Antiarrhytmia

Question 1

Quinidine(Oral) and Procainamide(IV), Disopyramide

Answer 1

Anti-arrhythmia Class 1A– Cardiomyocyte

Indications: VT, A-Fib and maintain NSR s/p cardioversion

MOA: Block inward Na+ channel and *SOME inward rectifying K+ channel. Slows phase 0(Depol) and 3(Repol)

Effects: Increased QRS, Increased QT, and increased AP duration

Adverse:
Quinidine: increased mortality(Not used) may induce VTachy

Procainamide: IV only slows conduction w/ WPW

Disopryamide: Anticholingeric effects

Question 2

Lidocaine and Mexiletine

Answer 2

Anti-arrhythmia Class 1B– Cardiomyocyte

Indication: TX ischemic arrhythmias… Difficult yo return to replarized stated

MOA: Inhibit Inward Na+ channels
Lido: terminates re-entry arrhythmias, by turning unidirectional to Bidirectional
Shortens Phase 3 Repol
Mexiletine: oral

Adverse: Bradycardia, Heart block and hypotension

Question 3

Flecainide(oral) and Propfenone(oral)

Answer 3

Anti-arrhythmia Class 1C– Cardiomyocyte

Indication: Use w/ structural nml hearts. Reduced A-fib but w/ nml hearts

MOA: Phase 0 Slowing, prevents premature vent contraction

Effects: Prolonged QRS…

Adverse: Need to monitor due to QRS prolongation could lead to cardiac arrest

Dizziness, N/V, HA, and blurred vision

ONLY NML can exacerbate CHF pts

Question 4

Amiodarone Sotalol, Ibutilide, Dofetilide, Dronedarone

Answer 4

Class 3 K+ channel blocker

indications: SVT, Vtach, and arterial fib/flutter. Increased sympathetic activity, bradycardia,

MOA: Prolongs AP duration nd refractory period
Amiodarone(can do all) works on Na+ and Ca2+ channels and some a/b receptors

Effects:Can lead to torsade de pointes – Vtach w/ increased QT interval…

Question 5

Amiodarone

Answer 5

Leads to increased QT intervals
-lower incidence of tornadoes
can prolong Qrs, and slow hr/ conductions
-Effective w/ AVT and A-fib
-Lipid soluble

-dont use in young or very old
-multiple issues but still the most used

Question 6

Dronedarone

Answer 6

Derivative of amidarone
-less lipophillc short half life
-not as effective of amiodarone

use in young pts

Question 7

Sotalol and dofetilide

Answer 7

Needs to be continuouslly monitored for cardiac resuscitation

-used as first line w/ a-fib and cardio version

can cause Torsades

Question 8

Propranolol(non-selective)
Esmolol
Metoprolol
Atenolol

Answer 8

Class 2 anti arrhythmic drugs

Indication:

MOA: slow depol(phase 4) and prolong AV conduction

Effects: decreased hr and contractility

Adverse: may aggravate CHF

Propranolol: reduces student arrhythmic death s/p MI
Metoprolol: B-antagonist: used to tx wide arrhythmia
Esmolol: short action acute arrhythmia

Question 9

Verapamil and diltizem

Answer 9

Class IV antiarrhythmia Ca2+ blocker

Indications: SVT, HTN, angina

MOA: Calcium channel blocker

Effect: Slows SA and AV nodal conduction, decreased cardiac contractility, reduced bp

Adverse: oral and IV,

Question 10

Adenosine

Answer 10

Class V

Indications: Acute SVT

MOA: Purinergic receptors on AV node, actives K+ channel, K+ leaves cell and hyperbole

Question 11

Adenosine

Answer 11

Class V

Indications: Acute SVT

MOA: Purinergic receptors on AV node, actives K+ channel, K+ leaves cell and hyperpol

Effect: Sloes Av noe conductions

Adverse: short half life, skin flushing and hypotension

Question 12

Magnesium

Answer 12

Class V

indications: manages torsades de pointes

MOA: Mg blocks Ca into the cell

Effects leads to early afterdepol.. Increace automaticity, increase atrial av node conduction time

Adverse:

Question 13

Digoxin

Answer 13

Class V

indication:

MOA: Stims PNS- – Vagus nerve — slow SA node and decrease AV nod… Inhibits Na/K/ATPase

effects:

Adverse: Gi, neuro, visual, and cardiac arrhythmias

Question 14

Ranoolazine

Answer 14

Indications: first line for stable angina

MOA: blocks late inward Na

Effects: Under investigation

Advers: dizzy, NV ,HA