AntiarrhythmicsFC

Question 1

The most common causes of an arrhythmia are…..

Answer 1

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

Question 2

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

Answer 2

good to know

Question 3

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

Answer 3

dose and duration

Question 4

what are some agents that have additive QT prolongation?

Answer 4

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

Question 5

Rate control vs rhythm control?

Answer 5

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

Question 6

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

Answer 6

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

Question 7

What are the Class 1 antiarrhythmics?

Answer 7

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

Question 8

what are the Class II antiarrhythmics?

Answer 8

BB - esmolol, propranolol

Question 9

What are the class III antiarrhythmics?

Answer 9

amiodarone, Dofetilide, dronaderone, Ibutilide, sotalol

Question 10

What are the class IV antiarrhythmics?

Answer 10

Verapamil, Diltiazem

Question 11

What is the MOA of the Class IAs?

Answer 11

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

Question 12

What dietary considerations should be made when taking quinidine?

Answer 12

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

Question 13

What is the BBW with quinidine?

Answer 13

may increase mortality in treatment of Afib/A.flutter

Question 14

What is the major side effects of quinidine?

Answer 14

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

Question 15

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

Answer 15

procaiamide and disopyramide

Question 16

what are the BBW’s on procainamide?

Answer 16

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

Question 17

what is the name of the active metabolite of procainamide ?

Answer 17

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

Question 18

SE procainamide

Answer 18

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

Question 19

What major side effects of disopyramide?

Answer 19

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

Question 20

Quinidine is a major substrate of what CYP?

Answer 20

3A4

Question 21

What is the MOA of class IB antiarrythmics?

Answer 21

block Na channels, decrease refractory period, decrease automaticity

Question 22

what is the use of class 1 b antiarrythmics

Answer 22

only used for ventricular arrhythmiaxs

Question 23

Lidocaine is a substrate of what 2 CYP ?

Answer 23

3A4 and 2D6

Question 24

What is the MOA of Class IC antiarrythmics?

Answer 24

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

Question 25

What are the Class II antiarrythmics?

Answer 25

esmolol (Brevibloc) / propranolol (Inderal)

Question 26

What is the MOA of the Class III antiarrythmics?

Answer 26

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

Question 27

what are the class 2 antiarrhytmics?

Answer 27

esmolol and propranolol

Question 28

what is the difference between esomolon and propranolol?

Answer 28

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

Question 29

what is the use of class 2 antiarrhythmics?

Answer 29

the use is for ventricular arrhythimias

Question 30

What are they?

Answer 30

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

Question 31

pacerone

Answer 31

amiodarone

Question 32

nexterone

Answer 32

amiodarone

Question 33

cordorone

Answer 33

amiodarone

Question 34

multaq

Answer 34

dronaderone

Question 35

betapace

Answer 35

sotalol

Question 36

corvert

Answer 36

ibutilide

Question 37

tikosyn

Answer 37

dofetilide

Question 38

Which class III has a REMS?

Answer 38

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

Question 39

What is unique about administration of IV amiodarone?

Answer 39

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

Question 40

What are the 4 BBWs for amiodarone? KNOW

Answer 40

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

Question 41

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

Answer 41

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

Question 42

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

Answer 42

Betapace should not be substituted for Betapace AF

Question 43

What is the BBW for sotalol (Betapace)

Answer 43

initiation and dosage increase should be done in a hospital

Question 44

What is the BBW for dofetilide?

Answer 44

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

Question 45

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

Answer 45

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

Question 46

DDIs for amiodarone?

Answer 46

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

Question 47

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

Answer 47

if the pt has asthma or COPD

Question 48

What is the therapeutic lab value for digoxin in afib?

Answer 48

0.8-2.0

Question 49

What is the dose adjustment from oral to IV digoxin?

Answer 49

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

Question 50

what are signs of digoxin toxicity?

Answer 50

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

Question 51

digoxin can accumulate with _____

Answer 51

renal insufficiency

Question 52

What electrolyte imbalances can increase chance of digoxin toxicity?

Answer 52

hypokalemia, Hypercalcemia

Question 53

Multaq - generic name and class, indication

Answer 53

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

Question 54

What is the normal lab value for K?

Answer 54

3.5-5 meq/L

Question 55

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

Answer 55

taste perversion

Question 56

greatest risk of qt prolongation

Answer 56

class 1a and class III

Question 57

how is the classification determined for van gough class 1

Answer 57

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

Question 58

dronadarone bbw

Answer 58

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

Question 59

Adenosine

Answer 59

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

Question 60

adenosine ADR

Answer 60

ADR: headache, flushing, chest pain

Question 61

half life of amiodarone is abt

Answer 61

60 days

Question 62

Digoxin- MOA

Answer 62

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

Question 63

amiodarone good for

Answer 63

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