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Pharm I ( Melicia) > Antiarrhythmic Drugs > Flashcards

Antiarrhythmic Drugs Flashcards

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1
Q

What are the 2 mechanisms of tachyarrhythmias?

A

Abnormality in impulse generation aka “automatic tachycardias”

abnormality in impulse conduction aka “reentrant” tachycardias

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2
Q

How do most antiarrhythmic drugs work?

A

by modulating the activity of ion channels in the plasma membranes

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3
Q

Generally, AADs alter cardiac rhythm by altering…

A
  • maximum diastolic potential of PPM cells
  • the rate of phase 4 depolarization
  • the threshold potential
  • the action potential duration
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4
Q

Class I antiarrhythmics

A

Na+ channel blocks

Prototype: Procainamide, Lidocaine, Flecainide

Depress Na+ conduction in ischemic tissue greater than normal tissue

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5
Q

Class II antiarrhythmics

A

Beta adrenergic receptor antagonists

Prototype: Propranolol

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6
Q

Class III antiarrhythmics

A

K+ channel blockers

Prototype: Amiodarone

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7
Q

Class IV antiarrhythmics

A

Ca+ channel blockers

Prototype: Verapamil

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8
Q

Misc AADs include

A

Adenosine, Mg, K

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9
Q

Class IA prototype? MOA?

A

Procainamide

Inhibits Na+ channel, inhibits K+ current

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10
Q

Effects of Procainamide

A

Slows conduction velocity and PPM rate

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11
Q

Clinical applications for procainamide?

A

can be used to tx most atrial and ventricular arrhythmias

2nd choice for most sustained V arrhythmias associated with acute MI

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12
Q

Procainamide toxicities?

A

torsades de pointes in pts with renal failure

hypotension, long-term therapy produces reversible lupus related sxs

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13
Q

Disopyramide is also a class 1A Na+ channel blocker, how does it differ from Procainamide? What about Quinidine?

A

longer duration of action, toxicity includes antimuscarinic effects and HF

toxicity includes cinchonism (tinnitus, HA, GI disturbances) and thrombocytopenia

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14
Q

Class IB prototype? MOA?

A

Lidocaine

highly selective Na+ channel blocker

minimal effect in normal tissue

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15
Q

Clinical application for Lidocaine?

A

ventricular arrhythmias post MI

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16
Q

Lidocaine toxicities?

A

reduce dose in pts with HF or liver disease

neurological sxs: CNS sedation or excitation

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17
Q

Mexiletine is also a Class IB AAD, how does it differ from Lidocaine?

A

oral med

longer duration of action

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18
Q

Class IC prototype? MOA?

A

Flecainide

Na+ channel blocker

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19
Q

Effects of Flecainide?

A

dissociated from channel with slow kinetics, no change in action potential duration

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20
Q

Clinical application of Flecainide?

A

supraventricular arrhythmias in pts with normal heart, do not use in ischemic conditions (post MI)

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21
Q

Flecainide toxicities?

A

pro arrhythmic

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22
Q

Class II antiarrhythmics are useful in the treatment of…

A

supraventricular and ventricular arrhythmias precipitated by sympathetic stimulation

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23
Q

Class II prototype? MOA?

A

Propranolol

Beta-Adrenoceptor blocker

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24
Q

Effects of Propranolol?

Study These Flashcards
A

direct membrane effects (Na channel block) and prolongation of action potential duration, slows SA node automaticity and AV nodal conduction velocity

25
Clinical application of Propranolol?
Atrial arrhythmias prevention of recurrent infarction/sudden cardiac death
26
Propranolol toxicities?
asthma, AV block, acute HF
27
Esmolol is also a class II BB, how does it differ from Propranolol?
Selective Beta 1 blockage, IV only, lasts 10 min. Used in perioperative and thyrotoxicosis arrhythmias
28
Class III prototype? MOA?
Amiodarone blocks K, Na and Ca channels, Beta adrenoceptors
29
Effects of Amiodarone?
prolongs action potenital duration and QT interval, slows HR and AV node conduction
30
Clinical applications of Amiodarone?
serious ventricular arrhythmias and supraventricular arrhythmias most commonly prescribed AAD
31
Amiodarone PK
oral, IV variable absorption and tissue accumulation hepatic metabolism
32
Amiodarone toxicities?
bradycardia and heart block in disease heart, peripheral vasodilation, pulmonary fibrosis, hepatic toxicity, tremor/ataxia, blue-gray skin hyper or hypothyroidism
33
Amiodarone drug interactions
lots, based on CYP metabolism
34
What should you monitor in a pt taking Amiodarone
CXR (pulmonary fibrosis) TFTs, ophtho exam, LFTs, ECG
35
Dofetilide is a Class...drug, MOA?
III K+ channel blocker
36
Clinical application of Dofetilide?
Maintenance or restoration of SR in AFib
37
Dofetilide toxicities?
torsades de pointes (initiate in hospital)
38
Effects of Class IV AAD
CCB decrease the excitability of SA nodal cells and prolong AV nodal conduction, primarily by slowing the action potential upstroke in nodal tissue
39
Name 2 Class IV AADs
Verapamil, Diltiazem
40
Verapamil/Diltiazem MOA?
calcium channel blocker, slows conduction in AC node and pacemaker activity, PR interval prolongation
41
Clinical applications of Verapamil?
AV nodal arrhythmias especially in prophylaxis
42
Clinical applications of Diltiazem
rate control in Afib
43
Toxicities of Verapamil and Diltiazem?
cardiac depression, constipation, hypotension
44
Mg MOA?
interacts with Na/KATPase and Ca channel blockers
45
Clinical applications of Mg?
torsades de pointes, digitalis induced arrhythmias
46
Mg toxicities?
muscle weakness in OD
47
K MOA?
increase K permeability, K currents
48
effects of K?
slows ectopic pacemakers, slows conduction velocity
49
Clinical applications of K?
digitalis induced arrhythmias, arrhythmias associated with hypokalemia
50
K toxicities?
reentrant arrhythmias, fibrillation or arrest in OD
51
Adenosine MOA?
activates inward rectifier K current, blocks Ca
52
Effects of adenosine
very brief, usually complete AV blockade
53
Clinical applications of Adenosine?
paroxysmal supraventricular tachycardias
54
Adenosine PK
IV only, duration 10-15 sec
55
Adenosine toxicities?
flushing, chest tightness, dizziness
56
In Afib therapy is aimed at...
Controlling Ventricular rate -Digoxin, non-DHP, CCBs, BB Preventing thromboembolic complications -Warfarin, ASA restoring and maintaining SR -AADs, direct current cardioversion
57
Should you ever leave a pt in afib?
yes, rate control alone is often sufficient in pts who can tolerate it
58
Sotalol is a Class....AAD, clinical applications?
Class III ventricular arrhythmias, and Afib

Pharm I ( Melicia) (18 decks)

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