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Pharmacology PaxFlan > Anti-arrhythmics > Flashcards

Anti-arrhythmics Flashcards

(61 cards)

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1
Q

what is the purpose of Na/K pump (;

A

K+ into cell, Na+ out of cell

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2
Q

Class I MOA (generally)

A

modulates/blocks Na+ channels

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3
Q

Class II MOA (generally)

A

inhibits sympathetic activity

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4
Q

Class III MOA (generally)

A

Blocks K+ channels

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5
Q

Class IV MOA (generally)

A

block Ca+ channels

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6
Q

what are the Class IA drugs

A

quinidine, procainamide, disopyramide

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7
Q

what are the class IB drugs

A

lidocaine, mexiletine

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8
Q

what are the class IC drugs

A

flecainide, propafenone

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9
Q

how does class IA affect conduction velocity and ADP (action potential duration)

A

increases conduction velocity, prolongs ADP

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10
Q

how do class IB affect conduction velocity and ADP (action potential duration)

A

no effect on conduction velocity, may shorten ADP

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11
Q

how do class IC affect conduction velocity and ADP (action potential duration)

A

increases conduction velocity, prolong ADP

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12
Q

how do class III affect conduction velocity and ADP?

A

no effect on conduction velocity, prolongs ADP

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13
Q

what are the class II drugs

A

B-blockers

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14
Q

what are class III drugs

A

sotalol, ibutilide, dofetilide, amiodarone, dronedarone

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15
Q

what are the class IV drugs

A

non-dhp CCBs - verapamil, diltiazem

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16
Q

what is a major ADR of all anti-arrhythmics

A

can be proarrhythmic (cause arrhythmias) –> may be fatal

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17
Q

TdP is more common with…

A

hypokalemia, hypmagnesemia, bradycardia

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18
Q

TdP results from what

A

QT prolongation, usually d/t blockade of the IKr potassium current

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19
Q

class interactions of anti-arrhythmics

A

QTc prolongers, rate slowers
CYP3A4, 2D6 enzymes b/c most are metabolized by these cyps
drugs that cause hypokalemia/hypomagnesemia

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20
Q

class ADRs of anti-arrhythmics

A

QTC prolongation/proarrhythmic potential

careful in pts with bradycardia/heart blocks

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21
Q

ADRs of quinidine

A

quinidine syncope - recurrent lightheadedness & fainting 2* to self-terminating Tdp
cinchonism - dry as bone, red as beet, blind as bat, etc…

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22
Q

ADRs of procainamide

A

reversible lupus-like syndrome

severe bone marrow suppression

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23
Q

ADRs of disopyramide

A

anticholinergic SE (urinary retention&raquo_space;)

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24
Q

ADRs of mexiletine and lidocaine

A

CNS toxicity (dizziness, lightheadedness, unsteady gait, tremor, seizures)

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25
ADR of flecainide
mostly proarrhythmic
26
monitoring of flecainide
make sure K+ is normal | echo to make sure pt has structurally normal heart
27
monitoring of propafenone
echo to make sure pt has structurally normal heart
28
propafenone ADRs
dysgeusia (altered taste) | lupus-like rxn
29
Sotalol interactions
avoid concurrent B-blockers, CCBs
30
ibutilide ADR
proarrhythmic
31
dofetilide ADR
dysrhythmia - death possible
32
amiodarone pharm characteristics
highly lipid soluble (stored in high levels in muscle, fat , liver, lungs, skin) = long 1/2 life iodine-containing (like thyroxine)
33
FDA indications for amiodarone
life-threatening VF or hemodynamically unstable VT
34
common clinical use for amiodarone
AF pharmacologic cardioversion AF prophylaxis following open heart surgery recurrent AF
35
interactions of amiodarone
substrate of 2C9, 3A4; inhibits multiple isoezymes additive QTc drugs additive AV block/bradycardia drugs that induce increase K or Mg
36
what effect can amiodarone have on digoxin
can increase digoxin for up to 3 months
37
ADRs of amiodarone (generally)
ocular effects, hypothyroidism>>, pulmonary toxicity, cardiac effects, dermatologic, CNS
38
how does pulmonary toxicity with amiodarone present
IPF (idiopathic pulmonary fibrosis) --> ARDS | interstitial infiltrates on imaging
39
how to treat amiodarone pulmonary toxicity
d/c drug, corticosteroids, supportive
40
amiodarone ocular toxicity
corneal microdeposits, optic neuropathy / optic neuritis | may --> blindness
41
derm effects of amiodarone
photosensitivity, blueish skin discoloration
42
CNS effects of amiodarone
abnormal gait, ataxia, dizziness memory impairment, involuntary body movements, peripheral neuropathy
43
cardiac effects of amiodarone
bradycardia, AV nodal block
44
dronedarone indications
AF/ atrial flutter
45
monitoring for dronedarone
K+, Mg+, SCr, LFTs, ECG q3 months
46
contraindications of dronedarone
``` NYHA class IV HF Class II-III HF with recent decompensation pts with 2nd/3rd degree AV blocks pts with SSS (sick sinus syndrome) pts with bradycardia <50bpm ```
47
dronedarone interactions
CYP3A4 substrate pgp inhibitor (remember digoxin) QTc prolonger INR elevations with warfarin?
48
dronedarone ADRs
N/V/D, photosensitivity?
49
MOA of digoxin for HF
inhibits Na/K pump = increase intracellular Na= Ca influx = increase intracellular Ca= increase contractility
50
MOA of digoxin for SV arrhythmias
increases vagal tone = decrease conduction through SA and AV nodes
51
clinical use of digoxin
1. advanced systolic HF - only AFTER they have been optimized w ACE, ARB, b-blocker, diuretic, aldosterone antagonist 2. 2nd line for AF in HF pts - only if b-blocker of non-dhp ccb isn't enough/isn't tolerated
52
monitoring of digoxin
ECG K+, Mg+, Ca2+ serum SCr serum trough [digoxin] measured prior to next dose
53
optimal [digoxin] for HF
0.5-0.9 ng/mL
54
optimal [digoxin] for AF
= 2 ng/mL
55
when should you monitor [digoxin] routinely
elderly, on interacting med (amiodarone, verapamil)
56
digoxin interactions
monitor if there is a toxicity risk with other drugs oral steroids, diuretics (increases toxicity because digoxin has more of a distribution to heart and muscles with low K or Mg) bile acid sequestrants (give other meds 1 hr before or 4-6 hrs after bile acid sequestrants)
57
acute digoxin toxicity
Cardiac - PVC, AV nodal blockade GI- n/v, abd pain, anorexia neuro - confusion, weakness
58
chronic digoxin toxicity
cardiac - rhythm disturbances neuro - lethargy, delirium, weakness visual - chromatopsia (yellow-green), scotomas, blindness
59
workup for digoxin toxicity
1. [digoxin] 2. serum [k] 3. BUN/SCr 4. baseline ECG
60
treatment for digoxin toxicity
1. assess/stabilize ABCs 2. continuous tele, pOx 3. place IV 4. blood sugar 5. digoxin immune Fab
61
can digoxin be stopped
yeth

Pharmacology PaxFlan (12 decks)

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