Anti Arrhythmias

Question 1

Class I Na + Channel Blockers

Answer 1

Class Ia ,Quinidine ,Intermediate Na + Block

Class Ib, Lidocaine, Weak Na Block

Class Ic, Flecainide , Strong Na Block

Question 2

Lidocaine
Clinical use
Adverse effects

Answer 2

Ventricular tachycardia post MI

Negatively ionotropic Seizures Nystagmus

Question 3

Flecainide

Answer 3

من اشهر ادويه Ic
Action blocks Na , K,Ca channels
Also also 👍 slow conduction
بالتالي راح يفيدني في AF
وايضا من يسد Na راح يقلل slope في SAN فاذا المشكلة بيه هم راح تتعالج
او مثلا واحد سويت له صدمات كهربائية وخايف عليه من SVT انطي flecanide لكن لازم المريض ما عنده Structural heart abnormal او IHD

Question 4

Clinical Use

Answer 4

Prophylaxis and treatment of SVT/PAF

Question 5

Adverse effects

Answer 5

Contraindicated with history of IHD/HF – Causes lethal dysrhythmias

Question 6

Class II Beta Blockers

Non-selective

Answer 6

— Propranolol

Sotalol

Question 7

b1 selective
Longer Acting
Shorter Acting

Answer 7

Longer Acting
Atenolol ,Bisoprolol

Shorter Acting
Metoprolol ,Nebivolol ,Esmolol

Question 8

Mixed b1 a1

Answer 8

Carvedilol ,Labetalol

Question 9

Clinical Use

Answer 9

Rate control of AF/Atrial flutter Cardioversion AVRT/AVNRT 2°prevention VT/VF Heart failure Hypertension Ischaemic Heart Disease

nodal reentrant tachycardia (AVNRT),
Atrioventricular reentrant tachycardia (AVRT)

Question 10

Adverse effects

Answer 10

Heart failure  
Bradycardia  
Bronchospasm 
Peripheral limb ischaemia 
Loss of hypoglycaemic symptoms 
Fatigue

Question 11

Class III Prolong Action Potential

Amiodarone

Answer 11

Amiodarone
هذا الدواء يطول AP بهوية طرق block Na ,K,Ca channels
وايضا يقيلل condiction
فبذلك يعالج معظم مراض arrhythmia ولكن ماعدا✋ اذا كانت arthyma جاي من thyrotoxicosis لان يحتوي على يود

Question 12

Acute indications

Answer 12

Atrial Fibrillation
Atrial Flutter
Ventricular Tachycardia رائع فيها
When other antiarrhythmics contraindicated

Question 13

Chronic indications

Answer 13

2°prevention of VT/VF When other antiarrhythmics not tolerated

Question 14

Adverse Effects

Short term

Answer 14

Phlebitis & hypotension with iv administration Requires central access when given iv

Question 15

Long term

Answer 15

Pulmonary fibrosis  
Hypo/hyperthyroidism 
Hepatic dysfunction 
Corneal microdeposits 
Slate grey skin/photosensitivity 
Peripheral neuropathy 
Proximal myopathy 
Increases defibrillation threshold for ICDs

Question 16

Sotalol

Clinical use

Answer 16

Paroxysmal AF

Question 17

Adverse effects

Answer 17

b blocker adverse effects Torsades de pointes

Question 18

Class IV Calcium Channels Blockers

Answer 18

Diltiazem & verapamil

Question 19

Clinical use

Answer 19

Best best drug to treatment Rate control of AF Cardioversion of AVRT/AVNRT
Antianginal/antihypertensive

Question 20

Adverse Effects

Answer 20

Bradycardia
Heart failure
Constipation

Question 21

Other Antiarrhythmic Drugs

Answer 21

Adenosine —
Digoxin —
Magnesium

Question 22

Adenosine

Action

Answer 22

Stimulates specific A1 receptors on the surface of cardiac cells thus influencing adenosine-sensitive K channel and cAMP production. This leads to prolonged conduction through the AV node, often with a high degree AV block.
يعني يطوّل الconduction بال AV node من خلال تأثيره على قنوات البوتاسيوم

Question 23

Clinical uses

Answer 23

1) Rapid reversal of SVT to sinus rhythm
2) SVT with aberrant conduction (specialist use only)
3) Aiding diagnosis of narrow or broad complex tachycardias

Question 24

CONTRA-INDICATIONS:

Answer 24

1) Second and third degree AV block
2) Sick sinus syndrome
3) Prolonged QT syndrome
4) Severe hypotension
5) Decompensated heart failure
6) Asthma

Question 25

SIDE-EFFECTS:

Answer 25

1) Chest pain
2) Dyspnoea
3) Bronchospasm
4) Nausea 🤢
5) Severe bradycardia
6) Choking sensation
7) Light-headedness🤕

Question 26

Digoxin

action

Answer 26

Inhibits Na /K ATPase in myocardium and thereby reduces extrusion of Ca 2&raquo_space; increase in end diastolic filling and force of contraction (in accordance with the Frank–Starling law of the heart). Indirectly slows conduction at SA node and AV node and centrally stimulates the vagus nerve, resulting in a negative chronotropic effect

Question 27

INDICATIONS

Answer 27

1) Supraventricular arrythmias (atrial fibrillation and atrial flutter)
2) Heart failure

Question 28

CAUTIONS AND CONTRA-INDICATIONS

Answer 28

1) Complete heart block and second degree block
2) Tachyarrhythmias associated with Wolff–Parkinson–White syndrome 3)Ventricular tachycardia/fibrillation
4) Myocarditis/constrictive pericarditis
5) Hypertrophic

Question 29

SIDE-EFFECTS

Answer 29

1) GI disturbance
2) Dizziness
3) Blurred or yellow vision (xanthopsia suggests toxicity)
4) Arrhythmias/conduction defects
5) Rash
6) Abdominal pain (suggests toxicity)

Question 30

Magnesium

Clinical uses

Answer 30

iv Mg2+used to treat Torsades de Pointes