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Flashcards in Arrhythmia 2 Deck (27):
1

Quinindine = Class 1a

3 therapeutic uses?
Side Effects?
Metabolism?

Therapy
1) A-Fib
2) Brugada's Syndrome
3) Short QTS syndrome

Side Effects
1) Pro-arrhythmia
2) Nausea/Diarrhea

hepatic metabolism

2

Quinindine = Class 1a

What 3 channels does Quinindine block? What effect does this have on the AP?

Quinindine --> block I-Na, I-K, I-to --> prolong QRS --> prolonged AP duration

3

Procainamide = Class 1a

What is the MoA for the parent compound? What about the metabolite?

What is it's effect on the SAN and AVN?

Parent compound:
Na chnl blocker --> prolong QRS

Metabolite:
K chnl blocker --> increase AP duration

Suppresses SAN, AVN

4

Procainamide = Class 1a

What are it's 2 therapeutic uses?

What side effect is associated with the oral form?

Therapy
1) acute treatment of atrial/ventricular arryhthmia
2) pre-excited A-Fib

Oral form --> Lupus

5

Disopyramide = Class 1a

MoA?
Treatment? (2)

A good choice for what patients?

MoA
--Na chnl blocker with vagolytic, anticholinergic effects

Treatment
1) vagal-mediated A-Fib
2) some VT

Good choice for patients with slow baseline HR

6

Disopyramide = Class 1a

Side Effects?

Urinary retention
Blurred vision
Worsened glaucoma

7

What are the two Class 1b anti-arrhythmics?

What is their MoA?

Class 1b
--Lidocaine, Mexiletine

MoA: block Na chnls, especially inactivated

8

What Class 1b drug is the treatment of choice for ischemia-related arrhythmia?

What are the side effects as related to proarrhythmia and neurological?

Lidocaine

Side Effects
Proarrhythmia: SAN arrest, impaired conduction
Neuro: tremor, paresthesia, seizure

9

What Class 1b drug is a form of oral lidocaine and has GI side effects that can be reduced by taking it with meals?

Treatment?

Mexiletine

Treatment: VT (in combo with QT prolonging meds)

10

What are the two Class 1c drugs, which are the most potent Na chnl blockers?

What do they treat, and in what kind of patients?

Class 1c
--Flecainide, Propafenone

Therapy
--atrial tach + v-tach in structurally normal hearts with preserved LV function

11

What are the side effects of the Class 1c drugs, Flecainide and Propafenone?

Flecainide is contraindicated in what patients that have what QRS interval?

Class 1c: Flecainide, Propafenone

Side Effects
--depress LV function (worsen HF)
--proarrhythmia in ischemic tissues

Flecainide contraindicated in patients with structurally abnormal heart; QRS > 120ms

12

In general, Na chnl blockers work best @ what kind of HR?

What about K chnl blockers?

Na chnl blocker: high HR

K chnl blocker: slow HR

13

How are beta blockers antiarrhythmogenic?

What are the 3 BBs used?

2 side effects?

They increase the refractory period of the A/V node.

Metoprolol, Atenolol, Nadolol

Side Effects
--bronchospasm, bradycardia

14

How do class III antiarrhythmics work?

How do they affect the action potential?

What is the major risk of class III drugs?

Class III drugs are K channel (IKr) blockers.

Increase AP duration and the refractory period (QT prolongation)

Thus, they cause a risk of Torsades de pointes.

15

What is special about sotalol?

What tests need to be performed while a patient is on sotalol?

Sotalol is also a non-specific beta blocker.

Serum K, Mg, and renal function should be closely followed.

16

What are the two therapeutic uses for Amiodarone?

How does its potency compare to other class III drugs?

Therapy: atrial and ventricular tachyarrhythmias.

It is more potent than Sotalol.

17

Why does Amiodarone have a ton of side effects?

Iodine-based medication

18

What is Dronedarone and how does it differ from Amiodarone?

When is it contraindicated?

Milder version of amiodarone that does not contain iodine. It is less effective and less toxic (non-toxic to the lungs and thyroid).

Contraindicated in HF

19

What is a concern when starting a patient on Ibutalide or Dofetilide?

Both have a chance of creating an arrhythmia (Torsades de pointes) with onset of medication. Therefore, patients need to be kept in the hospital for monitoring.

20

What is the MoA for Dofetilide, and what part of the heart is it selective for?

Dofetilide

Highly selective I-Kr blocker, selective @ atria

21

Name the four class 3 anti-arrhythmics.

Class 3
1) Amiodarone
2) Dronedarone
3) Sotalol
4) Dofetilide

(+ Ibutilide)

22

What type of Ca chnls to the Class 4 anti-arrhythmics block, and how do they affect the SAN/AVN?

What are they used to treat?

Which one is a negative inotrope, and can cause sinus arrest, hypotension, and AV block?

L type Ca Chnl Blocker --> slow conduction time, increase refractory period @ SAN, AVN

SVT

Verapamil is a negative inotrope.

23

How does Adenosine affect the K current? What is it used to treat?

Activates K current

SVT

24

What classes are used to treat sinus tachycardia?

Class II, IV

25

What classes are used to treat A-Fib/A-Flutter?

Class Ia, Ic, II, III, IV, Adenosine

26

What classes are used to treat paroxysmal supraventricular tachycardia?

Class Ia, Ic, II, III, IV, Adenosine

27

What classes are used to treat V-tach?

Class I, II, III