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DRUGS > Antiarrhythmics > Flashcards

Antiarrhythmics Flashcards

1
Q

Na channel blockers type Ia

A

disopyramide
quinidine
procainamide

double quarter pounder

Prolong the AP

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2
Q

Na channel blockers type Ib

A

Lidocaine
Tocainamide
Mexiletine

Lettuce, tomato, mayo

Decreases AP duration, shortens phase 3 repolarization

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3
Q

Na channel blockers type Ic

A

Moricizine
Flecainide
Propafenone

More fries please

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4
Q

B blockers Type II

A

Metropolol
Esmolol
Propanolol

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5
Q

K channel blockers type III

A 
amiodarone
Bretylium
Dofetilide
Ibutilide
Satalol

A big dog is scary

  • Diminish outward K during repolarization
  • Increase duration of AP
  • Prolong effective refractory period
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6
Q

Ca channel blockers Type IV

A

verapamil
diltiazem

  • Decrease inward Ca current
  • Decrease rate of phase 4 spontaneous depolarization
  • Slows conduction in Ca dependent tissues
  • Use dependent
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7
Q

early afterdepolarization

A

interrupts phase 3

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8
Q

delayed after depolarization

A

interrupts phase 4

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9
Q

interval b/w depolarizations

A

duration of AP + duration of diastolic interval

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10
Q

Depressed conduction

A

simple block- AV nodal block, BBB

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11
Q

Reentry

A
  • Impulse reenters/excites areas of heart more than once
  • Must be an obstacle
  • Must be unidirectional block
  • Conduction time must be long enough that retrograde impulse does not encounter refractory tissues
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12
Q

how to depress autonomic properties of abnormal pacemaker cells

A
  1. Decrease slope of phase 4
  2. Elevate threshold potential
  3. Increase max diastolic potential
  4. Increase AP duration
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13
Q

effective in supraventricular and ventricular arrhythmias

A

Type Ia

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14
Q

Procainamide

A

Class 1a
Used for atrial and ventricular arrhythmias

Slows upstroke of AP, slows conduction, prolongs QRS, prolongs AP duration

PK: metabolite NAPA w class III activity

ADRs: excessive APD prolongation, QT prolongation, reversible lupus erythematosus

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15
Q

Used for ventricular arrhythmias

A

2b

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16
Q

Lidocaine

A

2B
DOC for termination of VT and prevention of VF after cardioversion in setting of acute ischemia

Decreases AP duration, shortens phase 3 repolarization

PK: extensive first pass metabolism

ADRs: least cardiotoxic but associated with neurological findings

17
Q

Cannot be used in structural heart disease

A

1c

18
Q

Flecainide

A

Used for supraventricular arrhythmias

Blocks both Na and K channels but does not prolong AP or QT interval

ADR: severe exacerbation of arrthymia

19
Q

Propafenone

A

Similar to flecainide + beta blocking activity

20
Q

Amiodarone

A

K channel blocker
Prolongs AP duration, significantly blocks Na channels, weak adrenergic and Ca channel blockade; broad activity
- Extracardiac effects- peripheral vasodilation

associated with many drug/drug interactions

21
Q

Verapamil

A

Blocks activated and inactivated L-type Ca channels, slows SA node by direct action, suppresses both early and delayed afterdepolarizations

ADRs: hypotension and VF if given to a pt with a VT misdiagnosed as SVT; can induce AV block, constipation, lassitude, nervousness, peripheral edema

22
Q

Adenosine

A

Nucleoside- activates inward rectifier K current and inhibits Ca current resulting in marked hyperpolarization and increased refractory period

ADRs: flushing, SOB, chest burning, high grade AV block, atrial fibrillation, headache, hypotension, nausea, paresthesias

23
Q

DOC for conversion of paroxysmal SVT

A

Adenosine

24
Q

Atropine

A

Blocks actions of AcH at parasympathetic sites, increases CO

25
Q

Digoxin

A

Inhibits Na/K ATPase, results in increased intracellular Na, decrease Ca expulsion, increased free Ca.
Decreased HR
Increased refractory period
Decreased conduction velocity

ADRs: visual disturbances

26
Q

Atrial fibrillation drugs

A

Acute: IV CCB- rapid effects
BB- 1st choice in high catecholamine states. Should not be used acutely in systolic heart failure
digoxin- slower onset, less effective

Chronic: oral BB, CCB

27
Q

long term strategy of atrial fibrillation

A

Rate control > rhythm control

Direct current cardioversion most effective

28
Q

Paroxysmal supraventricular tachycardia treatment

A

Acute: IV adenosine, verapamil, diltiazem

Chronic: radiofrequency catheter ablation potentially curative

29
Q

Torsades de pointes treatment

A

magnesium

30
Q

CYP inducer

A

rifampin

31
Q

CYP blocker

A

cimetidine

32
Q

adverse drug reaction of class IV

A

ventricular fibrillation

if given to a pt with ventricular tachycardia instead of supraventricular tachycardia

DRUGS (6 decks)

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