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CRRAB I > Nordgren Drugs > Flashcards

Nordgren Drugs Flashcards

1
Q

Class I: Sodium channel blockers

  • USE
  • MOA
  • alteration to AP
  • effective where…
A
  • treat tachycardias
  • bind to and block fast Na+ channels (responsible for rapid depol of phase 0)
  • Decreases…
    • slope of phase 0 - affects conduction velocity
    • amplitude of action potential
  • effective in abnormal>normal tissue
  • some drugs have non-specific activity on efflux of K+
  • Subclasses
    • differ in efficiency of reducing phase 0 slope
    • differ in ERP - K+ efflux effect
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2
Q

Class IA

  • Drug examples
  • mechanism
  • effect on AP
A
  • quinidine, procainamide, disopyramide
  • moderate Na+ blockade
  • increases ERP
  • increases QT
  • increases QRS
  • increases action potential duration
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3
Q

Class IB

  • Drug examples
  • mechanism
  • effect on AP
A
  • Lidocaine, mexiletine, tocainide
  • WEAK Na+ blockade
  • WEAK inverse K+ influx
    • DECREASES ERP –> shorter QT
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4
Q

Class IC

  • Drug examples
  • mechanism
  • effect on AP
A
  • Flecainide, Propafenone, Moricizine
  • STRONG Na+ blockade = slows upstroke and conduction
  • no effect on K+
  • Widens QRS and elongates PR
    • no change in ERP
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5
Q

Procainamide

A
  • Class IA
  • prolongs PR, QRS and QT
  • Could cause..
    • torsades de pointes
    • lupus like erythematosus
  • hepatic (liver) met.
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6
Q

Quinidine

A
  • Class IA
  • prolongs PR, QRS, and QT
  • causes torsades de points
  • heptatic met and renal excretion
  • RARELY used
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7
Q

Disopyramide

A
  • Class IA
  • prolongs PR, QRS, and QT
  • atropine like effects
  • no loading dose - could cause heart failure
  • effective for ventricular arrythmias
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8
Q

Lidocaine

A
  • Class IB drugs
  • shorters QT interval - little effect on ECG
  • one of least cardiotoxic
  • extensive hepatic met.
  • used to terminate V tach or prevent after cardioversion
    • do not use prophylactically - could increase total mortality
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9
Q

Mexiletine

A
  • Class IB
  • shortens QT
  • orally active form of lidocaine
  • good for reliveing chronic pain - diabetic neuropathy and nerve injury
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10
Q

Tocainide

A
  • Class IB
  • shortens QT
  • lidociane analog
  • no longer sold in US
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11
Q

Flecainide

A
  • Class IC
  • Slows upstroke of AP
    • slows conduction
  • potent blocker of Na and K channels
  • slow unblocking kinetics - doesn’t prolong AP or QT interval
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12
Q

Propafenone

A
  • Class IC
  • slows upstroke of AP
  • weak B-blocking activity
  • doesn’t prolong AP
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13
Q

Strenth of class I on sodium channel blockade

A

IC > IA > IB

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14
Q

Class I effects on ERP

A
  • IA INCREASES
  • IC has NO EFFECT
  • IB SHORTENS
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15
Q

Class II: Beta Blockers

A
  • MOA: inhibit sympathetic activation
    • SLOW heart rate
    • DECREASE av node conduction velocity
    • INCREASE av node refractory period
    • no effect on ventricular conduction and repol.
  • treats supraventricular arrythmias and reduces ventricular ectopic depolarizations + sudden death in patients with MI
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16
Q

Describe the 4 Class II drugs Nordgren wants us to know

A
  1. Propranolol - some class I activity - adverse effects are bronchopasmi, bradycardia, fatigue
  2. Acebutolol - cardioselective B blocker - works good for asthma
  3. Esmolol - short acting for procedures or acute arrythmia
  4. Sotalol - nonselective B blcoker that prolongs action potential (slow outward K+)
17
Q

Amiodarone

A
  • K+ blocker
  • can block K+, Na+, Ca++, and beta blocker
    • ​prolongs AP, slows HR and AV node conduction
  • hepatic met.
  • Treats: V-tach, V-fib, a-fib, a-flutter
  • Toxicity = dose related pulmonary toxicity
    • ​accumulates in tissues
    • bradycardia, heart block
18
Q

Dofetilide

A
  • K+ channel blocker
  • selective for K+ - increases QT and prolongs AP
  • liver met.
  • Use = restores normal sinus rhythm in a-fib
    • don’t sue w/long QT, bradycardia, or hypokalemia
  • TOX = life threatening v. arrythmias
19
Q

Ibuitilide

A
  • K+ channel blocker
  • Increases ERP, delays repolarization, and prolongs AP
  • increases slow inward Na+ channels
  • Use = acute conversion of a=flutter and afib
  • tox = torsades de pointes
20
Q

Dihydropyridines

A
  • smooth muscle selective - vascular Ca2+ blocker
  • Use = hypertension
  • AE = flushing, headache, hypotension, edema, reflex tachycardia
21
Q

Verapamil

A
  • Ca2+ blocker - more CARDIAC specific
  • blocks activated and inactived L type calicum channels (state dependent)
  • Use: angina, arrythmias
  • Treats: supraventricular tachycardia, a-fib, a-flutter
  • hepatic (kidney) metabolism
  • DO NOT USE W/WPW
22
Q

Adenosine

A
  • activates K+ channels and blocks Ltype Ca2+ channels
  • slows conduction and increases AV refractory period
  • Use = prompt conversion of PSVT
  • do not use with 2’ or 3’ heart block

CRRAB I (8 decks)

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