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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

A

Tocainide

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
Q

What are Class 2 drugs

A

Beta blockers!

26
Q

What do class 2 drugs do

A

Treat arrythmias caused by high catecholamines

  • Reduce HR
  • Reduce CO
  • Reduce automaticity
  • Prolong AV
  • Reduce AP
27
Q

Selective cardio beta blockers (4)

A

‘MACE’

1. Metoprolol

2. Atenolol

3. Carvedilol

4. Esmolol

28
Q

Which class-2 can be used with COPD

A

Selective cardio B1 blockers

Metoprolol

Atenolol

Carvdiolol

Esmolol

29
Q

3 uses of propanolol

A
  1. Catecholamine induced supraventricular arrythmias
  2. Tachyarrythmias associated with Digitalis tox
  3. Arrythmias due to halogenated hydrocarbon anesthesia
30
Q

Your dog is in sugery under halogenated hydrocarbon anesthesia. He develops an arrythmia. What do you give? What do you definitely NOT give

A

Give: Propanolol (non-selective Class-2)

DONT GIVE: Bretylium (increased arrythmia)

31
Q

Can you give Propanolol to patients with COPD

A

No! Causes airway obstruction due to anatgonizes B2 receptors in lungs (b2 = bronchodilation)

32
Q

What do Class-3 antiarrythmics do? What are they?

A

Prolong AP

Extend RP

1. Amiodarone

2. Bretylium

33
Q

What does Amiodarone do?

A

Class III anti-arrythmic

  • Blocks K+ channels
  • Inhibits B-receptor
34
Q

Which species is Amiodarone preferred for

A

Dogs with ventricular arrythmias

35
Q

An adverse effect of Amiodarone is it can increase concentration of…

A
  1. Digoxin
  2. Quinidine (1**a)
  3. Procainamide (1a
  4. Phenytoin (1b)
  5. Warfarin
  6. Diltiazem (4)
36
Q

Which drug is contraindicated with halogenated hydrocarbon anesthetics

A

Bretylium

37
Q

What do class 4 antiarrythmics do

A

Ca++ channel blockers

38
Q

What are class-4 drugs used for? What are they?

A

Superventricular arrythmias

Ventricular hypertrophy

  1. Diltiazem
  2. Verpamil
39
Q

Which class-4 is good for atrial arrythmias and supraventricular tachycardia

A

Verpamil

40
Q

Can you give Class-2 drugs with Class-4 drugs?

A

No! AV shock

41
Q

Adverse effects of class 4 drugs

A

(Diltiazem, Verpamil)

  1. Hypotension (due to vascular dilation —> reduced Ca)
  2. Bradycardia (reduced Ca)
  3. Reduced CO
42
Q

What effect does Epinephrine have on the heart

A

Very potent vasodilator**

  1. B1 (heart): pos. inotrope, pos. chromotrope
  2. A1 (vessels): vasoconstriction
  3. B2 (vessels in skeletal m.): vasodilation
43
Q

Which drug is Epinephrine often used with

A

Lidocaine

44
Q

Adverse effects of Epinephrine

A
  • Allergic reactions
  • Cardiac arrest
45
Q

What beta-agonist is used for cardiac arrest

A

Isoproterenol

46
Q

What are effects of Isoproterenol (3)

A

Non-selective B agonist

  1. Pos. inotrope, pos. chromotrope (B1)
  2. Dilation of skeletal m vessels (B2)
  3. Bronchial relaxation (B2)
47
Q

Which receptors does Dopamine act on and what does it do

A
  • D1 receptor: vasodilation of spleen, kidneys
  • B1 receptor: increased CO
48
Q

What are two conditions Dopamine is preferred for

A
  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
Q

Your patient is in oliguric renal failure. Which two drugs do you give and how do they work?

A
  1. Dopamine: increased CO (B1 receptor), increased renal blood flow (D1 receptor)
  2. Furosemide (diuretic)

Pharm II (16 decks)

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