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Pharm 5 > Anti-Arrhythmic > Flashcards

Anti-Arrhythmic Flashcards

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1
Q

4 ways of decreasing spontaneous activity

A

Decrease phase 4 slope
Increase threshold
Increased maximum diastolic potential (hyperpolarize)
Increase APD

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2
Q

2 ways of increasing refractoriness

A

Na channel blockers - shift voltage dependence of recovery - delay Na recovery
AP prolonging drug - extend ERP w/out interacting w/Na channels

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3
Q

State dependent blockade

A

block fast inward Na channels when in open/inactivated but not resting

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4
Q

MOA Class I agents

A 
Block fast inward Na channels to varying degrees in conductive tissue
Decrease Vmax 
Reduce automaticity
delay conduction
prolong ERP
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5
Q

Class 1a Na targets

A

open > inactive

dissociation in seconds

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6
Q

MOA Quinidine

A

moderate binding to Na = decrease Vmax
block K = increase APD
block alpha adrenergic = decrease BP
block M2 = increase HR

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7
Q

TX Quinidine

A

Mainly used in refractory pts to:
convert AF/AFl
prevent recurrence of AF
Treat life-threatening ventricular arrhythmias

Also atrial/ventricular arrhythmias (re-entrant SVT, VT)

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8
Q

AE Quinidine

A

N/V/D - most common
cinchonism
hypotension (adrenergic)
proarrhythmic - TdP (QT)

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9
Q

1a agents

A

Quinidine
Procainamide
Disopyramide

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10
Q

MOA Procainamide

A

block Na = slow conduction, automaticity, excitability of A/V/Purk
block K = prolong APD and refraactoriness

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11
Q

Quinidine vs Procainamide

A

Procainamide has little vagolytic activity and does not prolong QT as much

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12
Q

TX Procainamide

A

Life-threatening ventricular arrhythmias**
Ventricular arrhythmias immediately post MI
convert VT

Acute supraventricular:
Re-entrant SVT
A fib
A flutter w/WPW

Requires adequate time - not emergency

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13
Q

AE Procainamide

A 
Arrhythmia aggravation
TdP - contraindicated in long QT, HX of TdP, hypo-K
heat block/sinus node dysfunction
SLE like syndrome
GI N/V - common
Decrease kidney fx
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14
Q

1b Na channel

A

inactive&raquo_space;» open

dissociate in under 1s

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15
Q

1b agents

A

Lidocaine

Mexiletine

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16
Q

MOA Lidocaine

A

block inactivated&raquo_space; open Na = reduced Vmax
shorten AP
more effective in ischemic tissue
lower slop of phase 4 = lower threshold for excitability
slows ventricular rate
potentiates infranodal block

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17
Q

TX Lidocaine

A

Used to be first-line for ventricular arrhythmias (post MI)
Now - second choice for immediate life-threatening or symptomatic arrhythmias
Ineffective:
prophylaxis after MI
Atrial tissue

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18
Q

PKX Lidocaine

A

Extensive first pass - IV use

Multiple loading doses and maintenance infusion

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19
Q

AE Lidocaine

A

Rapid bolus: tinnitus, seizure
High dose: drowsy, confused, hallucination
CV decreased

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20
Q

1c agents

A

Propafenone

Flecainide

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21
Q

1c Na channels

A

Strongest binding to Na channels
O state
slow dissociation = strong effects on p0 depol

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22
Q

MOA Propafenone

A

strong inhibitor of Na channel
can inhibit B-adrenergic
structurally similar to propranolol

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23
Q

TX Propafenone

A 
Ventricular arrhythmias in pts w/ no HD and preserved ventricular fx
atrial arrhythmias (Afib, PSVT)
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24
Q

