cardiac meds

Question 1

class Ia anti-arrhythmic - what receptor - what does it do

Answer 1

• NaCh blocker
• inhibits conduction (esp in depolarized cells) by decreasing slope of phase 0 and increasing threshold for firing in abnormal pacemaker cells …
• this increases AP duration and the effective refractory period

Question 2

class Ia anti-arrhyhtmic examples (3)

Answer 2

1. Disopyramide
2. Quinidine
3. Procainamide

Question 3

class Ia anti-arrhythmic toxicity (5)

Answer 3

1. cinchonism (Queen)
2. reversible SLE-like (Procainamide)
3. HF (disopyramide)
4. QT prolongation –> TdP
5. Thrombocytopenia

Question 4

class Ib anti-arrhythmic

• what receptor
• what does it do

Answer 4

• NaCh blocker in ischemic or depolarized Purkinje/ventricular tissue
• decreases AP duration

Question 5

uses of class Ia anti-arrhythmics (2)

Answer 5

1. atrial arrhthmia
2. ventricular arrhythmia

especially re-entrant and ectopic SVT and VT

Question 6

uses of class Ib anti-arrhythmics (2)

Answer 6

1. acute ventricular arrhyhtmia (esp post MI)
2. dig-induced arrhythmia

Question 7

Ib anti-arrhythmic toxicity (3)

Answer 7

1. CNS depression
2. CNS stimulation
3. CV depression

Question 8

examples of Ib anti-arrhyhmics (2)

Answer 8

1. Lidocaine
2. Tocainide
3. Mexiletine

“Lettuce Tomatos and Mayo”

Question 9

Ic anti-arrhyhtmic mechanism

Answer 9

prolongs refractory period in AV node

minimal effect on AP duration

Question 10

Ic anti-arrhythmic uses (3)

Answer 10

1. SVT
2. A-fib
3. Last resort refractory VT

Question 11

Class II anti-arrhyhtmic

• what does it do? (3)

Answer 11

beta blocker

in nodal cells

• decrease SA and AV nodal activity by decreasing cAMP and Ca
• decreases slope of phase 4
• increases PR interval

Question 12

examples of Ic anti-arryhtmics (2)

Answer 12

1. Moricizine
2. Flecainide
3. Propafenone

“More Fries Please”

Question 13

uses of class II anti-arrhythmics (2)

Answer 13

1. SVT
2. slowing ventricular response during A-fib or flutter

Question 14

short acting beta blocker?

Answer 14

esmolol

Question 15

class II anti-arryhtmic toxicity (6)

Answer 15

1. Sex :impotence
2. Pulm: exacterbation of COPD asthma
3. CV: brady, AV block, CHF
4. CNS: sedation, sleep alteration
5. Endo: metop can cause dyslipidemia
6. propranolol can exacerbate Printzmetal aginga

Question 16

treat class II anti-arrhythmic overdose with what?

Answer 16

glucagon

Question 17

class III anti-arryhtmic

• what does it do? (4)
• what receptor

Answer 17

KCh blocker in non-nodal fibers

• incresaes AP duration
• increases refractory period
• increases QT interval
• used when other anti-arrhythmics fail

Question 18

ex class II anti-arryhtmic (6)

Answer 18

1. metoprolol
2. propranolol
3. esmolol
4. atenolol
5. timolol
6. carvedilol

Question 19

use of class III anti-arryhtmic (3)

Answer 19

1. a-fib
2. a-flutter
3. VT

Question 20

ex of class III anti-arrhytmic (4)

Answer 20

1. Amiodarone
2. Ibutilide
3. Dofetilide
4. Sotalol

AIDS blocks potassium

Question 21

class III anti-arryhtmic toxicity (2)

Answer 21

1. TdP: sotalol, ibutilide
2. Amio: lungs, liver, thyroid

Question 22

which drug has class I, II, III, IV effects

how?

Answer 22

amiodarone

by altering lipid MB

Question 23

clas IV anti-arrhythmic

• receptor
• mechanism (3)

Answer 23

• CaCh blocker
• decreases conduction velocity in nodal cells
• increases PR interval
• increases refractory period

Question 24

class IV anti-arryhthmic uses (2)

Answer 24

1. prevent nodal arrhyhtmia (SVT)
2. rate control in A-fib

Question 25

class IV anti-arrhyhtmic toxicity (4)

Answer 25

1. constipation 2. flushing 3. edema 4. CV: CHF, AV block, sinus node depression

Question 26

examples of class IV anti-arrhythmic (2)

Answer 26

1. Verapamil 2. Diltiazem

Question 27

Adenosine - mechanism - used for?

Answer 27

- increases K out of cell --\> hyperpolarize -\> decrease Ca current - used for dx/abolishing SVT b/c short term (15sec)

Question 28

how does adenosine effects last?

Answer 28

15 seconds

Question 29

Adverse effects of adenosine (3)

Answer 29

1. flushing 2. hypotension 3. chest pain

Question 30

Mg in cardiac pharamcology

Answer 30

effective in TdP and dig toxicity