Anti-Arrythmic agents

Question 1

What ECG changes do you see in WPW?

Answer 1

Shortened PR

Lengthened QRS

Question 2

Which class 1 agent is only used for ventricular arrhythmia?

Answer 2

Lidocaine

Question 3

What are the side effects of 1a agents?

Answer 3

Pro-arrythmia
Hypotension
Dizziness, confusion
GI

Question 4

What ECG changes does flecainide cause?

Answer 4

Increase QRS, QT and PR (also decreases automaticity)

Question 5

What ECG changes do 1a agents cause?

Answer 5

Increase QRS and QT

Question 6

What ECG changes do 1b agents cause?

Answer 6

Increase QRS in ischaemic tissue only

Question 7

What are the side effects of flecainide?

Answer 7

Pro-arrythmia
Sudden death with chronic use
CNS
GI

Question 8

What effects do beta blockers have?

Answer 8

Decrease phase 4 - automaticity

Prolong AV repolarisation - increased RP

Question 9

What effects do beta blockers have on ECG?

Answer 9

Decrease HR

Increase PR

Question 10

What arrhythmia are beta-blockers used to treat?

Answer 10

Converting re-entry at AV node
SVT - protect ventricles from high atrial rates
Sinus tachycardia

Question 11

Why are beta-blockers used post-MI?

Answer 11

Decrease oxygen demand of heart - negative isotropy and chronotropy
Inhibit sympathetic activity following MI - ventricular arrhythmias.

Question 12

What are the side effects of beta blockers?

Answer 12

Bronchospasm - asthmatic
Hypotension 
Tremor
Fatigue 
Insomnia
Cold hands

Question 13

When are beta blockers inappropriate?

Answer 13

Partial AV block or heart failure - decrease CO

Question 14

What are the side effects of Amiodarone?

Answer 14

Pulmonary fibrosis
Raised LDL
Hypothyroidism
Optic neuritis 
Hepatic injury
Photosensitivity

Question 15

What effect does Sotalol have on ECG?

Answer 15

Lengthened QT

Decreased HR

Question 16

What are side effects of sotalol?

Answer 16

Pro-arrythmia
Fatigue
Insomnia

Question 17

What type of CCB are used to treat arrhythmias?

Answer 17

Phenylalkylamine - verapamil

Question 18

What are the effects of CCB?

Answer 18

Decrease automaticity - Phase 0 pacemaker
Decrease AV conduction
Increase AV refectory period

Question 19

What ECG changes with CCB?

Answer 19

Increased PR

HR altered - baroreflex

Question 20

What are SE of CCB?

Answer 20

Hypotension

GI

Question 21

What is the mechanism of adenosine?

Answer 21

Endogenous - given IV, short t1/2

A1 receptors - Gi coupled - opens K+ channels -> hyperpolarisation

Question 22

What are the effects of adenosine?

Answer 22

Slows AV conduction

Decrease automaticity - phase 4

Question 23

What is adenosine used for?

Answer 23

CAD diagnosis

Re-entrant supra ventricular arrhythmias

Question 24

What is vernakalent mechanism?

Answer 24

Atrial specific K+ channel blocker.
Decrease atrial conduction
Potency increases as HR increases

Question 25

What is vernakalent used for?

Answer 25

Convert recent onset AF to sinus rhythm

Question 26

What is Ivabradine MOA?

Answer 26

Inhibits If in SA node - decrease automaticity and HR.

Question 27

What is a SE of Ivabradine?

Answer 27

Flashing lights

Question 28

What is Ivabradine used for?

Answer 28

Sinus tachycardia | Decrease HR in HF or angina as NO effect on BP

Question 29

What is digoxin MOA?

Answer 29

Increase vagal activity, RP Decrease AV conduction and slow HR Inhibit Na+/K+ ATPase - increase inotropy

Question 30

What is digoxin used for?

Answer 30

Not used alone | Slow HR in permanent AF patients

Question 31

How does atropine work?

Answer 31

Muscarinic antagonist - block vagal activity

Question 32

What is atropine used for?

Answer 32

Vagal bradycardia - increase AV conduction and HR

Question 33

What AF rate control drugs are there?

Answer 33

Beta blocker -bisprolol CCB - verapamil, diltiazem +/- Digoxin

Question 34

What AF rhythm control drugs are there?

Answer 34

Sotalol Flecainide + bisoprolol Amiodarone

Question 35

When must flecainide never be used?

Answer 35

If structural abnormality or IHD | Alone to treat AF - need AV node blocking drug, either BB or CCB.

Question 36

What is used to treat ventricular tachycardia?

Answer 36

Beta blocker Lidocaine - if ischaemia Amiodarone

Question 37

What is used to treat WPW?

Answer 37

Flecainide | Amiodarone