
Proc – avoid in renal failure, drug induced lupus, +ANA, hypotension, torsades
Diso- Most anticholinergic effects – urinary retention, blurred vision, torsades. Caution with HF!
Contraindications of triptans?
Name 4 ADEs of triptans?
CAD/CVD/uncontrolled HTN, PVD, ischemic bowel disease. MAO inhibitors within 2 weeks, Ergots within 24 hours
Bitter taste, Paresthesia, Asthenia, Fatigue, Flushing, Pressure, tightness, cp, Neck/jaw pain, Drowsiness, dizziness, Nausea, Sweating, Coronary artery vasospasm, MI, arrythmias
Name two nonepileptic uses of Carbamazepine/Oxcarbazepine.
Name 4 ADEs of Carbamazepine/Oxcarbazepine
What are the two MOAs of Valproic acid?
Trigeminal neuralgia, bipolar disorder
Bone marrow suppression, aplastic anemia, hyponatremia (SIADH), diplopia, ataxia, spina bifida, Weight gain, SJS
Na channel blocker and T-type Ca channel blocker
Name the two PO nitrates used.
Which one is longer acting?
What is the contraindication for nitrate use?
Isosorbide dinitrate and isosorbide mononitrate - mono is longer acting
Use of Sildenafil within 24 hours can cause hypotension and MI risk
Class 1B is used best after what?
ADE of Mexiletine vs ADE of Propafenone
What two meds of Class 3 are mixed and what other classes do they belong in?
Post MI
Dyspepsia (inability to taste) vs Dysgeusia (altered taste sensation)
Amiodarone (All classes), Sotalol (Class II and III)
Name 3 ADEs of ergots
What drugs can be used as prophylaxis for migraines? (Name 5)
N/v, leg weakness, muscle pain, cp, numbness/tingling in fingers/toes
NSAIDs (ASA, naproxen, ibuprofen, ketoprofen, acetaminophen), TCAs (amitriptyline, nortriptyline, desipramine, protriptyline),
BBs (timolol, propranolol, metoprolol, atenolol, nadolol), anticonvulsants (valproic acid, topiramate, gabapentin),
CCBs (verapamil, flunarizine), riboflavin (B2), botox, butterbur
What 3 antiepileptic drugs have fetal ADE's: name them
What order kinetics is phenytoin?
↑ LFTs, tremors, thrombocytopenia, pancreatitis, alopecia, weight gain, Neural tube defects (spina bifida) in 1st trimester, fatal hepatic failure (in <2 yo), Weight gain
Carbamazepine/Oxcarbazepine (spina bifida), Valproic acid (spina bifida), Phenytoin (fetal hydantoin syndrome)
Name 4 uses of CCBs
Name 4 ADEs
What 3 Beta blockers are used for post MI?
-SVTs, Preterm labor, Migraine, Raynauds disease, Prophylaxis for prinzmetal angina, HTN
-Heart block (bradycardia), Flushing, nausea, dizziness, hypotension, peripheral edema, HA, palpitations, constipation
- "AMP" Atenolol, Metoprolol, Propanolol
Name 4 ADEs of Amiodarone
Class IV is contraindicated in what arrhythmia?
What two classes are used for HR control in A-fib
What two classes are used for Rhythm control in A-fib
Pulmonary fibrosis – cough, SOB, Hypo/Hyperthyroidism, Liver toxicity, Ocular – corneal deposits, optic neuritis, Skin – Photosensitivity, Blue skin, Neuro – Ataxia, paresthesia, tremor, Heart – Brady, Heart block, QT prolongation, torsade's, GI – nausea, anorexia, constipation
WPW - will cause VT
II and IV + digoxin
III and Ic
DOC for acute tension HA
The only approved tx for chronic tension headache?
Acetaminophen, aspirin, or NSAIDs.
Amitriptyline
Levetiracetam, Perampanel, Felbamate, Gabapentin, and Retigabine are all inhibitors of what channel?
What is the DOC for neonatal seizures?
What use other than antiepileptics is used for Topiramate and Zonisamide
Glutamate channel inhibitors
Phenobarbital
Weight loss
Name the 2 meds and Describe the MOA of pFOX inhibitors
Ivabradine reduces ___ without reducing _____
All of the ACS/Angina meds we learned decrease O2 demand and increase O2 supply except which category?
Inhibits the late Na current --> less Ca inside cell --> less contraction
HR; contractility
Beta blockers ONLY decrease O2 demand
What two classes can be used for WPW?
What cause can be used for PSVT?
What is the DOC for acute paroxysmal SVT and what is it's mechanism of action?
1a and 1c
Class IV
Adenosine - Blocks conduction in AV node. Opens K+ channels in AV nodal cells --> hyperpolarization
Acute tx for cluster HA (Name 4)
Chroinc tx for cluster HA (Name 4)
Oxygen, triptans, Lidocaine, SC Octreotide, dihydroergotamine
Verapamil, Valproic acid, gabapentin, topiramate, Melatonin, Prednisone, Lithium
Name 3 drugs used for generalized tonic clonic
Name 2 drugs used for absence seizures
Name 4 drugs used for status epilepticus
LVL T: Valproate, Lamotrigine, Topiramate, Levetiracetam
Ethosuximide, Valproate
BBL P: Diazepam, Lorazepam, Fosphenytoin, phenytoin, Phenobarbitone, lidocaine, general anesthesia