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Pharmacology > Exam 6 - Antiarrhythmic Drugs > Flashcards

Exam 6 - Antiarrhythmic Drugs Flashcards

(61 cards)

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1
Q

Causes of arrhythmias: abnormal automaticity

A
  • enhanced automaticity of SA node
  • damaged myocardial cells
  • after-depolarization (abnormal impulses) triggered by abnormal calcium influx provoked by digoxin toxictiy
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2
Q

Causes of arrhythmias: abnormalities in impulse conduction

A
  • reentry (most common cause of arrhythmias)

- unidirecitonal

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3
Q

Drug induced arrhythmias

A
  • Sympathetic drugs
  • Hypokalemia increase automaticity
  • Digoxin
  • Antiarrhythmic, antipsychotic drugs (ziprasadone)
  • DO NOT USE ANTIARRHYTHMICS IN HF
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4
Q

Drug induced arrhythmias: Sympathetic drugs

A
  • increase automaticity of SA and AV

- produces tachyarrhythmia

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5
Q

Drug induced arrhythmias: Digoxin

A
  • evokes after-depolarization (abnormal impulses) by increasing calcium influx into cardiac cells - can lead to extrasystole and tachycardia (toxic concentration)
  • impair AV node conduction
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6
Q

Drug induced arrhythmias: antiarrythmias, antipsychotic drugs

A

slow ventricular repolarization and cause QT prolongation evokes torsade de pointes

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7
Q

When should you not use antiarrhythmic?

A

Do not use antiarrhythmic in HF (except Amiodarone and Dofetilide)

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8
Q

Class IA

A

Na+ channel blocker

K+ channel blocker

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9
Q

Class IB

A

Na+ channel blocker

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10
Q

Class IC

A

Na+ channel blocker

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11
Q

Class II

A

B-adrenergic blocker

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12
Q

Class III

A

K+ channel blocker

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13
Q

Class IV

A

Ca2+ channel blocker

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14
Q

Procainamide

A

Class I Na+ channel blocker

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15
Q

Procainamide MOA

A

binds to sodium and potassium channels

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16
Q

Procainamide indiations

A

ACLS guidelines

- stable Wide-QRS tachycardia (ventricular arrhythmia

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17
Q

Procainamide adverse effects

A
  • systemic lupus erythematosus

- Torsade de pointes

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18
Q

Lidocaine

A

Class IB

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19
Q

What is Lidocaine?

A

Local anesthetic and has antiarrhythmic activity (more pronounced effect on ischemic tissue)

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20
Q

Lidocaine indications

A
  • ACLS guidelines
  • ALTERNATIVE TO AMIODARONE IN VENTRICULAR FIBRILLATION (VF)
  • pulseless ventricular tachycardia (PVT)
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21
Q

Propafenone

A

Class IC

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22
Q

Propafenone pharmacokinetics

A

Beta-blocker properties

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23
Q

Propafenone indications

A

Atrial fibrillation (AF)

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24
Q

Propafenone adverse effects

A

Bronchospasms

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25
Propafenone drug interactions
increase digoxin levels (toxicity)
26
Metoprolol | Atenolol
Class II drugs: B-blockers
27
Metoprolol and Atenolol MOA
inhibit sympathetic activation of cardiac automaticity and conduction
28
Metoprolol and Atenolol Indications
ACLD guidelines - stable narrow QRS irregular rhythm (narrow = atrial arrhythmia) - stable narrow QRS regular rhythm not controlled by adenozine
29
Amiodarone
Class III
30
Amiodarone MOA
- blocks potassium channel | - infrequently causes torsades de pointes
31
Amiodarone pharmacokinetics
- inhibits many CYP 450 isoenzymes | - long onset of action (half-life 40 days)
32
Amiodarone indications
ACLS guidelines - VF/pulseless VT unresponsive to CPR, defibrillation, and vasopressor therapy - stable VT - ATRIAL FIBRILLATION (PATIENTS W/ HF)
33
Amiodarone interactions
inhibits 1A2, 2C9, 2D6, and 3A4 - digoxin - warfarin - lovastatin and simvastatin
34
Amiodarone adverse effects
- hypotension - blue-gray discoloration (smurf syndrome) - photosensitivity - thyroid abnormalities (hypo or hyperthyroidism) - increase in liver enzymes - pulmonary fibrosis, pneumonitis - corneal deposits - optic neuritis
35
Ibutilide
Class III
36
Ibutilide MOA
blocks potassium channel
37
Ibutilide indications
conversion of AF to normal sinus rhythm
38
Ibutilide adverse effects
torsades de pointes
39
Dofetilide
Class III
40
Dofetilide MOA
blocks potassium channel
41
Dofetilide indications
- atrial fibrillation (AF) [CAD and HF; must initiate in hospital] - renal dosage adjustment
42
Dofetilide adverse effects
Torsade de pointes (due to QT prolongation)
43
Sotalol
Class III
44
Sotalol MOA
blocks potassium channel
45
Sotalol indications
``` ACLS guidelines - stable wide-QRS tachycardia (VT) Atrial arrhythmias (AF) ```
46
Sotalol adverse effects
- torsades de pointes (due to QT prolongation) - bronchospasms DO NOT USE IN HF
47
Ditliazem and Verapamil
nondyhydropyridine
48
Diltiazem and Verapamil indications
ACLS guidelines - stable narrow QRS irregular rhythm - stable narrow QRS regular rhythm not controlled by adenosine
49
Adenosine pharmacokinetics
administered IV bolus; extremely short half-life (10 sec)
50
Adenosine MOA
activates adenosine receptors
51
Adenosine indication
ACLS guidelines - stable, narrow complex regular tachycardia - stable, regular, monomorphic, wide complex tachycardia as a therapeutic and diagnostic maneuver
52
Adenosine adverse effects
- flushing - hypotension - bronchospasm, dyspnea - chest discomfort
53
When should you avoid adenosine?
patients w/ asthma
54
Digoxin and Magnesium sulfate (having to do w/ magnesium)
- magnesium deficiency can contribute to arrhythmias - ACLS guidelines: torsade de pointes - Adverse effects: hypotension, CNS toxicity, respiratory depression
55
Atrial fibrillation: rate control
- B-blocker - calcium channel blockers (nondihydropyridine) - digoxin
56
Atrial fibrillation: rhythmic control
antiarrhythmic drugs
57
Antiarrhythmic drug therapy for AF (1st line): Normal or minimal heat disease
Propafenone | Sotalol
58
Antiarrhythmic drug therapy for AF (1st line): HTN w/o LVH
Propafenone | Sotalol
59
Antiarrhythmic drug therapy for AF (1st line): HTN w/ LVH
Amiodarone
60
Antiarrhythmic drug therapy for AF (1st line): HF
Amiodarone | Dofetilide
61
Antiarrhythmic drug therapy for AF (1st line): CAD
Sotalol | Dofetilide

Pharmacology (19 decks)

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