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Pharmacology > Chapter 23: Cardiac Rhythm > Flashcards

Chapter 23: Cardiac Rhythm Flashcards

1
Q

MOA of Class IA Anti-arrhythmics

A

Block Na + channels
Block K+ channels
in ventricular myocytes
–> decreases conduction velocity thru myocardium

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2
Q

Class IA have what effect on AP duration, refractory period, and QT interval?

A

Increases all 3

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3
Q

Class IB effect on AP duration?

A

Decreases AP duration

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4
Q

What is Class IC MOA and effect of AP duration?

A

Marked (most) block of Na+ channels

Does not change AP duration

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5
Q

What are Class II drugs?

A

B-blockers…LOL!

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6
Q

MOA of Class III? Effect on AP duration, QT and refractory period?

A

K+ channel blockers

Increase AP duration
Increase refractory period
Increase QT interval

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7
Q

When do you use Class III?

A

When other anti-arrythmics fail

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8
Q

Class IV MOA? What do they do to conduction velocity, refractory period, and PR interval?

A

Ca2+ channel blockers

decrease conduction velocty
increase refractory
increase PR interval

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9
Q

Adenosine MOA?

A

opens G protein coupled K+ channel and suppress Ca dependent AP
–> increases K OUT of cell….suppress Ca AP

= inhibits SA node, atrial, and AV nodal conduction

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10
Q

Name the class IA drugs

A

quinidine
procainimide
disopyramide

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11
Q

Name the class IB drugs

A

Lidocaine
Mexiletine
Phenytoin

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12
Q

Name the class IC drugs

A

Flecainide

Propafenone

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13
Q

Name the class III drugs

A 
Ibutilide
Dofetilide
Sotalol
Bretylium
Amiodarone
Dronedarone
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14
Q

Name the class IV drugs

A

Verapamil

Diltiazem

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15
Q

Quinidine toxicity?

A

cinchonism (impaired hearing, headache, dizziness)

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16
Q

Procainamide toxicity?

A

lupus like syndrome (almost all chronic users get this…think increase ANAs)

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17
Q

Disopyramide toxicity?

A

heart failure

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18
Q

All class IAs can cause what serious adverse effect?

A

Torsades des pointes

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19
Q

What should be used in conjunction with quinidine?

A

An agent that will slow AV nodal conduction

- Ca channel blocker or B blocker

20
Q

What drug may be used in hypertrophic cardiomyopathy because it decreases cardiac contractility?

A

dispyramide

21
Q

Quinidine induced ____ toxicity may occur in a fraction of patients

A

digoxin

22
Q

What is the drug used to maintain normal sinus rhythm after conversion of atrial flutter?

A

procainamide

23
Q

What is the class IA drug for paroxysmal supraventricular tachycardia? What if this fails?

A

quinidine (class IA)

if fails, try a class IC --> used as last resort drugs
= Flecainide or Propafenone
24
Q

_____ suppresses purkinje automaticity without affecting the SA node

A

Lidocaine

25
Q

Clinical use of lidocaine/mixiletine?

A

Ventricular arrythmias in context of MI, cardiac manipulation or cardiac glycosides

26
Q

Class IB has an effect on what type of tissue?

A

INJURED/DISEASED myocardium

27
Q

What drug is used for local anesthesia of skin or mucous membranes?

A

lidocaine

28
Q

Clinical use of phenytoin?

A

tonic-clonic seizures

status epilepticus

non epileptic seizures

29
Q

IB is Best ____

IC is Contraindicated _____

A

post MI

post MI/structural heart disease

30
Q

What drugs are associated with excessive mortality and nonfatal cardiac arrest? (restrict these drugs to people who have failed other measures)

A

Class IC
= flecainide
propafenone

31
Q

What type of drug would you give to decrease the likelihood for mortality and re-infarction after MI?

A

B blockers!

32
Q

Ibutilide clinical use?

A

conversion of atrial fibrillation/atrial flutter to normal sinus rhythm

33
Q

What must you do if giving ibutilide? Why?

A

monitor QT interval during administration

Bc 2% develop torsades des pointes and need cardioversion

34
Q

Sotalol clinical use?

A

life threatening ventricular arrhythmias when patients can’t tolerate amiodarone

35
Q

Adverse effects of sotalol? So don’t use in pts that have a hx of __?

A

bradycardia

bronchospasm –> dont use in pts with asthma!!

36
Q

When v. arrythmias don’t respond to lidocaine or defibb, what drug should you try?

A

Bretylium (no effect on atrial tissue)

37
Q

What drugs targets the entire lipid membrane and can thus be considered a multi-class anti-arrhythmic?

A

amiodarone

38
Q

Co-administration of amiodarone with what drug would decrease amiodarone levels?

A

phenytoin

39
Q

Amiodarone toxicity?

A

severe pulmonary toxicity

thyroid dysfunction (40% iodine by weight)

Corneal deposits
Blue-gray skin discoloration
photosensitivity

40
Q

Which of the class III drugs can cause torsades des pointes?

A

sotalol

ibutilide

41
Q

Drug used for a fibb/a flutter that is similar to amiodarone, but has a shorter half life and less thyroid toxicity?

A

dronedarone

42
Q

Don’t use dronendarone in patients with what?

A

systolic heart failure!

43
Q

What is the drug of choice for paroxysmal supraventricular tachycardia?

A

adenosine

44
Q

Is adenosine short or long acting? What are the toxicities?

A

VERY short acting - 15sec

Facial flushing
Chest pressure
Diaphoresis

45
Q

Do not use adenosine to treat ____

A

atrial fibb or atrial flutter

46
Q

Ranolazine is used to treat ____

A

chronic angina pectoris

–> freq used in conjunction with nitrates or B blockers

Pharmacology (22 decks)

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