Arrhythmia

Question 1

What are the 1a medications, indication, LV function and ion block?

Answer 1

Disopyramide
Procaniamide
Quinidine

Indication:
SVT
Ventricular

LV function:
Decreases

Ion Block:
Na Channels (medium recovery)

Question 2

What are the 1b medications, indication, LV function and ion block?

Answer 2

Lidocaine
Mexiletine
Phenytoin

Indication:
Ventricular

LV function:
No Effect

Ion Block:
Na Channels (Fast Recovery)

Question 3

What are the 1c medications, indication, LV function and ion block?

Answer 3

Flecainide
Propafenone
Moricizine

Indication:
SVT

LV function:
Decreases

Ion Block:
Na Channels (Slow Recovery)

Question 4

What are the II medications, indication, LV function and ion block?

Answer 4

B Blockers

Indication:
SVT

LV function:
Decreases

Ion Block:
Work on SA and AV node tissue –> Do not restore NSR

Question 5

What are the III medications, indication, LV function and ion block?

Answer 5

Amiodarone
Dofetilide
Ibutilide
Sotalol
Dronedarone

Indication:
SVT

LV function:
Amiodarone - no effect
Dofetilide - no effect
Ibutilide - no effect
Sotalol - decreases
Dronedarone - decreases

Ion Block:
Amiodarone - K+ mainly but also Na, Ca, and B
Dofetilide -  K+ 
Ibutilide - K+ , IV only
Sotalol -  K+  and B
Dronedarone - Unknown

Question 6

What are the IV medications, indication, LV function and ion block?

Answer 6

Verapamil/Diltiazem

Indication:
SVT

LV function:
Decreases

Ion Block:
Ca channels (SA/AV node --> do not restore NSR

Question 7

What are the Misc medications, indication, LV function and ion block?

Answer 7

Digoxin
adenosine
magnesium

Indication:
Digoxin - SVT (a fib)
adenosine - SVT (PSVT)
magnesium - Ventricular

LV function:
No Effect

Ion Block:
Digoxin - increases vagal tone on AV node
adenosine - decreases conduction in AV node
magnesium - N/A

Question 8

1a

Answer 8

Medication:
Disopyramide
Procainamide
Quinidine

Side Effects:
TdP & HF

Notes:
Avoid Initiating if QTc> 440

Question 9

1b

Answer 9

Medication:
Lidocaine
Mexiletine

Side Effects:
Slurred speech, confusion, seizures

Notes:
Therapeutic level 1.5-5

Question 10

1c

Answer 10

Medication:
Flecainide
Propafenone
Moricizine

Side Effects:
HF

Notes:
N/A

Question 11

III - Amiodrone

Answer 11

Side Effects:
Corneal microdeposits, neuritis, pulmonary fibrosis, increase LFTs, hypothyriodism, hyperthyroidism, photosensitivity, blue-grey skin discoloration, hypotension (iv only)

Notes:
DDI: Digoxin and Warfarin (must decrease doses by 30-50%) simvastatin: max dose 20mg/day

Question 12

III

Answer 12

Medication:
Dofetilide
Ibutilide
Sotalol
Dronedarone

Side Effects:
TdP

Notes:
Avoid initiating if QTc > 440

Question 13

IV

Answer 13

Medication:
Diltiazem
Verapamil

Side Effects:
Bradycardia, GI upset

Notes:
N/A

Question 14

Misc

Answer 14

Medication:
Digoxin
Adenosine

Side Effects:
Heart block, bradycardia, GI upset, vision changes

Notes:
decrease digoxin dose with amiodarone
Use for PSVT caution in Bronchospasm