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Arrythmia > Antiarrythmic Drugs > Flashcards

Antiarrythmic Drugs Flashcards

0
Q

Digoxin function in arrhythmia

A

(Last line) Rate control ONLY on resting HR
(negative ionotropic)

Only for supraventricular arrhythmia

Enhance vagal tone –> decrease ventricular rate

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1
Q

Digoxin

Brand

A

Digox

Lanoxin

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2
Q

Therapeutic range for Afib (Digoxin)

A

0.8-2 ng/mL

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3
Q

Signs of Digoxin toxicity

A

Nausea/vomiting, loss of appetite and bradycardia

Double vision, confusion, arrhythmias

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4
Q

What factors (include electrolytes) increase risk of toxicity (digoxin)

A

Hypokalemia (<3.5 mEq/L), hypomagnesia, hypercalcemia. Hypothyroidism

Reduce renal function, dehydration

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5
Q

Digoxin renal adjustments?

Oral:IV conversion?

When do you obtain digoxin level?

What is the antidote and when do you give it?

A

Digoxin

CrCl < 50 reduce dose or reduce frequency

Reduce dose by 20-25% when going from po to IV

Get levels 12 to 24 hours after a dose?

Antidote: DigiFab give when levels are high AND symptoms present.

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6
Q

Drugs that increase digoxin levels?

A

Amiodarone, dronedarone, quinidine, propafenone, verapamil

Azoles, macrolide

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7
Q

Digoxin and amiodarone or dronedarone what do you do?

A

Reduce Digoxin by 50%

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8
Q

Digoxin is a substrate of what major enzyme

A

3A4 and P-BP

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9
Q

Adenosine (use)

A

Restore normal sinus rhythm

Slow conduction through AV nodes (supraventricular re-entrant tachyarrhythmias)

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10
Q

Class IV (MOA)

A

Verapamil, Diltiazem.

Block calcium channels (phase 2)

Slow ventricular rate (negative chronotropic )

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11
Q

Non-dihydropyridine CCB contraindication

A

Severe hypotension ( < 90 mmHg)
Acute MI —> heart failure
2nd/3rd degree heart block

May be used in HF with preserved EF

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12
Q

Non-dihydropyridine CCB side effect

A

Edema, constipation ( verapamil), gingival hyperplasia, bradycardia (- chronotropic), arrhythmia (- ionotropic), hypotension

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13
Q

Dofetilide (REMS)

BBW

A

Must be started inpatient with ECG monitoring for at least 3 days

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14
Q

Tikosyn monitoring

A

ECG, BP, SCr, HR, electrolyte (K, Mg)

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15
Q

Dofetilide

CrCl < 60mL/min reduce dose

Contraindicated: CrCl <50, azoles, antiviral, verapamil

A

…

16
Q

Sotalol

A

Renal adjusted (< 60 mL/ min)

Can’t substitute Betapace with Betapace AFib

17
Q

Dronedarone BBW

A 
HF (class IV or any class recently hospitalized)
Permanent AFib
18
Q

Dronedarone

Side effect

Pregnancy category

A

QT prolongation, increase SCr

Category X

19
Q

Amiodarone BBW

A

Must be started in hospital

Pulmonary toxicity

Liver toxicity

Proarrhythmic

20
Q

Amiodarone allergy caution

A

Contraindicated with iodine allergy

21
Q

Amiodarone side effect

A

Hypotension, bradycardia, corneal microdeposits, GI, hypothyroidism/hyperthyroidism (more hypo), blue-gray skin

22
Q

Infusion of amiodarone

A

Non-polyvinyl chloride (PVC) container such as glass, or polyolefin if infusion is longer than 2 hours

23
Q

Amiodarone

Half-life

Pregnancy

A

40- 60 days

Category D

24
Q

Which patients is amiodarone drug of choice?

A

Heart failure

25
Q

Dronedarone drug interaction

A

It’s a inhibitor of 2D6 and 3A4

26
Q

Amiodarone drug interaction

A

Amiodarone is an inhibitor of 2C9, 2D6, 3A4

Reduce warfarin by 30-50%
Do not exceed 20 mg Zocor, 40mg of mevacor

27
Q

Class III antiarrhythmic drug interaction

A

All are proarrhythmic agents (prolong QT)

Do not use grapefruit juice
Avoid ephedra and St. John wort

28
Q

Class II (beta blocker) MOA

A

Slow ventricular rate (blocks calcium indirectly) phase 3

29
Q

Class Ib ( allergy contraindication)

A

Corn

30
Q

Quinidine side effect

A

Diarrhea, stomach cramp, cinchonism (hearing loss)

Hemolysis, drug induce lupus

31
Q

Procainamide side effect

A

Metabolized acetylation–> NAPA (metabolite)

Lupus, hypotension

32
Q

Disopyramide side effect

A

Anticholingeric (dry eyes, dry mouth, constipation, urinary incontinence)

33
Q

Class Ic negative iontropic property contraindicated in?

A

Heart failure and recent MI

34
Q

Class Ib side effect

A

CNS cross BBB

35
Q

Quinidine drug interaction

A

Inhibit 2D6 and 3A4

Reduce digoxin by 50%

36
Q

Which rhythm can class IB used for?

A

Only ventricular arrhythmias

Arrythmia (3 decks)

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