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Pharm Midterm 1 > Anti-Arrhythmics > Flashcards

Anti-Arrhythmics Flashcards

1
Q

What do IA block

A

Na channels Ventricular and Supraventricular

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2
Q

What do IB block

A

Na channel Ventricular only

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3
Q

What do IC block

A

Na channels Ventricular and Supraventricular

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4
Q

What do II block

A

Beta

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5
Q

What do III block

A

K channel Ventricular and Supraventricular

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6
Q

What do IV (4) block

A

Ca channel Supraventricular only

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7
Q

What are the IA drugs

A

Quinidine

Procainamide

Disopyramide

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8
Q

What are the IB drugs

A

Lidocaine

Mexiletine

Tocainide

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9
Q

What are the IC drugs

A

Flecainide

Propafenone

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10
Q

What are the II drugs

A

Metoprolol

Propranolol

Esmolol

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11
Q

What are the III drugs

A

Amiodarone

Sotalol

Dofetilide

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12
Q

What are the IV (4) drugs

A

Verapamil

Diltiazem

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13
Q

Draw the IC block

A
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14
Q

Draw the II block

A
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15
Q

Draw the III block

A
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16
Q

Draw the IV block

A
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17
Q

Draw the IA block

A
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18
Q

Draw the IB block

A
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19
Q

How do IA act

A

Slow phase 0 depol

Prolong phase 3

Slow conduction, Prolong AP

Increase ventricular refractory

Affect normal tissue

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20
Q

How do IB act

A

Slow phase 0

Decrease phase 4 slope

Decrease AP by shortening repol

Little effect on normal cells

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21
Q

How do II act

A

Reduce HR and contractility

Longer repol at AV

Decrease phase 4 slope

Less spont depol in pacemaker

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22
Q

How do III act

A

Prolong AP and QT and refractory

No effect on phase 0

Can induce Arrhythmias

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23
Q

How do IV act

A

Decrease phase 4 spont depol

Slow conduction SA and AV

Effects on vascular and cardiac SM

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24
Q

What other class can Quinidine act as

A

III

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25
Q

Can Quinidine cause Arrhythmias

A

Yes

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26
Q

What do we use instead of Quinidine

A

Ca channel blockers

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27
Q

When is Quinidine contraindicated

A

Complete heart block

Caution in prolongued QT, torsades de pointes, myocarditis

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28
Q

When do you give quinidine

A

Conversion and prevention of A-fib and flutter

Ventricular arrhythmias

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29
Q

Which IA are oral

A

Quinidine

Procainamide

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30
Q

What CYP does Quinidine inhibit

A

2D6

3A4

Also p-glycoprotein

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31
Q

Notable Quinidine AE

A

Thrombocytopenic purpura

Cichonism

Increase digoxin conc

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32
Q

What is Cinchonism

A

Blurred vison

Tinnitus

HA

Psychosis

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33
Q

When is Procainamide contraindicated

A

Hypersensitivity

Complete heart block

2nd degree AV block

SLE

Torsades de pointes

Caution in HF with HTN

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34
Q

When do you give Procainamide

A

Ventricular Arrythmias

Life threatening cases

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35
Q

How does Procainamide have class III activity

A

Partially acetylated to NAPA

Prolongs AP duration

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36
Q

Most important AE of Procainamide

A

Lupus-like syndrome

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37
Q

Stronger -ve ionotrope than quinidine and procainamide

A

Disopyramide

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38
Q

Which IAs work mainly on ventricular arrhythmias

A

Quinidine

Procainamide

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39
Q

Which IA is used for ventricular and supraventricular arrhythmias

A

Disopyramide

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40
Q

AE for Disopyramide

A

Cardiac failure w/o preexisting dysfunction

Severe antimuscarinic effects

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41
Q

What other channel does Disopyramide act on

A

K channels

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42
Q

What is Lidocaine commonly used for

A

Local anesthetic

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43
Q

Which IB has little effect on K

A

Lidocaine

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44
Q

What is the DOC for V-tach, V-fib after cardioversion in acute ischemia

A

Lidocaine

45
Q

Which IB is IV only

A

Lidocaine

46
Q

Which IB had severe hematological and pulm tox

A

Tocainide

47
Q

Which IB is used for V-tach other than lidocaine

A

Tocainide

48
Q

Which IB has AE in CNS and GI

A

Mexiletine

49
Q

What happens with a toxic dose of Lidocaine

A

Convulsions

Coma

50
Q

Why is Lidocaine IV only

A

First pass

51
Q

Does Lidocaine have LV function or -negative inotropic effect

A

No

52
Q

Which IC doesn’t affect slope of phase 0 of AP

A

Flecainide

Propafenone

53
Q

Which IC increases threshold potential

A

Flecainide

54
Q

What do you give in life-threatening arrhythmias

A

Flecainide

Propafenone

Procainamide

55
Q

What do you give to maintain normal sinus rhythm in symptomatic A-fib

A

Propafenone

Amiodarone

Sotalol (and in flutter)

Dofetilide (and in flutter)

