Cardiovascular 2 Anti-arrhythmics Flashcards Preview

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Flashcards in Cardiovascular 2 Anti-arrhythmics Deck (57):
1

Drug class for Procainamide

class 1A Na channel

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MoA for Procainamide

Decreases myocardial excitability and conduction velocity and may depress myocardial contractility, by increasing the electrical stimulation threshold of ventricle, His-Purkinje system and through direct cardiac effects (UtD)

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Indications for Procainamide

life threatening ventricular arrhythmias

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SE/ADRs for Procainamide

hypotension, N/V/D, SLE sxs, agranulocytosis (w/ prolonged use), QTc prolongation

5

Contra-indications for Procainamide

complete heart block, 2nd deg AV block, SLE, tornadoes de pointes

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Dx-Dx interactions for Procainamide

other anti-arrhythmics

7

Monitoring for Procainamide

ECG, BP, eGFR, BUN, CBC, ANA titers, liver function, procainamide/NAPA conc (in liver disease)

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PG category for Procainamide

PG C

9

Drug class for Lidocaine

class 1B Na channel

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MoA for Lidocaine

blocks both the initiation and conduction of nerve impulses by decreasing the neuronal membrane's permeability to sodium ions, suppresses automaticity of conduction tissue, by increasing electrical stimulation threshold of ventricle, His-Purkinje system, and spontaneous depolarization of the ventricles during diastole (UtD)

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Indications for Lidocaine

suppression of existing ventricular arrhythmias

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SE/ADRs for Lidocaine

arrhythmias, CV collapse, increase defib threshold, edema, heart block, hypotension, agitation, anxiety, metallic, taste, bronchospasm

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Contra-indications for Lidocaine

severe SA, AV interventricular heart block w/out pacemaker, corn allergy

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Dx-Dx interaction for Lidocaine

multiple (prolonged use)

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Monitoring for Lidocaine

liver function, serum concentration, ECG, BP

16

PG category for Lidocaine

PG B

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Drug class for Flecainide

class 1C Na channel

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MoA for Flecainide

slows conduction in cardiac tissue by altering transport of ions across cell membranes; causes slight prolongation of refractory periods; increases electrical stimulation threshold of ventricle, His-Purkinje system

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Indications for Flecainide

ventricular arrhythmias (prevention); PSVT (prevention); paroxysmal A fib/flutter

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SE/ADRs for Flecainide

dizziness, blurred vision, dyspnea, palpitations, HA, pro-arrhythmic potential

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Contra-indications for Flecainide

pre-existing 2 or 3 deg heart block, RBBB w/out pacemaker, cardiogenic shock

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Dx-Dx interactions for Flecainide

multiple

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Monitoring for Flecainide

ECG, BP, HR, periodic trough serum levels w/ renal or liver impairment

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PG category for Flecainide

PG C

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Flecainide should not be used for what chronic arrhythmia?

A fibrillation

26

Drug class for Amiodarone

Class 3 Repolarization delay

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MoA for Amiodarone

inhibits adrenergic stimulation (alpha/beta) affecting Na, K, Ca channels; prolongs action potential & refractory period in cardiac tissues; decrease AV conduction & sinus node function

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Indications for Amiodarone

life-threatening recurrent VF, unresponsive or unstable VT refractory to other anti-arrhythmic; off label- AF, PSVT, adjunct to ICD to suppress ventricular tacky in otherwise optimally tx patients w/ HF

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SE/ADRs for Amiodarone

pulm toxicity, exacerbation of arrhythmias, optic neuritis, photosensitivity

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Contra-indications for Amiodarone

hypersensitivity to iodine, cardiogenic shock, severe sinus node dysfunction, 2nd or 3rd deg HB or severe bradycardia without pacemakers

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Dx-Dx interactions for Amiodarone

multiple, avoid grapefruit juice

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Monitoring for Amiodarone

BP, HR, EKG, PE for lethargy, edema, wt loss, pulm toxicity, LFT, electrolytes, thyroid function, eye exams w/ long term use

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PG category for Amiodarone

PG D

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Drug class for Adenosine

other

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MoA for Adenosine

-PSVT: slows conduction time through AV node, interrupting the re-entry pathways & restoring normal sinus rhythm
-Stress test: causes coronary vasodilation & increases blood flow in normal coronary arteries w/ little or no increase in stenotic coronary arteries

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Indications for Adenosine

PSVT, pharmacologic stress testing

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SE/ADRs for Adenosine

new arrhythmias, chest pain, HA, flushing, dyspnea, bronchospasm

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Contra-indications for Adenosine

2nd or 3rd deg AV block, sick sinus syndrome, symptomatic brady (except ones w/ pacemaker), known bronchoconstrictive or bronchospastic lung disease, asthma

39

Dx-Dx interactions for Adenosine

agents that have vascular impact (nicotine, caffeine); dipyridamole, carbamazepine, digoxin

40

Monitoring for Adenosine

EKG, HR, BP

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PG category for Adenosine

PG C

42

Drug class for Digoxin

other: cardiac glycoside

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MoA for Digoxin

inhibits Na/K ATPase pump in myocardial cells promoting influx Ca leadings to increased contractility; also direct suppressor of AV node which decreases ventricular rate

44

Indications for Digoxin

mild to moderate HF; A fib rate control

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SE/ADRs for Digoxin

incomplete heart block may proceed to complete block, digoxin toxicity, SSS

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Contra-indications for Digoxin

V fib, co-existing thyroid disorders, recent MI

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Dx-Dx interactions for Digoxin

Amiodarone, verapamil; multiple others

48

Monitoring for Digoxin

HR & rhythm, serum dig level, serum K+, eGFR, electrolytes, serum Ca, Mg, K, mental state (confusion, depression)

49

PG category for Digoxin

PG D

50

Drug class for MgSO4

other

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MoA for MgSO4

unknown

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Indications for MgSO4

digitalis induced arrhythmias w/ low serum Mg; low Mg induced arrhythmias (VF, VT); off label-torsades (severe exacerbation asthma in kids)

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SE/ADRs for MgSO4

flushing, hypotension, hypermagnesemia

54

Contra-indications for MgSO4

heart block

55

Dx-Dx interactions for MgSO4

multiple

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Monitoring for MgSO4

EKG, vital signs, serum Mg, K, Ca; eGFR, SaO2

57

PG category for MgSO4

avoid