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Cardio Module > 12. Anti Arrhythimic Drug Class 2-4 > Flashcards

12. Anti Arrhythimic Drug Class 2-4 Flashcards

1
Q

What are the effects of class II AADs?

A

Inhibit b-mediated increase in HR, contractile force and conduction velocity

  • decrease automaticity of SA node
  • decrease intracellular Ca overload
  • decrease conduction velocity of AV node, his/perkinje system, and ventricles
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2
Q

What are AAD class II primarily used for?

A

Protect ventricles from Supraventricular arrhythmias and junctional tachycardia

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3
Q

What are some adverse effects of ADD class II?

A
  • Reduce myocardial contractility
  • bradycardia
  • tachycardia and angina upon sudden withdrawal
  • bronchospasms
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4
Q

What are the contraindications of AAD class II?

A

Cardiogenic shock, 2nd and 3rd degree AV node block, sinus bradycardia, asthma

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5
Q

Can AAD class II be used to convert pts to NSR?

A

No, just a rate controlling medication, not used to convert pts to NSR

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6
Q

What is the use of type III AADs?

A

Prolong the refractory period by prolonging action potential, decreases the slop of phase 3 primarily

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7
Q

What are the effects of class III AADs?

A
  • Prolong duration of AP
  • Prolong refractory period
  • Block K channels
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8
Q

What AAD does amiodarone belong to?

A

Amiodarone is a class III AAD

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9
Q

What are amiodarone’s effects?

A
  • Block Na channels with fast T(recovery) - ectopic pacemakers
  • block Ca channels
  • noncompetative antagonist of alpha and beta AR receptors
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10
Q

What is amiodarone most commonly used for?

A

For atrial and ventricular arrhythmia conversion and maintenance of NSR

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11
Q

What are some problems w/ amiodarone?

A
  • Long half life, >50 days
  • CYP inhibitor: 3A4, 2D6, 2C9
  • Lots of monitoring! Done every 6 months
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12
Q

Class is dofetilide in?

A

AAD class III

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13
Q

What are the effects of dofetilide?

A
  • selective for I(kr) K channel
  • increase AP duration in atria and ventricles
  • no effect on conduction velocity or SA function
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14
Q

What is dofetilide used for? What is it an alternative to?

A

An alternative to amiodarone, used for atrial fibrillation and flutter conversion and maintenance of NSR

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15
Q

What are the contraindications of dofetilide?

A

QTc>440ms, CrCl

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16
Q

What kind of monitoring needs to be done on dofetilide?

A
  • electrolytes (Mg, K) - every 3-6 months
  • EKG, NSR continuous for 72 hrs - then every 3 months
  • renal function - every 3 months
17
Q

What class dose sotalol belong to?

A

AAD class III

18
Q

What are the effects of sotalol?

A
  • Nonselective b-AR antagonist
  • Decrease conduction velocity in AV node
  • Decrease automaticity of AV node
  • Prolong AV node refractory period
19
Q

What is the safest antiarrhythmic in pregnancy?

A

Sotalol

20
Q

What are the contraindications of sotalol?

A

CrCl450ms, bronchospasm, HR

21
Q

What is the black box warning for sotalol?

A

Initiate inpatient d/t QTc prolongation

22
Q

What should be monitored for sotalol?

A

HR, EKG, electrolytes, renal funciton

23
Q

What class does ibutilide belong to?

A

AAD class III

24
Q

What is ibutilide used for?

A

Conversion of atrial arrhythmias

25
Q

What is the black box warning for ibutilide?

A

Pro-arrhythmic effect may cause QTc prolongation and TdP

26
Q

What class does drondarone belong to?

A

AAD class III

27
Q

What is drondarone indicated for?

A

Indicated to decrease hospitalizations for Afib in pts w/ NSR w/ a history of Afib

28
Q

What pts should not be taking drondarone?

A

Heart Failure pts

29
Q

What are the main contraindications of drondarone?

A

QTc>500ms, liver/lung toxicity w/ amiodarone

30
Q

What drugs are included in AAD class IV? What is their indication?

A

Verapamil, diltiazem, bepridil. All are non-DHP CCBs

31
Q

What are the effects of AAD class IV?

A
  • Primarily in the SA/AV node
  • Decrease conduction velocity of AV node
  • Prolong refractory period in AV node
  • blocks Ca channels in vascular smooth muscle
32
Q

What are the uses for AAD class IV?

A
  • Reentry tachycardias involving AV node

- Reduce ventricular contractile rate during Afib/A flutter

33
Q

What are some contraindications of AAD class IV?

A
  • 2nd and 3rd degree heart block

- SBP

34
Q

What is an important drug interaction of AAD class IV?

A

Use of CCB w/ BB enhances AV node block

35
Q

What is magnesiums effect as an antiarrhythmic?

A

Treatment of digoxin-induced arrhythmias, treatment of TdP

36
Q

What is the use of adenosine in arrhythmias?

A
  • Increases K conductance –> hyperpolarization
  • GPCR mediated inhibition of Ca channels
  • Used for PSVT, particularly reentry
37
Q

What is the use of digoxin in arrhythmias?

A
  • for Afib, an adjunct to rate control, primarily for symptom treatment
  • Can be used safely in CHF pts
38
Q

What drugs are part of class II?

A

Beta blockers, selective and non selective

  • Esmolol, metoprolol, atenolol
  • propranolol, timolol

Cardio Module (12 decks)

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