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Anesthesia- Antiarrythmics > Pharmacology-Antiarrhythmic > Flashcards

Pharmacology-Antiarrhythmic Flashcards

(101 cards)

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1
Q

Anti-arrhythmic drugs are often used to treat

A

atrial arrhythmias

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2
Q

Anti-arrhythmic drugs have a potential to affect______ and may produce _______side effects

A

LV function
Pro-dysrhythmic

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3
Q

From Class 1-4, name the classes in order

A

Sodium
Beta
Potassium
Calcium
(shay better pass this class)

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4
Q

List subclass Sodium Channel Blockers in order from most potent to least

A

1C
1A
1B

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5
Q

Class 1 Sodium blockers are

A

negative Inotropes

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6
Q

MOA of Sodium Blockers

A

Bind to and block fast Na+ channels (keeps them in an inactive state)

decrease the slope of phase 0

decrease size of AP

decrease conduction velocity

cells have a harder time depolarizing

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7
Q

Negative Inotropes

A

decrease LV function

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8
Q

Some Na+ blockers act on _____channels

A

K+

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9
Q

With Na+channel blockers, class 1A prolongs phase_____, the refractory period

Class 1B shortens phase ____, the refractory period

A

3

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10
Q

Nodal cells are NOT dependent on

A

Fast Na+ channels

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11
Q

Class 1A drugs slows conduction velocity by prolonging _____ and __________

A

repolarization; duration of action potential

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12
Q

Class 1A often treats

A

Afib, Aflutter, SVT and VT

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13
Q

Class 1A have ______________effects, which can cause tachycardia

A

Anticholinergic

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14
Q

What are common Class 1A drugs

A

Quinidine
Procainamide
Disopyramide

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15
Q

Quinidine, a class 1A Na+ blocker slows the _____rate and is an ___________, which can cause vasodilation and HOTN

A

atrial rate; alpha 1 antagonist

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16
Q

What are the side effects of Quinidine, a class 1A Na+ blocker?

A

Anticholinergic
Torsades
Cinchonism (blurred vision, HA, tinnitus)
prolongs QT & QRS

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17
Q

Quinidine, a class 1A Na+ blocker is used to treat acute/chronic ______________ & ____________

A

SV arrhythmias
New onset Afib

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18
Q

Procainamide, a class 1A Na+ blocker slows __________rate and prolongs______

A

Ventricular; QRS

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19
Q

What are side effects of Procainamide?

A

HOTN

Myocardial depression

Vfib

SLE, leukopenia, thrombocytopenia (w/chronic administration)

Watch renal function

Drug fever/rash

N/V

Potential for Ventric asystole/fib

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20
Q

What is the metabolite of Procainamide?

A

NAPA metabolite

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21
Q

Disopyramide, a class 1A Na+ blocker slows_____&______ and can precipitate _____&______

A

atrial and ventricular rate;
CHF & HOTN

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22
Q

What are the side effects of disopyramide, a class 1A Na+ blocker?

A

Myocardial Depression
Anticholinergic
Prolong QT
Vtach
Dry Mouth
Urinary hesitancy
Blurred vision
Nausea

