Anti-arrhythmias

Question 1

Dofetilide (Tikosyn) Misc

Answer 1

Renal excretion; 100% bioavailability; work better in slow heart (can cause arrhythmia)

Question 2

Quinidine (Quinidex) Class

Answer 2

Class IA anti-arrhythmic

Question 3

Procainamide (Pronestyl) Class

Answer 3

Class IA anti-arrhythmic

Question 4

Disopyramide (Norpace) Class

Answer 4

Class IA anti-arrhythmic

Question 5

Lidocaine (Xylocaine) Class

Answer 5

Class IB anti-arrhythmic

Question 6

Mexiletine (Mexitil) Class

Answer 6

Class IB anti-arrhythmic

Question 7

Flecainide (Tambocor) Class

Answer 7

Class IC anti-arrhythmic

Question 8

Propafenone (Rythmol) Class

Answer 8

Class IC anti-arrhythmic

Question 9

Amiodarone (Cordarone) Class

Answer 9

Class III anti-arrhythmic

Question 10

Dronedarone (Multaq) Class

Answer 10

Class III anti-arrhythmic

Question 11

Sotalol (Betapace) Class

Answer 11

Class III anti-arrhythmic

Question 12

Dofetilide (Tikosyn) Class

Answer 12

Class III anti-arrhythmic

Question 13

Adenosine (Adenocard) MOA

Answer 13

Adenosine receptors in atrium, sinus node, AV node; activates inward K current and inhibition of Ca current

Question 14

Quinidine (Quinidex) MOA

Answer 14

Both sodium and potassium channel blockers (also, a-adrenergic blocker)

Question 15

Procainamide (Pronestyl) MOA

Answer 15

Sodium channel blocker

Question 16

Disopyramide (Norpace) MOA

Answer 16

Sodium channel blocker; induces vagal block

Question 17

Lidocaine (Xylocaine) MOA

Answer 17

Sodium channel blocker; decreases automaticity

Question 18

Mexiletine (Mexitil) MOA

Answer 18

Oral lidocaine

Question 19

Flecainide (Tambocor) MOA

Answer 19

Sodium channel blocker

Question 20

Propafenone (Rythmol) MOA

Answer 20

Sodium channel blocker

Question 21

Amiodarone (Cordarone) MOA

Answer 21

Prolong QT (potassium channel blocker); K, Na, b, and Ca channel blocker

Question 22

Dronedarone (Multaq) MOA

Answer 22

Prolong QT (potassium channel blocker)

Question 23

Sotalol (Betapace) MOA

Answer 23

Prolongs effective refractory period

Question 24

Dofetilide (Tikosyn) MOA

Answer 24

Prolong QT (potassium channel blocker); pure IKr blocker (phase 3)

Question 25

Adenosine (Adenocard) SE

Answer 25

Facial flushing, shortness of breath, chest tightness, nausea

Question 26

Quinidine (Quinidex) SE

Answer 26

Nausea, diarrhea in 1/3; development of arryhthmias like torsades de pointes (VT); "Quinidine syncope"

Question 27

Procainamide (Pronestyl) SE

Answer 27

Hypotension (ganglionic blocking properties); atrial and ventricular arryhthmia; 1/3 develop drug-induced lupus

Question 28

Disopyramide (Norpace) SE

Answer 28

Urinary retention, blurred vision, worsening glaucoma (anticholinergic)

Question 29

Lidocaine (Xylocaine) SE

Answer 29

Neurologic (after 3 days continuous infusion), including tremor, slurred speech, convulsion, seizure

Question 30

Mexiletine (Mexitil) SE

Answer 30

GI toxicity (very potent)

Question 31

Amiodarone (Cordarone) SE

Answer 31

End organ toxicities: pulmonary fibrosis; hypothyroidism, hyperthyroidism; blue discoloration, photosensitivity; nausea, anorexia; ataxia, paresthesias, and other neurological symptoms

Question 32

Dronedarone (Multaq) SE

Answer 32

Fewer side effects than amiodarone (no thyroid or pulmonary toxicities)

Question 33

Dofetilide (Tikosyn) SE

Answer 33

Proarrhythmia; hospital initiation to avoid, need to be monitored every 3 months

Question 34

Quinidine, procainamide, disopyramide Therapy

Answer 34

Block inward potassium rectifying channel (slow rate) at normal concentrations; blocks sodium channels (fast rate) at high concentrations

Question 35

Lidocaine, mexiletine, tocainide Therapy

Answer 35

Digitalis toxicity

Question 36

Flecainide, propafenone, moricizine therapy

Answer 36

Atrial fibrillation/flutter, paroxsymal supraventricular tachycardia, ventricular tachycardia

Question 37

Propanolol, carvedilol therapy

Answer 37

Control of ventricular rate in atrial fibrillation/flutter; prevent or terminate SVTs

Question 38

Sotalol, amiodarone, dofetilide, ibutelide, dronedarone therapy

Answer 38

Atrial fibrillation/flutter, paroxsymal supraventricular tachycardia, ventricular tachycardia

Question 39

Nifedipine, amlodipine, felopidine, isradipine, veapamil, diltiazam.

Answer 39

Prevent or terminate reentrant SVTs

Question 40

Adenosine therapy

Answer 40

AV node reentrant tachy, paroxsymal supraventricular tachycardia

Question 41

Digoxin therapy

Answer 41

Atrial fibrillation/flutter; chronic SVT

Question 42

Magnesium sulfate therapy

Answer 42

Prevents recurrent TdP and some digitalis-induced arrhythmias

Question 43

Digoxin MOA

Answer 43

Na/K pump inhibitor; slows AVN activity and conduction

Question 44

Digoxin ISE

Answer 44

Nausea, cognitive dysfunction, blurred or yellow vision, may cause DAD arrhythmias

Question 45

Digoxin Misc

Answer 45

Low therapeutic index

Question 46

Magnesium sulfate misc

Answer 46

Alternative to amiodarone for shock-refractory cardiac arrest.

Question 47

Adenosine SE

Answer 47

Sedation, dyspnea, hypotension

Question 48

How should acute Atrial flutter/fib be treated?

Answer 48

1. IV verapimil, dilitiazem, beta blocker or digoxin | 2. IV procainamide, ibutilide, dofetilide

Question 49

How should chronic a fib/flutter be treated?

Answer 49

1. rate control with verapamil, dilitiazem, beta blocker, or digoxin 2. Maintain sinus rhythm with amiodarone, sotalol, flecainide 3. Quinidine, procainamide, disopyramide

Question 50

How should acute SVTs be treated?

Answer 50

1. IV adenosine, verapamil, diltiazem | 2. IV esmolol, beta blockers, digoxin

Question 51

How should chronic SVTs be treated?

Answer 51

1. beta blockers, verapamil, diltiazem, flecainide, propafenone, amiodarone, solatol, digoxin 2. quinidine, procainamide, disopyramide

Question 52

How should PVCs or nonsustained VT be treated?

Answer 52

1. Asymptomatic: no treatment | 2. symptomatic: beta blockers