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Pharmacology > Anti-Arryhthmics > Flashcards

Anti-Arryhthmics Flashcards

1
Q

Arrhythmias result from abnormalities of what

A

impulse conduction and impulse initiation

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2
Q

Automaticity is

A

the ability of the heart to undergo spontaneous action potentials

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3
Q

NSR stands for

A

normal sinus rhythm

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4
Q

it is critical for the ventricles to be what

A

relaxed while the atria are filling

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5
Q

Things that cause ectopic foci

A

electrolyte disturbances, ischemia, excessive myocardial stretch, drugs, toxins

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6
Q

the most common conduction abnormalities involve

A

conduction blocks

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7
Q

Usually conduction abnormalities are caused by

A

localized or regional hypoxia from decreased coronary blood flow

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8
Q

Effective refractory period

A

period of time a new action potential cannot be initiated, limits rapid depolarization, target of antiarrhythmetic drugs, prolonged ERP effective for abolishing reentry currents

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9
Q

Classification of antiarrhythmics

A

Vaughan Williams; class 1- Na channel blockers, class II- B blockers, Class III- k channel blockers, Class IV- Ca channel blockers; miscellaneous- atropine, adenosine, digoxin, electrolyte

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10
Q

Class Ia

A

Procainamide, Quinidine, disopyramide

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11
Q

What do all class 1a drugs do

A

selectively block Na channels undergoing depolarization of non-nodal action potential at a high rate, INCREASE ERP, slow conduction velocity through His purkinje, depresses automaticity

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12
Q

Non-nodal

A

drugs active in atrial and ventricular myocytes and purkinje cells; depolarization of nodal cells occurs via Ca channels

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13
Q

Quinidine other use

A

for RLS

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14
Q

MOA of class 1a

A

decreases myocardial excitability and conduction velocity by increasing threshold for firing

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15
Q

Class 1a used for

A

atrial or ventricular arrhythmias, A fib, a flutter, PSVT, PVCs, Vtach

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16
Q

Class 1a NOT recommended for

A

Vfib or hemodynamically unstable V tach

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17
Q

ADRs of class1a

A

can cause dyscrasisas such as agranulocytosis, lupus like syndrome, hypotension, arrhythmias; lot of drug interactions

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18
Q

Disopyramide (3)

A

rarely used, last line therapy, strong anticholinergic activity, can be used for atrial or ventricular arrhythmias

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19
Q

Class 1B

A

lidocaine, mexiletine, decrease ERP, not active with K channels,

20
Q

Lidocaine (Xylocaine) (5)

A

Can be given ET tube, decreases erp, used for PVC, Vfib, hemodynamically staple V tach, cause bradycardia and arrythmias, not used in WPW syndrome

21
Q

Mexiletine (Mexitil) (4)

A

oral form of lidocaine, used for PVC in pt with pacemaker, significant hepatotoxicity in some, lots of drug interactions

22
Q

Class 1C

A

Flecainide, propafenone, very little effect on action potential duration, no change in ERP, used more

23
Q

Propafenone (Rythmol) (5)

A

blocks fast Na channel, Ca and BB activity, prevents recurrence of Afib, on BEERS list, Lots of drug interactions

24
Q

Flecainide (tambocor) (5)

A

slows conduction in cardiac tissue, slight prolong ERP, used for life threatening ventricular arrhythmias (can also induce them!), WPW syndrome, BEERS list, don’t use with CAD pt

25
Q

Class II MOA

A

bind to B receptor and block activity of epinephrine or norepinephrine, blocks B receptors in SA/AV nodes, conducting system and contracting myocytes

26
Q

Effect of Class II

A

increase SA node automaticity, increase sinus rate, abort reentry circuits by decreasing conduction velocity, also affect non-pacemaker action potentials, increase ERP

27
Q

Metoprolol (lopressor, toprol XL) (5)

A

A fib, SVT contol, acute not chronic arrhythmias, DOC for BB, only use if hemodynamically stable, caution with CHF, WPW

28
Q

Class III

A

K channel blockers; Work both nodal and non nodal tissue; Amiodarone, Dronedarone, sotalol, dofetilide, ibutilide

29
Q

K is responsible for

A

repolarization, slow in nodal tissue, fast in non-nodal tissue

30
Q

a prolonged action potential duration has what effect

A

increases ERP

31
Q

Classic effect of Class III

A

prolonged QT, prolonged time the cells is not excitable

32
Q

Amiodarone (Cordarone, Nexterone) (3)

A

iodine allergy, VERY long half life, used for Afib (DOC)

33
Q

MOA of amiodarone

A

active on Na, Ca, K channels and prolongs action potential, lengthens ERP, slows SA function and AV conduction

34
Q

ADRs of amiodarone

A

brady, hypotension, hypothyroidism, slate blue skin, pulmonary toxicity

35
Q

Dronedarone (Multaq) (5)

A

only available PO, very similar to amiodarone (no iodine), used for paroxysmal Afib, no CHF or pulmonary impaired pts, BEERS

36
Q

Contraindications of Dronedarone (Multaq)

A

double risk of death in pt with permanent Afib, and in pt with CHF

37
Q

Sotalol (Betapace) (3)

A

only PO, MOA- non selective BB, also K channel blocker- prolong PR and QT interval, used for stable Vtach and prevention of Afib

38
Q

Dofetilide (Tikosyn) (5)

A

only PO, EKG monitored x 3 days, pt who have failed others or high risk SVT, few providers allowed to prescribe, MOA: blocks cardiac ion channel carrying rapid component of K current

39
Q

Ibutilide (Corvert (3))

A

rarely used, NK MOA, usually one time dose to convert

40
Q

Class IV

A

only non-dihydropyridines, blocks Ca channels in cardiac nodal tissue, cause peripheral vasodilation, NO USE IN CHF, slows AV conduction, increase time for each beat, decreases myocardial demand

41
Q

Diltizem (Cardizem)

A

IV for acute afib or flutter, DOC for arrythmias, rate control not rhythm, only for hemodynamically stable pts

42
Q

Digoxin (lanoxin)**

A

a cardiac glycoside from foxglove plant, TDM required, used for heart failure, A fib; CANNOT give to atrial tachyarrhythmias, Inhibits Na/K ATPase, increases intracellular Ca, increased contractility

43
Q

Adenosine (Adenocard)

A

very short half life (10 secs); proximal vein administration, used for PVST, causes inhibition of L-type Ca channels, reduces HR and conduction in AV node

44
Q

Magnesium and Potassium

A

low Mg and K can induce arrhythmias, also make digoxin toxicity worse

45
Q

Atropine

A

increases phase 4 depolarization, increase firing rate, used for brady, post procedurally, does not improve overall outcomes

46
Q

Most important anti-Arrhythmic

A

amiodarone

Pharmacology (61 decks)

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