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FA17 Cardio 2 > Anti-Arrythmics > Flashcards

Anti-Arrythmics Flashcards

1
Q

sodium channel blockers (3)

generic + brand

A

procainamide (Procan)
lidocaine (xylocaine)
Flecainide (tambocor)

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2
Q

cardioselective beta blocker

generic + brand

A

metoprolol (Lopressor)

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3
Q

non-cardioselective beta blocker

generic + brand

A

carvedilol (Coreg)

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4
Q

potassium channel blockers

generic + brand

A

amiodarone (Pacerone)
droedarone (Multaq)
dofetilide (Tikosyn)

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5
Q

Non-DHP CCB generic/brand

A

diltiazem (Cardizem)

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6
Q

Type I antiarrhythmics

A

sodium channel blockers

active during systole but dissociate during diastole

effect Phase 0 of cardiac AP

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7
Q

type Ia drug used

A

Procainamide

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8
Q

type Ia indication

A

Procainamide

wide stable v-tach
2nd line agent used in Torsades
AVRT/Wolfe Parkinson’s White**

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9
Q

Procainamide MOA

A

block Na (and small extent K)

decreased conduction velocity

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10
Q

Procainamide side effects

A

Type Ia

cardiac toxicity (Hypotension, Torsades)
bone marrow suppression
lupus

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11
Q

Type Ib drug

A

lidocaine

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12
Q

lidocaine indication

A

2nd line to Amiodarone in pulseless VF or VT

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13
Q

lidocaine MOA

A

faster dissociation, targets tissues with higher rates of depolarization (ventricles)

decrease duration of AP

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14
Q

lidocaine side effects

A

bradycardia/heart block
defibrillator threshold increase
hypotension
drowsiness, hallycinations, HA, confusion, etc

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15
Q

lidocaine CI

A

patients with WPW

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16
Q

dosing with VT/VF lidocaine

A

IV 1mg/kg
MAX 3mg/kg

no renal dosing, pregnancy category B

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17
Q

lidocaine toxicity

A

found most often in pts with continuous, high dose drips

neurologic (seizures!, tremors, insomina, drowsinuess)

cardiac (sinus slowing, hypotension, shock, asystole)

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18
Q

type Ic

A

flecainide

propafenone

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19
Q

Flecainide indication

A

3rd line agent in persistent ventricular arrythmias

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20
Q

Flecainide moa

A

blocks BOTH Na and K

slowest dissociation = slowing conduction

no effect on refractory period, no effect on ectopic pacemakers

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21
Q

Flecainide side effects

A

visual disturbances
dyspnea
PRO-ARRHYTHMIC

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22
Q

special considerations with Flecainide

Drug interactions

A

NO loading dose

stop other anti-arrhythmics for 4 days

drug-drug interactions: TZDs, Digoxin

23
Q

propafenone indications and MOA

A

3rd line VF, sometimes better than flecainide

blocks Na, K channels + beta blocker

slowest dissociation

24
Q

propafenone s/e

A 
bradycardia 
exacerbates HF
bronchospasms 
Pro-arrhythmic 
agranulocytosis
25
Q

special considerations propafenone

Drug interactions and CI (3)

A

Drugs: Warfarin, digoxin

C/I: HF, sick sinus, pregnancy, heart block

26
Q

beta blockers indications

A

rate control in patients with AFib w/RVR (metoprolol)

rate control in chronic heart failure (carvedilol)

27
Q

beta blockers MOA

A

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

28
Q

indications of amiodarone

A

A fib (pts with heart failure who require rate control)

1st line V tach or V Fib

29
Q

MOA of amiodarone

A

potassium channel blockers

impact repolarization and refractory period

sodium and calcium channel blocking effects which prolongs action potential and slows AV conduction

30
Q

amiodarone long-term use

A

not used for chronic suppression of VT or SVT

after 3 years, drug decreases in efficacy 10%

req. 3 month wash out

31
Q

amiodarone side effects

A

SJS, blue man, Opthalmology, thyroid

32
Q

recommendations for patients on long-term amiodarone

A

annual eye checks

pulmonary fxn test and CXR every 6 mo

EKG every 6 mo

thyroid function testing 3-6 months

33
Q

type III drugs

A

Dronedarone (Multaq)
Amiodarone (Pacerone)
Dofetilide (Tikosyn)
Sotalol (Betapace)

34
Q

Dronedarone (Multaq)

A

Alternative for amiodarone:

treatment of stable V-tach

rhythm control of paroxysmal A-Fib

35
Q

Dronedarone (Multaq) MOA

A

similar to amiodarone

potassium channel locker

works on phases 1, 2, 3

36
Q

Dronedarone (Multaq) req. before starting

A

EKG

BMP

37
Q

Dronedarone (Multaq) side effects

A

worsen HF
torsades QTc
Hepatotoxicity

38
Q

Dronedarone (Multaq) C.I.

A 
permanent AFib 
heart block 
LVEF 
pregnancy 
prolonged QTc
hx of torsades 
hypokalemia, hypomagnesia
39
Q

Dofetilide (tikosyn) indications

A

pharmacologically convert AFib/AFlutter to NSR

40
Q

Dofetilide (tikosyn)

special

A

started in hospital for 3 days

req. REMS, EKG, BMP

41
Q

Sotalol (Betapace) indications

A

rate control of AFib

stable ventricular tachycardia

42
Q

Sotalol (Betapace) MOA

A

combines K+ and B-blockers

effects all phases of cardiac cycle

43
Q

Sotalol (Betapace) CI

A

prolonged QTc
history of torsades
hypokalemia, hypomagnesium
heart block

44
Q

Type IV drugs

A

diltizem (cardizem)

Verapamil (calan, verlan)

45
Q

diltizem (cardizem) indications

A

A. Fib RVR

paroxysmal SVT

46
Q

diltizem (cardizem)

MOA

A

Non-DHP CCB

slows depolarization of SA and AV nodes

47
Q

Verapamil indications

A

rate control of HF patients

A Fib with RVR

paroxysmal SVT

48
Q

Verapamil specific side effects

A

gingival hyperplasia

constipation

49
Q

Verapamil drug interactions

A

Tikosyn

Pradaxa

50
Q

Verapamil/dilitizem CI

A

reduced HF
WPW
wide complex ventricular tachycardia

51
Q

CAST Trial

A

looked at efficacy of anti-arrythmics post MI

use of Ic had lower risk of CV event and death than placebo

52
Q

CTAF

A

compared amiodarone, stall, propafenone

amiodarone was more effective and longer duration at preventing AFIB

53
Q

BHAT

A

adding B-blocker post MI is likely to reduce MI recurrence and death

54
Q

AFFIRM

A

compared rate v. rhythm control in AFib pts

no advantage between two, increased mortality for those in rhythm control group

FA17 Cardio 2 (10 decks)

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