Block II: Antiarrythmics Flashcards
(103 cards)
1
Q
What constitutes a prolonged QTC interval and may bar you from initiating an antiarrythmic?
A
M > 450
F > 470
2
Q
What drugs belong to class Ia?
A
- quinidine
- procanimide
- disopryramide
Double
Quarter
Pounder
3
Q
Where do class Ia drugs exert their effects primarily?
A
Supraventricular/ventricular arrythmias
4
Q
What ion channel do class Ia drugs affect?
A
Na+
5
Q
What drugs are class Ib
A
- lidocaine
2. mexiletine
6
Q
where do class Ib drugs exert their effect?
A
ventricular arrythmias
7
Q
what ion channel do class Ib drugs alter?
A
Na +
8
Q
Where to BB exert their effects?
A
supraventricular, ventricular
9
Q
what ion channel to BB block
A
Ca+
10
Q
What are class Ic drugs?
A
- flecaninide
2. propfanone
11
Q
where do class Ic drugs exert their effects?
A
supraventricular, ventricular
12
Q
what ion channel do class Ic drugs exert their effects on?
A
Na+
13
Q
Where do non-DHP CCBs exert their effects?
A
termination SVT, slow rapid Afib or Aflutter
14
Q
what drugs belong to class III
A
- amiodarone
- Dofetilide
- dronedarone
- sotalol
- ibutilide
15
Q
What drugs belong to class II
A
BB
16
Q
where do class III drugs exert their effects?
A
any tachycardia
17
Q
what ion to class III drugs work on?
A
K+
18
Q
what are class IV drugs?
A
Non-DHP CCB
19
Q
Quinidine belongs to what class?
A
Ia (supravent/ventricular Na+ block)
20
Q
Procanimide belongs to what class?
A
Ia (supravent/ventricular Na+ block)
21
Q
Disopyramide belongs to what class?
A
Ia (supravent/ventricular Na+ block)
22
Q
Lidocaine belongs to what class?
A
Ib ventricular, Na+ block
23
Q
Mexiletine belongs to what class?
A
Ib ventricular, Na+ block
24
Q
Flecanide belongs to what class?
A
Ic supravent, vent Na+ block
25
Propafenone belongs to what class?
Ic supravent, vent Na+ block
26
How can you remember class one drugs?
```
Ia:
Double- Disopyramide
Quarter-Quinidine
Pounder- Procanimide
Ib:
Lettuce-Lidocaine
Mayo-Mexiletine
Ic:
Flecainidie- fries
Please- Propafenone
```
27
What class does Amiodarone belong to?
III, tachyarrythmias K+
28
What class does dofetilide belong to?
III, tachyarythmias, K+
29
What class does Dronedarone belong to?
III, tachyarythmias, K+
30
What class does sotalol belong to?
III, tachyarythmias, K+
31
What class does Ibutalide belong to?
III, tachyarythmias, K+
32
What class does verapamil belong to?
IV, termination SVT and slowing rapid Afib/flutter
33
What class does diltiazem belong to?
IV, termination SVT and slowing rapid Afib/flutter
34
What is the MOA class Ia
Prolong phase 0, rapid depolarization phase, and widen QRS
Moderate Na+ channel blocker may increase ERP (refractory period)- prolongs action potential
-risk for secondary arrythmia (dose dependent)
35
Disopyramide is a strong []
anticolingergic
36
Quinidine is a []
anticholinergic
37
Procanamide may cause []
lupus like syndrome
38
MOA class Ib drugs
shorten refractory period, shorten AP, and shorten QTc
39
Class Ib drugs are only used for
ventricular arrythmias
40
What is mexilteines dosage limitation
severe nausea
41
MOA class Ic drugs
NO change refractory period, QTc, no risk secondary arrythmias
42
what is the mc use Ic drugs
atrial arrythmias or life threatening ventricular
43
What is the MOA class II drugs
BB
| Block adrenergic stimulation (decrease HR, CO, Force contraction)
44
What is the use Class II drugs
BB
1. terminate re-entrant arrythmia at AV node
2. control ventriculat rate in afib/flutter
3. exercise tachycardia
45
What BB are used to treat arrythmias?
1. metoprolol
2. propanolol
3. esmolol
46
What is the MOA class III drugs
```
K+ channel blocker
prolong repolarzation (phase 3) AP
-halt exit K+, prolong repolarization, refractoriness, an QT interval
```
47
How are class III drugs used
to control tachyarrythmias
48
SE class III drugs
may be pro arrythmic
49
what is the MC antiarrythmic?
