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Pharm II > Anti-Arrhythmics > Flashcards

Anti-Arrhythmics Flashcards

1
Q

Aims of antiarrythmic therapy (2)

A
  1. Reduce ectopic pacemaker activity
  2. Regularize impulse of conduction pathway
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2
Q

What do class 1 anti-arrythmics do

A

Membrane stabilizers

  • Increase threshold of excitability
  • Decrease conduction velocity
  • Prolong effective refractory period
  • Reduce phase zero of AP
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3
Q

Who are class 1a antiarrythmics? What do they do

A
  1. Quinidine sulphate
  2. Procainamide
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4
Q

Which anti-arrythmic is good for ventricular premature complexes and supra-ventricular tachycardia in large breeds

A

Quinidine sulphate

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5
Q

Which drug is good for atrial flutter in horses

A

Quinidine sulphate

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6
Q

What are A/E of quinidine sulphate in horses

A
  • Wheals
  • Laminitis
  • GI upset
  • Nasal mucosa damage
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7
Q

Which Class 1a is best for atrial arrythmias

A

Quinidine sulphate

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8
Q

Which class 1a is best for ventricular arrythmias

A

Procainamide

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9
Q

Which class 1a is less vagolytic

A

Procainamide

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10
Q

Which class 1a has long half-life in dogs

A

Procainamide

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11
Q

Toxicity of procainamide

A

Wide QRS

Arrythmias

Hypotension

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12
Q

What do Class-1b drugs do

A

Reduce conduction velocity in injured cardiac cells

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13
Q

What effects do Class-1b drugs have on AP/RP

A

minimal effects

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14
Q

Which Class-1b drug is a broad antiarrythmic

A

Aprindine, Indecainide (more potent)

  • Good for dogs that are resistant to others*
  • Lots of A/E! –> give as last resort*
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15
Q

Which class-1B is used for cardiac emergencies

A

Lidocaine - give IV (rapid effect, short half-life)

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16
Q

Class-1b drugs mainly target what kind of arrythmias

A

Ventricular arrythmias

(except Aprindine/Indecainide which are broad spectrum)

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17
Q

Adverse effects of Aprindine.

A
  • Leukopenia
  • Hepatotoxicosis
  • Hypotension
  • Seizures
  • etc…
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18
Q

Whats the difference between Indecainide and Aprindine

A

Indecainide is more potent and has fewer A/E

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19
Q

Which Class-1b is given for digitalis arrythmias (along with ventricular arrythmias)

A

Phenytoin

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20
Q

Toxicity occurs with Phenytoin if you give it with what….

A

Chloramphenicol (potent inhibit for CP450 – phenytoin tox)

Postural ataxia, hypermetric gait

21
Q

Which class-1b has good oral absorption (no 1st pass effect) and long duration

22
Q

Compare/contrast Lidocaine and Tocainide for administration and duration

A

Lidocaine: inefficient oral administration. Short half-life

Tocainide: efficient oral administration (no 1st pass). Long duration

23
Q

Which class-1b is similar to Tocainide (good for oral admin, long duration, ventricular arrythmias)

A

Mexiletine

24
Q

What are class-1c drugs used for? Name them (3)

A
  • Ventricular tachycardia
  • Premature beats (ventricular or atrial)

‘FEL’

1. Flecainide

2. Encainide

3. Lorcainide

25
What are Class 2 drugs
Beta blockers!
26
What do class 2 drugs do
Treat arrythmias caused by high catecholamines * Reduce HR * Reduce CO * Reduce automaticity * Prolong AV * Reduce AP
27
Selective cardio beta blockers (4)
'MACE' ## Footnote **1. Metoprolol** **2. Atenolol** **3. Carvedilol** **4. Esmolol**
28
Which class-2 can be used with COPD
Selective cardio B1 blockers ## Footnote Metoprolol Atenolol Carvdiolol Esmolol
29
3 uses of propanolol
1. Catecholamine induced supraventricular arrythmias 2. Tachyarrythmias associated with **Digitalis tox** 3. Arrythmias due to **halogenated hydrocarbon anesthesia**
30
Your dog is in sugery under halogenated hydrocarbon anesthesia. He develops an arrythmia. What do you give? What do you *definitely NOT give*
Give: **Propanolol** (non-selective Class-2) _DONT GIVE_: **Bretylium** (increased arrythmia)
31
Can you give Propanolol to patients with COPD
No! Causes airway obstruction due to anatgonizes B2 receptors in lungs (b2 = bronchodilation)
32
What do Class-3 antiarrythmics do? What are they?
Prolong AP Extend RP **1. Amiodarone** **2. Bretylium**
33
What does Amiodarone do?
Class III anti-arrythmic * Blocks K+ channels * Inhibits B-receptor
34
Which species is Amiodarone preferred for
**Dogs** with **ventricular arrythmias**
35
An adverse effect of Amiodarone is it can increase concentration of...
1. Digoxin 2. Quinidine (*1**a)* 3. Procainamide (*1a* 4. Phenytoin (*1b*) 5. Warfarin 6. Diltiazem (*4)*
36
Which drug is contraindicated with halogenated hydrocarbon anesthetics
**Bretylium**
37
What do class 4 antiarrythmics do
Ca++ channel blockers
38
What are class-4 drugs used for? What are they?
Superventricular arrythmias Ventricular hypertrophy 1. **Diltiazem** 2. **Verpamil**
39
Which class-4 is good for atrial arrythmias and supraventricular tachycardia
**Verpamil**
40
Can you give Class-2 drugs with Class-4 drugs?
No! **AV shock**
41
Adverse effects of class 4 drugs
(Diltiazem, Verpamil) ## Footnote 1. Hypotension (due to vascular dilation ---\> reduced Ca) 2. Bradycardia (reduced Ca) 3. Reduced CO
42
What effect does Epinephrine have on the heart
**Very potent vasodilator\*\*** ## Footnote 1. **B1** (heart): pos. inotrope, pos. chromotrope 2. **A1** (vessels): vasoconstriction 3. **B2** (vessels in skeletal m.): vasodilation
43
Which drug is Epinephrine often used with
**Lidocaine**
44
Adverse effects of Epinephrine
* Allergic reactions * Cardiac arrest
45
What beta-agonist is used for cardiac arrest
**Isoproterenol**
46
What are effects of **Isoproterenol** (3)
*Non-selective B agonist* 1. Pos. inotrope, pos. chromotrope (B1) 2. Dilation of skeletal m vessels (B2) 3. Bronchial relaxation (B2)
47
Which receptors does Dopamine act on and what does it do
* **D1 receptor:** vasodilation of spleen, kidneys * **B1 receptor:** increased CO
48
What are two conditions Dopamine is preferred for
1. **Oliguric renal failure** (increased CO, increased renal blood flow) ---\> *with Furosemide* 2. **Cardiogenic shock/ Severe Hypotension** (IV) * A1 receptors: vasoconstriction * B1 receptor: increased contractility
49
Your patient is in oliguric renal failure. Which two drugs do you give and how do they work?
1. **Dopamine**: increased CO (B1 receptor), increased renal blood flow (D1 receptor) 2. **Furosemide** (diuretic)

Pharm II (16 decks)

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