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Pharmacology PaxFlan > Anti-arrhythmics > Flashcards

Anti-arrhythmics Flashcards

1
Q

what is the purpose of Na/K pump (;

A

K+ into cell, Na+ out of cell

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2
Q

Class I MOA (generally)

A

modulates/blocks Na+ channels

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3
Q

Class II MOA (generally)

A

inhibits sympathetic activity

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4
Q

Class III MOA (generally)

A

Blocks K+ channels

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5
Q

Class IV MOA (generally)

A

block Ca+ channels

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6
Q

what are the Class IA drugs

A

quinidine, procainamide, disopyramide

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7
Q

what are the class IB drugs

A

lidocaine, mexiletine

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8
Q

what are the class IC drugs

A

flecainide, propafenone

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9
Q

how does class IA affect conduction velocity and ADP (action potential duration)

A

increases conduction velocity, prolongs ADP

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10
Q

how do class IB affect conduction velocity and ADP (action potential duration)

A

no effect on conduction velocity, may shorten ADP

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11
Q

how do class IC affect conduction velocity and ADP (action potential duration)

A

increases conduction velocity, prolong ADP

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12
Q

how do class III affect conduction velocity and ADP?

A

no effect on conduction velocity, prolongs ADP

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13
Q

what are the class II drugs

A

B-blockers

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14
Q

what are class III drugs

A

sotalol, ibutilide, dofetilide, amiodarone, dronedarone

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15
Q

what are the class IV drugs

A

non-dhp CCBs - verapamil, diltiazem

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16
Q

what is a major ADR of all anti-arrhythmics

A

can be proarrhythmic (cause arrhythmias) –> may be fatal

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17
Q

TdP is more common with…

A

hypokalemia, hypmagnesemia, bradycardia

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18
Q

TdP results from what

A

QT prolongation, usually d/t blockade of the IKr potassium current

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19
Q

class interactions of anti-arrhythmics

A

QTc prolongers, rate slowers
CYP3A4, 2D6 enzymes b/c most are metabolized by these cyps
drugs that cause hypokalemia/hypomagnesemia

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20
Q

class ADRs of anti-arrhythmics

A

QTC prolongation/proarrhythmic potential

careful in pts with bradycardia/heart blocks

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21
Q

ADRs of quinidine

A

quinidine syncope - recurrent lightheadedness & fainting 2* to self-terminating Tdp
cinchonism - dry as bone, red as beet, blind as bat, etc…

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22
Q

ADRs of procainamide

A

reversible lupus-like syndrome

severe bone marrow suppression

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23
Q

ADRs of disopyramide

A

anticholinergic SE (urinary retention&raquo_space;)

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24
Q

ADRs of mexiletine and lidocaine

A

CNS toxicity (dizziness, lightheadedness, unsteady gait, tremor, seizures)

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25
Q

ADR of flecainide

A

mostly proarrhythmic

26
Q

monitoring of flecainide

A

make sure K+ is normal

echo to make sure pt has structurally normal heart

27
Q

monitoring of propafenone

A

echo to make sure pt has structurally normal heart

28
Q

propafenone ADRs

A

dysgeusia (altered taste)

lupus-like rxn

29
Q

Sotalol interactions

A

avoid concurrent B-blockers, CCBs

30
Q

ibutilide ADR

A

proarrhythmic

31
Q

dofetilide ADR

A

dysrhythmia - death possible

32
Q

amiodarone pharm characteristics

A

highly lipid soluble (stored in high levels in muscle, fat , liver, lungs, skin) = long 1/2 life
iodine-containing (like thyroxine)

33
Q

FDA indications for amiodarone

A

life-threatening VF or hemodynamically unstable VT

34
Q

common clinical use for amiodarone

A

AF pharmacologic cardioversion
AF prophylaxis following open heart surgery
recurrent AF

