Pharmacology - Antiarrhythmics

Question 1

P wave corresponds to:

Answer 1

Atrial activation

Question 2

Q wave corresponds to:

Answer 2

His, BB, and septum activation

Question 3

R wave corresponds to:

Answer 3

LV activation

Question 4

S wave corresponds to:

Answer 4

late RV activation

Question 5

T wave corresponds to:

Answer 5

ventricular repolarization (direction is opposite of activation

Question 6

On EKG, Atrial Phase 0 corresponds to:

Answer 6

P wave

Question 7

On EKG, Ventricular Phase 0 corresponds to:

Answer 7

QRS complex

Question 8

On EKG, Ventricular Phase 2 corresponds to:

Answer 8

ST segment

Question 9

On EKG, ventricular phase 3 corresponds to:

Answer 9

T wave

Question 10

On EKG, the duration of the ventricular action potential corresponds to:

Answer 10

QT interval (start of QRS to end of T)

Question 11

AVN conduction is measure on EKG by:

Answer 11

PR interval (start of P to start of QRS)

Question 12

When are U waves (Purkinje repolarization) seen on EKG?

Answer 12

Prolonged QT interval;

Hypokalemia

Question 13

What is the effect of hypercalcemia on the QT interval?

Answer 13

Increases it

Hypocalcemia decreases it

Question 14

Wenckebach phenomenon is what kind of arrhythmia?

Answer 14

2nd degree AV block - not every P wave is followed by QRS complex
PR interval gets progressively longer until a beat is dropped
aka Mobitz Type I AVN Block

Question 15

What is one notable cause of 1st degree AVN block?

Answer 15

Lyme disease

Prolonged PR interval, but 1:1 P:QRS complex

Question 16

What is the recommended treatment for 2nd and 3rd degree AVN block?

Answer 16

Ventricular pacemaker installation

Question 17

2/3 of all SVTs are what kind?

Answer 17

AV node re-entry tachycardia
dual AVN conduction pathways

Next most common is bypass tract re-entry - AVN and bypass tract reentry (1/5)

Question 18

T/F: Adenosine will stop any kind of AVN reentry tachycardia.

Answer 18

Fuck yea it will (so will vagal tone - carotid massage)

Question 19

What pharmacotherapy is indicated for treatment of WPW syndrome?

Answer 19

Amiodarone (class III anti-arrhythmic - K channel blocker)
Procainamide (class IA anti-arrhythmic)

NO AVN blockers - CONTRAINDICATED so NO amlodipine, nifedipine, verapimil, diltiazem)

Question 20

What is Torsades de Pointes syndrome (TdP)?

Answer 20

A kind of Polymorphic ventricular tachycardia;
associated with long QT interval;
can be genetic

Question 21

Class IA, IB, IC anti-arrhythmic drugs all have actions where?

Answer 21

Direct membrane action - Na channel blockade

Question 22

Antiarrhythmics that:
Are involved in Na channel blockade;
Depress Phase 0;
Slow conduction;
Prolong repolarization
belong to what class?

Answer 22

Class IA
ie Quinidine
Procainamide
Disopyramide

Question 23

Antiarrhythmics that:
Are involved in Na channel blockade;
Depress Phase 0 ONLY in abnormal (ie ischemic tissue);
Shortern repolarization
belong to what class?

Answer 23

Class IB
ie Lidocaine
Mexiletine (oral lidocaine)

Question 24

Antiarrhythmics that:
Are involved in Na channel blockade;
Markedly depress Phase 0;
Markedly slow conduction;
Have a slight effect on repolarization
belong to what class?

Answer 24

Class IC
ie
Flecainide;
Propafenone;
Moricizine

Question 25

Antiarrhythmics that: Are sympatholytic drugs belong to what class?

Answer 25

Class II Nonselective: --ie Propranolol --Carvedilol Selective - -Metoprolol - -Acebutolol Esmolol (IV only - fast acting)

Question 26

Antiarrhythmics that: Are drugs that ONLY prolong repolarization belong to what class?

Answer 26

Class III Sotalol (K channel blocker) Ibutilide Dofetilide Mixed: - -Amiodarone - -Dronedarone

Question 27

Antiarrhythmics that: Are calcium channel blockers belong to what class?

Answer 27

``` Class IV Dihydropyridines: --Nifedipine --Amlodipine --Felodipine --Isradipine ``` Verapimil (phenylakamine) Diltiazem (benzothiazepine)

Question 28

When are Quinidine, Procainamide and Disopyramide (Class IA antiarrhythmics) indicated?

Answer 28

``` Secondary drug of choice for tx of: chronic Afib; PSVTs; sustained VT/VF (procainamide) acute Afib/flutter (IV procainamide) ``` Lidocaine (Class IB) is ALSO secondary choice, but NOT for atrial arrhythmias Class IC are ALSO secondary mgmt for chronic AF or SVT patients w/o structural HD

Question 29

SLE-like syndrome TdP QT Prolongation Heart block are toxicities of what drugs?

