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DT III Exam 1 > Drugs to Treat Dysrhythmias > Flashcards

Drugs to Treat Dysrhythmias Flashcards

(69 cards)

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1
Q

Effects of Proarrhythmic drugs (4)

A

Increased automaticity
Conduction block or slowing
Decreased/ increased ERPs
Heterogeneity of ERP

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2
Q

Effects of antiarrhythmic drugs (5)

A

Decreased automaticity
Restore conduction (depressed conduction/ reverse reentry)
Decreased conduction
Decreased/ increased ERPs (reverse/ block reentry)
Homogeneity of ERPs

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3
Q

Class I antiarrhythmic drug

A

Na channel block

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4
Q

Class II antiarrhythmic drug

A

Beta-receptor block

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5
Q

Class III antiarrhythmic

A

Prolong APD

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6
Q

Class IV antiarrhythmic

A

Ca channel block

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7
Q

Class IA

A

Moderate dissociation rate

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8
Q

Class IB

A

Rapid dissociation

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9
Q

Class IC

A

Slow dissociation

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10
Q

State dependent ion channel block

A 
Class I antiarrhythmic drug
Binding to open/ inactivated channel
Association during systole
Dissociation during diastole
Block related to depolarization (HR, ischemia, APD)
Block related to dissociation rate
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11
Q

Class IA drugs (3)

A

Procainamide

Quinidine, Disopyramide

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12
Q

Procainamide

A

Class IA drug

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13
Q

Class IA: function

A

Direct effect: decrease automaticiy and conduction velocity, increase APD and ERP
Anticholinergic effects

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14
Q

Class IA: effects on AV node

A

Direct effect= decrease AV conduction
Anticholinergic= increase AV conduction
Net= variable AV conduction

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15
Q

Class IA: contra

A

Prolonged QT syndrome causes Torsades de pointes

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16
Q

Class IA: indication

A

Life-threatening ventricular arrythmia

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17
Q

Procainamide: kinetics

A

Well absorbed orally (or IV)

RE and HM

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18
Q

Procainamide active metabolite

A

NAPA

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19
Q

Procainamide: ADR

A

+ANA (Lupus-like syndrome)
Agranulocytosis/ Leuopenia
Proarrhythmic effects
Conduction block, decreased myocardial contractility, hypotension, GI

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20
Q

Procainamide: contra

A

Prolonged QT
Hypokalemia
SLE

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21
Q

Class IB

A

Lidocaine

Mexiletine

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22
Q

Lidocaine

A

Class IB drug

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23
Q

Mexiletine

A

Class IB drug

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24
Q

Class IB: general characteristics

A

Minimal effects on normal myocardium

Class IA action in diseased myocardium

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25
Lidocaine: indication
Life threatening V arrhythmias | Digoxin-induced arrhythmias
26
Lidocaine: pharmacokinetics
HM (first pass elimination) Decrease dose in liver disease and CHF IV only
27
Lidocaine: ADR
CNS (disorientation to seizures) Hypotension Decrease cardiac contractile
28
Lidocaine: Contra
Hypersensitivity to Amides Severse hepatic dysfunction History of lidocaie-induced seizures
29
Mexiletine: ADR
GI Tremors CNS Thrombocytopenia *
30
Class IC
Flecainide | Propafenone
31
Clas IC: general
Markedly slow conduction ADP, ERP +/- Decrease automaticity
32
Flecainide: indication
Life threatening V. arrhythmias in absence of organic heart disease Disabling supraventricular arrhythmias in absence of organic heart disease
33
Flecainide: ADR
``` Increase Post MI mortality Conduction block CHF (by decreased contractility) Proarrhythmic AV block ```
34
Propafenone: general
Similar to Flecainide Weak Beta blockade (class II) Proarrhythmic Negative inotropic effect *
35
Class II: MoA
``` Inhibit sympathetic input Decrease automaticity Decrease conduction velocity Increase Refractoriness Prominent effects on SA/ AV nodes Decrease contractility ```
36
Class II: indication
``` Supraventricular arrhythmia A flutter and fib Symptomatic PVC Post MI CHF ```
37
Class II: ADR
``` Bronchoconstriction CHF AV block Cold extremities Increase insulin induced hypoglycemia Block Increase in HR (hypoglycemia) ```
38
Class II (3)
Propranolol (nonspecific Beta blocker) Metoprolol (cardioselective beta-blocker) Esmolol (cardioselective, short, control V rate in A fib/ flutter, control sinus tachycardia)
39
Class III: general
Homogeneous prolongation of APD (proarrhythmic)
40
Class III: indication
Refractory, life-threatening ventricular arrhythmia
41
Class III drugs
Amilodarone Dronedarone Ibutilide/ Dofetilide
42
Amiodarone:general
Highly efficacious DOC acute suppression of V arrhythmia refractory life threatening V tach Sustained V tach
43
Amiodarone: kinetics
Highly lipophilic | Very long half life (month)
44
Amiodarone
Class III
45
Amilodarone: ADR
``` Pulmonary fibrosis Hyper/hypothyroidism Hepatotoxicity AV block, Bradycardia Proarrhythmic Corneal microdeposite, photosensitivity, blue/gray nose/ cheeks ```
46
Dronedarone
Class III
47
Dronedarone: indication
Prevent A flutter/ fib
48
Dronedarone: kinetics
24 hr half life
49
Dronedarone: ADR
Increase mortality in CHF Liver injury/ failure (Monitor liver function 6 mos)
50
Ibutilide/ Dofetilide
Class III
51
Ibutilide/ Dofetilide: inidication
Prolong ADP/ERP | Terminate A flutter/ fib
52
Ibutilide/ Dofetilide: ADR
Proarrhythmic (Torsades de pointes)
53
Sotolol
Class III + nonselective Beta blockade
54
Sotolol: indication
Life-threatening ventricular arrhythmia | Prevent recurrence of symptomatic A flutter/ fib
55
Sotolol: ADR
Prolongs QT (Torsades de pointes)
56
Verapamil
Class IV
57
Class IV
Verapamil
58
Verapamil: MoA
In SA/ AV nodes Decrease firing rate of SA node (decrease HR) Decreased conduction velocity in AV node Increase APD and ERP (increase AV refractoriness) In Atrial/ ventricular muscle Decrease contractility Vasodilation + decrease CO= Decrease BP
59
Class IV: indication
Supraventriular arrhythmias PSVT with AV notal reentry A flutter/ fib
60
Verapamil: ADR
Hypotension CHF AV block Constipation
61
Verapamil: drug interaction
Concurrent Beta blocker Digoxin Antiarrythmic drugs HM interaction (Cimetidine)
62
Adenosine
Decrease AV doncution short acting Rapid uptake/ adenosine deaminase Rapid bolus dosing
63
Adenosine: indication
Acute termination of PSVT
64
Adenosine: ADR
Asthma and COPD
65
Vagomimetics
Decrease AV conduction
66
Terminate PSVT
Valsalva | Carotid sinus massage
67
Drug that controls V rate in A/ fib and flutter
Digoxin
68
Drugs that increase conduction, AS node rate | Treat bradyarrhythmias
Atropine | Isoproterenol
69
Know the graphs for Class I-IV
Refer to the lecture ppt 1/14/2016

DT III Exam 1 (5 decks)

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