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Pharmacology > Anti-arrhythmics > Flashcards

Anti-arrhythmics Flashcards

1
Q

What is the cardiac pacemaker

A

SA node

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2
Q

what is the cardiac gatekeeper

A

AV node

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3
Q

how do anti-arrhythmic drugs work

A

affect specialized ion channels or affect sympathetic tone

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4
Q

Ia MOA

A

moderate block of both open Na and K channels
slow phase 0 depolarization
prolong action potential and slow conduction

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5
Q

Ia drugs

A

DQP: Disopyramide, Quinidine, Procainamide

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6
Q

Ia uses

A

ventricular tachy-arrhythmias
Paroxysmal recurrent afib
Wolff-Parkinson-White syndrome (Procainamide)

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7
Q

Ib MOA

A

mild blocking or inactivating sodium channels
shorten phase 3 repolarization
decrease duration of AP

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8
Q

Ib drugs

A

LPM: Lidocaine, Phenytoin, Mexiletine

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9
Q

Ib uses

A

ventricular tachycardias

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10
Q

Ic MOA

A

block open Na channels

markedly slow phase 0 depolarization

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11
Q

Ic drugs

A

FP: Flecainide

Propafenone (avoid in HF and MI)

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12
Q

Ic uses

A

paroxysmal a-fib

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13
Q

II MOA

A

block catecholamines
block AV node
decrease slope of phase 4 depolarization
prolong repolarization in AV node –> block reentry

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14
Q

II drugs

A

Propranolol

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15
Q

II uses

A

Tachyarrhythmia supraventricular

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16
Q

III MOA

A

blocking IKr

prolong phase 3 repolarization without altering phase 0

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17
Q

III drugs

A 
Amiodarone
Sotalol
Ibutilide
Dofetilide (initiated in hospital, mandates testing every 3 months to check K, Mg, SCR and EKG)
Dronedarone
18
Q

III uses

A

Wolff-Parkinson-White syndrome (Sotalol)
Ventricular arrhythimias
atrial tachyarrhythmias

19
Q

IV MOA

A

block L-type calcium channels
decrease AV node conduction
increase refractory period
similar to class II but does not block adrenergic system

20
Q

IV drugs

A

Non-dihydrophyridine
CCBs
Verapamil
Diltiazem

21
Q

IV uses

A

prevent recurrence of paroxysmal supraventricular tachycardias
control ventricular rate in afib

22
Q

rate classes control rate?

A

Class II, IV

digoxin

23
Q

which classes control rhythm

A

Ia, c, III

24
Q

what are non-pharmacologic choices?

A

ablation

pacing

25
Q

DI’s of Quinidine

A

warfarin

digoxin

26
Q

DI’s of Disopyramide

A

glaucoma

27
Q

indications of Disopyramide

A

only paroxysmal supraventricular tachycardia

28
Q

CI of Mexiletine

A

3rd degree AV block

29
Q

indications of Mexiletine

A

ventricular arrhythmias

commonly as an add on to Amiodarone and not sole agent

30
Q

BB DI’s

A

severe sinus bradycardia or heart block

31
Q

Amiodarone, Dronedarone, Sotalol, Dofetilide CI’s

A

iodine hypersensitivity, hyperthyroidism, 3rd degree AV heart block
(Dronedarone lacks iodine and therefore thyroid side effects)

32
Q

which class has the highest risk of proarrhythmias?

A

class I

33
Q

which class has anticholinergic effects?

A

IA

34
Q

Adenosine MOA

A

acts on adenosine receptors (GPCR) to decrease adenylyl cyclase to decrease cAMP

35
Q

side effect of Adenosine

A

transient hypotension and chest pain (within 15 seconds)

36
Q

Atropine MOA

A

competitieve inhibitor of muscarinic acetylcholine receptors

37
Q

indication of Atropine

A

bradycardia

38
Q

side effects of Atropine

A

blurry vision, dry mouth, tachycardia “dry as a bone, red as a beet, hot as a hare, blind as a bat, mad as a hatter”

39
Q

antidote to Atropine

A

Physostigmine

40
Q

Digoxin MOA

A

inhibit the Na/K ATPase in myocardium
decrease membrane sodium gradient
decrease sodium-calcium exchange
increase intracellular calcium

41
Q

indications for Digoxin

A

Afib, atrial flutter with RVR, heart failure

42
Q

which anti-arrhythmics cause constipation

A

Verapamil and diltiazem

Pharmacology (6 decks)

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