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23
Q

What are the medications that are 1B Na+ blockers

A

Lidocaine
Mexiletine
Tocainide
Phenytoin

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24
Q

When are class 1B drugs best used

A

work better in ischemic cells

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25
Class 1B drugs have minimal effect on conduction velocity in normal cells and shortens _____&______
repolarization & AP duration
26
MOA of Class 1B Na+ blockers
bind inactivated Na+ channels in ischemic cells and maintain state
27
1B Na+ blockers treat
V-tachyarrhythmias associated w/MIs
28
All 1B Na+ blockers slow_________rate
Ventricular
29
What is the dose of Lidocaine?
2mg/kg IV 1-4mg/min IV
30
What are the side effects of Lidocaine?
Assess for LAST
31
What are side effects of Tocainide & Mexiletine, class 1B Na+ blockers
synergistic effects w/BB Pulmonary fibrosis w/toc
32
Phenytoin act similar to
Lidocaine
33
What are side effects of Phenytoin
CNS related (vertigo, sedation, confusion, nystagmus, and ataxia)
34
Class 1C Na+ blockers slows conduction velocity and treats
life-threatening ventricular & SVT
35
Class 1C Na+ blockers can cause
other dysrhythmias pro-dysrhythmic effects
36
Examples of 1C Na+ blockers
Flecainide Propafenone Moricizine
37
Flecainide, 1C Na+ blocker, slows______ and treats________
atrial; PVCs and SVT
38
What are side effects of Flecainide, a class 1C Na+ blocker
Negative Inotrope Depressed SA node Vtach Blurred Vision
39
Propafenone and Moricizine, class 1C Na+ blockers, slow_______
Ventricular rates
40
What are side effects of Propafenone
Dysrhythmias CHF exacerbation Blurred Vision
41
Side effects of Moricizine
Increased mortality post-MI Dysrhythmias
42
Na+ channel blockers slow_______, effect __________Na+channels, and some have effects on phase ______
tachyarrythmias fast 3 repolarization
43
What are the 2 common Class II beta blockers in the OR
Metoprolol Esmolol
44
Class II Beta Blockers work on the _______action potential and slows down the ______cells
nodal pacemaker
45
MOA of Class II Beta Blockers
Bind to and block Beta-1 receptors Decreases conduction velocity, cAMP, Ca+ currents and slope of phase 4 Slows spontaneous depolarization Prolonged repolarization/refractory period at AV node
46
Class II Beta Blockers slows_____&_____ and treats_______,_______and_______
atrial & ventricular rate treats SNS induced arrhythmias ectopic beats tachyarrhythmias Non-nodal: prolongs AP duration and refractory period
47
What are side effects of Class II BETA BLOCKERS
Myocardial Depression HOTN,bradycardia, AV block Increased airway resistance Depression Fatigue Upregulation of beta receptors in chronic therapy Non-selective: Hypoglycemia, hyperkalemia, bronochoconstriction
48
Class III potassium blockers prolong
Phase III
49
MOA of Class III Potassium blockers
bind to and block K+ channels decrease K+ currents slows repolarization increases effective refractory period
50
Class III potassium blockers prolongs cardiac __________, action potential _________, and effective ________period
depolarization duration refractory
51
What is the prodrug of Class III potassium blockers
Amiodarone
52
Amiodarone exhibits what blockades
Na+, BB, and Ca+
53
Amio has anti-anginal effects by ______coronary arteries and ______coronary blood flow
dilating; increasing
54
Amio affects what classes
Class I, II, III, IV
55
Amio treats
ventricular and atrial tachyarrhythmias
56
Amio has both _____&____receptoor blockade, making it a negative ______& ______
alpha & beta (anti-adrenergic effects) inotrope & vasodilation prolongs QT
57
Amio is ______, which is why it often needs a loading dose
lipophilic (PO may take days to week)
58
What is the active metabolite of Amio
Desmethylamiodarone (slow effects and lingers)
59
Dosage of Amio
Loading 150mg over 10min Maintenance 1mg/min over 6hrs 0.5mg/min over 18hrs
60
What are the side effects of Amio
Alveolar Pneumonitis Pulm Edema ARDS HOTN AV/SA node block Decreased response to catecholamines Increases free O2 radicals=cellular destruction Inhibits CYP450 Photosensitivity
61
What are other Class III drugs
Sotalol Ibutilide Dofetilide
62
Class III Potassium blockers Ibutilide and Dofetilide treat Afib/flutter with these side effects
Prolonged QT Life-threatening V-arrhythmias Torsades
63
