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Y2S1-Pharmacology > Anti-Arrythmic drugs > Flashcards

Anti-Arrythmic drugs Flashcards

1
Q

What is bradycardia and what are its causes?

A
  • It is a condition where the heart rate is less than 60bmp which can be due to an AV block or sick sinus syndrome (alternating tachycardia & bradycardia)
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2
Q

What are the non-pharmacological treatment for arrythmias?

A

1) radiofrequency ablation

2) Pacemaker

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3
Q

Why is it necessary to administer atropine for patients with bradycardia before placing a pacemaker?

A

Atropine is a parasympatholytic which eliminates the vagus tone, accelerating the HR

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4
Q

What is tachyarrhythmia, and what are its sutypes?

A
  • It is when the heart beats more than 100bmp

1) Atrial tachyarrhythmia (supraventricular tachycardia):

  • Atrial Flutter
  • Atrial Fibrillation
  • SVT
  • AV nodal reentrant tachycardia
  • WPWS

2) Fast HR in the Ventricles:

  • Ventricular tachycardia
  • Ventricular flutter
  • Ventricular fibrillation
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5
Q

How is ventricular fibrillation treated?

A

1) DC Shock

2) Internal defibrillator

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6
Q

What are the different classification of antiarrhythmic drugs?

A

1) Class-1, A, B, C (sodium channel blockers)

2) Class-2

3) Class-3 (broad spectrum)

4) Class-4

5) Class-5

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7
Q

What are the class-1a antiarrhythmic drugs?

A

1) Quinidine

2) procainamide

3) disopyramide

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8
Q

What are the class-1B antiarrhythmic drugs?

A

1) Lidocaine

2) Mexiletine

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9
Q

What are the class-1C antiarrhythmic drugs?

A

1) Flecanide

3) Propafenone

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10
Q

What are the class-2 antiarrhythmic drugs?

A

-Beta Blockers

1) Propranolol

2) Metoprolol

3) Atenolol

  • Act on both the myocadiac muscle and the conduction system (SA & AV nodes)
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11
Q

What are the class-3 antiarrhythmic drugs?

A

1) Amiodarone

2) Sotalol

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12
Q

What are the class-4 antiarrhythmic drugs?

A
  • Calcium Channel Blockers of the SA node

1) Verapamil

2) Diltiazem

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13
Q

What is the drug of choice to treat acute supraventricular tachycardia?

A

Adenosine

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14
Q

What is the mechanism of action of class-1A antiarrhythmic drugs?

A

They block the open/inactivated Na channel slowing the depolarization of phase 0 of the AP, they also prolong the time of the AP as they do not dissociate easily from the Na channels in addition to their blocking effect of K channel, increasing the duration of the effective refractory period

  • Quinidine blocks the muscarinic and alpha receptors, and they are available both IV and orally
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15
Q

What is the mechanism of action of class-1B antiarrhythmic drugs?

A
  • Intra venous infusion
  • They block the inactivated Na channels (preferably hypoxic and ischemic tissue) slowing down the phase 0 of the AP but as they dissociate quickly from the Na channel they shorten the duration of AP
  • They have a rapid offset of action
  • Useful in treating ventricular tachycardia after a MI
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16
Q

What is the mechanism of action of class-1C antiarrhythmic drugs?

A

They block the Na channel slowing phase 0 of the AP, but within the normal action potential timing

  • Propafenone slows the conduction in all cardiac tissues (like b-blockers and flecainide “a class-1C drug”)
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17
Q

What is the mechanism of action of class-2 antiarrhythmic drugs?

A

They diminish the phase 4 slope by blocking beta-adrenergic receptors, which decreases the effects of catecholamine which enhances the activity of the funny current (If) and calcium currents (ICa) on the heart, reducing the heart rate, contractility, and conduction through the cardiac conduction system, helping to prevent abnormal electrical signals that cause arrhythmias.

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18
Q

What is the mechanism of action of class-3 antiarrhythmic drugs?

A

Broad spectrum (Amiodarone has all classes MOA) Works on phase 3 of myocardial contractility, They block the potassium channels, increasing the duration of the effective refractory period

Sotalol is a BB with a class-3 effect (blocking K channels)

What is the importance of prolonging the AP duration?

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19
Q

What is the mechanism of action of class-4 antiarrhythmic drugs?

A

Inhibiting L-type calcium channels, in the sinoatrial (SA) and atrioventricular (AV) nodes, slowing the depolarization in the SA node and prolonging conduction time through the AV node, decreasing the heart rate and AV nodal conduction, which is particularly effective in treating reentrant arrhythmias and controlling the ventricular rate.
Increasing the refractory period & slowing the conduction of AP

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20
Q

What are the unclassified antiarrhythmic drugs?

