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Pharm Quiz #2 > Arrhythmias > Flashcards

Arrhythmias Flashcards

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1
Q

Types of Channels

A
  • Fast sodium channel
  • Potassium channels
  • Calcium channels
  • “Funny” sodium channels (If channels)
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2
Q

Fast sodium channel

A
  • Voltage dependent

- Lets sodium in, keeps potassium from going out and keeps calcium from blocking channel

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3
Q

Potassium channels

A

Contribute to regulation of action potential duration

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4
Q

Calcium channels

A
  • T-type channels initiate action potential (short)

- L-type channels sustain action potential (long)

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5
Q

“Funny” sodium channels (If channels)

A

In SA and AV nodes

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6
Q

Voltage clocks influenced by?

A

Autonomic Nervous System

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7
Q

Divisions of Autonomic Nervous System and their function?

A
  1. Sympathetic: increases activity

2. Parasympathetic: decreases activity

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8
Q

Antiarrhythmic drugs are used to

A
  • decrease or increase conduction velocity
  • alter the excitability of cardiac cells by changing the duration of the effective refractory period
  • suppress abnormal automaticity
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9
Q

Antiarrhythmic drugs treat which arrhythmias?

A
  • Supraventricular arrhythmias: atrial fibrillation

- Ventricular arrhythmias: ventricular fibrillation

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10
Q

Class I do what?

A
  • Fast sodium channel blockers

- Slows Phase 0 depolarization

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11
Q

Example of Class I?

A

lidocaine

quinidine

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12
Q

Class II do what?

A
  • Beta blockers

- Suppresses Phase 4 depolarization

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13
Q

Example of Class II?

A

metoprolol

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14
Q

Class III do what?

A
  • Repolarization prolongation

- Prolongs Phase 3 repolarization

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15
Q

Example of Class III?

A

amiodarone

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16
Q

Class IV do what?

A
  • calcium channel blockers

- shortens action potential

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17
Q

Example of Class IV?

A

verapamil

diltiazem

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18
Q

Class V do what?

A
  • calcium accumulation

- vagal effect

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19
Q

Example of Class V?

A

digoxin

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20
Q

Quinidine uses

A
  • Atrial tachyarrhythmias

- AV-junctional and ventricular arrhythmias

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21
Q

ADR of Quinidine

A 
	Diarrhea
	Hemolytic anemia, thrombocytopenia
	Aggravate heart failure
	Liver failure
	Digoxin interaction
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22
Q

