Anti-Arrhythmic Drugs Flashcards by Jamaira Belmes

Sodium Channel Blockers

Class IA - PROLONGS AP duration

Quarter Pounder Delight

Quinidine
Procainamide
Disopyramide

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Sodium Channel Blockers

Class IB - REDUCES AP duration

Lettuce, Mayo, Tomato, Pickles

Lidocaine
Mexiletine - for neuropathic
Tocainide
Phenytoin

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Drugs that can cause AGRANULOCYTOSIS

CCCAPPIT Me!

Clozapine
Co-trimoxazole
Colchicine
Aminopyrine
Phenylbutazone
PTU
Indomethacin
Tocainide
Methimazole

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Sodium Channel Blockers

Class IC - NO EFFECT ON AP duration

MOST ARRHYTHMOGENIC AMONG CLASS I

More Extra Fries Please

Morticizine
Encainide
Flecainide
Propafenone

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Nonselective Beta Blockers

Propanolol

Timolol

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Beta 1 selective beta blockers

Acebutolol
Betaxolol
Esmolol
Atenolol
Metoprolol

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Partial Agonist Beta Blockers

Pindolol

Acebutolol

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Lacking local anesthetic effect BB

Timolol

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Low lipid solubility BB

Atenolol

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Shortest acting BB

Esmolol

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Longest acting BB

Nadolol

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Combined a and B blockade

Carvedilol

Labetalol

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Class 3 - blocks K channel

PROLONGS AP duration

AIDS

Amiodarone
Ibutilide
Dofetilide
Dronedarone
Sotalol

Vernakalant

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Amiodarone Toxicity

Pulmonary fibrosis
Paresthesia
Tremors
Thyroid dysfunction
Corneal deposits
Skin deposits

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Prolongs AP duration

Prolongs:
PR interval
QRS duration
QT interval

IA - Procainamide, Quinidine, Disopyramide

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Shortens AP duration

No effect on normal cells

IB - Lidocaine

No effect on AP duration

Prolongs QRS duration

IC - Flecainide, Propafenone, Encanide, Moricizine

No effect on AP duration

Prolongs PR interval

Class 2 - Propanolol

Prolongs AP durations

Prolongs QT interval

Class III - Amiodarone, Ibutilide, Droneodarone, Sotalol

No effect on AP duration

Prolongs PR interval

Class IV - Verapamil

Adverse Effects Class Ia

Procainamide - SLE
Quinidine - Cinchonism
Disopyramide - Torsades des Pointes

Adverse Effects Class II

HYPOglycemia
COPD exacerbation
impotence

Adverse Effects Class III

Torsades de Pointes
thyroid
liver
pulmonary

Adverse Effects Class IV

edema

constipation

Why are DIHYDROPRIDINE CCBs NOT useful as antiarrhythmics

DIHYDROPRIDINE CCBs - evoke compensatory sympathetic discharge which facilitates arrhythmias rather than terminating them can cause REFLEX TACHYCARDIA and PRO-ARRHYTHMOGENIC

MOA of ADENOSINE

Increase in diastolic Ik of AV node that causes marked hyperpolarization and conduction block

Adverse Effects of Adenosine

Flushing Hypotension Transient chest pain Dyspnea

DOC for Supraventricular Tachycardia (SVT)

ADENOSINE Verapamil

DOC for Ventricular Tachycardia (VT)

AMIODARONE

DOC for Atrial Fibrillation (aFib)

AMIODARONE Propafenone

A 76-year-old retired postal worker with rheumatoid arthritis and chronic heart disease presents with ancardiac arrhythmia and is being considered for treatment with procainamide. She is already receiving an ACE inhibitor, digoxin, and hydrochlorothiazide for her cardiac condition. 1. In deciding on a treatment regimen with procainamide for this patient, which of the following statements is most correct? (A) A probable drug interaction with digoxin suggests that digoxin blood levels should be obtained before and after starting procainamide. (B) Hyperkalemia should be avoided to reduce the likelihood of procainamide toxicity. (C) Procainamide cannot be used if the patient has asthma because it has a β-blocking effect. (D) Procainamide cannot be used if the patient has angina because it has a β-agonist effect. (E) Procainamide is not active by the oral route

(B) Hyperkalemia should be avoided to reduce the likelihood of procainamide toxicity.

