Anti-Arrhythmics

Question 1

T OR F

arrhythmias are asymptomatic or fatal

Answer 1

True

Question 2

What is the pharmacologic rule?

Answer 2

all anti-arrhythmics are arrhythmogenic (they can all cause an arrhythmia)

Question 3

How do AAs affect the heart?

Answer 3

negative inotrope

Question 4

pacemaker cells within the heart possess what?

Answer 4

automaticity

Question 5

what node has the highest rate of automaticity?

Answer 5

SA then AV

Question 6

the 2 main causes of cardiac arrhythmias?

Answer 6

1) slowed conduction in the pacemaker system leading to re-entry circuits
2) altered rate of spontaneous discharge (ectopic pacemakers)

Question 7

What is:
Class I
Class II
Class III
Class IV

Answer 7

I: sodium channel blockers
II: Adrenergic Beta Blockers
III: Potassium channel blockers
IV: Calcium channel blockers

Question 8

How do class I work?

Answer 8

slow depolarization

have membrane stabilizing affect

Question 9

Name Ia drugs

Answer 9

Quinidine
Disopyramide
Procainamide

Question 10

Name Ib drugs

Answer 10

Lidocaine (used in fillings as local anesthetic)
Mexiletine
Tocainide
Phytoin

Question 11

Name Ic drugs

Answer 11

Flecanide
Propafenone
BLACK CLOUD- increase cardiovascular mortality

Question 12

Name Class III drugs

Answer 12

Amiodarone
Dofetilide (ignore)
Sotalol

No negative inotropy so good for CHF

Question 13

Name class IV drugs

Answer 13

Diltiazem

verapamil

Question 14

IA drugs possess what properties?

Answer 14

IA

anticholinergic properties

Question 15

What does anticholinergic mean

Answer 15

dry mouth
tachycardia
sedation
urinary retention
confusion

Question 16

What is a/e of procainamide?

Answer 16

lupus-like syndrome– butterfly rash & joint pain

Question 17

Lidocaine indications?

Answer 17

ventricular arrhythmias

potent local anesthetic

Question 18

Lidocaine a/e?

Answer 18

hypotension, numbness, blurry vision, tinnitus

Question 19

Mexiletine is used for wihat?

Answer 19

PO maintenance after IV lidocaine

Poorly tolerated

Question 20

Flecainide, Propafenone, Moricizine

Answer 20

IC

RARELY USED- CAST trial showed increased mortality in post-MI patients

Question 21

Beta blockers do what to the heart?

Answer 21

negative inotrope

Question 22

Why esmolol?

Answer 22

extremely short half life (IV admin) since plasma esterase metabolism in the plasma

Question 23

Amiodarone efficacy against what?

Answer 23

atrial and ventricular arrhythmias

may be IV or PO

Question 24

MOA with amiodarone?

Answer 24

K channel blocker, slow on slow off

Question 25

What does amiodarone do thats bad?

Answer 25

muck with thyroid

Question 26

VD and T1/2 of amiodarone?

Answer 26

large Vd

Long T1/2

Question 27

A/e of amiodarone?

Answer 27

visual disturbances, blue discoloration of skin, contains iodine,, dysphagia

EYE LUNG THYROID SKIN

Question 28

Amiodarone administration?

Answer 28

loading dose (both I and PO)

Question 29

What must you monitor in patient with amiodarone?

Answer 29

TSH (since giving iodine)

pulmonary fibrosis (get cxr at baseline)

Question 30

what is dronedarone?

Answer 30

Prodrug of amiodarone

Question 31

Use of dronedarone?

Answer 31

atrial arrhythmias

Question 32

Benefit of dronedarone?

Answer 32

Lacks iodine moiety that contributes to thyroid, pulmonary, hepatic, and ocular toxicity

Question 33

Dronedarone half life?

Answer 33

LONG

Question 34

Contraindications for dronedarone?

Answer 34

Not in patients with heart failure or heapatotoxicity

USE amiodarone

Question 35

What is sotalol?

Answer 35

B Blocker+ K channel blocker

Question 36

Indication for CCB?

Answer 36

verapamil / diltiazem

atrial fibrillation

Question 37

Treatment for torsades de pontes?

Answer 37

QT interval prolongation

use magnesium sulfate