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pharm 2 > Anti-Arrhythmetic Drugs > Flashcards

Anti-Arrhythmetic Drugs Flashcards

1
Q

What is the rationale or goal for Anti-Arrhythmetic drugs considering that there is no cure

A
  • Normalize conduction velocity
  • rectify altered exciteablity of cardiac cells
  • Maintain normal sinus rhythm
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2
Q

Torsade de Pointes, a persistant EAD tachyarrhythmia pathology can be induced by prolonged use of what drugs

A

Prolonged use of:
1) Antiarhythmic drugs
2) Tricyclic Antidepressants
3) antiviral drugs –> gene mutations

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3
Q

How does prolonged use of Antiviral drugs lead to Torsade de Pointes
What are the 3 specifics

A

Antiviral drugs can lead to mutations in genes for ion channels:

A) KCNQ1 & HERG; –> K+ CHANNEL Mutation

B) SCN5A –> Na+ CHANNEL mutation

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4
Q

An Inotropic HF drug known as _____ induces TdP
What is used to treat this drug induced TdP

(anatomy word)

A

Digitalis is the Inotropic HF drug which causes TdP

Treated by MgSO4 infusion/ bolus dose

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5
Q

4 classes of drugs associated with QT prolongation (ventricular cycle long) and TdP
(all anti)

A

Antiarrhythmatics
Antimicrobials
Antidepressants
Antipsychotics

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6
Q

Class 1A Antiarrhythmics - MOA, CI

A

MOA:
-Moderately blocks Na channels (preferentially open channels than inactive)
-Also, K channel blocking (increase ERP)
-Decrease phase 0 upstroke
-decreases myocardial conduction

CI: QT prolongation (can cause TDP)

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7
Q

Quinidine

A

Class 1A
- Moderately Blocks Na Channels
- Strong Anticholinergic effect

CI: Atrial Flutter, b/c increases nodal conduction

DDI: Digoxin, b/c same CYP Digoxin toxicity
AE: -ocular toxicity

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8
Q

Disopyramide

A

Class 1A
-Moderately blocks Na channels
-Severe Anticholinergic effects

CI: Uropathy, Glaucoma

AE: ocular toxicity

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9
Q

Procainamide

A

Class 1A
-Moderately blocks Na channels
- less anticholinergic effect
-Acetylated to active form in the liver N-acetylprocainamide

DDI: Digoxin

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10
Q

Class 1B Antiarrhythmics

A

MOA:
- Blocks Na channels, open and inactive, (prefer inactive) (weakest in class 1)
- Decreases ERP
- Decreases AP duration

AE: unwanted CNS effects, dizziness and seizure, b/c cross BBB

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11
Q

Lidocaine

A

Class 1B
- blocks Na channels (weak)
-also local anesthetic for ocular and dental procedures

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12
Q

Mexiletine

A

Class 1B
-blocks Na channels
(weak)
-Analog of Lidocaine
with negligible QT influence compared to Lidocaine, and less vagolytic effects

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13
Q

Phenytoin

A

Class 1B
-blocks Na channels (weak)
-Also used as epileptic medication
-CYP3A4 inducer

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14
Q

Class 1C Antiarrhythmics

A

MOA:
-Blocks Na channels (Most potent blocker) (mostly open/active state)
-Decrease phase 0 upstroke (ventricular cells)
No change in ERP

ONLY FOR LIFE THREATENING, like Paroxysmal Supraventricular Arrhythmia
b/c can worsen pre-existing arrhythmia

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15
Q

Class 1C safety warning

A

Encainide or Flecainide tx for average 10 months developed cardiac arrest or mortality in CAST study

Propafenone also has mortality warning

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16
Q

Class 1 comparisons

A

-1C is strongest Na channel blocker (mostly open channels)
-1B is weakest Na channel blocker (both open and inactive, but mostly inactive channels)
-1A is moderate Na channel blocker (open channels preferred)

ERP effect
-1A increase (b/c K channel blocking)
-1B decrease
-1C no change

17
Q

Class 2 Antiarrhythmic

A

Beta Blockers
MOA:
-act on both SA and AV nodes
- slows phase 4 in PM cells
- prolongs ERP, decreasing rate of automaticity

18
Q

-Propranalol
-Sotalol

A

Non-specific Beta blocker (beta 1 and 2)
-WARNING: life threatening proarrhythmia

AE:
-beta 1: bradycardia and block
-beta 2: bronchospasm

19
Q

-Atenolol
-Metaprolol

A

Beta 1 specific blocker
- Preferred B/c only acts on SA node

AE:
-beta 1: bradycardia and block

20
Q

-Labetalol
-Carvedilol

A

Beta and Alpha 1 blocker
- if also vascular complication and SA node 100+

21
Q

Class 3 Antiarrhythmic

A

K channel blockers
MOA:
-prevent K efflux, slows rate of outward flow
- Longer plateau phase
- ERP increased

Used when K efflux is high and phase 2,3,4 are too fast

AE: Prolonged plateau can cause EAD and lead to TDP

22
Q

Sotalol

A

mixed class 2 and class 3
- nonselective beta blocker and K channel blocker

23
Q

Amiodarone

A

K channel blocker
-DEA metabolite is active form, longer half life
AE:
- toxic to thyroid follicular cells
-37% iodine, affinity to thyroid gland
- causes hypothyroidism if long term
- inhibits 5-deiodonase activity and prevents T4 to T3 conversion
Ophthalmic toxicity: corneal deposits, keratopathy
- optic neuropathy
CI: Skin, eye, thyroid conditions

24
Q
  • Dronedarone
  • Ibutilide
  • Dofetilide
A

Dronedarone:
Substitute for Amiodarone with reduced toxic effects, less iodine, and decreased half life

  • Ibutilide
  • Dofetilide
    also alternatives
25
Q

Class 4 Antiarrhythmics

A

Ca channel blockers
- SA and AV nodal tissue predominant
- slows AP
- slows conduction of impulses
-regulated AV node mediated re-entry phenomenon

26
Q

-Verapamil
-Diltiazem

A

Ca channel blockers
AE: AV nodal block (Rare)
CI: beta blockers, b/c HF problems
DDI: Digoxin, Digoxin toxicity

27
Q

Class 0

A

Ivabradine:

Inhibits Na entry, inward funny current through HCN

Used for Arrhythmias due to SA nodal origin: Sinus Tachycardia

28
Q

Digoxin

A

Misc. group
-HF drug with antiarrhythmic property
-Reduces PM firing frequency (SA node)
- Effective in A-fib and Paroxysmal Supraventricular Tachycardia

Stringent monitoring narrow therapeutic window

29
Q

Adenosine

A

Misc. group
- stim purinergic receptor
- Decrease SA and AV nodal conductance

30
Q

Atropine

A

Anti muscarinic agent
- inhibits M2 receptors in SA and AV nodes, normalize sinus rhythm and reverse AV nodal block

AE: Tachycardia
urinary retention,constipation
CI: glaucoma

31
Q

Potassium

A

irregularity in heartbeat results from K out of range(3.5-5 mM)

32
Q

Stroke

A

Multiple re-entries, blood not pumped from atrium, results in clot
1. anticoagulants (Dabigatran, Rivaroxaban, Apixaban)
2. HR control (B-Blocker: Atenolol; or Ca channel blocker: Diltiazem.
3. Rhythm control ( Na channel blocker: flecainide, or K channel blocker Amiodarone.

33
Q
A

pharm 2 (11 decks)

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