Anti-arrythmic Drugs Flashcards
What is the difference between AVRT and AVNRT?
What needs to occur to kickstart and AVNRT arrythmia?
What will be seen on ECG?
AVRT = AV conduction pathway PLUS an accessory pathway formation
Premature beat needs to enter whilst the fast pathway is in refractory period
SVT - narrow QRS
Heart rate greater than 100BPM
Class 1b agent - name two.
Differences in ROA.
Overall effects on the action potential.
ECG effects?
Uses?
Lidocaine mexiletine.
IV vs oral.
Decrease phase 0 upstroke (Ischaemic tissue only)
Shorten APD
QRS increase
Ventricular tachycardia post MI
Side effect lidocaine.
Side effects mexilletine.
Dizziness and drowsiness
N/V
Name two class IC.
Major effect?
Minor effect?
ECG effects?
Uses?
Side effects?
Substantial decrease in phase 0 conduction of Na+ due to slow offset biding kinetics.
Some APD and refractory period prolonging.
increased PR QRS and QT interval
Atrial fibrillation and flutter
WPW
Premature ventricular contractions.
CNS again - dizziness, blurred vision
N/V
Class II Effects?
What is special about esmolol?
Special about bisoprolol?
Name two others and their route of admins.
Side effects?
Increased AV node conduction velocity
Decreased heart rate (SAN)
IV only - very short half life and fast onset of action used in acute catecholamine dependant arryhtmias
Oral - given for ectopic beats
Propanolol
Metoprolol
Bronchospasm and hypotension
CLASS III.
Name 2.
ECG effects of amiodarone.
Give some side effects.
What is the name of the closely related drug that contained no iodine.
Amiodarone
Sotalol
Increased PR, QRS and QT
Thyroid damage hepatic injury Pulmonary fibrosis Optic neuritis Photosensitivity Increased LDLs
Dronaderone
Sotalol effects?
Side effects?
K channel block and B blockade
Increased APD and refractory period.
Slow AV conduction due to B blockade also.
Pro arrythmia
Fatigue
Insomnia
Class IV.
Effect?
Uses?
When do you have to be cautious with these?
Adverse effect?
Slow AV node conduction and increase refractory period in AV node.
Increased slope in SAN to slow heart rate.
SVT
AVNRT
Partial AV block - can get asystole if B blocker is also present.
Hypotension, decreased CO or sick sinus syndrome.
Constipation
Digoxin.
Effects?
Used?
Increased vagal activity
Increased contractility
Heart failure
Atrial fibrillation/ flutter
Adenosine.
Effects?
Uses?
AV node and SAN A1 receptors - hyperpolarisation - slowing conduction through AV node - interruption of AVNRTs.
Convert SV arrythmias
Diagnosis of coronary artery disease
Diagnosing masked arrythmias.
Atropine.
Use?
Vagal bradycardia
Ivabradine.
Mechanism?
USe?
Why is it useful in the treatment of heart failure with a reduced ejection fraction?
Side effects?
Blocks funny current in SAN.
Inappropriate sinus tachycardia
Reduce heart rate in heart failure and angina but avoids dropping blood pressure due to not decreased contractility.
Because it can decreased heart rate without decreasing contractility like B blockers and CCBs do.
Flashing lights
Teratogencity.
Vernakalant MOA?
How does its effects vary with heart rate?
Use?
Side effects?
Blocks class III transient outward K+ channels and Na channels.
Blocks more at higher heart rates.
Conversion of recent onset atrial fibrillation to normal sinus rhythm.,
Hypotension
AV block
Sneezing and taste disturbance
Tx for WPW?
Give 3 drugs that can be used acutely in AVNRT.
Chronic?
Sinus tachycardia?
Flecanide
Amiodarone
Adenosine
Verapamil
Flecanide
Bisoprolol Verapamil Sotalol Flecainide Procainamide Amiodarone
Ivabradine, bisoprolol and verapamil.
