Download Lesson 5

Lesson 5
Medications (drugs)
Ex 1. Key-words:
1
antiarrhythmic agents
2
to suppress fast rhythms of the heart
(cardiac arrhythmias)
3
atrial fibrillation
4
atrial flutter
5
ventricular tachycardia
6
to prolong life
7
to have multiple modes of action
8
interfere with the sodium channel
9
to
describe
the
decrease
of
excitogenicity of the plasma membrane
10
to be useful in the treatment of
supraventricular tachycardias
11
prevent re-entrant arrhythmias
12
to exert vasodilating, spasmolytic,
adaptogenic and immune stimulating actions
13
to improve synaptic transmission in
spinal cord
14
aggravation of hyportension
15
breastfeeding
16
sweatiness
17
dizziness
18
fever
19
nausea
20
skin manifestation
21
syringes and needles
22
out of the reach of children
антиаритмический агент
2,
подавить быстрые ритмы сердца
(сердечные аритмии
3 относящихся к предсердию приобретения
волокнистой структуры
4 относящихся к предсердию порхания
5 желудочковая тахикардия
6, продлить жизнь
7, иметь многократные способы действия
8 сталкиваются с каналом натрия
9
описать уменьшение excitogenicity
плазменной мембраны
10,
быть
полезными
в
обработке
наджелудочковой тахикардии
11 предотвращают аритмии переучастника
12,
проявить vasodilating, spasmolytic,
adaptogenic и свободные стимулирующие
действия
13, улучшить синаптическую передачу в
спинном мозге
14 ухудшение давления
15 кормление грудью
16 потливость
17 головокружений
18 лихорадка
19 тошнота
20 проявлений кожи
21 шприцы и иглы
22 вне досягаемости детей
Ex 2. Read and remember the pronunciation of the following symptoms:
heartburn, headache, and decreased muscle flexibility, renal insufficiency, constipation,
arterial hypertension, heart failure, increased heart rate, hypotension, hot flash, sweatiness, skin
allergic reactions, rash and itching, spasms of the blood vessels, sweatiness, dizziness, fever,
nausea, skin manifestation, loss of consciousness, the relief of headaches, minor aches, cold,
fever, excessive gastric acid secretion, prolongation of bleeding, inflammation, redness, and
swelling of the joint, the risk of upper gastrointestinal complications, stomach bleeding.
Ex 2. Read and translate the following word-combinations:
antiarrhythmic agents, catecholamine, β1-adrenergic receptors, to suppress arrhythmias,
the loss of the atrial component to ventricular filling (atrial kick), atrial fibrillation (flutter), the
first-line therapy in the prevention of sudden death, lead to implantation of an implantable
cardioverter-defibrillator, the decrease of excitogenicity of the plasma membrane, 1A lengthens
the action potential, 1B shortens the action potential, the treatment of supraventricular
tachycardias, slow calcium channel blockers, relaxes smooth muscles of the blood vessels and
internals, improves synaptic transmission in spinal cord.
Ex 3. Read some information about “Drugs for the cardiovascular system”:
For the cardiovascular system

General: β-receptor blockers ("beta blockers"), calcium channel blockers,
diuretics, cardiac glycosides, antiarrhythmics, nitrate, antianginals, vasoconstrictors,
vasodilators, peripheral activators

Affecting blood pressure (antihypertensive drugs): ACE inhibitors, angiotensin
receptor blockers, α blockers

Coagulation: anticoagulants, heparin, antiplatelet drugs, fibrinolytics, antihemophilic factors, haemostatic drugs

