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3b_Boards - SketchyPharm > (2) CV & Renal: Antiarrhythmics (4.1-4.5) > Flashcards

(2) CV & Renal: Antiarrhythmics (4.1-4.5) Flashcards

1
Q

MOA: Class I antiarrhythmics

A

Block Na+ channels

(and ∴ ↓ Rate of rise of AP)

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2
Q

Class I antiarrhythmics readily bind to Na+ channels in what state?

A

Open or inactivated

(Not resting)

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3
Q

Are type I antiarrhythmics use-dependent or use-independent?

A

Use-dependent

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4
Q

What effect do class I antiarrhythmics have on SA and AV node?

A

None

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5
Q

What effect do class I antiarrhythmics have on EKG tracing?

A

Widened QRS complex

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6
Q

What are the class IA antiarrhythmics?

A

“Double Quarter Pounder”

(1) Disopyramide
(2) Quinidine
(3) Procainamide

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7
Q

What are the class IB antiarrhythmics?

A

“Lettuce, Pickles, Mustard”

(1) Lidocaine
(2) Phenytoin
(3) Mexilitine

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8
Q

What are the class IC antiarrhythmics?

A

“Extra fries, please!”

(1) Encainide
(2) Flecainide
(3) Propafenone

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9
Q

Rank the class I antiarrhythmics in regards to Na+ channel affinity

A

Think: “CAB”

  • Highest: Class IC
  • Intermediate: Class IA
  • Lowest: Class IB
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10
Q

Other than affecting Na+ channels, what is the MOA of class IA antiarrhythmics?

A

Inhibit K+ channels

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11
Q

What region of the heart is each division of class I antiarrhythmics selective for?

A
  • Class IA: Supraventricular and ventricular
  • Class IB: Ventricles and Purkinje system
  • Class IC: Supraventricular and ventricular
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12
Q

What class of antiarrhythmic is used to treat Wolff-Parkinson-White syndrome?

A

Class IA

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13
Q

Adverse Effects (3) : Quinidine

A

(1) Cinchonism
(2) Thrombocytopenia
(3) Torsades
* (Remember all class IA can cause Torsade de Pointes)*

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14
Q

Which Class I antiarrhythmic is a negative inotrope?

A

Disopyramide

(*Remember all class IA can cause Torsade de Pointes)

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15
Q

Which division of class I antiarrhythmics can cause Torsades de Pointes?

A

Class IA

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16
Q

Which division of class I antiarrhythmics are used for ischemia-induced ventricular arrhythmias?

A

Class IB

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17
Q

Adverse Effect: Class IB antiarrhythmics

A

Neurological side effects

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18
Q

Distinguish class IA, IB, and IC antiarrhythmics by their effect on action potential duration

A
  • Class IC: No affect
  • Class IB: Shorten AP
  • Class IA: Prolongs AP
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19
Q

Which division of class I antiarrhythmics are used to treat atrial fibrillation?

A

Class IC

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20
Q

Contraindication: Class IC antiarrhythmics

A

(1) Structural heart disease
(2) Ischemic heart disease
* (≅ Preexisting heart disease)*

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21
Q

Which class I antiarrhythmic is a negative inotrope?

A

Disopyramide

22
Q

Which antiarrhythmic can cause a lupus-like syndrome?

A

Procainamide

23
Q

What are the class II antiarrhythmics?

A

β-blockers

24
Q

What is the mechanism of β-blocker treatment of arrhythmias?

A

Prolongs nodal Φ4

(Via reducing sympathetic input to SA/AV node)

25
Q

What part of the heart do class II antiarrhythmics most affect?

A

AV node

(Although they do affect SA too)

26
Q

What type of arrhythmias do class II antiarrhythmics treat?

A

Supraventricular

(i.e., atrial fibrillation)

27
Q

Name a class II antiarrhythmic that can be used for acute supraventricular arrhythmia

A

Esmolol

(∵ IV administration)

28
Q

What effect do class II antiarrhythmics have on EKG tracing?

A

Prolonged PR interval

29
Q

What are the class III antiarrhythmics?

A

(1) Amiodarone
(2) “-tilide”
(3) Sotalol

30
Q

MOA: Class III antiarrhythmics

A

Inhibit cardiac K+ channels

31
Q

What phase of cardiac action potential is affected by class III antiarrhythmics?

A

Phase 2 and 3

32
Q

What class III antiarrhythmic shares mechanistic features of class I-IV drugs?

A

Amiodarone

33
Q

What β-blocker is a class III antiarrhythmic?

A

Sotalol

34
Q

What type of arrhythmias can class III antiarrhythmics treat?

A

Supraventricular and ventricular

35
Q

Adverse Effects (9) : Amiodarone

A

(1) Neurological side effects
(2) Gray corneal deposits
(3) Hypo/Hyperthyroidism
(4) Pulmonary fibrosis
(5) Heart block
(6) Induce heart failure
(7) Hypersensitivity hepatitis
(8) Gray-blue skin discoloration
(9) Photodermatitis

36
Q

Which antiarrhythmic inhibits CYP-450?

A

Amiodarone

37
Q

Which class III antiarrhythmic has the lowest incidence of Torsades de Pointes?

A

Amiorodone

38
Q

Generally, what is the difference in mechanism between class II/IV antiarrhythmics and class I/III?

A
  • Class II/IV: Rate control
  • Class I/III: Rhythm control
39
Q

Which antiarrhythmic agents do not fall into class I-IV designation?

A

(1) Digoxin
(2) Mg2+
(3) K+
(4) Adenosine

40
Q

MOA: Digoxin treating atrial fibrillation

A

↑ Parasympathetic effects

41
Q

What type of arrhythmia does Mg2+ treat?

A

Torsades de pointes

42
Q

What changes on EKG tracing will be present in hyperkalemia?

A

Peaked T waves

(With shortened QT interval)

43
Q

What changes on EKG tracing will be present in hypokalemia?

A

U wave

(At the end of T wave)

44
Q

What receptor does Adenosine stimulate to ↓ SA/AV node activity?

A

A1

45
Q

What effect does the stimulation of A1 receptor have on the cardiac ion currents?

A

(1) ↑ Outward K+ current
(2) ↓ Inward Ca2+ current
* (Both factors inhibit AP)*

46
Q

Where in the heart does Adenosine exert most of its effects?

A

AV node

47
Q

What type of arrhythmia is Adenosine a first-line treatment for?

A

Supraventricular

48
Q

What effect does the stimulation of coronary A2 receptors have?

A

Vasodilation

49
Q

Adverse Effects (3) : Adenosine

A

(1) Cutaneous flushing
(2) Shortness of breath/Chest pain
(3) Hypotension

50
Q

What class of drugs inhibits the cardiac effects of Adenosine?

A

Methylxanthines

(Caffeine, Theophylline)

3b_Boards - SketchyPharm (32 decks)

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