amiodarone
50
MOA amiodarone
Class III: K+ blocker, some Na+ activity, alpha block, and beta block activity
51
What is the use amiodarone
prevent recurrent ventricular arrythmias, sinus rhythm w/ paradoxical afib,
52
SE amiodarone
EXTENSIVE, may cause neuropathies
53
What is the MOA Sotalol
Class III
| NOS BB Ca2+ channel effective
54
Pearl on Sotalol
check baseline EKG!! to eval. QTc
and titrate accordingly
don't use if over 500
55
Use Ibutalide
class III
IV only
Afib/flutter
56
pearl ibutalide
SULFONAMIDE
| *sulfa allergy
57
Use dofetilade
```
class III
Afib/flutter
```
58
Pearl dofetalide
renal dose adjustment
| Monitor EKG x3 days post intiation and 12 hrs post dose increase
59
use non-DHP CCB
Class IV
affect slow response myocardial tissue by blocking long Ca++ channels
Supraventricular tachycardia
RATE control afib/flutter
work in SA and AV node
60
Who should avoid diltiazem/verapamil
HF or decreased ventricular function
61
If a pt. has sinus bradycardia with symptoms of hemodynamic compromise, what is the tx of choise
Atropine
62
If a pt. has sinus bradycardia with symptoms of hemodynamic compromise and a likelihood or coronary ischemia, what is the treatment of choice?
Isoproterenol, dopamine, epi, dobutamine
63
What if a pt is hemodynamically compromised and is refractory to medical therapy
temporary pacing until pacemaker can be set
64
How are you treating a 1st degree AV block?
No tx
- eval meds, dc causative agents
- check lytes
65
How are you treating 2nd degree AV block
Pacemaker
66
How are you treating a 3rd degree Av Block
Pacemaker
67
Pts. showing symptoms of bradycardia and hemodynamic compromise must receive
atropine
68
How are you treating a pt. with hemodynamic compromise and suffering acute MI
Aminophylline
69
How are you treating Asystole
Epi
70
what should you run through in a PEA pt?
H's and T's
H: hypovolemia, H+ acidosis, Hypo/Hyper kalemia, Hypoxia, hypoglycemia, hypothermia
T: thrombosis, trauma, tension/pneumothorax, tamponade, toxines
71
How are you treating a PEA pt?
Epi (asystole)
72
Are PEAs shockable?
NO, shocking gets you in rythm, if no beat no rythm to fix
73
How are you treating a hemodynamically stable Vtach pt
IV procainamide, amiodarone, or sotalol
74
How are you treating a hemodynamically unstable Vtach pt?
Defibrillation
75
How are you treating a polymorphic Vtach pt. due to MI
BB
| unless torsades!!!!
76
How are you treating a torsades pt?
Mg IV
| D/c offending agent
77
How are you treating your Vfib patient?
SHOCK
78
How are you treating your SVT pt who is hemodynamically stable?
1. vagal maneuvers, cold water, carotid massage
| 2. adenosine, BB, non-DHP CCB if all else fails
79
How are you treating your SVT patient who is hemodynamically unstable?
shock (DCC) direct cardio version
80
MOA Adenosine
slow conduction through AV node, interrupt re-entrant pathway, flatline x10 s
81
SE adenosine
flushing, HA, SOA
82
How are you treating acute Afib?
Rate control
| BB, non-DHP CCB, digoxin
83
How are you treating Afib pts. long term?
1. Rate control (easier, less SE)
vs.
2. Rythym (if sympomatic)
3. stroke prevention
84
How are you treating Afib rate control and why?
if asypmtomatice, easier with less SE
1. BB
2. Non-DHP CCB
3. Digoxin (can only be adjunct, only works when pt. at rest)
85
What is the rate goal Afib?
< 110 BPM if stable LV function
| <80 BPM at rest
86
How are you treating afib ryhtm control and why?
If symptomatic, get rythm
1. cardioversion, will need anticoag. post shock x 4 weeks.
will need antiarrythmic after schock too.
2. Dofetalide, Flecanide, Ibulilide, propafenone, amiodarone
87
If afib > [] hrs (or UK time), what is needed prior to shock?
48 hours, warfarin or DOAC x 3 weeks prior, 4 weeks after shock
*heparin if hemodynamically unstable
88
What is 1st line rythm maintenance in an Afib pt. with no structural heart defects?
1. flecainide
2. propafenone
3. stoalol
89
What is 1st line rythm maintenance Afib with CAD
1. dofetalide
| 2. sotalol
90
What is 1st line rythm maintenance in afib with HF
1. amiodarone
| 2. dofetilide
91
What is second line Afib rythm maintenance
1. amiodarone
2. dofetalide
3. catheter ablation
92
What is second line afib rythm maintenance if CAD
1. amiodarone
| 2. cath ablation
93
what is second line afib rythm mainteneance if HF
amiodarone
94
what drug is category X
dronedarone
95
What drug is category D
amiodarone
96
[] anticoag is used if mechanical valves
warfarin
97
What CHADs is women req. anticoag
3
98
what CHADs in men req. anticoag
2
99
Dabigitran is a [] drug
factor IIa DOAC
100
Rivaroxaban is a [] drug
Factor Xa DOAC
101
How would you treat symptomatic PVCs
BB
102
Afib patients must be [] to be considered rate controlled
asymptomatic
103
What can cause pharmacologic cardioversion?
Dofetilide, flecainide, ibutilide, propafenone, amiodarone
