Na+ channel blockers and Beta blockers Flashcards Preview

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Flashcards in Na+ channel blockers and Beta blockers Deck (26):
1

Digoxin

Na+/K+/ATPase pump inhibitor

positive inotrope --> increased intracellular Ca2+ (reduced NCX activity) --> increased contractility and SV

negative chronotrope --> prolongation of AP in SA node = decreased HR

**toxic side effects, not first line

2

Class I Na+ channels blockers alter effective refractory period based on________.

non-specific K+ channel blockage

3

moderate Na+ channel blockade

increased effective refractory period

Class IA

ie. quinidine

4

weak Na+ blockade

decreased effective refractory period

Class IB

ie. lidocaine

5

strong Na+ blockade

no net effect on effective refractory period

Class IC

ie. flecainide

6

-inhibit sympathetic activation of cardiac automaticity

-used to prevent and treat supraventricular arrhythmias

Beta blockers

7

Beta blockers effect on AV node conduction:

What would this look like on EKG?

Decreased AV node conduction

Increased PR interval

8

Beta blockers effect on AV node refractory period:

Increased

9

Beta blockers effect on ventricular conduction and repolarization:

little to none

10

Beta blocker with some Class I activity

-AE: bronchospasm, bradycardia, fatigue

Propanolol

11

Cardioselective B-blocker

-better for pts with asthma

Acebutolol

12

Short acting B-blocker

-used intraoperatively and in acute arrhythmias

Esmolol

13

Non-selective b-blocker

-prolongs action potential (delays slow outward K+ current)

Sotalol

14

Class IA

Cardiac effects: slows AP, slows conduction, prolongs QRS, prolongs APD via non-specific K+ blockade

Extracardiac effects: ganglion blocking --> reduces peripheral vascular resistance can cause hypotension

Tox: excessive AP prolongation, long QT, TORSADES de POINTES arrhythmia and syncope, excessive slowing of conduction
-long term can cause lupus like syndrome

PK: metabolite (NAPA) has class III activity associated w/ TORSADES
-hepatic metabolism of NAPA and renal excretion
-NAPA has longer half-life than procainamide
-plasma protein binding 15-20%

Used in: atrial and ventricular arrhythmias
-2nd or 3rd line for sustained ventricular arrhythmias associated with acute MI

Procainamide

15

Class IA
Cardiac effects: slows upstroke of AP, long QRS, long APD (non-specific K+ blockade), ANTIMUSCARINIC effects

Extracardiac effects: GI, cinchonism (HA, dizziness, tinnitus) at toxic conc.

Tox: long QT, TORSADES

PK: GI absorption, hepatic metabolism, renal excretion

Used in: rarely used d/t side effects and availability of less toxic drugs

Quinidine

16

Class IA
Cardiac Effects: slow upstroke of AP, slow conduction, long QRS, long APD (via non-specific K+ blockade), antimuscarinic

Extracardiac effects: Atropin-like activity --> urinary retention, dry mouth, blurred vision, constipation

Toxicity: same as Quinidine. may precipitate HF de novo or in preexisting depression of LV function. Not first line in USA or in pts with HF.

PK: NO loading dose --> de novo HF.
-Hepatic metabolism, renal excretion.
-protein binding 50-60%

Used in: ONLY ventricular arrythmias in USA.

Disopyramide

17

Class IB
Cardiac effects: selective depression of conduction in depolarized cells. Little effects on EKG in NSR.

Extracardiac effects: not much?, pretty well tolerated

Tox: one of the least toxic class I's, neurologic: paresthesias, tremor, nausea of central origin, lightheadedness, hearing disturbances, slurred speech, and convulsions. These occur most commonly in elderly or otherwise vulnerable patients or when a bolus of the drug is given too rapidly

PK: extensive first pass hepatic metabolism --> only 3% of oral admin gets to plasma...... must give parenterally. Half-life 1-2 hours.

Used in: first line for V-tach and preventing V-fib AFTER cardioversion in acute ischemia
****prophylactic use may increase total mortality

Lidocaine

18

Class IB
Cardiac effects: orally active congener of lidocaine

Extracardiac effects: good efficacy in relieving chronic pain --> esp d/t diabetic neuropathy and nerve injury (off-label)

Tox: predominantly neurologic, including tremor, blurred vision, and lethargy

PK: elimination half-life is 8–20 hours and permits administration two or three times per day

Uses: Ventricular arrhythmias, chronic pain (off label)

Mexiletine

19

Class IB
Cardiac effects: selective depression of conduction of depolarized cells (not much change on EKG in NSR)

Lidocaine analog withOUT sig first pass metabolism

***not sold in USA

Tocainide

20

Class IC
Cardiac effects: slows upstroke of AP, slows conduction. Potent Na+ and K+ blocker--SLOW unblocking kinetics. Does NOT prolong AP or QT.

Tox: severe exacerbation of arrhythmia in patients with preexisting ventricular tachyarrhythmias, previous myocardial infarction and ventricular ectopy

PK: half-life of approximately 20 hours. Elimination is both by hepatic metabolism and by the kidney

Uses: PVCs, supraventricular arrhythmias

Flecainide

21

Class IC
Cardiac effects: slows upstroke of AP, slows conduction. Weak Beta-blocker. No effect on AP duration.

Tox: metallic taste and constipation

PK: metabolized in the liver, with an average half-life of 5–7 hours

Uses: supraventricular arrhythmias

Propafenone

22

Class IC
Cardiac effects: Potent Na+ channel blocker, no prologation of AP.

used to treat ventricular arrhythmias

***not sold in USA

Moricizine

23

Class II
Cardiac effects: non-selective beta antagonist. decreases heart rate, myocardial contractility, blood pressure, and myocardial oxygen demand

Tox: a lot; see Katzung's

PK: Extensive first-pass effect, hepatically metabolized. Oral: ~25%; oral bioavailability may be increased in Down syndrome children; protein-rich foods increase bioavailability of immediate release formulations by ~50%

Uses: mostly HTN, also migraine prophylaxis

Propanolol

24

Class II

Cardiac effects: β1, β2 antagonist, with intrinsic sympathomimetic (partial agonist) effect
-Lower BP • modestly lower HR

Uses: Hypertension • arrhythmias • migraine • may avoid worsening of bradycardia

PK: Oral •

Toxicity: Fatigue • vivid dreams • cold hands

Acebutolol

25

Class II

Cardiac effects: Blockade of β1 > β2. Very brief cardiac β blockade

Uses: Rapid control of BP and arrhythmias, thyrotoxicosis, and myocardial ischemia intraoperatively

PK: Parenteral only • half-life ∼10 min •

Toxicity: Bradycardia • hypotension

Esmolol

26

Class II (and III)

Cardiac effects: both β-adrenergic receptor-blocking (class 2) and action potential-prolonging (class 3) actions

PK: well absorbed orally with bioavailability of nearly 100%. It is NOT** metabolized in the liver (few drug-drug interaction) and is not*** bound to plasma proteins.
Excretion- predominantly by the kidneys. Half-life of approximately 12 hours

Uses: life-threatening ventricular arrhythmias
-maintenance of sinus rhythm in patients with atrial fibrillation
-approved for treatment of supraventricular and ventricular arrhythmias in the pediatric age group
-decreases the threshold for cardiac defibrillation.

Sotalol