Anti-arrhythmic Flashcards
Implantable defib and ablations
May increase the risk of death
Treatment of dysrhythmia
2 stages: termination and long term suppression
Empiric treatment, require trial and error approach
SV dysrhythmias: not harmful. class 2 and 4 agents and adenosine and digoxin
V dysrhythmias significant. Class 1 and 3
A-Fib
BB and Non-dihydropyridine CCB
Prevent stroke via aspirin, warfarin, dabigatran, rivaroxaban, edoxaban, or apixaban
A Flutter
Cardioversion. Electrical or ibutilide
Long term: Class IC (flecainide or propafenone) or III (amiodarone, dronedarone, sotalol, dofetilide)
Prevent stroke: same as a fib, reduce risk with anticoagulants
SVT
Valsalva, ice, blowing thru straw
Adenosine (chemical cardioversion)
BB and non-dihydropyridine CCBs: rate control short and long term
V-tach/V-FIb
Not life compatible
Cardioversion
Lidocaine, procainamide, amiodarone if cardioversion fails
Long term: amiodarone
Class 1 Na Channel Blockers
Block cardiac Na channels: decrease conduction velocity
1a: delay repolarization
1b: accelerate
1c: pronounced prodysrhythmic actions
Procainamide
Class 1a
Ventricular and SV arrhythmia
BOX: positive ANA test, Mortality increase (CAST Trial), blood dyscrasias
CONTRA: allergy to ester type local anesthetics, complete heart block, 2nd degree, lupus, torsade’s
ADR: + ANA titer, Lupus-like syndrome, QT prolongation
Hepatic and renal adjustments
Lidocaine
1B
Acute Ventricular arrhythmia, local and regional anesthesia, nerve block, epidurals
CONTRA: Allergies to amide type anesthetic, Stokes-Adam syndrome, WPW, severe SA or AV or intraventricular heart block
ADR: bradycardia, edema, hypotension. Drowsy, confusion. Seizures and resp. arrest
Mexiletine
1B
Ventricular arrhythmia
BOX: increased mortality (CAST), acute liver injury
CONTRA: cardiogenic shock, 2/3 degree AV block (unless pacemaker present)
ADR: dysrhythmias, dizzy, ataxia, nervousness, unsteady gait, psychosis, GI disturbance (N/V/D), tremors
Flecainide
1C
Paroxysmal a fib/flutter and ventricular arrhythmia or PSVT PREVENTION
BOX: increased mortality (CAST), Ventricular proarrhythmic effects in pts with afib/flutter
CONTRA: 2/3 degree heart block, cardiogenic shock, use of Ritonavir
ADR: Ventricular arrhythmias, dizzy, visual disturbances
Propafenone
1c
Ventricular arrhythmia treatment. Afib/flutter and SVT prevention
BOX: Mortality CAST
CONTRA: SA, AV, Intraventricular disorders (unless pacemaker is present), Brugada, bradycardia, cardiogenic shock, HF, Hypotension, Broncho reactive disorders, or electrolyte imbalances
ADR: Taste disturbances, dizzy
Beta blockers Class II
Propanolol, acebutolol, esmolol, sotalol. Metoprolol used w/o FDA indication
Beta1 receptor blockade. Stops sympathetic stimulation of the heart
K+ channel blockers
Class 3
Delay repolarization by prolonging QT interval
Amiodarone
Class III K+ blocker
BOX: only for life threatening situations, pulm toxicity (MUST MONITOR with CXR for 3-6 MONTHS), hepatotoxic, worsening arrhythmia
CONTRA: cardiogenic shock, iodine allergy, SSS, 2/3 AV block, bradycardia
ADR: bradycardia, hypotension, thyroid effects, visual, blue-gray skin
Hepatic adjustments
Dronedarone
Class III K+ Blocker Paroxysmal or persistent Afib BOX: mortality (CAST) CONTRA: SYMPTOMATIC HEART FAILURE and SEVERE LIVER IMPAIRMENT ADR: AKI (increased SCr)
Sotalol
Beta blocker with Class 3 properties
Ventricular arrhythmia, afib/flutter
Beta blocker that also delays repolarizing
BOX: life threatening proarrhthymias (QT prolongation)
CONTRA: BRONCHO REACTIVE DISORDERS, BRADY, 2/3, qt PROLONGATION, SHOCK, DECOMPENSATED heart failure
ADR: brady, cpain, palps, dizzy, fatigue, headache
Renal adjustment required
Dofetilide
Class 3
Afib/flutter treatment and prevention
BOX: requires 3 days in a facility for continuous EKG monitoring
CONTRA: QT prolongation, severe renal impairment
ADR: Torsades, cardiac failure, MI
LOTS of drug interactions, call a pharmacist
Ibutilide
Class 3 Afib/flutter treatment BOX: life threatening arrhythmias CONTRA: NONE ADR: NONE
Class 4
Verapamil and Diltiazem
HTN, angina, Afib/flutter, SVT prevention and treatment
N-D CCB = vasodilation with reduced HR, conduction, and force of contraction
CONTRA: severe LV dysfunction, hypotension, cardio shock, 2/3 (unless pacemaker)
ADR: (reduced CO), bradycardia, headache, constipation
M/E Strong CYP 3A4 Inhibitors means that Verapamil requires a 20-30% adjustment with liver failure
Adenosine
SVT treatment (chemical cardioversion) Interrupts AV node re-entry to restore sinus rhythm CONTRA: 2/3, brady 6mg IV, flush, 12...... ADR: hit by a truck
Digoxin
HFrEF and Afib/flutter
Decreases HR and slows AV conduction velocity
CONTRA: Ventricular fib
ADR: Digoxin toxicity
