Anti-arrhythmics

Question 1

What are the 2 characteristics to evaluate for arrhythmias?

Answer 1

1) Is it a bradyarrhythmia or tachyarrhythmia?

2) Is the rhythm originating from the AV node or above (supraventricular) or the AV node in the ventricles?

Question 2

What do you use to treat supraventricular bradyarrhythmias?

Answer 2

• Atropine and glycopyrrolate to assess for response to anticholinergic agent
• this will determine if it’s vagally induced or not
• Terbutaline
• beta-2 agonist effects

Question 3

Ventricular bradyarrhythmias treatment

Answer 3

• Isoproterenol (beta agonist)

* Related to third degree AV heartblocks - need pacemaker

Question 4

Supraventricular tachyarrhythmias Tx

Answer 4

Calcium channel blockers, beta blocker and digitalis glycosides - all slows down conduction through the AV node

Question 5

Ventricular tachyarrhythmias Tx

Answer 5

Acute: Class I antiarrhythmic drugs - lidocaine, procainamide and quinidine
or
Class 3 antiarrhythmic drugs - sotalol or amiodarone (has anti-fibrillatory characteristics)

Question 6

Lidocaine and procainamide and quinidine

Answer 6

Lidocaine and procanimide : Decrease automaticity
Quinidine: decreases conductivity

They are Sodium channel blockers

Question 7

Side effects of lidocaine, procainamide and quinidine

Answer 7

GI upset in all three

Lidocaine: CNS disturbances from generalized tremors to grand mal seizures

Procainamide : AV blocks

Question 8

Sotalol and amiodarone

Answer 8

• Potassium channel blockers
• Have beta blocking properties
• Hence class 3 drugs do a bit of everything

Question 9

What are the drawbacks of class 3 anti-arrhythmic drugs?

Answer 9

Depresses systolic function and cardiac output

Question 10

What is the chronic treatment for ventricular tachyarrhythmias?

Answer 10

Class I antiarrhythmic, tocainide (oral analogue of lidocaine) and mexiletine (oral drug similar to lidocaine), beta blockers and certain calcium channel blockers