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Pharm Test 3 > Anti-Arrhythmics > Flashcards

Anti-Arrhythmics Flashcards

1
Q

Class 1B

A

VT

  • lidocaine - POST MI
  • mexiletine - LONG QT

UP K+ out = shorter AP duration

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2
Q

Class 1C

A

VT»>SVT

  • Flecainide =
  • IF NO HX OF ISCHEMIC DZ
  • RHYTHM CONTROL

STRONG Phase 0 block
NO POST MI
ATAXIA S.E>.

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3
Q

Class 1A

A

VT»>SVT (RHYTHM CONTROL)

  • Quinidine = SUPPRESS AFIB (W/ BB/CCB)
  • Procainamide
  • Disopyramide

DOWN K+ out = AP duration longer
S.E = anticholinergic (quinidine more), Torsades de Pointe (long QT), lupus-like syndr, IN HOSPITAL ONLY

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4
Q

Class 3

A

K+
VT + SVT
*amiodarone, dronedarone
*Sotalol, ibutalide

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5
Q

Class 4

A

Ca2+ block in AV node(L type) (rate control)
SVT
*verapamil
*Diltiazem

  • slow pacemaker current
  • slow conduction velocity
  • longer ERP

Careful CHF = less cardio muscle contract

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6
Q

Class 2

A

Beta (rate control)

SVT
*metoprolol

  • DOWN AV NODE conduction
  • DOWN excitability (ectopic pace)

Post MI reduce mortality

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7
Q

Other

A

SVT

  • digoxin
  • adenosine
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8
Q

Interfere with Na+ channels

Rx

A
  • lidocaine, Mexiletine
  • flecainide
  • quinidine, procainamide, disopyramide
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9
Q

Cause long QT

A
  • quinidine, procainamide, disopyramide

* Amiodarone, dronedarone, sotalol, ibutalide

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10
Q

Rhythm control

A
  • flecainide
  • quinidine, procainamide, disopyramide
  • amiodarone, dronedarone, sotalol, ibutalide
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11
Q

Rate control

A
  • Verapamil, diltaziem
  • Metoprolol
  • digoxin, adenosine
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12
Q

General concepts

A
  • antiarrythmics = possibly pro-arrythmic
  • dirty rx (synergistic, too many S.E.)
  • Tx of CHOICE = procedure (not Rx)
  • Tx tachs that are SYMPTOMATIC
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13
Q

Action potential duration

A

Start of AP to end

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14
Q

Refractory period duration =

A

Action potential duration

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15
Q

Sodium channels work best + recover quicker at

A

Depolarized (-) state

Explain why RPD has no APs

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16
Q

Phase 0 Na+ voltage channels depolarizing

A
  • Quick open/quick close

* Affect Velocity + ERP

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17
Q

Phase 2-3 Ca++ in channel depolarizing

A
  • slow open/close

* affects AP duration

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18
Q

Just VT

Rx

A

Lidocaine, mexiletine

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19
Q

VT»>SVT

Rx

A
  • Flecainide
  • Quinidine
  • Procainamide, disopyramide
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20
Q

VT + SVT

A
  • Amiodarone, dronedarone

* Sotalol, Ibutalide

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21
Q

SVT

Rx

A
  • Verapamil, Diltiazem
  • metoprolol
  • digoxin, adenosine
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22
Q

Phase 2-3 K+ (TEA) out channel repolarizing

A
  • delayed rectifier

* affects AP duration

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23
Q

Phase 4 Na+ in channels depolarizing

A
  • pacemaker

* affects heart rate (automaticity)

