Flashcards in Cardiovascular 2 Anti-arrhythmics Deck (57)
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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
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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
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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
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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)
15
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
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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
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Dx-Dx interactions for Adenosine
agents that have vascular impact (nicotine, caffeine); dipyridamole, carbamazepine, digoxin
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Monitoring for Adenosine
EKG, HR, BP
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PG category for Adenosine
PG C
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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
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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
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Monitoring for Digoxin
HR & rhythm, serum dig level, serum K+, eGFR, electrolytes, serum Ca, Mg, K, mental state (confusion, depression)
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PG category for Digoxin
PG D
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Drug class for MgSO4
other
51
MoA for MgSO4
unknown
52
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
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Contra-indications for MgSO4
heart block
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Dx-Dx interactions for MgSO4
multiple
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Monitoring for MgSO4
EKG, vital signs, serum Mg, K, Ca; eGFR, SaO2
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