Atherosclerosis/cholesterol inhibitors: hypolipidaemic agents, statins.
Text 12. Antiarrhythmic agent
Definition. Antiarrhythmic agents are a group of pharmaceuticals that are used to
suppress fast rhythms of the heart (cardiac arrhythmias), such as atrial fibrillation, atrial flutter,
ventricular tachycardia and ventricular fibrillation.
While the use of antiarrhythmic agents to suppress atrial arrhythmias (atrial fibrillation
and atrial flutter) is still in practice, it is unclear whether suppression of atrial arrhythmias will
prolong life.
In individuals with atrial fibrillation, antiarrhythmics are still used to suppress
arrhythmias. This is often done to relieve the symptoms that may be associated with the loss of
the atrial component to ventricular filling (atrial kick) that is due to atrial fibrillation or flutter.
In individuals with ventricular arrhythmias, antiarrhythmic agents are often still in use
to suppress arrhythmias. In this case, the patient may have frequent arrhythmic events or be at
high risk for ventricular arrhythmias. Antiarrhythmic agents may be considered the first-line
therapy in the prevention of sudden death in certain forms of structural heart disease, and failure
of these agents to suppress arrhythmias may lead to implantation of an implantable cardioverterdefibrillator (ICD).
Many attempts have been made to classify antiarrhythmic agents. The problem arises
from the fact that many of the antiarrhythmic agents have multiple modes of action, making any
classification imprecise.
There are five main classes in the Vaughan Williams classification of antiarrhythmic
agents (1970):
Known
Class
Examples
Mechanism
Clinical uses
as
 ventricular
arrhythmias
 prevention
of
paroxysmal
recurrent
fast
Quinidine
(Na+) channel block
atrial
fibrillation
Ia
channel 
Procainamide (intermediate
(triggered
by
vagal
blockers 
Disopyramide association/dissociation)
overactivity),
*procainamide in WolffParkinson-White
syndrome

treatment
and
prevention during and
immediately
after

Lidocaine
(Na+) channel block myocardial
infarction,
Ib

Phenytoin
(fast
though this practice is

Mexiletine
association/dissociation) now discouraged given
the increased risk of
asystole
o
ventricular
Ic



Flecainide
Propafenone
Moricizine
II






Propranolol
Esmolol
Timolol
Metoprolol
Atenolol
Bisoprolol
Betablockers
tachycardia
o
atrial fibrillation
 prevents
paroxysmal
atrial
fibrillation
(Na+) channel block
 treats
recurrent
(slow
tachyarrhythmias
of
association/dissociation)
abnormal
conduction
system.
 decrease
myocardial
beta
blocking
infarction mortality
Propranolol also shows
 prevent recurrence of
some class I action
tachyarrhythmias

III
IV
V
slowchannel
blockers





Amiodarone
Sotalol
Ibutilide
Dofetilide
E-4031
K+ channel blocker
Sotalol is also a beta
blocker


Verapamil
Diltiazem
Ca2+ channel blocker
Adenosine
Digoxin
Work by other or
unknown mechanisms
(Direct
nodal
inhibition).


in
Wolff-Parkinsonwhite syndrome
 (sotalol:)
ventricular
tachycardias and atrial
fibrillation
 (Ibutilide:) atrial flutter
and atrial fibrillation
 prevent recurrence of
paroxysmal
supraventricular
tachycardia
 reduce ventricular rate
in patients with atrial
fibrillation
Used in supraventricular
arrhythmias, especially in
heart failure with atrial
fibrillation,
contraindicated
in
ventricular arrhythmias.
Class I agents. The class I antiarrhythmic agents interfere with the sodium channel.
Class I agents are grouped by what effect they have on the Na+ channel, and what effect they
have on cardiac action potentials.
Class I agents are called membrane stabilizing agents. The 'stabilizing' is the word used
to describe the decrease of excitogenicity of the plasma membrane which is brought about by
these agents.
Class I agents are divided into three groups (1a, 1b and 1c) based upon their effect on
the length of the action potential.