Answer 29

Class IA ie Quinidine Procainamide Disopyramide

Question 30

What drug class is indicated for LAST resport in patients with refractory VT?

Answer 30

Class IC anti-arrhythmics: Flecainide Propafenone CONTRAINDICATED in HF and post-MI (pro-arrhythmic) - cannot use in pts with structural HD

Question 31

Beta-blockers (Class II anti-arrhythmics) are contraindicated in what disease?

Answer 31

WPW syndrome Ca blockers and Digoxin are ALSO contraindicated in WPW (anything that does AVN block)

Question 32

Amiodarone is the primary drug of choice for sustained VT/VF. Why?

Answer 32

Acts on fast-acting Na channels, Ca channels AND K channels AND is both and alpha and beta blocker AND has a long half life (80 days) MANY adverse side effects DO NOT use for digitalis toxicity

Question 33

Acute SVT --> first line therapy is:

Answer 33

IV Adenosine Verapimil Diltiazem

Question 34

Acute SVT --> second line therapy is:

Answer 34

IV Esmolol beta-blockers digoxin

Question 35

Chronic SVT --> first line therapy is:

Answer 35

``` Beta blockers Verapimil Diltiazem Flecainide Propafenone Amiodarone Sotalol Digoxin ``` DC cardioverion Atrial pacing effective but rarely required

Question 36

Chronic SVT --> second line therapy is:

Answer 36

Quinidine Procainamide Disopyramide RF ablation may cure most patients

Question 37

Acute Afib/flutter --> first line therapy is:

Answer 37

Verapimil Diltiazem beta-blocker Digoxin DC cardioversion

Question 38

Acute Afib/flutter --> secondary line therapy is:

Answer 38

IV procainamide Ibutilide Dofetilide single large dose of Propafenone or Flecainide

Question 39

PVCs or nonsustained VT --> therapy is:

Answer 39

If symptomatic or post-MI, use beta blockers

Question 40

Sustained VT --> use

Answer 40

First-line - amiodarone, intracardiac device, beta blockers often added Second-line - procainamide, lidocaine SAME for tx of Vfib

Question 41

Vfib first line therapy is:

Answer 41

Amiodarone, intracardiac device, beta blockers often added Second-line - procainamide, lidocaine

Question 42

EADs happen in what phase of the cardiac cycle?

Answer 42

EAD - Early Afterdepolarization Phase 3 EADs result from blockade of repolarizing K channels (eg) and/or increased INa late, ICa,L

Question 43

DADs happen in what phase of the cardiac cycle?

Answer 43

DAD - Delayed Afterdepolarization Phase 4 DADs result from blockade of IK1, which maintains the resting potential (can be the result of cardiac glycoside toxicity)

Question 44

Drug-induced TdP can cause what kind of arrhythmia?

Answer 44

EAD - Early Afterdepolarization Phase 3 EADs result from blockade of repolarizing K channels (eg) and/or increased INa late, ICa,L

Question 45

Class III anti-arrhythmics, K channel blockers, are known carriers of the risk of developing TdP. These include Sotalol, Amiodarone, Ibutelide, Dronedarone and Dofetilide. What OTHER anti-arrhythmic class also carries the risk of TdP development?

Answer 45

Class IA Because they are both fast Na channel blockers and K rectifier blockers Procainamide - Quinidine - Disopyramide

Question 46

Double Quarter Pounder

Answer 46

Class IA anti-arrhythmics | Procainamide - Quinidine - Disopyramide

Question 47

“Lettuce, Tomato, Mayo, Pickles”

Answer 47

Class IB anti-arrhythmics | *Lidocaine, Tocainide, *Mexilitine, Phenytoin

Question 48

“More Fries Please”

Answer 48

Class IC anti-arrhythmics | Moricizine, *Flecainide, *Propafenone

Question 49

"A Big Dog Is Scary"

Answer 49

Class III anti-arrhythmics | (*Amiodarone, Bretylium, *Dofetilide, *Ibutilide, *Sotalol). + *Dronedarone

Question 50

Class: Dipyridamole

Answer 50

Antiplatelet agent Anti-anginal Pyrimido-pyrimidine

Question 51

Class: Aspirin

Answer 51

NSAID | Antiplatelet agent

Question 52

Class: Ticlopidine

Answer 52

Antiplatelet agent | Thienopyridine

Question 53

Class: Clopidogrel

Answer 53

Antiplatelet agent | Thienopyridine

Question 54

Class: Ticagrelor

Answer 54

Antiplatelet agent | Adenosine-like

Question 55

Class: Prasugrel

Answer 55

Thienopyradine | Antiplatelet agent

Question 56

Class: Cilostazol

Answer 56

Antiplatelet agent | Quinoline

Question 57

What APA is standard of care with a stent placement?

Answer 57

Clopidogrel

Question 58

What is a notable SE of Ticlopidine?

Answer 58

Neutropenia TTP rare not used anymore

Question 59

What APA carries the greatest bleeding risk?

Answer 59

Prasugrel

Question 60

What APA is contraindicated in HF?

Answer 60

Cilostazol