A 76-year-old retired postal worker with rheumatoid arthritis and chronic heart disease presents with a cardiac arrhythmia and is being considered for treatment with procainamide. She is already receiving an ACE inhibitor, digoxin, and hydrochlorothiazide for her cardiac condition If this patient should take an overdose and manifest severe acute procainamide toxicity with markedly prolonged QRS, which of the following should be given immediately? ``` (A) A calcium chelator such as EDTA (B) Adenosine (C) Nitroprusside (D) Potassium chloride (E) Sodium lactate ```

(E) Sodium lactate

A 54-year-old airline pilot is admitted to the emergency department with chest pain and a rapid heart rhythm. The ECG shows an inferior myocardial infarction and ventricular tachycardia. Amiodarone is ordered. Amiodarone (A) Decreases PR interval in normal sinus rhythm (B) Increases action potential duration (C) Increases contractility (D) Often causes liver function abnormalities (E) Reduces resting potential

(B) Increases action potential duration

. A 36-year-old woman with a history of poorly controlled thyrotoxicosis has recurrent episodes of tachycardia with severe shortness of breath. During elective surgery to remove her thyroid, she develops a heart rate of 200 with a slightly decreased blood pressure. Which of the following drugs would be most suitable? ``` (A) Amiodarone (B) Disopyramide (C) Esmolol (D) Quinidine (E) Verapamil ```

A 16-year-old girl has paroxysmal attacks of rapid heart rate with palpitations and shortness of breath. These episodes occasionally terminate spontaneously but often require a visit to the emergency department of the local hospital. Her ECG during these episodes reveals an AV nodal tachycardia. Which of the following drugs would be most suitable for prophylaxis of future episodes of acute AV nodal tachycardia? ``` (A) Adenosine (B) Amiodarone (C) Flecainide (D) Propranolol (E) Verapamil ```

(E) Verapamil

A 55-year-old man is admitted to the emergency department and is found to have an abnormal ECG. Overdose of an antiarrhythmic drug is considered. Which of the following drugs is correctly paired with its ECG effects? (A) Quinidine: Increased PR and decreased QT intervals (B) Flecainide: Increased QRS interval (C) Verapamil: Decreased PR interval (D) Lidocaine: Decreased QRS and PR interval (E) Metoprolol: Increased QRS duration

(B) Flecainide: Increased QRS interval

A 60-year-old woman comes to the emergency department with atypical chest pain. Her ECG reveals ventricular tachycardia with rare normal sinus beats, and ST-segment elevation. Troponin C levels are markedly increased, suggesting myocardial damage. A diagnosis of myocardial infarction is made, and the woman is admitted to the cardiac intensive care unit. Her arrhythmia will probably be treated initially with ``` (A) Adenosine (B) Digoxin (C) Lidocaine (D) Quinidine (E) Verapamil ```

(C) Lidocaine emergency treatment of myocardial infarction arrhythmias useful in digoxin-induced arrhythmias after recovery from the acute phase of a myocardial infarction, β blockers are used for 2 years or more to prevent sudden death arrhythmias

Which of the following drugs slows conduction through the AV node and has a duration of action of 10–20 seconds? ``` (A) Adenosine (B) Amiodarone (C) Diltiazem (D) Esmolol (E) Flecainide (F) Lidocaine (G) Mexiletine (H) Procainamide (I) Quinidine ```

(A) Adenosine

When working in outlying areas, this 62-year-old rancher is away from his house for 12–14 h at a time. He has an arrhythmia that requires chronic therapy. Which of the following has the longest half-life of all antiarrhythmic drugs? ``` (A) Adenosine (B) Amiodarone (C) Disopyramide (D) Esmolol (E) Flecainide (F) Lidocaine (G) Mexiletine (H) Procainamide (I) Quinidine (J) Verapamil ```

(B) Amiodarone