Acute Cardiac

Question 2

Nitroprusside–clinical use

Answer 2

hypertensive emergency

Question 3

nitroprusside–mechanism

Answer 3

short acting

increases cGMP via direct release of NO

Question 4

nitroprusside–toxicity

Answer 4

releases cyanide, so can lead to cyanide toxicity

Question 5

what are the class IA antiarrhythmic drugs?

Answer 5

Quinidine, Procainamide

Question 6

class IA antiarrhythmics–mechanism

Answer 6

inc AP duration

inc effective refractory period (ERP) in ventricular action potential

inc QT interval

Question 8

class IA antiarrhythmics–use

Answer 8

both atrial and ventricular arrhythmias, especially re-entrant and ectopic SVT and VT

Question 9

class IA antiarrhythmics–toxicity

Answer 9

cinchonism–headache, tinnitus with quinidine

reversible SLE like syndrome (procainamide)

torsades de pointes due to inc QT interval

Question 10

what are the class IB antiarrhythmic drugs?

Answer 10

Lidocaine

MexileTine

“I‘d Buy Liddy’s Mexican Tacos”

Question 11

class IB antiarrhythmics–use

Answer 11

acute ventricular arrhythmias (especially post MI)

digitalis-induced arrhythmias

“IB is Best post MI”

Question 12

class IB antiarrhythmics–toxicity

Answer 12

CNS stimulation/depression

cardiovascular depression (heart blocks, altered AV conduction)

Question 13

what is the best antiarrhythmic drug to use for a post MI patient?

Answer 13

class IB

Question 14

what are the class IC antiarrhythmic drugs?

Answer 14

Flecainide

Propafenone

“Can I have Fries, Please?”

Question 15

which class IA antiarrhythmic drug may cause digoxin toxicity?

Answer 15

Quinidine–decreases digoxin clearance and displaces digoxin from tissue binding sites

Question 16

class IC antiarrhythmics–use

Answer 16

SVTs, including atrial fibrillation

only as a last resort in refractory VT

do not affect AP duration

Question 17

when are class IC antiarrhythmics contraindicated?

Answer 17

structural heart diseases and post MI

Question 18

what are class II antiarrhythmics?

name 5

Answer 18

beta blockers

propranolol

atenolol

metoprolol

labetolol

carvedilol

Question 19

class III antiarrhythmics–mechanism

Answer 19

Alteration of lipid membrane in which ion channels and receptors are located

Question 20

what are class III antiarrhythmics and name 4

Answer 20

potassium channel blockers

Amiodarone

Ibutilide

Dofetilide

Sotalol

“AIDS”

Question 22

class III antiarrhythmics–use

Answer 22

atrial fibrillaiton

atrial flutter

ventricular tachycardia (amiodarone, sotalol)

Question 23

what is the indication for class III antiarrhythmics?

Answer 23

when all other antiarrhythmics fail

Question 24

sotalol toxicity

Answer 24

(class III antiarrhythmic)

torsades de pointes

excessive beta blockade

Question 25

ibutilide–toxicity

Answer 25

(class III antiarrhythmic)

torsades de pointes

Question 26

amiodarone–toxicity

Answer 26

(class III antiarrhythmic)

pulmonary fibrosis

hepatotoxicity

hypothyroidism/hyperthyroidism (amiodarone is 40% iodine by weight)

acts as hapten–corneal deposits, blue/gray skin deposits causing photodermatitis

neurologic effects

cardiovascular effects–bradycardia, heart block, HF

Question 27

what should you always check when using amiodarone?

Answer 27

pulmonary function tests

liver function tests

thyroid function tests

Question 28

amiodarone has effects of which classes and why?

Answer 28

I, II, III, IV

b/c lipophilic–alters lipid membrane

Question 29

name 2 antiarrhythmics other than those in classes

Answer 29

adenosine

Mg2+

Question 30

what is the antiarrhythmic mechanism of adenosine?

Answer 30

inc K+ out of cells –> hyperpolarizes the cell and dec intracellular Ca

Question 31

adenosine–use as a antiarrhythmic

Answer 31

diagnosing/terminating certain forms of SVT

Question 32

how long does adenosine last?

Answer 32

~15 seconds

Question 33

adenosine as a antiarrhythmic–toxicity

Answer 33

flushing, hypotension, chest pain, sense of impending doom, bronchospasm

Question 34

when would you use Mg as an antiarrhythmic?

Answer 34

torsades de pointes

digoxin toxicity

Question 35

what are class I antiarrhythmics, and how do they work?

Answer 35

sodium channel blockers

slow or block (dec) conduction especially in depolarized cells

Question 36

what causes toxicity in all class I antiarrhythmics?

Answer 36

hyperkalemia

Question 37

which class II antiarrhythmic is most short acting?

Answer 37

esmolol

Question 38

how to treat beta blocker overdose

Answer 38

saline

atropine

glucagon