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Pharm II MHM - FINAL > Antiarrhythmics > Flashcards

Flashcards in Antiarrhythmics Deck (97)
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1

What are non-VW agents used in arrhythmias?

Adenosine and digoxin

2

Describe the Vaughan Williams classification of antiarrhythmics

Class I = Na channel blockers
Class II = Beta blockersC
lass III = K channel blockers
Class IV = CCBs
Class V = variable mechanisms (adenosine, digoxin)

3

Class IA antiarrhythmics

Procainamide
Quinidine
Disopyramide
(Na channel blockers)

4

Class IB antiarrhythmics

Lidocaine
Mexilitine
(Na channel blockers)

5

Class IC antiarrhythmics

Flecainide
Propafenone
(Na channel blockers)

6

Which Class I antiarrhythmics should NOT be used after IC?

IA

7

Effects of Class IA drugs

-Reduces AP duration and ventricular refractoriness
-Increases repolarization

8

Effects of Class IB drugs

Shortens AP duration, ventricular refractoriness and repolarization

9

Effects of Class IC drugs

Markedly slows depolarization without affecting repolarization

10

Procainamide (class, indications, key features)

-Class IA Na channel blocker
-Stable monomorphic VT, VT w/accessory pathway, non-VT/VF arrest
-IV only!

11

Procainamide ADRs

-Peripheral vasodilation
-Hypotension
-Reflex tachy
-Arrest

12

How is procainamide metabolized? What is its half life?

-CYP2D6
-2.5 to 8 hours (NAPA metabolite 5-9 hours)

13

How is procainamide dosed in renal and hepatic impairments?

-Lower loading dose in renal
-Cut all doses 50% in hepatic

14

What drugs interact with procainamide?

-Tricyclics
-SSRIs
-Opioids

15

Procainamide serious adverse events

-Heart block, widening QRS, Torsades
-Hepatotoxicity
-Drug induced lupus

16

Disopyramide (class, indications, key features)

-Class IA Na channel blocker
-Stable monomorphic VT, AF conversion
-Used as an alternative to procainamide
-A/w cardiogenic shock

17

How is disopyramide metabolized? What is its half life?

-CYP3A4, significant 1st pass
-Half life 4-10 hours

18

How is disopyramide dosed?

Weight based

19

When is disopyramide adjusted in renal impairment?

CrCl less than 40 mL/min

20

Disopyramide serious adverse events

-Torsades, HF, hypotension
-Xerostomia
-Urinary hesitancy
-Constipation
-Rash

21

Disopyramide contraindications

-AV block
-QT prolongation
-Cardiogenic shock

22

Disopyramide has significant ____ effects, so it should be avoided in patients with _____

-Anticholinergic
-Avoid in glaucoma and myasthenia gravis

23

Quinidine (class, indications, key features)

-Class IA Na channel blocker
-Maintenance of sinus rhythm when LV function is preserved
-NOT used for ventricular arrhythmias

24

How is quinidine metabolized?

-CYP3A4
-Metabolite has antiarrhythmic effects that need to be accounted for

25

Quinidine serious adverse events

-Arrhythmias, QT prolonged, Torsades
-GI issues
-Dizzy, HA, tremor

26

Quinidine contraindications

-WPW
-AV block
-Digitalis toxicity
-Myasthenia gravis

27

Lidocaine (class, indications, key features)

-Class IB Na channel blocker
-VT/VF when defib/epi fails and amiodarone unavailable
-Digoxin induced VT, monomorphic VT
-Efficacy is reduced over duration of arrest
-"Safest" of all Na channel blockers

28

What is the safest of all Na channel blockers?

Lidocaine

29

How is lidocaine metabolized? What is its half life?

-CYP1A2, hepatic blood flow determines rate (significantly impaired during arrest)
-1.8 hours

30

Lidocaine serious adverse events

-Arrhythmias
-Seizure, tremor, paresthesias