Drugs For Cardiac Arrhythmias - Dr. Konorev

Question 1

antiarrhymia drugs :
class 1
class 2
class 3
class 4

Answer 1

1. Na channel Blockers class, ABC
2. Beta blockers
3. K+ Channel Blockers
4. Cardioactive CCB

Question 2

class 1A drugs 3

Answer 2

= Na channel Blockers class

1. Quinidine
2. Procainamide
3. Disopyramide

Question 3

class 1B drugs 2

Answer 3

= Na channel Blockers class

1. Lidocane
2. Mexiletine

Question 4

class 1C drugs 2

Answer 4

= Na channel Blockers class

1. Flecainide
2. Propafenone

Question 5

Class 2 drugs 2

Answer 5

= BB

1. Esmolol
2. Propanolol

Question 6

Class 3 Drugs 4

Answer 6

= K+ Channel Blocker

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

Question 7

Class 4 drugs 2

Answer 7

= Cardioactive CCB

1. Dilitiazem
2. Verapamil

Question 8

Fast AP where

Answer 8

1. Ventricular contractile cells
2. Atrial cells
3. Purkinje fibers

Question 9

Slow AP where

Answer 9

1. SA node

2. AV node

Question 10

Fast AP phases

Answer 10

0 : fast Na+ open , Na+ enters cell
1 : K+ exit cell, Na+fast close (some repolarization)
2. plateau phase, K+ exit, Ca+ enter slow voltageC
3. Ca+2 slow close, K+ exits faster
(fast repolarization)
4. resting membrane potential (Na/K+, and Na/Ca)

Question 11

phase 4 has what channels pacemaker (slow AP)

Answer 11

1. If (funny current) : Na+ channel, K+ channels
2. slow Ca+
   = slanted up line until threshold

Question 12

phase 0 has what channels pacemaker (slow AP)

Answer 12

1. slow L type (long lasting Ca+ influx)

Question 13

phase 3 has what channels pacemaker (slow AP)

Answer 13

1. K+ exits, repolarization

2. Ca+ close

Question 14

no class antiarrhythmic drug

Answer 14

adenosine

Question 15

refractory period

Answer 15

Na+ inactive stage

Question 16

class 1 drug Na blockers MOA

Answer 16

Block Na = prolong phase 0

Block K+ = prolong AP duration

Question 17

class 1 drug Na blockers EKG changes

Answer 17

1. prolong QRS (NA+ block)
2. prolong QT interval (K+
   block)

Question 18

Procainamide clinical use

Answer 18

1. not as much due to lupus related side effects

2. sustained V Tachy, or MI arrhythmia

Question 19

Procainamide adverse effects

Answer 19

1. prolong QT
2. torsade de pointes **
3. syncope
4. Lupus erythemaatosus syndrome ** + arthritis, pleuritis, pulm D, fever, hep
5. hypotension

Question 20

Quinidine is from what and clinical use

Answer 20

Cinchona bark

1. rare
2. may enhance AV conductance

Question 21

Quinidine adverse effects

Answer 21

QT interval prolongation
torsade de pointes **
GI issues
CNS probs

Question 22

Disopyramide MOA beside Na block

clinical use

Answer 22

anti-muscarinic effect

= recurrent V arrythmias

Question 23

Disopyramide adverse effects

Answer 23

1. QT prolongation **
2. torsades de pointes **
3. • iontrophic effect can cause HF
4. atropine -like sx : tachy, dry, blurred vision, C, urinary retention

Question 24

class 1B drugs do what

Answer 24

block NA by binding to inactivated NA (long QRS)

DONT block K+ (QT and AP length normal)

Question 25

Lidocaine administered how and clinical use

Answer 25

IV only = ventricular tachy during Acute MI = also used for a local anesthetic

Question 26

Lidocaine adverse effects

Answer 26

least toxic | - can cause hypotension , tremor, slurred speech, paresthesias

Question 27

Mexiletine administration and clinical use

Answer 27

oral = V arrhythmia = chronic pain relief (diabetic neuropathy + nerve injury)

Question 28

Mexiletine adverse effects

Answer 28

tremor blurred vision lethargy

Question 29

Class 1C drugs do what

Answer 29

``` block NA (prolong QRS) Block K+ (only same QT and AP length) ```

Question 30

Flecainide clinical use

Answer 30

= supraventricular arrhythmia | = refractory severe V arrhythmia

Question 31

Flecainide adverse reactions

Answer 31

make arrhythmia worse

Question 32

Propafenone clinical use

Answer 32

= supraventricular arrhythmia

Question 33

Propafenone adverse effect

Answer 33

worse arrhythmia

Question 34

Class 2 drugs effect what channels and usually acts on what cells

Answer 34

1. increase cAMP 2. If (funny current) to open slower 3. lower Ca channel = pacemaker cells (lower slope of phase 4

Question 35

BB have what effect on EKG

Answer 35

1. SA = decrease HR (longer RR interval) | 2. AV = decrease AV conductance (longer PR interval)

Question 36

Propanolol clinical use

Answer 36

``` cardiac arrhythmia from : = atrial flutter, atrial fib = stress and thyroid storm = MI = Paroxysmal supraventricular arrhythmia ```

Question 37

Esmolol clinical use and administration

Answer 37

short lived B1 blocker, continuous IV = supraV = thyrotoxicosis

Question 38

Class 3 drugs do what

Answer 38

block K+ (regulate AP length = regulating refractory period)

Question 39

BB and EKG

Answer 39

prolong QT segment | = lower slope of phase 3

Question 40

Amiodarone clinical use

Answer 40

most used = recurrent V tachy = atrial fib (slows HR and AV conduction)

Question 41

Amiodarone adverse effects

Answer 41

= fatal pulmonary fibrosis = hypo or hyperthyroidism = torsades de pointes (since it prolongs QT and AP) ONLY RARE with this drug**

Question 42

Sotalol does what and clinical use

Answer 42

= nonselective B blocker and K+ blocker = severe V arrhythmia = atrial fib to keep sinus rhythm

Question 43

Sotalol adverse effects

Answer 43

1. torsades | 2. depress cardial function

Question 44

Doferilide and Ibutilide clinical use

Answer 44

restore sinus rhythm esp after Atrial fib Doferilide maintains it

Question 45

Class 4 drugs L CA+ channels

Answer 45

also has inactive phase | = Ca+ usually closes the gate (when its high ICM)

Question 46

Class 4 drugs L CA+ channels does what to graph and what cells

Answer 46

1. phase 0 decrease slope | 2. increase threshold potential in SA and AV node

Question 47

Verapamil, Diltiazem clinical use

Answer 47

= termination + prevention of paroxysmal supraventricular tachycardia = V rate during A fib and a flutter controlled

Question 48

adenosine does what MOA

Answer 48

1. activates a Gi 2. increase K+ exit and inhibit Ca+, inhibit If 3. hyperrepolarization, lowering AP

Question 49

adenosine clinical use

Answer 49

sinus rhythm in paroxysmal supraventricular arrhythmia | by IV

Question 50

Adenosine cells it acts on and graph

Answer 50

``` pacemaker cells (AV and SA) = inhibits AV conduction and longer AV refractory period ```