Antiarrhythmic pharmacotherapy

Question 1

class I antiarrhythmics block what channel?

Answer 1

sodium

Question 2

class II antiarrhythmics block what channel?

Answer 2

beta

Question 3

class III antiarrhythmics block what channel?

Answer 3

potassium

Question 4

class IV antiarrhythmics block what channel?

Answer 4

calcium

Question 5

class Ia antiarrhythmics have what effect on sodium levels

Answer 5

moderate sodium blockage

Question 6

class Ib antiarrhythmics have what effect on sodium levels

Answer 6

mild sodium blockage

Question 7

class Ic antiarrhythmics have what effect on sodium levels

Answer 7

marked sodium blockage

dcreasing conduction velocity, no effect on repol

Question 8

what must be used first before quinidine in aF?

Answer 8

digoxin

Question 9

where is quinidine metabolized?

Answer 9

liver

Question 10

what is the main cardiac adverse effect of quinidine?

Answer 10

prolonged QT interval (torsade de pointes)

Question 11

what is the main metabolite of procainamide?

Answer 11

NAPA

Question 12

what are the main adverse effects of procainamide?

Answer 12

QT prolongation

drug induced lupus

Question 13

where is disopyramide cleared?

Answer 13

kidney

Question 14

what are the adverse effects of disopyramide?

Answer 14

potent anticholinergic (dryness)

Question 15

what type of local anesthetic is lidocaine?

Answer 15

amide

Question 16

what is a benefit of lidocaine?

Answer 16

minimal effect of QT or QRS

Question 17

lidocaine is only effective for what type of arrhythmia?

Answer 17

ventricular

Question 18

flecainide is only effective for what type of arrhythmia? what is their first line use?

Answer 18

atrial (SVTs with normal heart function)

atrial fibrillation only

Question 19

class Ic antiarrhythmics are contraindicated in what population?

Answer 19

anyone with structural heart disease (CHF)

Question 20

what is the indication for propafenone?

Answer 20

without sig CHF that have aF or sustained VT/VF

torsades, AV block, CHF

Question 21

MOA of beta blockers

Answer 21

prolongs AP and slows HR

Question 22

what is the only class of antiarrhythmics found to reduce mortality in arrhythmia patients?

Answer 22

beta blockers

Question 23

what kind of drug is sotolol

Answer 23

beta blocking agent with class III properties

also blocks potassium channels

Question 24

what are the indications for sotolol?

Answer 24

AF and sustained VT/VF

Question 25

what is the main side effect of sotolol?

Answer 25

torsades de pointes potent QT prolongation

Question 26

what class of drug is amiodarone? what are its effects on channels?

Answer 26

class III has effects in all four Vaughn-WIlliams classes (all channels)

Question 27

what is the principal MOA of amiodarone?

Answer 27

delayed repolarization by prolonging APD and ERP

Question 28

what are the indications for amiodarone?

Answer 28

all types of arrhythmias, increasingly for VF

Question 29

why does amiodarone have such potent side effects?

Answer 29

huge volume of distribution long tissue half life short peripheral half life

Question 30

what are the cardiac and pulmonary side effects of amiodarone?

Answer 30

cardiac - torsades | pulmonary - fibrosis

Question 31

amiodarone is only one of two antiarrhythmics safe to use in what condition?

Answer 31

CHF

Question 32

what are the thyroid and ocular side effects of amiodarone?

Answer 32

thyroid - hypo or hyperthyroidism | ocular - corneal deposits, halos, photophobia, retinopathy

Question 33

what are the neuro and derm side effects of amiodarone?

Answer 33

neuro - tremor, ataxia, peripheral neuropathy, seizure | derm - photosensitivity, blue-gray discoloration

Question 34

what are the hepatic and GI side effects of amiodarone?

Answer 34

hepatic - elevated transaminases | GI - loss of taste

Question 35

what kind of drug is dronaderone? what is its clinical use?

Answer 35

derivative of amiodarone AF

Question 36

dronaderone is contraindicated in what population?

Answer 36

CHF

Question 37

what are the indications for dofetilide?

Answer 37

acute conversion of AF to NSR and for maintenance of NSR

Question 38

what is the main adverse effect of dofetilide?

Answer 38

HIGH incidence of torsades de pointes

Question 39

treatment for AF with no other heart disease?

Answer 39

flecainide or propafenone

Question 40

treatment for AF with history of CAD, but normal EF?

Answer 40

sotolol

Question 41

treatment for AF with CHF?

Answer 41

amiodarone, dofetilide

Question 42

what are the rate control drugs for atrial arrhythmias?

Answer 42

beta blockers diltiazem digoxin