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Pharmacology 2 > Antiarrhythmics - Important Points > Flashcards

Antiarrhythmics - Important Points Flashcards

1
Q

All antiarrhythmics are ___________, meaning they do what?

A

All antiarrhythmics are PROARRHYTHMICS

- They create an arrhythmia to stop an arrhythmia

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2
Q

What is one side effect you can assume regarding all antiarrhythmics?

A

That they all have a risk of some kind of arrhythmia

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3
Q

What class and specific medication of antiarrhythmics are the MOST proarrhythic?

A
  • Class 1 C

- Flecainide

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4
Q

What 2 antiarrhythmics change PR & prolong phase 3, but also can block Na channels, also some Beta-blockade, & Ca2+ channel blockade, making them significant antiarrhythmics?

A

Amiodarone

Sotalol

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5
Q

What do 1A’s bock & what are they used to treat?

A

Na+-K+ channel blockers = used for both ventricular & atrial tachyarrhythmias

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6
Q

What can QT prolongation lead to?

A

Torsades

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7
Q

What 3 important things are associated with procainimide?

A
  1. Associated with QT prolongation
  2. Increases ANA titers (LUPUS)
  3. Has an active NAPA metabolite, which has a longer half-life than the med itself
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8
Q

If you see Quinidine what should you think? When is the only time you will really see Quinidine now?

A
  • Think MANY drug interactions with other meds that prolong QT
  • Med is making a comeback with psych med Neudexda (for pseudobulbar affect - inappropriate laugh/cry)
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9
Q

What are class 1B meds used to treat? And what can they worsen?

A
  • Used to treat VENTRICULAR arrhythmias

- Will WORSEN the SUPRAVENTRICULAR rhythms (a fib/flutter)

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10
Q

Studies have show that controlling the rate with a ___A____ vs. the rhythm with ___B___ , shows NO difference with morbidity and mortality, only increases the r/o side effects with ___C___

A

A. Beta blocker
B. Amiodarone
C. Amiodarone

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11
Q

What is the electrolyte of choice in class 2 antiarrhythmics? What are they used to treat, and what will they worsen?

A
  • Class 2 (beta blockers)
  • Treat supraventricular arrhythmias (SVT, a fib/flutter)
  • Can worsen ventricular arrhythmias
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12
Q

What antiarrhythmics can worsen bronchospasm?

A 
Beta blockers (depending on the selectivity)
- propranolol & labetolol are less selective and can cause bronchoconstriction
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13
Q

Which antiarrhythmic has an extremely long half life (weeks to months)? Why is this important?

A
  • amiodarone
  • important because it also has a lot of medication interactions, and may still have residual meds in system despite stopping the med
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14
Q

What are the 4 different types of medications interactions of amiodarone?

A
  1. CYP3A4 substrate
  2. CYP3A4
  3. CYP2C9
  4. PGP inhibitor
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15
Q

Which medication has an iodine moiety? Why is this important? How can this present in the patient?

A
  • Amiodarone
  • Can cause hypo- or hyperthyroidism
  • Can present as bluish/purple ear lobes, cheeks (lipid soluble)
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16
Q

What medication must the pt be in sinus rhythm to use? What are the side effects if not?

A
  • Dronedarone (Multaq)

- If pt is not in SR (pts with decompensated HF or chronic a fib) will increase r/o death, stroke & HF

17
Q

What is Ibutilde/Dofetilide (Tykosin) used for? What is important to know?

A
  • Used to convert artrial fib to NSR
  • Has a high incidence of Torsades & ventricular arrhythmias
  • Given in conjunction with a beta blocker would worsen these risks
18
Q

Verapamil & Diltiazem are part of which class? And selectively block what? What part of the heart do these effect?

A
  • Class IV
  • Selectively block Slow channels by inhibiting the normal Ca2+ influx into the cell
  • Slow channels most important in S-A & A-V nodes
19
Q

What dysrhythmias are verapamil & diltiazem used to treat?

A

Treats SVT dysrhythmias (SVT, a fib/flutter)

20
Q

What is different about verapamil that could cause it to lead to ventricular arrhythmias?

A

Does NOT affect accessory tracts, unlike amio & sotalol

21
Q

Diltiazem is a potent ____A____, which could lead to many ___B_____?

A

A. CYP3A4 inhibitor

B. Many drug interactions

22
Q

Digoxin is in what class? What does it inhibit?

A
  • Unclassified

- Inhibits Na+/K+ ATPase

23
Q

What type of dysrhythmias does digoxin treat? Who does it work?

A
  • Treats SUPRAVENTRICULAR arrhythmias
  • Enhances conduction through accessory pathways
  • Directly prolongs AV node refractory pd
  • Slows ventricular response rate in a fib
24
Q

What is the MOST COMMON arrhythmia for digoxin?

What is the MOST FATAL rhythm of digoxin?

A
  • most common = PVCs

- most fatal = ventricular tachycardia

25
Q

Which med alters Rate & rhythm and may stimulate almost every known rhythm disturbance?

A

Digoxin

26
Q

How does adenosine work? Half life?

A

Hyperpolarizes K+ channel so far that NO impulse can get through.
T1/2 = 1.5 seconds

27
Q

What are the adenosine receptors and where are they located?

A
  • A1, A2, A3
  • A1 = atrial myocytes
  • A2 = vasodilation (facial flushing)
  • A3 = bronchoconstriction
28
Q 
Which are class 1A meds (3)?
What do they block?
What do they treat?
What is one common side effect of all?
A
  1. Procainimide
  2. Quinidine
  3. Disopyramide
    - Block Na+/K+ channels
    - Treat atrial & ventricular tachydysrhythmias
    - Common side effect is QT prolongation — Vtach
29
Q 
What are the class 1B medications (2)?
What do they work on (channel & phase)?
Which rhythms do they treat?
A
  1. Lidocaine
  2. Phenytoin
    - Work on Na+ channel blocker (open and inactivate) Depressing phase 4
    - Treats ventricular dysrhythmias
30
Q

Which medication with rapid administration is associated with respiratory arrest, severe hypotension, ventricular ectopic, and death?

A

Phenytoin

31
Q

What is the 1C medication?
What does it block, what phase does it work on?
Who should this NOT be used on?

A
  • Flecainide
  • Blocks Na+, K+, and Ca+ channels
  • Prevents atrial tachydysrrhythmias (incl. WPW), PVCs, and delays conduction in by pass tracts
  • Moderate negative inotrope = Do not give to pts with CAD, LV failure, Vtach
32
Q

What are the Class 2 antiarrhythmics?
What do they treat?
What do they make worse?

A
  • Beta blockers - slows SA node = decrease slope of phase 4
  • Treat SUPRAVENTRICULAR dysrhythmias
  • Worsens a ventricular arrhythmia
33
Q

What are 3 main side effects of class 2 antiarrhythics?

A

Beta blockers

  1. Profound bradycardia or asystole
  2. LV failure
  3. Acute bronchospasm (depending on selectivity)
34
Q

What can be given IV for the acute termination of ventricular & supraventricular arrhythmias?

A

Amiodarone (class 3)

35
Q

How does amiodarone work? And what does it do to EKG?

A
  • Blocks inactivated Na+ channels and K+ movement

- Prolongs PR, QRS, & QT intervals

36
Q

What are the type 3 antiarrhythmics? (3)

A
  1. Amiodarone
  2. Dronedarone (Multaq)
  3. Ibutilide/Dofetilide (Tykosin)

Pharmacology 2 (2 decks)

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