56
Q

When do you give Flecainide

A

Refractory PVC or V-tach

Severe supraventricular arrhythmia

Prevent paroxysmal A-fib

57
Q

Contraindication for Flecainide

A

Post-MI PVC

58
Q

AE for Flecainide and Propafenone

A

Aggravate CHF
Dizziness, blurred vision, HA

N/V/D

Arrhythmia and V-tach

59
Q

What do you use to reduce incidence of suddent arrhythmic deaths post-MI

A

Metoprolol

Propranolol

60
Q

Used to control SVT and V-tach

A

Metoprolol

Propranolol

61
Q

Give to control V-tach due to NE or digoxin tox

A

Metoprolol

Propranolol

62
Q

Use for Acute arrhythmias in surgery/emergencies

A

Esmolol

63
Q

Contraindications for class II

A

CHF

Bradycardia

Heart block

Hyperactive airway disease

64
Q

Class II AE

A

Bradycardia

Hypotension

CNS effects

65
Q

Class III that is a pure K blocker

A

Dofelitide

66
Q

Structurally related to thyroxine

A

Amiodarone

67
Q

Which Antiarrhythmic has class I, II, III, IV effects

A

Amiodarone

68
Q

What is the most common antiarrhythmic

A

Amiodarone

69
Q

What is low dose Amiodarone used for

A

Maintain normal sinus in A-fib

70
Q

How long does it take for full clincal AE of Amiodarone to be apparent

A

6 weeks

71
Q

Effects of Amiodarone

A

Decrease AV conduction and sinus node function

Block inactivated Na channels

Weak Ca blocker

Inhibit adrenergic stimulation

Anti-anginal

72
Q

How common are Amiodarone AE

A

> 50% of people

73
Q

Notable AE of Amiodarone

A

IPF

Blue/Gray skin discoloration (Iodine accumulation)

Thyroid dysfunction

74
Q

What is Amiodarone never coadministered with

A

Digoxin

Theophylline

Warfarin

Quinidine

75
Q

When do you never give Amiodarone

A

Bradycardia

SA/AV block

Severe hypotension

Resp failure

76
Q

What kind of a drug is Sotalol

A

Non-selective Beta-blocker

77
Q

Which drug is the delayed K channel rectifier

A

Sotalol

78
Q

What do you NOT use Sotalol for

A

Asymptomatic arrhythmias

79
Q

Class III with least AE

A

Sotalol

80
Q

Main AE in Sotalol

A

Torsades de pointes (prolong QT)

Caution in renal impairment

81
Q

AE for Dofetilide

A

HA, chest pain, Dizziness, V-tach

TORSADES DE POINTES

82
Q

What are the Miscellaneous Antiarrhythmics

A

Digoxin

Adenosine

Mg

Atropine

83
Q

What kind of Ca channel blockers are class IV antiarrhythmics

A

Non-Dihydropyridines

84
Q

Which class IV is more selective for Myocardium

A

Verapamil

85
Q

How do class IV act

A

Bind open, depolarized channels

Decrease HR, contractility, conduction velocity

86
Q

When do you give class IV

A

SVT

A-fib and flutter

HTN, angina

87
Q

Why do class IV cause transient increase in BP and CO

A

They are negative inotropes

88
Q

What do you not give class IV with and why

A

Digoxin

Dofetilide

Simvastatin

Lovastatin

89
Q

What does Digoxin do

A

Shorten refractory in atrial and ventricular myocardium

Lengthen refractory and lower conduction in AV node

90
Q

When do you give Digoxin

A

A-fib/flutter with impaired LV function or HF

91
Q

Direct action of Digoxin

A

AV node blocking

Activate Ach-mediated K currents in atrium

92
Q

Indirect effects of Digoxin

A

Hyperpol

Shorten atrial AP

Increase AV refractory

93
Q

Effect of Digoxin toxicity

A

V-tach

V-fib

94
Q

Which miscellaneous antiarrhythmic is given in IV form

A

Adenosine

95
Q

What is the DOC for abolishing acute SVT in emergency

A

Adenosine

96
Q

Which antiarrhythmic is a P1r agonist

A

Adenosine

97
Q

What does high dose Adenosine do

A

Decrease conduction velocity

Prolong refractory

Decrease AV automaticity

98
Q

How does Adenosine act

A

Increase K conduction

Decrease Ca influx leading to hyperpol

99
Q

What are the AE for Adenosine

A

Chest pain similar to MI

Hypotension

Bronchoconstriction in asthmatics

100
Q

What is a functional Ca antagonist

A

Mg

101
Q

What is used in bradyarrhythmia to decrease vagal tone and increase HR

A

Atropine

102
Q

When is Mg used

A

Torsades de Pointes

Digitalis arrythmias (also lidocaine)

Arrhythmia prophylaxis in acute MI

103
Q

When is Atropine used

A

Bradyarrhythmia

104
Q

What is the most common clinical arrhythmia

A

A-fib

105
Q

What drugs are involved in Rhythm control of A-fib

A

Class IC

Class III

IA (more AE)

106
Q

What drugs are involved in Rate control of A-fib

A

Ca channel blockers

Beta blockers

Digoxin

107
Q

When do you use IV Heparin to control thromboembolic events in A-fib

A

Unstable pts needing immediate cardioconversion

108
Q

When do you use oral Warfarin to control thromboembolic events in A-fib

A

If cardioversion can be delayed 3-4 days

Pharm Midterm 1 (36 decks)

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