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Pharmacology > Anti-arrhythmics > Flashcards

Anti-arrhythmics Flashcards

1
Q

ALL anti-arrhythmic agents can be ________

A

Proarrhythmic

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2
Q

Class I (Vaughan-Williams Classification)

A

Na channel blockers

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3
Q

Class II (Vaughan-Williams Classification)

A

Beta blockers

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4
Q

Class III (Vaughan-Williams Classification)

A

K channel blockers

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5
Q

Class IV (Vaughan-Williams Classification)

A

Ca channel blockers

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6
Q

What is the pneumonic to remember the anti-arrhythmic drug classes (Vaughan-Williams Classification)?

A

NoBody Kills Cats

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7
Q

Quinidine

A
  • Classification: Class 1a antiarrhythmic
  • MOA: blocks fast Na channels (Prolongs AP duration, delays repolarization, depresses conduction), effect dependent upon serum K
  • Uses: SVT and VT, chemical cardioversion of Afib in horses
  • Contraindications: bradyarrhythmias, caution in HF
  • AE: nausea, diarrhea, colic, vagolytic, hypotension, negative inotrope, tachycardia, wide QRS, wide QT, depression, laminitis, increases digoxin levels
  • Administered: PO, IV (rarely used)
  • Cross BBB? Yes
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8
Q

Lidocaine

A
  • Classification: local anesthetic & Class 1b antiarrhythmic
  • MOI: blocking of fast Na channels (shorten AP duration), K dependence
  • Uses: local and topical anesthetic, ventricular arrythmias (VT)
  • Contraindications: bradyarrhythmias
  • AE: CNS depression, ataxia, seizures, nausea
  • Administered: IV ONLY as antiarrhythmic; lower doses in cats/horses
  • Cross BBB? yes
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9
Q

Mexiletine

A
  • Classification: Class 1b antiarrhythmic
  • MOI: blocking of fast Na channels (shorten AP duration), K dependence
  • Uses: ventricular arrhythmias, not SVT
  • Contraindications: bradyarrhythmias
  • AE: CNS depression, ataxia, seizures, lethargy, tremors, nausea, vomiting, inappetance
  • Administered: PO (give with food)
  • Cross BBB? Yes
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10
Q

Propanolol

A

Classification: beta blocker; Class II anti-arrhythmic

MOI: beta-adrenergic antagonist (non-selective)

Uses: antiarrythmic (for SVTs & VTs); treat HCM; CHF (only when heart failure is resolved/”stable”)

AE: bradycardia, AV block, negative inotropic effect, bronchospasm, hypotension, may cause hypoglycemia, tachycardia w/ rapid withdrawal, potential CNS effects of lethargy & depression

Administered: PO every 8 hours, IV

Half-life: < 2hrs

Cross BBB? Yes (lipid soluble)

Elimination: primarily by liver

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11
Q

Atenolol

A
  • Classification: beta blocker; Class II anti-arrhythmic
  • MOI: beta1-adrenergic antagonist (selective)
  • Uses: antiarrythmic (for SVTs & VTs); treat HCM; CHF (only when heart failure is resolved/”stable”)
  • AE: bradycardia, AV block, negative inotropic effect, hypotension, may cause hypoglycemia, tachycardia w/ rapid withdrawal, less CNS effects
  • Administered: PO every 12 hours, IV
  • Half-life: 5-6 hrs
  • Cross BBB? Not readily (water soluble)
  • Elimination_:_ excreted unchanged in urine
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12
Q

Esmolol

A

Classification: beta blocker; Class II anti-arrhythmic

MOI: beta1-adrenergic antagonist (selective)

Uses: acute (emergency) anti-arrhythmic (for SVTs)

AE: bradycardia, AV block, negative inotropic effect, hypotension, may cause hypoglycemia, tachycardia w/ rapid withdrawal, less CNS effects

Half-life: < 10mins

Cross BBB? Not readily (more water soluble)

Elimination: rapidly metabolized by blood esterases

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13
Q

Sotalol

A

Classification: beta blocker; Class II and III anti-arrhythmic

MOI: beta-adrenergic antagonist (non-selective); K channel blocker

Uses: antiarrythmic (for SVTs & VTs); also class III antiarrhythmic for VT; CHF (only when “stable”)

AE: bradycardia, AV block, negative inotropic effect, hypotension, bronchospasm; pro-arrythmic

Administered: PO, IV

Half-life: 5 hrs

Cross BBB? Not readily (more water soluble)

Elimination: excreted unchanged in urine

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14
Q

Amiodarone

A
  • Classification: Class III antiarrythmic; also Class I, II, IV antiarrythmic and alpha1 blocker
  • MOI: K channel blocker (plus Na, beta, Ca); homogenous AP
  • Uses: extremely potent antiarrythmic (for SVTs/VTs)
  • AE: pulmonary fibrosis, hypo or hyperthyroidism, toxic hepatopathy, GI, skin discoloration; neurologic, corneal micro-deposits, reaction to IV solvents
  • Half-life: extremely long
  • Cross BBB? Yes
  • Elimination: excreted unchanged in urine
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15
Q

Verapamil

A
  • Classification: Class IV antiarrhythmic; strong vasodilator
  • MOI: Ca channel blocker (marked effect on AV node, less on SA node, potent negative inotropic effects)
  • Uses: mostly SVTs (decrease ventricular response, stop AV nodal re-entry), not frequently used in vet med
  • AE: negative inotrope, vasodilation, hypotension, use caution with CHF, bradycardia/AV block; depression, nausea, anorexia
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16
Q

Diltiazem

A

Classification: Class IV antiarrhythmic; weak vasodilator

MOI: Ca channel blocker (small change in inotropy, may affect SA node occasionally, marked effect on AV node)

Uses: mostly SVTs in dogs (decrease ventricular response, stop AV nodal re-entry)

AE: not a strong negative inotrope, weak vasodilation (< verapamil), hypotension, use caution with CHF, bradycardia/AV block; depression, nausea, anorexia

17
Q

Amlodipine

A

Classification: Class IV antiarrhythmic; weak antiarrythmic, strong vasodilator

MOI: Ca channel blocker (minimal effect on inotropy, no major effect on AV or SA nodes)

Uses: mostly for treating hypertension, esp in cats/dogs

AE: minimal negative inotropy, hypotension, anorexia, possible reflex tachycardia, use caution with CHF and liver dz

18
Q

Procainamide

A

Classification: Class 1a antiarrhythmic

MOA: blocks fast Na channels (Prolongs AP duration, delays repolarization, depresses conduction), effect dependent upon serum K

Uses: SVT and VT

Contraindications: bradyarrhythmias, caution in HF

AE: hypotension, tachycardia, wide QT; autonomic and negative inotropic effects tend to be less w/ procainamide than quinidine; immune-mediated reactions

Administered: IV, IM (PO tough to find)

Cross BBB? Yes

19
Q

Class Ic antiarrythmics

A
  • Flecainide, propafenone
  • MOI: block fast Na channels
  • no obvious change to AP
20
Q

What are the effects of beta blockade?

A
  • Decrease SA node firing rate = decrease in HR and improved myocardial perfusion
  • Slows AV nodal conduction = useful in treatment of SVTs and atrial fibrillation
  • Decrease myocardial contractility = less myocardial O2 consumption

Pharmacology (33 decks)

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