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Board Study Topics > 00 Antiarrhythmics > Flashcards

00 Antiarrhythmics Flashcards

1
Q

What are Class I antiarrhythmics main MOA?

A

Sodium channel blockers

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2
Q

What is Class I divided?

A

Class Ia (intermediate acting), Class Ib (short acting), Class Ic (long acting)

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3
Q

What are the Class Ia drugs?

A

Disopyramide, Quinidine, Procainamide

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4
Q

What are the Class Ib drugs?

A

Lidocaine, Tocainide, Mexiletine (Phenytoin)

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5
Q

What are the Class Ic drugs?

A

Flecainide, Propafenone, Morizicine

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6
Q

Which Class I subgroup has the most ADRs?

A

Class Ia

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7
Q

What are some of the ADRs seen with Class Ia drugs?

A

Strong antiACh, All agents capable of causing QT prolongation (from blocking K channels) –> TdP, all proarrhythmic

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8
Q

Which Class Ia has the most DDIs and can cause Cinchonism?

A

Quinidine

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9
Q

What are Class Ib drugs only useful for?

A

VENTRICULAR arrhythmias (can’t be used for A.fib)

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10
Q

What kind of ADR is seen with Class Ib drugs?

A

All cross BBB d/t lipophilicity, all have CNS depression ADRs

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11
Q

When do you NOT want to use Class Ic drugs?

A

Do not use in patients with ischemic (CAD) or structural heart disease (LVEF < 40% or severe LVH). Avoid in heart disease!

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12
Q

Which Class I subgroup has the least ADRs?

A

Class Ic

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13
Q

What are the Class II Antiarrhythmics?

A

Beta-Blockers (Metoprolol, Propranolol, Esmolol)

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14
Q

What are the Class II Antiarrhythmics mainly used for?

A

Ventricular rate control and to prevent ventricular arrhythmias

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15
Q

What is unique about Esmolol (Class II Antiarrhythmics)?

A

Ultra short acting, IV only, large fluid volume (comes in big IV bag)

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16
Q

How do Class III Antiarrhythmics work?

A

Prolong refractory period. Blockade of potassium channels

17
Q

What are the Class III Antiarrhythmic drugs?

A

Amiodarone/Dronedarone. Sotalol. Ibutilide/Dofetilide

18
Q

How is Ibutilide different than the other Antiarrhythmics in Class III?

A

Instead of blocking potassium channels, it activates inward sodium channels

19
Q

What are the Class IV Antiarrhythmic drugs?

A

CCBs (Verapamil and Diltiazem)

20
Q

What are Class IV Antiarrhythmic drugs used for?

A

Slow conduction through AV node, used for ventricular rate control

21
Q

What are the common ADRs with Verapamil?

A

Constipation/GERD

22
Q

What are some common Antiarrhythmics used that don’t fall into the four classes?

A

Adenosine. Digoxin. Magnesium

23
Q

What is Magnesium most commonly used for?

A

Torsades de Pointes

24
Q

What is the DOC for patients with ischemic (CAD) or structural heart disease (LVEF < 40% or severe LVH)?

A

Amiodarone

25
Q

What is the PK of Amiodarone like?

A

Slow distribution (need loading dose). Long half-life (60 days parent compound, up to 180 days for desethylamiodarone)

26
Q

What is the PO dosing for Amiodarone like?

A

LD: 800-1600 mg/day
Maintenance: 100-400 mg/day

27
Q

What is the IV dosing for Amiodarone like?

A

150mg x1, 1mg/min x6h, 0.5mg/min x18h = approx 1g in first day. For life-threatening arrhythmias (ACLS): 300mg IV push

28
Q

What are the most common ADRs with Amiodarone?

A

Thyroid (hypo/hyper), Pulmonary fibrosis (dose and time dependent, treatment limiting step), Hepatic, GI (take with food), Photosensitivity

29
Q

What looking at AF management, what must you think about?

A

Always consider the need for the 3 major therapeutic modalities: Ventricular rate control, Anticoagulation, Rhythm conversion/maintenance

30
Q

What type of agents can be selected for Ventricular Rate Control in AF?

A

Class II and IV (Beta-blocker, CCB (Diltiazem, Verapamil)), Digoxin, Amiodarone (less common)

31
Q

What are the factors looked at for the CHADS2 score?

A

CHF (1), HTN (1), Age 75+ (1), Diabetes (1), Stroke/TIA (2)

32
Q

How does the CHADS2 score determine anticoagulation needs?

A

0 = ASA, 1 = ASA or Warfarin/Dabigratran/Rivaroxaban/Apixaban, 2+ = Warfarin/Dabigratran/Rivaroxaban/Apixaban

33
Q

What agents are used for Rhythm CONVERSION?

A

1a, 1c, III. (II & IV are rate control). Amiodarone DOC for patients with ischemic or structural heart disease (Dronedarone may be first-line for all others). Sotalol DOC for post-MI/CAD w/o structural heart disease

34
Q

What must be monitored when initiating Amiodarone?

A

Liver function and Pulmonary function

35
Q

What properties does Propafenone have?

A

Beta-blocker

36
Q

Which agent must be initiated in-hospital with renal function and QT documented?

A

Dofetilide

37
Q

Make sure you know:

A

The chart on slide 57

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