Anti-Arrhythmics Flashcards
(108 cards)
1
Q
What do IA block
A
Na channels Ventricular and Supraventricular
2
Q
What do IB block
A
Na channel Ventricular only
3
Q
What do IC block
A
Na channels Ventricular and Supraventricular
4
Q
What do II block
A
Beta
5
Q
What do III block
A
K channel Ventricular and Supraventricular
6
Q
What do IV (4) block
A
Ca channel Supraventricular only
7
Q
What are the IA drugs
A
Quinidine
Procainamide
Disopyramide
8
Q
What are the IB drugs
A
Lidocaine
Mexiletine
Tocainide
9
Q
What are the IC drugs
A
Flecainide
Propafenone
10
Q
What are the II drugs
A
Metoprolol
Propranolol
Esmolol
11
Q
What are the III drugs
A
Amiodarone
Sotalol
Dofetilide
12
Q
What are the IV (4) drugs
A
Verapamil
Diltiazem
13
Q
Draw the IC block
A
14
Q
Draw the II block
A
15
Q
Draw the III block
A
16
Q
Draw the IV block
A
17
Q
Draw the IA block
A
18
Q
Draw the IB block
A
19
Q
How do IA act
A
Slow phase 0 depol
Prolong phase 3
Slow conduction, Prolong AP
Increase ventricular refractory
Affect normal tissue
20
Q
How do IB act
A
Slow phase 0
Decrease phase 4 slope
Decrease AP by shortening repol
Little effect on normal cells
21
Q
How do II act
A
Reduce HR and contractility
Longer repol at AV
Decrease phase 4 slope
Less spont depol in pacemaker
22
Q
How do III act
A
Prolong AP and QT and refractory
No effect on phase 0
Can induce Arrhythmias
23
Q
How do IV act
A
Decrease phase 4 spont depol
Slow conduction SA and AV
Effects on vascular and cardiac SM
24
Q
What other class can Quinidine act as
A
III
25
Can Quinidine cause Arrhythmias
Yes
26
What do we use instead of Quinidine
Ca channel blockers
27
When is Quinidine contraindicated
Complete heart block
Caution in prolongued QT, torsades de pointes, myocarditis
28
When do you give quinidine
Conversion and prevention of A-fib and flutter
Ventricular arrhythmias
29
Which IA are oral
Quinidine
Procainamide
30
What CYP does Quinidine inhibit
2D6
3A4
Also p-glycoprotein
31
Notable Quinidine AE
Thrombocytopenic purpura
Cichonism
Increase digoxin conc
32
What is Cinchonism
Blurred vison
Tinnitus
HA
Psychosis
33
When is Procainamide contraindicated
Hypersensitivity
Complete heart block
2nd degree AV block
SLE
Torsades de pointes
Caution in HF with HTN
34
When do you give Procainamide
Ventricular Arrythmias
Life threatening cases
35
How does Procainamide have class III activity
Partially acetylated to NAPA
Prolongs AP duration
36
Most important AE of Procainamide
Lupus-like syndrome
37
Stronger -ve ionotrope than quinidine and procainamide
Disopyramide
38
Which IAs work mainly on ventricular arrhythmias
Quinidine
Procainamide
39
Which IA is used for ventricular and supraventricular arrhythmias
Disopyramide
40
AE for Disopyramide
Cardiac failure w/o preexisting dysfunction
Severe antimuscarinic effects
41
What other channel does Disopyramide act on
K channels
42
What is Lidocaine commonly used for
Local anesthetic
43
Which IB has little effect on K
Lidocaine
44
What is the DOC for V-tach, V-fib after cardioversion in acute ischemia
Lidocaine
45
Which IB is IV only
Lidocaine
46
Which IB had severe hematological and pulm tox
Tocainide
47
Which IB is used for V-tach other than lidocaine
Tocainide
48
Which IB has AE in CNS and GI
Mexiletine
49
What happens with a toxic dose of Lidocaine
Convulsions
Coma
50
Why is Lidocaine IV only
First pass
51
Does Lidocaine have LV function or -negative inotropic effect
No
52
Which IC doesn't affect slope of phase 0 of AP
Flecainide
Propafenone
53
Which IC increases threshold potential
Flecainide
54
What do you give in life-threatening arrhythmias
Flecainide
Propafenone
Procainamide
55
What do you give to maintain normal sinus rhythm in symptomatic A-fib
Propafenone
Amiodarone
Sotalol (and in flutter)
Dofetilide (and in flutter)
56
When do you give Flecainide
Refractory PVC or V-tach
Severe supraventricular arrhythmia
Prevent paroxysmal A-fib
57
Contraindication for Flecainide
Post-MI PVC
58
AE for Flecainide and Propafenone
