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Cardiology > Anti-arrhythmic Drugs > Flashcards

Anti-arrhythmic Drugs Flashcards

1
Q 
Class IA 
(Mechanism of action, Effects on: APD, ERP, HR and AV conduction)
A
  • Block fast sodium channels (open or activated state), and also blocks K+ channels
  • Increases APD and ERP
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2
Q 
Class IB
(Mechanism of action, Effects on: APD, ERP, HR and AV conduction)
A
  • Block sodium channels (inactivated state) in partly depolarized tissues (hypoxic and ischemic)
  • Decrease APD, but increase diastole and decrease heart rate
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3
Q 
Class IC
(Mechanism of action, Effects on: APD, ERP, HR and AV conduction)
A
  • Block fast sodium channels especially His-Purkinje tissue

- No effect on APD

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4
Q 
Class II
(Mechanism of action, Effects on: APD, ERP, HR and AV conduction)
A
  • Prevent beta-receptor activation; thereby decrease cAMP

- Decrease SA and AV nodal activity

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5
Q 
Class III
(Mechanism of action, Effects on: APD, ERP, HR and AV conduction)
A
  • Block K+ channels

- Increase APD and ERP; especially in Purkinje and ventricular fibers

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6
Q 
Class IV
(Mechanism of action, Effects on: APD, ERP, HR and AV conduction)
A
  • Block slow Ca++ channels

- Decrease SA and AV nodal activity

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7
Q

Quinidine

Class, Specific Mechanism of action, Specific effects

A
  • Class IA
  • Blocks muscarinic and alpha-adrenergic receptors
  • Increase heart rate and AV conduction, vasodilation with possible reflex tachycardia
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8
Q

Procainamide

Class, Specific Mechanism of action, Specific effects

A
  • Class IA
  • Blocks muscarinic receptors (but less than quinidine)
  • Slight increase in heart rate and AV conduction
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9
Q

Disopyramide

Class, Specific Mechanism of action, Specific effects

A
  • Class IA
  • Blocks muscarinic receptors
  • Increase heart rate and AV conduction; also -ve inotropic effect that significantly decreases contractility
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10
Q

Ajmaline

Class, Specific Mechanism of action, Specific effects

A
  • Class IA
  • None
  • None
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11
Q

Lidocaine

Class, Specific Mechanism of action, Specific effects

A
  • Class IB
  • None
  • None
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12
Q

Phenytoin

Class, Specific Mechanism of action, Specific effects

A
  • Class IB
  • None
  • None
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13
Q

Mexiletine

Class, Specific Mechanism of action, Specific effects

A
  • Class IB
  • None
  • None
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14
Q

Tocainide

Class, Specific Mechanism of action, Specific effects

A
  • Class IB
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15
Q

Flecainide

Class, Specific Mechanism of action, Specific effects

A
  • Class IC
  • Inhibits ryanodine receptor 2 (RyR2); a major regulator of sarcoplasmic release of stored Ca++
  • Negative inotropic effect
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16
Q

Propafenone

Class, Specific Mechanism of action, Specific effects

A
  • Class IC
  • Blocks beta-adrenergic receptors
  • Decrease heart rate
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17
Q

Amiodarone

Class, Specific Mechanism of action, Specific effects

A
  • Class III
  • Blocks fast sodium, Ca++, K+ channels, and beta-adrenergic receptors
  • Increase APD and ERP in all cadiac tissue
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18
Q

Sotalol

Class, Specific Mechanism of action, Specific effects

A
  • Class III
  • Non-selective beta blocker
  • Decrease heart rate and AV conduction
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19
Q

Ibutilide

Class, Specific Mechanism of action, Specific effects

A
  • Class III
  • Activation of specific slow sodium channels leading to inward sodium current
  • Increase APD and ERP by that mechanism
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20
Q

Verapamil

Class, Specific Mechanism of action, Specific effects

A
  • Class IV
  • Non
  • None
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21
Q

Diltiazem

Class, Specific Mechanism of action, Specific effects

A
  • Class IV
  • None
  • None
22
Q

Adenosine

Class, Specific Mechanism of action, Specific effects

A
  • Unclassified
  • Activates adenosine receptors (Gi-coupled) which leads to decrease cAMP causing increased K+ efflux and hyperpolarization (transient asystole)
  • Decrease SA and AV nodal activity
23
Q 
Magnesium sulfate 
(Class, Specific Mechanism of action, Specific effects)
A
  • Unclassified
  • None
  • None
24
Q

