Anti-Arryhtmics

Question 1

Phase of the Cardiac Action Potential where Na+ and Ca2+ are rushing in.

Answer 1

Phase 0 (Depolarization)

Question 2

Phase of the Cardiac Action Potential where Na+ channels close.

Answer 2

Phase 1

Question 3

Phase of the Cardiac Action Potential where Ca2+ continues to go into the cell and K+ is leaving the cell.

Answer 3

Phase 2

Question 4

Phase of the Cardiac Action Potential where K+ leaves the cell and Ca2+ channels close.

Answer 4

Phase 3 (Rapid Repolarization)

Question 5

Phase of the Cardiac Action Potential with leaky K+ channels.

Answer 5

Phase 4 (Resting Potential)

Question 6

What Class of medications works on Phase 0 of the Cardiac Cycle?

Answer 6

Class 1 = Na⁺ Channel Blocker

Question 7

What Class of medications works on Phase 4 of the Cardiac Cycle?

Answer 7

Class 2 = Beta Blocker

Question 8

What Class of medications works on Phase 3 of the Cardiac Cycle?

Answer 8

Class 3 = K+ Channel Blocker

Question 9

What Class of medications works on Phase 2 of the Cardiac Cycle?

Answer 9

Class 4 = Ca²⁺ Channel Blocker

Question 10

What does the Relative Refractory period coincide with on an EKG?

Answer 10

T Wave Apex

Question 11

Ia Na⁺ Channel Blockers

Answer 11

Disopyramide
Quinidine
Procainamide

Question 12

Ib Na⁺ Channel Blockers

Answer 12

Lidocaine
Mexiletine

Question 13

Ic Na⁺ Channel Blockers

Answer 13

Flecainide
Propafenone

Question 14

Beta Blockers

Answer 14

Metoprolol
Atenolol

Question 15

K⁺ Channel Blockers

Answer 15

Amiodarone
Fofetilide
Ibutilide
Sotalol

Question 16

Non-Dihydropyridine Ca²⁺ Channel Blockers

Answer 16

Diltiazem
Verapamil

Question 17

Class V Medications

Answer 17

Adenosine
Digoxin

Question 18

Medications that slow the rate of rise of phase 0 by prolonging the duration of action potential and increases the effective refractory period of the ventricle.

Answer 18

Class Ia Na⁺ Channel Blockers
(↑ ERP + ↑ AP Duration)

Question 19

What do Class Ia Na⁺ Channel Blockers treat?

Answer 19

Ventricular + Atrial Arrhythmias in patients without a history of ischemic heart disease

Question 20

What is an adverse drug reaction caused by Class Ia Na⁺ Channel Blockers?

Answer 20

Lupus-Like Syndrome
Increase Arrhythmias

Question 21

Medications that shorten the action potential duration and refractory period of the Purkinje Fibers and ventricular muscles.

Answer 21

Class Ib Na⁺ Channel Blockers
(↓ ERP + ↓AP Duration)

Question 22

When do you give Class Ib Na⁺ Channel Blockers?

Answer 22

Ventricular Arryhtmias

Question 23

What is a Class Ib Na+ Channel Blocker that is 2nd line in treating V-Tach and V-Fib?

Answer 23

Lidocaine

Question 24

Is Lidocaine effective against Atrial Arrhythmias?

Answer 24

No

Question 25

Medication that has the greatest effect on early depolarization. Can cause a markedly prolonged QRS during normal sinus rhythm.

Answer 25

Class Ic Na⁺ Channel Blockers.

Question 26

What is the indication for a Class Ic Na⁺ Channel Blocker?

Answer 26

Supra-ventricular Arrhythmias in patients without structural heart disease.

Question 27

Medications that block cardiac Beta-1 receptor and reduces cAMP

Answer 27

Beta Blockers - Metoprolol - Propranolol - Atenolol - Esmolol

Question 28

What do Beta Blockers ultimately result in?

Answer 28

Cardiac Membrane Stabilization Slowed SA + AV Node Conduction ↑ Refractory Period

Question 29

What are Beta-Blockers used to treat?

Answer 29

Re-infarction & sudden death in patients with HF or MI.

Question 30

What are some adverse drug reactions caused by Beta-Blockers?

Answer 30

AV BLOCK Bronchospasm Cardiac Depression Hypotension

Question 31

Medications that prolong or delay repolarization.

Answer 31

K⁺ Channel Blockers

Question 32

What do all K⁺ Channel Blockers do?