MOA Flecainide

A

potent Na channel blockade = prolonged p0 + wide QRS

markedly slows intraventricular conduction**

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25
TX Flecainide
ONLY life-threatening ectopic ventricular arrhythmias | Not first line agent - fatal proarrhythmic
26
AE 1c
proarrhythmic especially post-MI | Contraindicated in structural and ischemic HD
27
MOA Class II agents
B-blockers | decrease cAMP/Ca = decrease SA node automaticity, AV node conduction, ventricular contractility
28
TX Class II
Supraventricular arrhythmias (sympathetic) ONLY drug effective in preventing sudden cardiac death post-MI NOT effective in severe arrhythmias (recurrent VT)
29
Esmolol
very short t.5 - only IV No ISA, no membrane depressant little/no bronchospasm useful for short term B-blockade (aortic dissection, critically ill, post-op HTN)
30
Class II AE
Impotence COPD/asthma exacerbation Bradycardia, AV block, HF - mask signs of hypo-G CNS sedation Dyslipidemia (metoprolol) Exacerbation of angina (propranolol) contraindicated in pheochromocytoma or cocaine (except carvedilol and labetalol)
31
TX of B-blocker overdose
Saline Atropine Glucagon
32
MOA class III
Multiple effects at K, Ca, Na and autonomic | Main: prolong phase 3 repol = increased QT
33
Class III agents
``` Amiodarone Ibutilide Dofetilide Dronedarone Sotalol ```
34
MOA Amiodarone
``` block K = long APD/refractory Block Na (inactivated) block Ca = slow SA P4 Slow AV node conduction noncompetitive blockade of a, B, M ```
35
TX Amiodarone
Widely used Conversion of AF - maintain sinus rhythm - DOC* AVNRT* WPW tachycardia Oral - LT VT or resistant VF IV - acute termination of VT/VF - replacing lidocaine for out-of-hospital cardiac arrest
36
PKX Amiodarone
Lipophilic metabolized to DEA - potent responsible for early arrhythmias after discontinuation
37
AE Amiodarone
Lethal pulmonary fibrosis Hyper/hypothyroidism Elevated hepatic enzymes Check PFTs, LFTs, TFTs
38
MOA Ibutilide
Block rapid component of delayed rectifier K = slow repol | Activate slow inward Na = prolong AP
39
TX Ibutilide
IV - acute conversion of AF/AFl to NSR (20 min)
40
AE Ibutilide
Excessive QT prolongation | TdP - continuous ECG monitoring for 4h
41
MOA Dofetilide
Block delayed rectifier K current | does not block other K
42
PKX Dofetilide
100% bioavailable Verapamil - increased peak plasma Cimetidine - prolong t.5
43
TX Dofetilide
Restore/maintain NSR in A-fib
44
AE Dofetilide
dose-dependent QT prolongation | ventricular proarrhythmia
45
MOA Sotalol
``` B-blocker AP prolonging (K) ```
46
TX Sotalol
Life-threatening ventricular arrhythmias | Children SV/V arrhythmias
47
AE Sotalol
TdP | LV depression w/HF
48
Class IV agents
Verapamil | Diltiazem
49
MOA Class IV
Ca channel antagonists Similar to Class II w/ primary effects on nodal p0 Incomplete blockade
50
Major CV actions of Class IV
Negative chronotrope, dromotrope, inotrope
51
Class IV TX
Systemic HTN Angina pectoris SVT Post-infarct protection
52
Verapamil MOA
block slow inward Ca channels in nodal tissue Decrease SA automaticity, HR, AV conduction (increase PR), increase ERP Ineffective on ventricular arrhythmia
53
Verapamil TX
``` PO - prevention IV - conversion nodal arrhythmias (PSVT) Rate control - A-fib angina pectoris HTN ```
54
AE Verapamil
``` HA Constipation Exacerbate CHF Hypotensino AV block w/B-blocker ```
55
Contraindication Verapamil
Sick sinus syndrome Pre-existing AV nodal dz WPW w/Afib V-tach
56
MOA Adenosine
A1 receptor in SA/AV = increase K = SA node hyperpol and low firing rate Short APD Depression of AV conduction velocity A2 receptor Increase endothelial Ca Increase NO Vasodilation
57
TX Adenosine
Acute conversion of paroxysmal supraventricular tachycardia cause by reentry bypass
58
PKX Adenosine
IV bolus to central vein | Blunted by adenosine antagonist - caffeine, theophylline
59
TX Mg
TdP | Digitalis arrhythmias
60
TX Bradycardia
Atropine - vagal block Isoproterenol - B1 agonist Pacemaker
61
TX Sinus Tachycardia, PSVT
vagal stimulation carotid massage Valsalva

Pharm 5 (4 decks)

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