A

1) Atropine

2) Adrenaline

3) Isoprenaline

4) Digoxin

5) Adenosine

6) Calcium Chloride

7) Magnesium Chloride

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21
Q

What is the clinical use of atropine?

A

Sinus Bradycardia

22
Q

What is the clinical use of adrenaline?

A

Cardiac arrest

23
Q

What is the clinical use of isoprenaline?

A

Heart block

24
Q

What is the clinical use of digoxin?

A

Rapid atrial fibrillation

25
Q

What is the clinical use of adenosine?

A

Supra-Ventricular fibrillation

26
Q

What is the clinical use of calcium chloride?

A

Hyperkalemia induced ventricular tachycardia

27
Q

What is the clinical use of magnesium chloride?

A

Ventricular fibrillation and digoxin toxicity

28
Q

What is the only medication that does not have a proarrhythmogenic effect

A

amiodarone (class-3)

29
Q

What are the adverse effects of quinidine?

A

1) Cinchonic

2) Hypotension

3) Prolongation of QRS & QT interval which might lead to torsade de pointes

4) It displaces digoxin from the tissue which might lead to toxicity

5) Atropine like effect including tachycardia

30
Q

What is the adverse effects of procainamide?

A

1) SLE-like syndrome

2) Hematotoxicity (thrombocytopenia, agranulocytosis)

3) Torsade as it prolongs the QT interval

31
Q

Which drug is indicated for the treatment of WPW and SVT?

A

Procainamide

32
Q

What are the adverse effects of disopyramide?

A

1) It has a negative inotropic effect which might lead to heart failure

2) Atropine like effect (urinary retention, blurred vision, dry mouth, increasing glaucoma)

33
Q

Which drug is important in treating ventricular arrythmias after MI?

A

Lidocaine IV

34
Q

Why is lidocaine used parentally only?

A

As i has an extensive firstpass metabolism

35
Q

What is the side effects of lidocaine?

A

1) High doses can cause CNS toxicity (behavioral changes)

2) Delirium

3) Confusion

36
Q

What is the clinical use of mixiletine?

A

It is the same as lidocaine but taken orally

37
Q

What are the adverse effects of flecainide?

A

1) Sudden death as it can cause proarrhythmogenic effect when used after MI or VT

2) Nausea

3) Confusion

4) Ataxia

38
Q

What is the clinical uses of propafenone?

A

1) It is like the DC shock as it can control the rhythm of atrial fibrillation and flutter

2) Paroxysmal supra-ventricular tachycardia prophylaxis

39
Q

What is the clinical effect of amiodarone?

A

SV-arrhythmias and Ventricular arrhythmias

It is safe in patients with cardiac failure

40
Q

Describe the pharmacokinetics of amiodarone

A

It has a large distribution in the tissue

  • Its half life is 60-80 days requiring a loading dose (4-6 doses)
  • It is extensively metabolized in the liver and excreted in the bile
41
Q

What are the adverse effects of amiodarone?

A
  • Most are reversible

1) Thyroid dysfunction (hypo and hyper) as the drug contains iodide (blocks the conversion of T4 into T3)

2) Cornela micro-deposits

3) Skin photosensitivity (blue-gray pigmentation)

4) Pulmonary toxicity (including pulmonary infiltrates)

42
Q

What is the importance of the class-3 drug dronedarone?

A
  • It is an amiodarone derivative but without iodine moieties and thus no thyroid dysfunction
  • Contraindicated in symptomatic heart failure and permanent atrial fibrillation
43
Q

What is the importance of sotalol?

A

A BB with class-3 antiarrhythmic effect

44
Q

What is the clinical use of sotalol?

A

1) Ventricular arrhythmias

2) Effective as amiodarone

3) Can be used with implantable defibrillators

45
Q

What are the adverse effects of sotalol?

A

1) BB side effects and pro-arrhythmic

2) QT prolongation thus torsade de pointes

46
Q

What is ivabradine and what is its importance?

A

Heart rate lowering agent that cats on the cardiac pacemaker funny current

  • Its importance is that it does not affect the BP, CONTRACTILITY, CONDUCTION IN THE HEART & REPOLARIZATION
47
Q

What is ranolazine and what is its importance?

A
  • Used when we run out of options for treating angina
  • It restores the balance between O2 supply and demand, by inhibiting the late phase of sodium current
48
Q

Which drug is used in the treatment of chronic angina?

A

ranolazine

  • Prolongs the QT interval and should be avoided when other drugs are used that prolonged the QT interval
49
Q

V-tach after MI which drug?

A

Lidocaine

50
Q

Which drug is used to treat re-entrant tachy

A

CCB

Y2S1-Pharmacology (10 decks)

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