Answer 32

Prolong QT (Amiodarone does it the least)

Question 33

What is the drug of choice for the acute treatment of V-Tach and V-Fib?

Answer 33

Amiodarone

Question 34

What medications are safe to treat heart failure with A-Fib?

Answer 34

Amiodarone Dofetilide

Question 35

What are two adverse drug reactions of K⁺ channel blockers?

Answer 35

QT Prolongation Torsades de Pointes

Question 36

What are some signs of Amiodarone toxicity?

Answer 36

GI = Nausea + Vomiting Pulmonary = Pulmonary Fibrosis Endocrine = Hyper or Hypo Thyroid Eyes = Corneal Microdepsoits (100%) Liver = Heptatotoxicity

Question 37

What is the half-life of Amiodarone?

Answer 37

52 days (Reactions can take Months or Years)

Question 38

How does Amiodarone interact with Warfarin?

Answer 38

Inhibits Warfarin Metabolism ↑ INR Tx: ↓ Warfarin by 50%

Question 39

How does Amiodarone interact with Digoxin?

Answer 39

↑ Digoxin Effect ↑ Risk of AV Block ↑ Risk of GI + Neuro Toxicity Tx: ↓ Digoxin by 50%

Question 40

How does Amiodarone interact with Statins (HMG Co-A Reductase Inhibitors)

Answer 40

Inhibits Statin Metabolism ↑ Risk of Myopathy + Myalgia Tx: Avoid high doses of: Lovastatin Atorvastatin Simvastatin

Question 41

Medications that slow conduction through the AV node and increase the effective refractory period in the AV node.

Answer 41

Ca²⁺ Channel Blockers

Question 42

Ca²⁺ channel blockers prolong what?

Answer 42

PR Interval

Question 43

What is an indication for a Ca²⁺ channel blocker?

Answer 43

A-Fib rate control

Question 44

What are some adverse drug reactions of Ca²⁺ channel blockers?

Answer 44

Cardiac: - Negative Inotrope - AV Node Block - Sinus Arrest Non-Cardiac: - Peripheral Vasodilation - Constipation

Question 45

Class of medications used for Ventricular Arrhythmias and A-Fib.

Answer 45

Ia + Ic Na⁺ Channel Blockers

Question 46

Class of medications used for A-Fib, Ventricular Arrhythmias, and Post-Myocardial Infarction.

Answer 46

Beta Blockers

Question 47

Class of medications used for Atrial and Ventricular Arrhythmias, especially when other drugs fail.

Answer 47

K⁺ Channel Blockers

Question 48

Class of medications effective for A-Fib and A-Flutter.

Answer 48

Ca²⁺ Channel Blockers

Question 49

Medication that can cause tinnitus, headache, vision changes, thrombocytopenia, and lupus-like syndrome.

Answer 49

Quinidine

Question 50

Medication that can cause CNS effects, confusion, and seizures.

Answer 50

Lidocaine

Question 51

Medication that is pro-arrhythmic, especially in structural heart disease.

Answer 51

Flecainide

Question 52

Medications that can cause Bradycardia, Hypotension, and Bronchospasm.

Answer 52

Beta-Blockers

Question 53

Medications that can cause QT Prolongation.

Answer 53

K⁺ Channel Blockers

Question 54

Medication that can cause pulmonary fibrosis, thyroid abnormalities, and hepatotoxicity.

Answer 54

Amiodarone

Question 55

Medication that can cause AV Blocks, bradycardia, and hypotension.

Answer 55

Ca²⁺ Channel Blockers

Question 56

Medication used to treat paroxysmal SVT.

Answer 56

Adenosine

Question 57

What are some adverse drug reactions of Adenosine?

Answer 57

Flushing Dyspnea AV Block Arrhythmia

Question 58

Medication that partially inhibits Na⁺/K⁺ ATPase Pump and increases contraction without effecting heart rate.

Answer 58

Digoxin

Question 59

When is Digoxin used?

Answer 59

2nd or 3rd Line for: A-Fib or Heart Failure

Question 60

What are some adverse drug reactions caused by Digoxin?

Answer 60

Nausea + Vomiting Blurred Vision + Halos AV Block MUST MONITOR DRUG LEVEL

Question 61

What medications can cause QT Prolongation?

Answer 61

Class 1A and III Tricyclic Antidepressants Quinolones Phenothiazines Haloperidol Zofran