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24
Q

Phase 4 (3Na+ out/2K+ in) polarizing

A
  • Defines RMP

* indirectly affects Ca++ out

25
Myocardium What initatiates AP?
Na+ current starts AP CCB doesnt’ affect
26
Pacemaker What channel during AP?
Only Ca+ channel during AP CCB affects nodes
27
QRS starts when
Depole ventricle starts (not purkinje)
28
PR interval from
Atrial depole to start of apex ventricle depole Index of conduction velocity + AV node delay
29
QRS duration
* index of conduction velocity | * Duration of ventricular AP
30
Flutter
*organized tach (regular space b/w waves)
31
Fibrillation
Disorganized tach (uneven spacing)
32
CHD What is
* regional hypoxia | * less depole = UP refractory period
33
Myocardium blood flow
Epi to endocardium Endocardium MOST AT RISK for ischemia (ventricle, not for thin atria = less atrial reentry circuits)
34
Requirements for Reentry
* multiple conduction pathways * refractory (late) tissue * conduction time around circuit must be longer than late-refraction on late tissue
35
Ectopic pacemakers
* usually atrial * faster than Sa node * pulm vein * fastest ectopic takes over rhythm * AV node brakes signal (max 250bpm)
36
Rate control in Afib
* screw p wave = won’t be normal * A-fib remains, a-fib conduction slowed * metoprolol * verapamil * digoxin
37
Rhythm control in A-fib
Want normal P wave, abolish a-fib *Rx/cardioversion *amiodarone, flecainide
38
A-fib Rate vs. Rhythm control
Either acceptable
39
A-fib Anti-coag therapy
NOT ESSENTIAL IN EVERYONE 2+ CHA2DS2-VASc = high stroke risk, consider anti-coag
40
Goals of tachyarrythmia Rx therapy
* DOWN automaticity * DOWN conduction velocity AV node (PR interval, QRS duration UP) * UP AP duration (UP QT duration) * interfere w/ Sympa regulation of HR at SA/AV nodes
41
Class 1 Na+ channel Rx
VT *lidocaine, mexiletine VT>>>SVT * Flecainide * Quinidine, Procainamide, disopyramide
42
Class 1 Na+ channel drugs Selectivity
* only block fraction of Na+ channels * Channel must be open * more selective for “diseased” tissue (unactivated state)
43
Class 1 Na+ channel Rx Mech + ECG
* LESS activated channel * LESS Na+ in * LESS conduction velocity * UP ERP (refractory period) = longer than AP, longer to reset ECG: Longer PR + QRS (Use to monitor efficacy/toxicity)
44
Class 1 Na channel Rx Ectopic pacemakers
Make less excitable
45
Class 1 Na+ channel Rx Reentry
Up ERP * ERP now longer than conduction time around circuit = stops reentry * reentries are predominantly ventricular
46
Class 1 Na+ effects
* block Open (activated) states * UP ERP/recovery * Ectopic pacemakers * block reentry (UP erp)
47
Class 1 Na+ channel blocker Prolongation of ERP comparison
1C > 1A > 1B
48
Inherited Long QT syndrome
Class 1A contraindicated = Torsades de Pointes tach Mutations: * Rectifying K+ channel = tx metoprolol * Na+ channel = mexiletine (1B) WATCH giving RX with long qt side effect
49
Amiodarone
Class 3 *block K+ efflux (phase 3), LONG AP DURATION + REFRACTORY PERIOD * Low dose = A-fib (rhythm control) * High dose = VT (structurally abnormal hearts (post-MI))
50
Amiodarone S.E.
Rhabdomyolysis, long qt, pulm fibrosis BITCH * B radycardia/Blue Man * I nterstitial Lung Dz * T hyroid (hyper/hypo) * C orneal/Cutaneous (blue) * H epatic/Hypotension (IV-solvents)
51
Sotalol
Class 3 = SVT + VT * Block K+ Phase 3 * Longer AP Duration Reduce repeated arrythmia (now amiodarone)
52
Ibutalide (semi-not important)
Class 3 Block K+ efflux, Long AP duration ACUTE CARDIOVERSION SVT
53
Vtach after MI Acute Chronic
Acute = amiodarone, DC cardioversion Chronic = ICD w/ or w/o amiodarone
54
Vfib Acute crhonic
Acute= Defib Chronic = ICD w/ or w/o amiodarone
55
Contraindicated in WPW
Rate control Rx. (Down AV conduction)
56
DIgoxin
Good choice w/ CHF * Up vagal activity * Long refractory period * Down AV conduction
57
Adenosine
Down AV node conduction IV T1/2 = seconds AV-node dependent narrow complex tach (TX + DX acute)
58
Afib / A tach Acute Chronic
``` CONTROL V RATE ACUTE/CHRONIC= *Verapamil/diltiazem *BBlocker *digoxin ``` ``` RESTORE SINUS RHYTHM: ACUTE= *Defib *ibutilide CHRONIC= *Amiodarone ```
59
A flutter Acute Chronic
``` CONTROL V RATE ACUTE: *Verapamil/diltiazem *Beta-blocker *Digoxin CHRONIC: *ablation ``` RESTORE SINUS RHYTHM *Defib/Ibutilide

Pharm Test 3 (11 decks)

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