Anti-arrythmics

Question 1

Class 1’s

Answer 1

1A - Quinidine, procainemide
1B - Lidocaine
1C- Flecainide

Question 2

Class 2’s

Answer 2

Propranolol, esmolol

Question 3

Class 3’s

Answer 3

Amiodorone, Sotolol

Dofetalide, Ibutilide

Question 4

Class 4’s

Answer 4

Verapamil, diltiazem

Question 5

Local anesthetics - MoA

Answer 5

Binds to, inhibits, and releases from Na+ Channels a different rates

Question 6

Class 1A (Procainamide, quinidine) - specific MoA

Answer 6

Intermediate binding
Drops conductivity, automaticity
Increases refractory, threshold

Increases QRS, QT
nothing to PR

Question 7

Quinidine - adverse effects

Answer 7

anticholinergic, alpha receptor antagonist

Use with digitalis, beta block, or calcium channel block

Question 8

Quinidine - spectrum

Answer 8

Atrial fibrillation and flutter

Question 9

Procainamide - spectrum

Answer 9

supraventricular and ventricular arrhythmias

WPW with atrial fib

Question 10

Class 1A- adverse effects

Answer 10

hypotension, torsades de pointes (incr. QT)

Lupus like syndrome with procainamide

Question 11

Class 1B (lidocaine) - specific MoA

Answer 11

Fast binding,
No change in phase 0
incr. threshold
decr. phase 0 conduction in fast beating heart

incr. QRS in fast beating or ischemic heart

Question 12

Lidocaine - spectrum

Answer 12

only ventricular tachycardia and fibrillation NOT atrial

Question 13

Lidocaine - adverse effects

Answer 13

Dizziness, drowsiness

Less QT effect

Question 14

Class 1C- Flecainide and propafenone - specific MoA

Answer 14

Very slow binding
Subs. decr. phase 0 and automaticity
incr. APD (K+) and refractory

Incr. PR, QRS, and QT

Question 15

Flecainide - spectrum

Answer 15

supraventriculars, PVCs, ventricular tachy, and WPW

Question 16

Flecainide - adverse effects

Answer 16

Proarrythmia and sudden death

heart failure

Question 17

Class 2 (propranolol, esmolol) - MoA

Answer 17

Beta-blockers

Question 18

Class 2 - specific MoA

Answer 18

incr action potential duration and refractory period in AV node
decr slope of phase 4 depolar

Incr. PR
Decr. HR

Question 19

Propranolol - spectrum

Answer 19

sinus and other tachys

convert reentry loops through AV node

Question 20

Propranolol - adverse effects

Answer 20

bronchospasm, hypotension

AV block or ventri. failure maybe produce detrimental results

Question 21

Class 3 (amiodorone, dronedarone, sotalol, ibutilide, dofetalide) - MoA

Answer 21

Potassium channel blockers

Question 22

Class 3 - specific MoA

Answer 22

incr refractory, APD, threshold
decr. phase 0, phase 4, speed of AV conduction

Incr. PR, QRS, QT,
Decr HR

Question 23

Amiodorone -oral/IV - spectrum

Answer 23

most arrythmias
Ventr. tachy and V fib
Heart failure arrythmias

Question 24

Amiodorone - adverse effects

Answer 24

pulmonary fibrosis
hepatic injury
increase LDL cholesterol
Thyroid disease
photosensitivity
corneal lesions

Question 25

Dronedarone -oral

Answer 25

No iodine like amiodorone No thyroid disease risk Torsades risk No for heart failure

Question 26

Sotolol -oral

Answer 26

Ventricular and atrial tachycardias Incr QT Decr HR

Question 27

Sotolol- adverse effects

Answer 27

Proarrhythmia Fatigue Insomnia

Question 28

Ibutilide -IV

Answer 28

Pure potassium current blocker Atrial fib and flutter Incr APD, QT (torsades risk)

Question 29

Dofetilide - oral

Answer 29

Pure potassium current blocker Atrial fib and flutter Incr APD, refractory, QT

Question 30

Class IV (Verapamil/Diltiazem)- MoA

Answer 30

Calcium channel blockers

Question 31

Class IV - specific MoA

Answer 31

decr. phase 0 slope (AV, calcium current) decr. phase 4 incr. refractory period in AV node Incr. PR

Question 32

Class IV - spectrum

Answer 32

control ventricles during atrial tachy. convert supraventricular tachy DAD derived ventricular tachycardia

Question 33

Calcium channel blockers

Answer 33

Partial AV block caution Beta blocker on board can lead to asystole Caution with hypotension

Question 34

Adenosine (IV) - MOA

Answer 34

binds alpha1 receptors and activates K+ currents in AV and SA node decr. APD and hyperpolarization decr HR Blocks/slows AV conduction

Question 35

Adenosine - spectrum

Answer 35

convert re-entrant supraventricular arrhythmias

Question 36

Digioxin

Answer 36

enhances vagal activity (incr. K currents, decr. Ca, incr. refractory) Slows AV conduction and slows HR Atrial fib and flutter

Question 37

Atropine

Answer 37

muscarinic antagonist | blocks vagal activity to speed av conduction and incr HR

Question 38

Magnesium

Answer 38

Treats torsades (long QT)