1A lengthens the action potential

1B shortens the action potential

1C does not significantly affect the action potential
Class II agents are conventional beta blockers. They act by blocking the effects of
catecholamines at the β1-adrenergic receptors, thereby decreasing sympathetic activity on the
heart. These agents are particularly useful in the treatment of supraventricular tachycardias. They
decrease conduction through the AV node.
Class II agents include atenolol, esmolol, propranolol, and metoprolol.
Class III agents predominantly block the potassium channels, thereby prolonging
repolarization. Since these agents do not affect the sodium channel, conduction velocity is not
decreased. The prolongation of the action potential duration and refractory period, combined
with the maintenance of normal conduction velocity, prevent re-entrant arrhythmias.
Class IV agents are slow calcium channel blockers. They decrease conduction through
the AV node, and shorten phase two (the plateau) of the cardiac action potential. They thus
reduce the contractility of the heart, so may be inappropriate in heart failure. However, in
contrast to beta blockers, they allow the body to retain adrenergic control of heart rate and
contractility.
Class IV agents include verapamil and diltiazem.
Other agents (Class V). Since the development of the original Vaughan-Williams
classification system, additional agents have been used that don't fit cleanly into categories I
through IV.
Agents include:

Digoxin, which decreases conduction of electrical impulses through the AV node
and increases vagal activity via its central action on the central nervous system.

Adenosine

Magnesium sulfate
Remember that all anti-arrhythmics "some block potassium channels" can help you:

Class I "Some" = S = Sodium

Class II "Block" = B =Beta blockers

Class III "Potassium" = Potassium channel blockers

Class IV "Channels" = C =Calcium channel blockers
Specific drugs:

Class I agents:
o
Class IA “Double Quarter Pounder” (Disopyramide, Quinidine, Procainamide)
o
Class IB “Lettuce, Tomato, Mayo, Pickles” (Lidocaine, Tocainide, Mexilitine,
Phenytoin)
o
Class IC “More Fries Please” (Moricizine, Flecainide, Propafenone).

Class III agents: "A Big Dog Is Scary" (Amiodarone, Bretylium, Dofetilide,
Ibutilide, Sotalol).

Class IV: Calcium channel blockers are verapamil and diltiazem.
Text 13. Dibazol-Damita (Dibazol)
Active Ingredients: bendazol
Therapeutic actions: Dibazol contains the active ingredient bendazol that exerts
vasodilating, spasmolytic, adaptogenic and immune stimulating actions. Dibazol relaxes smooth
muscles of the blood vessels and internals, improves synaptic transmission in spinal cord.
Immune stimulating action is associated with regulation the amount of cyclic AMP and cyclic
GMP in the immune cells. Dibazol also exerts moderate hypertensive action.
Indications: Dibazol is indicated in the following conditions:
- Spasms of the blood vessels (coronary spasm, spasm of the peripheral arteries)
- Aggravation ofhypcrtension (high blood pressure)
- Spams of the smooth muscles of the internals (stomach ulcer, spasms of the pylorus
and bowel, kidney and liver colic)
- Diseases of the central nervous system- residual effect of poliomyelitis, Bell's palsy,
polyneuritis.
Contraindications and cautions:
- Dibazol should not be used in patients with known individual intolerance to
bendazol
- Necessarily talk with your doctor if you arc pregnant or breastfeeding.
- Dibazol should be used with caution in kidney diseases
- Do not use Dibazol in HIV infection and hypotension(low blood pressure)
Adverse effects: There are possible side-effects associated with this medicine that can
afreet individuals in different ways. If a side effect is stated here, that does not necessarily mean
the fact that all people using Dibazol will experience it or any other. Dibazol is usually well
tolerated. However, some people may experience sweatiness, dizziness, fever, headache, nausea,
skin manifestatio
Interactions: Dibazol enhances the effects of drugs used to treat high blood pressure
(ACE inhibitors, beta-blockers. Calcium channel blockers and others).
Additional Information: DO NOT SHARE Dibazol with others. DO NOT USE THIS
MEDICINE for other health conditions. KEEP THIS PRODUCT, as welt as syringes and
needles, if needed during treatment, out of the reach of children. Do not reuse needles, syringes,
or other materials.
Ex 4. Retell the topic about the influence of antiarrhythmic agents on development of
heart failures.
Ex 5. Writing. Write the composition describing your favourite friend. Follow this plan:
1.
Introduction
2.
Appearance
3.
Character
4.
Interests and hobbies
5.
Your personal attitude to the person.