Anti-Arrythmics Flashcards
sodium channel blockers (3)
generic + brand
procainamide (Procan)
lidocaine (xylocaine)
Flecainide (tambocor)
cardioselective beta blocker
generic + brand
metoprolol (Lopressor)
non-cardioselective beta blocker
generic + brand
carvedilol (Coreg)
potassium channel blockers
generic + brand
amiodarone (Pacerone)
droedarone (Multaq)
dofetilide (Tikosyn)
Non-DHP CCB generic/brand
diltiazem (Cardizem)
Type I antiarrhythmics
sodium channel blockers
active during systole but dissociate during diastole
effect Phase 0 of cardiac AP
type Ia drug used
Procainamide
type Ia indication
Procainamide
wide stable v-tach
2nd line agent used in Torsades
AVRT/Wolfe Parkinson’s White**
Procainamide MOA
block Na (and small extent K)
decreased conduction velocity
Procainamide side effects
Type Ia
cardiac toxicity (Hypotension, Torsades)
bone marrow suppression
lupus
Type Ib drug
lidocaine
lidocaine indication
2nd line to Amiodarone in pulseless VF or VT
lidocaine MOA
faster dissociation, targets tissues with higher rates of depolarization (ventricles)
decrease duration of AP
lidocaine side effects
bradycardia/heart block
defibrillator threshold increase
hypotension
drowsiness, hallycinations, HA, confusion, etc
lidocaine CI
patients with WPW
dosing with VT/VF lidocaine
IV 1mg/kg
MAX 3mg/kg
no renal dosing, pregnancy category B
lidocaine toxicity
found most often in pts with continuous, high dose drips
neurologic (seizures!, tremors, insomina, drowsinuess)
cardiac (sinus slowing, hypotension, shock, asystole)
type Ic
flecainide
propafenone
Flecainide indication
3rd line agent in persistent ventricular arrythmias
Flecainide moa
blocks BOTH Na and K
slowest dissociation = slowing conduction
no effect on refractory period, no effect on ectopic pacemakers
Flecainide side effects
visual disturbances
dyspnea
PRO-ARRHYTHMIC
special considerations with Flecainide
Drug interactions
NO loading dose
stop other anti-arrhythmics for 4 days
drug-drug interactions: TZDs, Digoxin
propafenone indications and MOA
3rd line VF, sometimes better than flecainide
blocks Na, K channels + beta blocker
slowest dissociation
propafenone s/e
bradycardia exacerbates HF bronchospasms Pro-arrhythmic agranulocytosis
special considerations propafenone
Drug interactions and CI (3)
Drugs: Warfarin, digoxin
C/I: HF, sick sinus, pregnancy, heart block
beta blockers indications
rate control in patients with AFib w/RVR (metoprolol)
rate control in chronic heart failure (carvedilol)
beta blockers MOA
inhibit beta-adrenergic increases in HR, the force of contraction, and conduction (slows HR, decreases contraction strength)
not a rhythm drug but a RATE drug
indications of amiodarone
A fib (pts with heart failure who require rate control)
1st line V tach or V Fib
MOA of amiodarone
potassium channel blockers
impact repolarization and refractory period
sodium and calcium channel blocking effects which prolongs action potential and slows AV conduction
amiodarone long-term use
not used for chronic suppression of VT or SVT
after 3 years, drug decreases in efficacy 10%
req. 3 month wash out
amiodarone side effects
SJS, blue man, Opthalmology, thyroid
recommendations for patients on long-term amiodarone
annual eye checks
pulmonary fxn test and CXR every 6 mo
EKG every 6 mo
thyroid function testing 3-6 months
type III drugs
Dronedarone (Multaq)
Amiodarone (Pacerone)
Dofetilide (Tikosyn)
Sotalol (Betapace)
Dronedarone (Multaq)
Alternative for amiodarone:
treatment of stable V-tach
rhythm control of paroxysmal A-Fib
Dronedarone (Multaq) MOA
similar to amiodarone
potassium channel locker
works on phases 1, 2, 3
Dronedarone (Multaq) req. before starting
EKG
BMP
Dronedarone (Multaq) side effects
worsen HF
torsades QTc
Hepatotoxicity
Dronedarone (Multaq) C.I.
permanent AFib heart block LVEF pregnancy prolonged QTc hx of torsades hypokalemia, hypomagnesia
Dofetilide (tikosyn) indications
pharmacologically convert AFib/AFlutter to NSR
Dofetilide (tikosyn)
special
started in hospital for 3 days
req. REMS, EKG, BMP
Sotalol (Betapace) indications
rate control of AFib
stable ventricular tachycardia
Sotalol (Betapace) MOA
combines K+ and B-blockers
effects all phases of cardiac cycle
Sotalol (Betapace) CI
prolonged QTc
history of torsades
hypokalemia, hypomagnesium
heart block
Type IV drugs
diltizem (cardizem)
Verapamil (calan, verlan)
diltizem (cardizem) indications
A. Fib RVR
paroxysmal SVT
diltizem (cardizem)
MOA
Non-DHP CCB
slows depolarization of SA and AV nodes
Verapamil indications
rate control of HF patients
A Fib with RVR
paroxysmal SVT
Verapamil specific side effects
gingival hyperplasia
constipation
Verapamil drug interactions
Tikosyn
Pradaxa
Verapamil/dilitizem CI
reduced HF
WPW
wide complex ventricular tachycardia
CAST Trial
looked at efficacy of anti-arrythmics post MI
use of Ic had lower risk of CV event and death than placebo
CTAF
compared amiodarone, stall, propafenone
amiodarone was more effective and longer duration at preventing AFIB
BHAT
adding B-blocker post MI is likely to reduce MI recurrence and death
AFFIRM
compared rate v. rhythm control in AFib pts
no advantage between two, increased mortality for those in rhythm control group
