AntiarrhythmicsFC Flashcards Preview

Board Review > AntiarrhythmicsFC > Flashcards

Flashcards in AntiarrhythmicsFC Deck (63):
1

The most common causes of an arrhythmia are.....

coronary heart disease, heart valve disorders, heart failure, and damage from heart attack

2

QT prolongation is a marker for ventricular tachyarrhythmias, including torsades.

good to know

3

what are 2 factors to consider when looking at drugs that can prolong the QT interval?

dose and duration

4

what are some agents that have additive QT prolongation?

Class 1a and Class III antiarrhythmics (amiodarone, disopyramide, dronaderone, pocainamide, quinidine, sotalol)
abx - FQNs, macrolides,
azole antifungals
anticancer agents
protease inhibitors
SSRIs / SNRIs
antiemetics - ondansetron, droperidol
antipyschotics

5

Rate control vs rhythm control?

studies show that ventricular RATE control is as effective as rhytum control with cardioversion and antiarrhytimic drugs

6

What drugs are used for rate control in pts with afib?

BB, non DHP CCBs (V&D) and digoxin

7

What are the Class 1 antiarrhythmics?

1a - Double Quarter Pounder = Disopyramide, Quinidine, Procainamide
2a - Mayo Lettuce - Mexiletine, Lidocaine
3a - Fries Please - Flecainide , Popafenone

8

what are the Class II antiarrhythmics?

BB - esmolol, propranolol

9

What are the class III antiarrhythmics?

amiodarone, Dofetilide, dronaderone, Ibutilide, sotalol

10

What are the class IV antiarrhythmics?

Verapamil, Diltiazem

11

What is the MOA of the Class IAs?

block Na channels, decrease conduction velocity, increase refractory period, decrease automaticity

12

What dietary considerations should be made when taking quinidine?

Avoid changes in Na intake. decreased Na intake can increase quinidine serum conc.
-take with food or milk to dec GI upset

13

What is the BBW with quinidine?

may increase mortality in treatment of Afib/A.flutter

14

What is the major side effects of quinidine?

diarrhea, cramping, cincohnism (tinnitus, eye issues etc), N, V

15

What 2 Class 1A's must be taken on an empty stomach?

procaiamide and disopyramide

16

what are the BBW's on procainamide?

fatal blood dyscrasias,
positive ANA test leading to drug induced lupus like syndrome

17

what is the name of the active metabolite of procainamide ?

METABOLIZED by acetylation to N-acetylprocainamide (NAPA), which makes it active!! KNOW

18

SE procainamide

hypotension, n, V, D, Lupus like syndrome, qt prolongation, and agranulocytosis

19

What major side effects of disopyramide?

anticholinergic effects (can't see ,spit, pee, poop)

20

Quinidine is a major substrate of what CYP?

3A4

21

What is the MOA of class IB antiarrythmics?

block Na channels, decrease refractory period, decrease automaticity

22

what is the use of class 1 b antiarrythmics

only used for ventricular arrhythmiaxs

23

Lidocaine is a substrate of what 2 CYP ?

3A4 and 2D6

24

What is the MOA of Class IC antiarrythmics?

block Na channels, significantly decrease conduction velocity, decrease automaticity
Not used much

25

What are the Class II antiarrythmics?

esmolol (Brevibloc) / propranolol (Inderal)

26

What is the MOA of the Class III antiarrythmics?

blocks mainly K channels, no change on conduction velocity, significant increase in refractory period

27

what are the class 2 antiarrhytmics?

esmolol and propranolol

28

what is the difference between esomolon and propranolol?

esmolol is beta 1 selective (just affects the heart) and propranolol is beta non selective

29

what is the use of class 2 antiarrhythmics?

the use is for ventricular arrhythimias

30

What are they?

amiodarone (cordorone)
Dronaderone (Multaq)
sotalol (Betapace)
ibutilide (Corvert)
dofetilide (Tikosyn)

31

pacerone

amiodarone

32

nexterone

amiodarone

33

cordorone

amiodarone

34

multaq

dronaderone

35

betapace

sotalol

36

corvert

ibutilide

37

tikosyn

dofetilide

38

Which class III has a REMS?

Tikosyn (dofetilide)- initial dose HAS to be given in a hospital and adjusted based on QT and renal function

39

What is unique about administration of IV amiodarone?

infusions lasting longer than 2 hours must be administered in non-PVC container

40

What are the 4 BBWs for amiodarone? KNOW

1. pts should be hospitilized when therapy is initiated
2. lung damage may occur w/out symptoms
3. liver toxicity
4. exacerbation of arrhythmias - more difficult to reverse

41

what are some side effects of amiodarone? (theres a lot)

hypotension (IV), bradycardia, increase LFTs, corneal microdeposits, optic neuritis, pulmonary fibrosis, photosensitivity, blue skin, insomnia

42

what is important about the dosing /dosage forms of sotalol?

Betapace should not be substituted for Betapace AF

43

What is the BBW for sotalol (Betapace)

initiation and dosage increase should be done in a hospital

44

What is the BBW for dofetilide?

Tikosyn must be initiated or reinitiated in a setting with continuous ECG monitoring for 3 days or 12 hours after cardioversion

45

What medications must have a dose reduction of 30-50% while taking amiodarone?

digoxin, warfarin, quinidine, procainamide
also, lower doses of Ator, Lova, Simvastatin

46

DDIs for amiodarone?

Amiodarone is an inhibitor of CYP 2C9, 2D6, 3A4 and p-glycoprotein

47

When might CCB's be preferred over BB's in pts with arrythmias?

if the pt has asthma or COPD

48

What is the therapeutic lab value for digoxin in afib?

0.8-2.0

49

What is the dose adjustment from oral to IV digoxin?

decrease dose by 20-25% when going from oral to IV

50

what are signs of digoxin toxicity?

N/V, loss of appetite, bradycardia
blurred or yellow vision, confusion

51

digoxin can accumulate with _____

renal insufficiency

52

What electrolyte imbalances can increase chance of digoxin toxicity?

hypokalemia, Hypercalcemia

53

Multaq - generic name and class, indication

dronedarone - Class III
only indicated for maintenance of sinus rhythm. CI IN persistant afib

54

What is the normal lab value for K?

3.5-5 meq/L

55

Which of the following is not a side effect of amiodarone? skin discoloration, corneal deposits, lung damage, taste perversion, hypothyroidism

taste perversion

56

greatest risk of qt prolongation

class 1a and class III

57

how is the classification determined for van gough class 1

a= INTERMEDIATE
b- SHORT
C. long
NOTICE NOT in right order.

58

dronadarone bbw

1. class IV heart failure
2. pts w/ permenant AFIB.

59

Adenosine

works by ACTIVATING A1 receptors- causes a transiet BLOCK in the AV node.

60

adenosine ADR

ADR: headache, flushing, chest pain

61

half life of amiodarone is abt

60 days

62

Digoxin- MOA

helps to control RATE. digoxin works on AV node conduction. DEcreases resting RATE.

63

amiodarone good for

pts w/ structural heart dz, decompensated heart failure. BUT 1c- is BAD CI in these cases and 1a- is meah