35
Q

interactions of amiodarone

A

substrate of 2C9, 3A4; inhibits multiple isoezymes
additive QTc drugs
additive AV block/bradycardia
drugs that induce increase K or Mg

36
Q

what effect can amiodarone have on digoxin

A

can increase digoxin for up to 3 months

37
Q

ADRs of amiodarone (generally)

A

ocular effects, hypothyroidism», pulmonary toxicity, cardiac effects, dermatologic, CNS

38
Q

how does pulmonary toxicity with amiodarone present

A

IPF (idiopathic pulmonary fibrosis) –> ARDS

interstitial infiltrates on imaging

39
Q

how to treat amiodarone pulmonary toxicity

A

d/c drug, corticosteroids, supportive

40
Q

amiodarone ocular toxicity

A

corneal microdeposits, optic neuropathy / optic neuritis

may –> blindness

41
Q

derm effects of amiodarone

A

photosensitivity, blueish skin discoloration

42
Q

CNS effects of amiodarone

A

abnormal gait, ataxia, dizziness memory impairment, involuntary body movements, peripheral neuropathy

43
Q

cardiac effects of amiodarone

A

bradycardia, AV nodal block

44
Q

dronedarone indications

A

AF/ atrial flutter

45
Q

monitoring for dronedarone

A

K+, Mg+, SCr, LFTs, ECG q3 months

46
Q

contraindications of dronedarone

A 
NYHA class IV HF
Class II-III HF with recent decompensation 
pts with 2nd/3rd degree AV blocks
pts with SSS (sick sinus syndrome) 
pts with bradycardia <50bpm
47
Q

dronedarone interactions

A

CYP3A4 substrate
pgp inhibitor (remember digoxin)
QTc prolonger
INR elevations with warfarin?

48
Q

dronedarone ADRs

A

N/V/D, photosensitivity?

49
Q

MOA of digoxin for HF

A

inhibits Na/K pump = increase intracellular Na= Ca influx = increase intracellular Ca= increase contractility

50
Q

MOA of digoxin for SV arrhythmias

A

increases vagal tone = decrease conduction through SA and AV nodes

51
Q

clinical use of digoxin

A
  1. advanced systolic HF - only AFTER they have been optimized w ACE, ARB, b-blocker, diuretic, aldosterone antagonist
  2. 2nd line for AF in HF pts - only if b-blocker of non-dhp ccb isn’t enough/isn’t tolerated
52
Q

monitoring of digoxin

A

ECG
K+, Mg+, Ca2+
serum SCr
serum trough [digoxin] measured prior to next dose

53
Q

optimal [digoxin] for HF

A

0.5-0.9 ng/mL

54
Q

optimal [digoxin] for AF

A

= 2 ng/mL

55
Q

when should you monitor [digoxin] routinely

A

elderly, on interacting med (amiodarone, verapamil)

56
Q

digoxin interactions

A

monitor if there is a toxicity risk with other drugs
oral steroids, diuretics (increases toxicity because digoxin has more of a distribution to heart and muscles with low K or Mg)
bile acid sequestrants (give other meds 1 hr before or 4-6 hrs after bile acid sequestrants)

57
Q

acute digoxin toxicity

A

Cardiac - PVC, AV nodal blockade
GI- n/v, abd pain, anorexia
neuro - confusion, weakness

58
Q

chronic digoxin toxicity

A

cardiac - rhythm disturbances
neuro - lethargy, delirium, weakness
visual - chromatopsia (yellow-green), scotomas, blindness

59
Q

workup for digoxin toxicity

A
  1. [digoxin]
  2. serum [k]
  3. BUN/SCr
  4. baseline ECG
60
Q

treatment for digoxin toxicity

A
  1. assess/stabilize ABCs
  2. continuous tele, pOx
  3. place IV
  4. blood sugar
  5. digoxin immune Fab
61
Q

can digoxin be stopped

A

yeth

Pharmacology PaxFlan (12 decks)

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