00 Antiarrhythmics Flashcards Preview

Board Study Topics > 00 Antiarrhythmics > Flashcards

Flashcards in 00 Antiarrhythmics Deck (37):
1

What are Class I antiarrhythmics main MOA?

Sodium channel blockers

2

What is Class I divided?

Class Ia (intermediate acting), Class Ib (short acting), Class Ic (long acting)

3

What are the Class Ia drugs?

Disopyramide, Quinidine, Procainamide

4

What are the Class Ib drugs?

Lidocaine, Tocainide, Mexiletine (Phenytoin)

5

What are the Class Ic drugs?

Flecainide, Propafenone, Morizicine

6

Which Class I subgroup has the most ADRs?

Class Ia

7

What are some of the ADRs seen with Class Ia drugs?

Strong antiACh, All agents capable of causing QT prolongation (from blocking K channels) --> TdP, all proarrhythmic

8

Which Class Ia has the most DDIs and can cause Cinchonism?

Quinidine

9

What are Class Ib drugs only useful for?

VENTRICULAR arrhythmias (can't be used for A.fib)

10

What kind of ADR is seen with Class Ib drugs?

All cross BBB d/t lipophilicity, all have CNS depression ADRs

11

When do you NOT want to use Class Ic drugs?

Do not use in patients with ischemic (CAD) or structural heart disease (LVEF < 40% or severe LVH). Avoid in heart disease!

12

Which Class I subgroup has the least ADRs?

Class Ic

13

What are the Class II Antiarrhythmics?

Beta-Blockers (Metoprolol, Propranolol, Esmolol)

14

What are the Class II Antiarrhythmics mainly used for?

Ventricular rate control and to prevent ventricular arrhythmias

15

What is unique about Esmolol (Class II Antiarrhythmics)?

Ultra short acting, IV only, large fluid volume (comes in big IV bag)

16

How do Class III Antiarrhythmics work?

Prolong refractory period. Blockade of potassium channels

17

What are the Class III Antiarrhythmic drugs?

Amiodarone/Dronedarone. Sotalol. Ibutilide/Dofetilide

18

How is Ibutilide different than the other Antiarrhythmics in Class III?

Instead of blocking potassium channels, it activates inward sodium channels

19

What are the Class IV Antiarrhythmic drugs?

CCBs (Verapamil and Diltiazem)

20

What are Class IV Antiarrhythmic drugs used for?

Slow conduction through AV node, used for ventricular rate control

21

What are the common ADRs with Verapamil?

Constipation/GERD

22

What are some common Antiarrhythmics used that don't fall into the four classes?

Adenosine. Digoxin. Magnesium

23

What is Magnesium most commonly used for?

Torsades de Pointes

24

What is the DOC for patients with ischemic (CAD) or structural heart disease (LVEF < 40% or severe LVH)?

Amiodarone

25

What is the PK of Amiodarone like?

Slow distribution (need loading dose). Long half-life (60 days parent compound, up to 180 days for desethylamiodarone)

26

What is the PO dosing for Amiodarone like?

LD: 800-1600 mg/day
Maintenance: 100-400 mg/day

27

What is the IV dosing for Amiodarone like?

150mg x1, 1mg/min x6h, 0.5mg/min x18h = approx 1g in first day. For life-threatening arrhythmias (ACLS): 300mg IV push

28

What are the most common ADRs with Amiodarone?

Thyroid (hypo/hyper), Pulmonary fibrosis (dose and time dependent, treatment limiting step), Hepatic, GI (take with food), Photosensitivity

29

What looking at AF management, what must you think about?

Always consider the need for the 3 major therapeutic modalities: Ventricular rate control, Anticoagulation, Rhythm conversion/maintenance

30

What type of agents can be selected for Ventricular Rate Control in AF?

Class II and IV (Beta-blocker, CCB (Diltiazem, Verapamil)), Digoxin, Amiodarone (less common)

31

What are the factors looked at for the CHADS2 score?

CHF (1), HTN (1), Age 75+ (1), Diabetes (1), Stroke/TIA (2)

32

How does the CHADS2 score determine anticoagulation needs?

0 = ASA, 1 = ASA or Warfarin/Dabigratran/Rivaroxaban/Apixaban, 2+ = Warfarin/Dabigratran/Rivaroxaban/Apixaban

33

What agents are used for Rhythm CONVERSION?

1a, 1c, III. (II & IV are rate control). Amiodarone DOC for patients with ischemic or structural heart disease (Dronedarone may be first-line for all others). Sotalol DOC for post-MI/CAD w/o structural heart disease

34

What must be monitored when initiating Amiodarone?

Liver function and Pulmonary function

35

What properties does Propafenone have?

Beta-blocker

36

Which agent must be initiated in-hospital with renal function and QT documented?

Dofetilide

37

Make sure you know:

The chart on slide 57