Sotalol, a Class III Potassium blocker treats_____&_____ tachyarrhythmias and is a _______beta blocker at low doses
Atrial & Ventricular Non-selective
64
Sotalol, a Class III potassium blocker has what side effects
Prolonged QT Bradycardia Torsades Decreased MI Contractility Delayed Conduction
65
Class IV CCB MOA
Bind to and block Ca+ channels Maintains inactivate/closed states Inhibits slow inward Ca+ currents Decreases/flatten slope of phase 0 and 4 slows conduction velocity Prolongs repolarization in AV node
66
Class IV CCB can be subdivided into
Dihydropyridines and non Dihydropyridines
67
Non-dihydropyridines are
cardiac selective
68
Non-dihydropyridines medications are
Diltiazem Verapamil
69
Non-dihydropyridines treat
SVT, VTs (reentry) early/delayed afterdepolarizations
70
CCB and BB should
NOT be administered together due too exaggerated effects
71
What are the side effects of Class IV Non-dihydropyridines
negative inotropy (MI depression and decreased CO) bradycardia AV nodal block Vasoodilation and HOTN
72
Class I Na+ channel blockade can cause
reentry mechanism v-tachyarrhythmias, wide-complex common w/1C
73
Class III Potassium can
Prolong repolarization, refractory, and QT interval Torsades is Common!! Exacerbated by hypokalemia/magnesemia
74
Adenosine is made by our bodies by
breakdown of ATP
75
Adenosine MOA
Stimulates cardiac A1 (adenosine) receptors, which increases K+ conductance (hyperpolarization) & inhibits L-type Ca+ influx in nodal cell Decreases slope of phase 0 & 4 Decreases conduction velocity & automaticity
76
Adenosine can treat
acute PSVT, WPW
77
Additional actions of adenosine include
Stimulates vascular A2 adenosine receptors, which increases cAMP in smooth muscle and causes vasodilation Also blocks NE release from presynaptic SNS terminals increased cAMP has a negative effect on kinase
78
What is the dosage of Adenosine
6mg IV initial 6mg or 12 mg IV after 3min rapid flush 10-20 mL NS due to rapid transport into RBC (give close to heart)
79
What are side effects of Adenosine
AV block (pause common) Vasodilation (rapid arterial HOTN, flushing, HA)
80
Digitalis Glycosides (Digoxin) is used to
Slow down atria arrythmias
81
What is the MOA of Digoxin
Na/K/ATPase potent inhibitor Reduced activity of Na/Ca+ exchanger
82
Digoxin _____slope of phase 4 and _______slope of phase 0 Increases __________&__________ positive inotropy
increases; decreases depolarization & automaticity
83
Digoxin is used to treat_______inotropy in _______patient
increased; HF
84
Digoxin treats_________ and is known to be a________
atrial tachyarrhythmias and HF parasympathomimetic, which increases vagal activity, decreases SA firing and AV conduction (prolongs PR) and suppresses ectopic PMs
85
Digoxin will show these ECG changes
ST depression Shorter QT Inverted T waves
86
What are the therapeutic levels of digoxin
0.5-2ng/mL
87
Digoxin uses what as a resivoir
muscle may be floating around in the elderly cleared by the kidney
88
What are the toxic levels of digoxin
>2-3 ng/mL >3.5ng/mL in PEDS
89
What are the causes of dig toxicity
*Hypokalemia Hypomagnesemia Impaired renal function Decreased muscle mass
90
What are the early manifestation of digitalis toxicity
anorexia N/V trigeminal neuralgia
91
What are the cardiac effects of digitalis toxicity
atrial & ventricular dysrhythmias delayed AV conduction *AT w/block *VF most common cause of death
92
What is the treatment of digitalis toxicity
treat underlying cause lidocaine or class I for ventricular atropine for excess vagal activity propranolol or class II to suppress increased automaticity
93
When would a patient need a pacemaker
CHB
94
What is the ultimate treatment for digitalis toxicity
Digibind and Digifab: which decreases plasma concentration (antigen binding abx)
95
What are the H&Ts of arrhythmias
HYPO/HYPERthermia Hypovolemia Tension PTX Tamponade Toxins/Drugs Thromboembolism
96
Atropine dose
0.02mg/kg
97
How to treat AFIB (ABCD)
Anticoag BB CCB/cardiovert Digoxin prevent w/procainamide
98
How to treat SVT (ABC)
Adenosine BB CCB (Mg sulfate, Class 1A or 1C III)
99
How to treat PVCs
BB Non-dihydropyridine CCB Class I Mg Lidocaine
100
How to treat Vtach/fib
Lidocaine Amio Mg BB tx polymorphic w/Mg prevention w/amio and lidocaine
101

Anesthesia- Antiarrythmics (4 decks)

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