How Quinidine works

A

Slow Phase 0 depolarization, prolong action potential, slow conduction

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23
Q

What Vaughn Williams class is Quinidine

A

IA

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24
Q

uses for Lidocaine

A

Ventricular arrhythmias

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25
ADR of Lidocaine
 Worsen certain arrhythmias  Seizures  CNS effects  Contraindicated in second degree or complete heart block
26
How Lidocaine works
Shorten Phase 3 repolarization and decrease duration of action potential
27
What Vaughn Williams class is Lidocaine
Vaughn-Williams-IB
28
Dose for Lidocaine
Prefilled syringe of 100 mg IV bolus
29
uses for Propafenone (Rhythmol™)
- Life-threatening ventricular tachycardia or ventricular fibrillation - Refractory supraventricular tachycardia
30
How Propafenone (Rhythmol™)works
Slow Phase 0 depolarization
31
What Vaughn Williams class is Propafenone (Rhythmol™)
Vaughn-Williams-IC
32
Prescription for Propafenone (Rhythmol™)
225 mg | One tablet every 8 hours
33
ADR of Propafenone (Rhythmol™)
- Potential to worsen heart failure | - Prone to drug-drug interactions that can raise warfarin and digoxin levels
34
What type of metabolism for Propafenone (Rhythmol™)?
o Extensive 1st pass metabolism --> CYP2D6 (genetic differences)  Concern with drugs that inhibit CYP2D6 activity  Dose adjustment in patients with liver impairment
35
1. What are the Beta Blockers? | 2. What Class
1. Metoprolol (Lopressor™) | 2. Esmolol (Brevibloc™)
36
Metoprolol (Lopressor™) prescription for maintenance dose
50 mg | One tablet twice a day
37
Metoprolol (Lopressor™) prescription for ED
o 2.5-5 mg IV push q. 2-5 mins. o After ~15 mins, shouldn’t have repeated more than 3 times o Max dose = 15 mg
38
Metoprolol (Lopressor™) prescription for On floors for HTN
o 5 mg IV q. 6 hours PRN HTN (Optimal BP or HR…etc.) | - Also tell nurses when to not give
39
How does Metoprolol work?
o Selective inhibitor of beta1 receptors |  Metabolized by CYP2D6; extensive first pass effect (smaller IV dose)
40
Contraindications for Metoprolol
 Can treat acute myocardial infarction except if: (Don’t use ↓) • Heart rate less than 45 bpm • Greater than first-degree heart block • Systolic blood pressure less than 100 mm Hg • Moderate to severe heart failure
41
Esmolol (Brevibloc™) administration
Loading dose(s) and continuous infusion
42
How Esmolol (Brevibloc™) works
``` o Selective inhibitor of beta1 receptors  Very short elimination half life • Onset of action in 6 to 10 minutes • Action ceases approximately 20 minutes after infusion stop  For immediate beta receptor blockade ```
43
How Beta blockers work in general
o Diminish Phase 4 depolarization (↓ functional refractory period)  Depresses automaticity  Prolongs AV conduction  Decreases heart rate and contractility ***Control rates!
44
Prescription of Amiodarone
 Amiodarone 200 mg One tablet daily  maintenance dose, once > 400 mg --> side effects
45
How Amiodarone works
 Predominantly block the potassium channels, thereby prolonging repolarization.  Controls Rhythm
46
Uses of Amiodarone
Supraventricular arrhythmias, atrial fibrillation/flutter, prevent recurrence of ventricular tachycardia or ventricular fibrillation
47
ADR of Amiodarone
 Dose dependent  Pulmonary toxicity: Respiratory arrest (infiltration, fluid) • Get pulmonary function tests; make sure patient knows S/S  Photosensitivity  Possible bradycardia  Thyroid Toxicity: inhibits T3  T4 and gives iodine. Both Hypo/hyper possible • Monitor TSH levels
48
How initiate therapy of Amiodarone
- Big loading dose (1400-1600 mg)  tapper down to maintenance dose - Do in hospital with telemeter so can monitor
49
How Dofetilide (Tikosyn) works
- Prolongs action potentials in atria and ventricles | - Blocks rapid potassium channels only
50
How initiate therapy of Dofetilide (Tikosyn)
o Initiate in Hospital for 3 days
51
Kinetics of Dofetilide (Tikosyn)
 Renal excretion --> adjust based on creatinine clearance  3 strengths based on CrCl • 500, 250, 125 mcg q. 12 hours  CYP3A4 metabolism --> drug interactions
52
ADR of Dofetilide (Tikosyn)
QTc prolongation leading to torsades | ≥ 500 msec. or ↑by 15% = bad
53
How Sotalol works
 L-isomer exhibits non-selective beta blocking activity  Increase in action potential duration in both atria and ventricles • Decreased sinus rate and AV conduction
54
Kinetics of Sotalol
Renal excretion --> adjust based on creatinine clearance
55
ADR of Sotalol
QTc prolongation leading to torsades
56
When is Sotalol Contraindicated
heart block
57
Prescription for Diltiazem
20 mg IV bolus now and infuse intravenously at a rate of 10 mg per hour
58
Uses for Diltiazem
Treatment of PSVT, atrial fib/flutter
59
How Diltiazem works
- Inhibit calcium-dependent slow action potentials in the SA and AV nodes • Slow diastolic depolarization both nodes (Phase 4 spontaneous depolarization) • Reduction of ventricular responses to atrial fibrillation
60
ADR of Diltiazem
 Avoid in advanced heart disease or hypotension  Bradycardia, hypotension  Contraindicated in WPW and atrial fibrillation
61
Kinetics of Diltiazem
 IV push, infusion- peak effect in 15 minutes
62
Uses for Verapamil
slows ventricular response to atrial fib/flutter, terminates PSVT
63
Dose for Verapamil
5 mg vials (max), 2.5 mg next lowest | IV push
64
The longer you give a Calcium channel blocker...
the more refractory your body becomes to the drug | o Why it is stopped after 24 hours
65
Prescription for Adenosine
o Adenosine 6 mg IV bolus Repeat dose at 12 mg if first dose ineffective o Give in left arm because it’s closest to the heart  Rapid half-life (8 seconds
66
Administration for Adenosine
o Rapid bolus with immediate flush (0.9% NaCl)
67
Uses for Adenosine
o Treatment of paroxysmal supraventricular tachycardia associated with WPW o Get rapid resolution
68
ADR of Adenosine
o Chest pressure, flushing, tightness in throat
69
Contraindication for Adenosine
o Second/third degree heart block
70
2 major factors for Atrial fibrillation
 The electrical trigger that initiates the arrhythmia |  Abnormal myocardial substrate that allows atrial fibrillation to be maintained
71
What is the risk associated with Atrial fibrillation
Embolism --> stroke (2-7x’s ↑)
72
Stroke pneumonic
* F- Face * A- arms * S- Slurred speech * T- Time
73
Drugs to treat Atrial fibrillation
1. Amiodarone 100 to 400 mg 2. Sotalol 160 to 320 mg 3. Dofetilide 500 to 1000 mcg 4. Propafenone 450 to 900 mg
74
Acute therapy for Supraventricular Tachycardia
Responsive to adenosine, beta blockers or calcium channel blockers
75
Long-term Therapy for Supraventricular Tachycardia
 Associated with frequent recurrences and adverse effects • Without structural cardiac disease o propafenone or flecainide
76
Ventricular Arrhythmias classes?
All classes may have application
77
Class I in Ventricular Arrhythmias
• proarrhythmic effect
78
Class II in Ventricular Arrhythmias
• efficacy in reducing morbidity and mortality more evident
79
Class III in Ventricular Arrhythmias
• proven efficacy with lower proarrhythmic effect than the Class IA agents
80
Class IV in Ventricular Arrhythmias
• no appreciable effect on conduction velocity or repolarization and tend to increase sympathetic activation
81
Role in therapy for Ventricular Arrhythmias
- CAST study/ESVEM study and beta blockers - Amiodarone: no increased survival and no increased risk of sudden death? - Heart failure patients: Class IA and IC “out” and amiodarone “in”?

Pharm Quiz #2 (6 decks)

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