Aggravate CHF
Dizziness, blurred vision, HA
N/V/D
Arrhythmia and V-tach
59
What do you use to reduce incidence of suddent arrhythmic deaths post-MI
Metoprolol
Propranolol
60
Used to control SVT and V-tach
Metoprolol
Propranolol
61
Give to control V-tach due to NE or digoxin tox
Metoprolol
Propranolol
62
Use for Acute arrhythmias in surgery/emergencies
Esmolol
63
Contraindications for class II
CHF
Bradycardia
Heart block
Hyperactive airway disease
64
Class II AE
Bradycardia
Hypotension
CNS effects
65
Class III that is a pure K blocker
Dofelitide
66
Structurally related to thyroxine
Amiodarone
67
Which Antiarrhythmic has class I, II, III, IV effects
Amiodarone
68
What is the most common antiarrhythmic
Amiodarone
69
What is low dose Amiodarone used for
Maintain normal sinus in A-fib
70
How long does it take for full clincal AE of Amiodarone to be apparent
6 weeks
71
Effects of Amiodarone
Decrease AV conduction and sinus node function
Block inactivated Na channels
Weak Ca blocker
Inhibit adrenergic stimulation
Anti-anginal
72
How common are Amiodarone AE
\> 50% of people
73
Notable AE of Amiodarone
IPF
Blue/Gray skin discoloration (Iodine accumulation)
Thyroid dysfunction
74
What is Amiodarone never coadministered with
Digoxin
Theophylline
Warfarin
Quinidine
75
When do you never give Amiodarone
Bradycardia
SA/AV block
Severe hypotension
Resp failure
76
What kind of a drug is Sotalol
Non-selective Beta-blocker
77
Which drug is the delayed K channel rectifier
Sotalol
78
What do you NOT use Sotalol for
Asymptomatic arrhythmias
79
Class III with least AE
Sotalol
80
Main AE in Sotalol
Torsades de pointes (prolong QT)
Caution in renal impairment
81
AE for Dofetilide
HA, chest pain, Dizziness, V-tach
TORSADES DE POINTES
82
What are the Miscellaneous Antiarrhythmics
Digoxin
Adenosine
Mg
Atropine
83
What kind of Ca channel blockers are class IV antiarrhythmics
Non-Dihydropyridines
84
Which class IV is more selective for Myocardium
Verapamil
85
How do class IV act
Bind open, depolarized channels
Decrease HR, contractility, conduction velocity
86
When do you give class IV
SVT
A-fib and flutter
HTN, angina
87
Why do class IV cause transient increase in BP and CO
They are negative inotropes
88
What do you not give class IV with and why
Digoxin
Dofetilide
Simvastatin
Lovastatin
89
What does Digoxin do
Shorten refractory in atrial and ventricular myocardium
Lengthen refractory and lower conduction in AV node
90
When do you give Digoxin
A-fib/flutter with impaired LV function or HF
91
Direct action of Digoxin
AV node blocking
Activate Ach-mediated K currents in atrium
92
Indirect effects of Digoxin
Hyperpol
Shorten atrial AP
Increase AV refractory
93
Effect of Digoxin toxicity
V-tach
V-fib
94
Which miscellaneous antiarrhythmic is given in IV form
Adenosine
95
What is the DOC for abolishing acute SVT in emergency
Adenosine
96
Which antiarrhythmic is a P1r agonist
Adenosine
97
What does high dose Adenosine do
Decrease conduction velocity
Prolong refractory
Decrease AV automaticity
98
How does Adenosine act
Increase K conduction
Decrease Ca influx leading to hyperpol
99
What are the AE for Adenosine
Chest pain similar to MI
Hypotension
Bronchoconstriction in asthmatics
100
What is a functional Ca antagonist
Mg
101
What is used in bradyarrhythmia to decrease vagal tone and increase HR
Atropine
102
When is Mg used
Torsades de Pointes
Digitalis arrythmias (also lidocaine)
Arrhythmia prophylaxis in acute MI
103
When is Atropine used
Bradyarrhythmia
104
What is the most common clinical arrhythmia
A-fib
105
What drugs are involved in Rhythm control of A-fib
Class IC
Class III
IA (more AE)
106
What drugs are involved in Rate control of A-fib
Ca channel blockers
Beta blockers
Digoxin
107
When do you use IV Heparin to control thromboembolic events in A-fib
Unstable pts needing immediate cardioconversion
108
When do you use oral Warfarin to control thromboembolic events in A-fib
If cardioversion can be delayed 3-4 days
