Anti-arrhythmic Agents

Question 1

What is the best treatment for an asymptomatic or minimally symptomatic arrhythmia

Answer 1

No pharmacological treatment

Question 2

what are use or state-dependent work

Answer 2

drugs that are more effective in blocking channels that are being used frequently (activated) or in an inactivated state (have a higher affinity for activated for inactive channels and low affinity for resting channels)

Question 3

What is the MOA of the class I anti-arrhythmic agents

Answer 3

Na+ channel blockers

Question 4

What is the MOA of the class II anti-arrhythmic agents

Answer 4

B-adrenergic receptor blocker

Question 5

What is the MOA of the class III anti-arrhythmic agents

Answer 5

prolong action potential duration (K+ channel blocker)

Question 6

What is the MOA of the class IV anti-arrhythmic agents

Answer 6

Ca++ channel blockers

Question 7

What are the 3 drugs in the class 1A AAA

Answer 7

procainamide, quinidine, disopyramide (Intermediate kinetics)

Question 8

what are the 2 drugs in the class 1B AAA

Answer 8

LIDOCAINE, mexiletine (Fast Kinetics)

Question 9

What are the 3 drugs in the class 1C AAA

Answer 9

amiodarone, dronedarone, sotalol (Slow kinetics)

Question 10

What is the MOA of propranolol

Answer 10

BB (class II)

Question 11

What is the MOA of esmolol

Answer 11

BB (class II)

Question 12

What is the MOA of amiodarone

Answer 12

prolong APD (K+ channel blocker)

Question 13

What is the MOA of dronedarone

Answer 13

prolong APD (K+ channel blocker)

Question 14

What is the MOA if sotalol

Answer 14

prolong APD (K+ channel blocker)

Question 15

what is the MOA of verpamil

Answer 15

CCB (class IV)

Question 16

what is the MOA of diltiazem

Answer 16

CCB (class IV)

Question 17

what is the MOA of procainamide

Answer 17

blocks Na+ and K+ channels (intermediate kinetics - prolong APD)

Question 18

What is the clinical effect of procainamide

Answer 18

slows upstroke of AP and conduction, prolong QRS, direct depressant action on SA/AN nodes use/state-dependent action

Question 19

Indication for procainamide

Answer 19

atrial and ventricular arrhythmias, 2nd choice for ventricular arrhythmias post aMI

Question 20

Metabolism of procainamide

Answer 20

half life: 3-4hrs, metabolized to NAPA and renal eliminated

Question 21

Adverse effects of procainamide

Answer 21

Torsades des pointes, Hypotension, anti-cholenergic effects, Lupus (long term use)

Question 22

MOA of quinidine

Answer 22

blocks Na+ and K+ channels

Question 23

Adverse effects of quinidine

Answer 23

strong anti-cholenergic effects, Cinchonism (headache, dizziness, tinnitus), rarely used because of cardiac and extra-cardiac effects

Question 24

MOA of disopyramide

Answer 24

blocks Na+ and K+ channels

Question 25

Adverse effects of quinidine

Answer 25

worst anti-cholenergic effects of the class IA and requires co-administration of drugs that slow AV conduction. negative iontrophic effect may induce heart failure

Question 26

Indications for quinidine

Answer 26

Not drug of 1st or second choice. ONLY approved for ventricular arrhythmias

Question 27

MOA of Lidocaine

Answer 27

Na+ channel blockers use/state dependent drug action (fast kinetics - reduces APD)

Question 28

Clinical effect of lidocaine

Answer 28

at normal resting potential: no effect on conduction, selective depression of conduction in depolarized (ischemic cells)

Question 29

Indication for LIdocaine

Answer 29

Drug of choice for ventricular tachycardia and fibrillation after cardioversion in the setting of ischemia/infarction, highly effective for ventricular arrhythmias post MI

Question 30

Adverse Effects of Lidocaine

Answer 30

Least cardiotoxic drug among class I drugs, neurological side effects due to local anesthetic properties

Question 31

Metabolism of Lidocaine

Answer 31

extensive first pass metabolism, half life: 1-2hrs (3-6 hrs with liver disease)

Question 32

Difference between lidocaine and mexiletine

Answer 32

Mexiletine is an orally active lidocaine analog with similar actions and AEs. Has a longer half life 8-20 hrs. Off label use to treat chronic pain

Question 33

MOA of flecainide

Answer 33

Na+ and K+ blocker (Class 1C: slow kinetics)

Question 34

Clincial effect of flecainide

Answer 34

no effect on APD. no anti-cholinergic effect

Question 35

Indication for flecainide

Answer 35

Supraventricular arrhythmias in pts with otherwise normal hearts

Question 36

Metabolism of flecainide

Answer 36

half life: 20hrs, renal and hepatic elimination

Question 37

Adverse effects of flecainamide

Answer 37

increases mortality in pt with v. tach, MI and ventricular ectopy

Question 38

Contraindication of flecainamide

Answer 38

ventricular ectopy

Question 39

MOA of propafenone

Answer 39

potent blocker of Na+ channel and may also block K+ channels, weak BB activity

Question 40

Clinical effect of propafenone

Answer 40

no effect on APD

Question 41

Indications for propafenone

Answer 41

supraventricular arrhythmias in pt with otherwise normal hearts

Question 42

Metabolism of propafenone

Answer 42

half life: 5-7hrs, hepatic elimination

Question 43

Adverse Effects of propafenone

Answer 43

arrhythmogenic, sinus bradycardia/bronchospasm (B-blockade), metallic taste and constipation

Question 44

MOA of propanolol

Answer 44

non-selective BB

Question 45

MOA of Esmolol

Answer 45

selective B1 antagonist

Question 46

Clinical effects of the BB on the heart

Answer 46

1. inhibit sympathetic influenes on the the cardiac electrical activity 2. reduce HR 3. decrease intracell Ca overload 4. decrease pacemaker activity 5. Reduce conduction velocity 6. decrease catecholamine induced DAD and EAD arrhythmias

Question 47

Indications for the BBs

Answer 47

Exercise induced arrhythmias, A. fib. atrial flutter, AV nodal re-entry, prevention of recurrent infarction post MI

Question 48

AE of the BBs

Answer 48

bradycardia, reduced exercise capacity, heart failure, hypotension, AV block, bronchospasms, masking hypoglycemia in diabetic pts.

Question 49

Contraindications of BBs

Answer 49

Asthma/COPD, sinus bradycardia or partial AV block