Quinidine

Clinical Uses

A

Many arrhythmias especially in AF

25
Q

Procainamide

Clinical Uses

A

Life-threatening arrhythmias

26
Q

Disopyramide

Clinical Uses

A

Ventricular tachycardia

27
Q

Ajmaline

Clinical Uses

A
  • Diagnosis of Brugada syndrome
  • Treatment of WPW
  • Ventricular tachycardia
28
Q

Lidocaine

Clinical Uses

A
  • Post-MI arrhythmias
  • Open heart surgery arrhythmias
  • Digoxin toxicity
  • Local anesthetic
29
Q

Phenytoin

Clinical Uses

A
  • Seizures
  • Status epilepticus (second-line)
  • Trigeminal neuralgia (second-line)
  • Digoxin toxicity
  • Ventricular tachycardia (after all others have failed)
30
Q

Mexiletine

Clinical Uses

A
  • Post-MI arrhythmias
  • Open heart surgery arrhythmias
  • Digoxin toxicity
  • Back-up for ventricular tachycardia
31
Q

Flecainide

Clinical Uses

A

Supraventricular tachycardias including AVNRT and WPW

32
Q

Amiodarone

Clinical Uses

A

Any type of arrhythmia

33
Q

Sotalol

Clinical Uses

A

Life-threatening ventricular arrhythmias

34
Q

Ibutilide

Clinical Uses

A

Acute cardioversion in AF and atrial flutter of a recent onset to sinus rhythm

35
Q

Verapamil

Clinical Uses

A

Supraventricular tachycardias

36
Q

Diltiazem

Clinical Uses

A

Supraventricular tachycardias

37
Q

Adenosine

Clinical Uses

A
  • Paroxysmal supraventricular tachycardias (drug of choice)

- AV nodal arrhythmias

38
Q

Magnesium sulfate

Clinical Uses

A

Torsade de pointes

39
Q

Quinidine

Adverse Effects

A
  • Cinchonism (GI upset, tinnitus, ocular dysfunction, and CNS excitation)
  • Hypotension
  • Increase QRS and QT interval (Torsade)
  • Hyperkalemia increases its toxicity; and it increases toxicity of digoxin (by displacing it from binding sites)
  • Increase mortality due to tachycardia
40
Q

Procainamide

Adverse Effects

A
  • SLE like syndrome (30%) which is more likely in slow acetylators (metabolized to NAPA)
  • Hematotoxicity (thrombocytopenia and agranulocytosis)
  • CNS: dizziness and hallucinations
  • Cardiovascular: torsade de pointes
41
Q

Disopyramide

Adverse Effects

A
  • Anti-cholinegic effects

- Agranulocytosis

42
Q

Lidocaine

Adverse Effects

A
  • Seizures

- Least cardiotoxic of all conventional anti-arrhythmics

43
Q

Flecainide

Adverse Effects

A

Contra-indicated in post-MI patients and patients with structural heart abnormalities because it causes sudden cardiac death

44
Q

Amiodarone

Adverse Effects

A
  • Pulmonary fibrosis
  • Blue pigmentation of skin (“smurf skin”)
  • Phototoxicity
  • Corneal deposits
  • Hepatic necrosis
  • Thyroid dysfunction
45
Q

Sotalol

Adverse Effects

A

Torsade de pointes

46
Q

Ibutilide

Adverse Effects

A

Torsade de pointes

47
Q

Verapamil

Adverse Effects

A
  • Constipation
  • Dizziness and nausea
  • Hypotension
  • Headache
  • AV block (additive with beta-blockers and digoxin)
  • Gingival hyperplasia
  • Increases digoxin toxicity (by displacing it from binding sites)
48
Q

Diltiazem

Adverse Effects

A
  • Flushing
  • Hypotension and bradycardia
  • Dizziness
  • AV block (additive with beta-blockers and digoxin)
49
Q

Adenosine

Adverse Effects

A
  • Flushing
  • Dyspnea
  • Sedation
  • Antagonized by theophylline and caffeine
50
Q

Effects of increased cAMP on Action potential

A
  • Increase upstroke velocity in pacemakers by increase of I-Ca-L
  • Shorten APD by increase of I-K
  • Increase heart rate by increase of I-f, thus increasing slope of phase 4
51
Q

Effects of decreased cAMP on Action potential

A
  • Decrease upstroke velocity in pacemakers by decrease of I-Ca-L
  • Prolong APD by decrease of I-K
  • Decrease heart rate by decrease of I-f and produces K+ current (I-K/ACh) which slows rate of diastolic depolarization

Cardiology (8 decks)

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