Anti-Arrhythmic Drugs 2

Question 1

Esmolol

Answer 1

Class II
Selective Beta 1 adrenregic receptor blocker which leads to decreased HR, decrease AP in SA nodes, Decreased conduction velocity through AV node

Question 2

Esmolol Recovers

Answer 2

Within 15 minutes after termination

Question 3

Esmolol Excretion and Metabolism

Answer 3

Renal

Question 4

Esmolol Cautions

Answer 4

Hypotension, compensated HF, bronchospastic, DM

Question 5

Esmolol Contraindications

Answer 5

2nd and 3rd degree AV block
Severe HF
Cardiogenic shock
SA bradycardia

Question 6

Amiodarone (Cordarone, Pacerone)

Answer 6

Class III
Blocks K channels
Blocks Na and Ca channels
Blocks adrenergic receptors
Structural analog of thyroid hormone
Highly lipophilic

Question 7

What all does Amiodarone do?

Answer 7

Inhibits abnormal automaticity
Prolongs AP duration
Prolongs PR, QRS and QT
Causes sinus bradycardia
Prolongs refractory period
Inhibits cell-cell coupling

Question 8

Amiodarone Elimination and Metabolism

Answer 8

Hepatic
CYP3A4
SUPER LONG HALF LIFE

Question 9

Amiodarone AE

Answer 9

Pulmonary fibrosis
Corneal microdeposits
Hepatotoxicity
Peripheral neuropathy and muscle weakness
Proarrhythmic
Thyroid dysfunction
QT PROLONGATION
Bradycardia
Photosensitivity

Question 10

Amiodarone Caution

Answer 10

Optic neuropathy
Respiratory distress syndrome
Pre-existing QT prolongation

Question 11

Amiodarone Contraindications

Answer 11

2nd and 3rd degree AV block
Severe SA node dysfunction
Syncope

Question 12

Dronedarone (Multaq)

Answer 12

Analog amiodarone
Targets same as amiodarone
Anti-adrenergic properties
LESS THYROID effects
Simpler kinetics (less lipophilic)

Question 13

Dronedarone Elimination and Metabolism

Answer 13

Hepatic
CYP3A4
Shorter half life than amiodarone

Question 14

Dronedarone AE

Answer 14

Bradycardia
MODERATE QT PROLONGATION
Worsening HF
Asthenic conditions
Skin conditions
N/D/abdominal pain
Increase SCr

Question 15

Dronedarone Cautions

Answer 15

Patients with HF, sever hepatic impairment, electrolyte disturbances (K)
Increased level of digoxin

Question 16

Amiodarone vs Dronedarone

Answer 16

A: used to maintain a normal sinus rhythm (rate control) in pts with afib
D: Increases mortality in those pts

Question 17

Dofetilide (Tikosyn)

Answer 17

Potent and pure K channel blocker (increases duration of AP and refractory periods in atria and ventricles)

Question 18

Dofetilide Elimination and Metabolism

Answer 18

H/R (mostly urine)

CYP3A4

Question 19

Dofetilide AE

Answer 19

PROLONGS QT INTERVAL (torsade de pointes)

Headache, angina, dizziness

Question 20

Dofetilide Cautions

Answer 20

Must start under close EKG monitoring
Other QTc prolongaters
Renal impairment
K-depleting diuretics

Question 21

Dofetilide Contraindications

Answer 21

Prolong QTc

Severe renal impairment

Question 22

What drugs cannot be used with Dofetilide?

Answer 22

Verapamil
Cimetidine
Trimethoprim
Ketoconazole
HCTZ

Question 23

Sotalol (Betapace)

Answer 23

Inhibit K channels (160 mg) and increase duration of AP

Blocks beta 1/2 (25 mg)

Question 24

Sotalol elimination

Answer 24

Renal

Question 25

Sotalol AE

Answer 25

Pro-arrhythmic effects (torsades) May mask hypoglycemia induced tachycardia in DM Bradycardia, dyspnea and fatigue Bronchospasms

Question 26

Sotalol Cautions

Answer 26

``` Must be started under close EKG monitoring PROLONG QT HF Renal Impairment Hypokalemia and hypomagnesium ```

Question 27

Sotalol Contraindications

Answer 27

``` 2nd or 3rd degree AV block Prolong QTc Bradycardia Cardiogenic Shock Uncontrolled HF HYPOKALEMIA (less than 3.5) ```

Question 28

Ibutilide (Corvert)

Answer 28

Inhibits K channels and increases duration of AP | PROLONGS QTc via activation of slow Na channels

Question 29

Ibutilide Elimination and Metabolism

Answer 29

H/R | Metabolism unknown

Question 30

Ibutilide AE

Answer 30

``` Torsades Hypotension Postural hypotension Bradycardia HF ```

Question 31

Ibutilide Caution

Answer 31

Must be under close EKG Prolong QTc drugs Heart block

Question 32

Ibutilide Contraindication

Answer 32

History of polymorphic VT (torsades, prolong QTc)

Question 33

Digoxin MOA

Answer 33

Inhibition of Na K ATPase

Question 34

Digoxin Main effects

Answer 34

+ Inotropic Increased vagal tone and decrease sypathetic activity Increase AV refractory period and decreased AV conductance

Question 35

Digoxin Ion and Cardiac glycoside Actions

Answer 35

Hypokalemia- potentiates digoxin | Hyperkalemia- attenuates digoxin

Question 36

Digoxine Cautions

Answer 36

Absorption is inhibited by antacids and BAS Renal impairment Combo with diuretics bc of hypokalemia Combo with diltiazem and verapamil