Anti-Arrythmics Flashcards by Sara Fieger

sodium channel blockers (3)

generic + brand

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

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cardioselective beta blocker

generic + brand

metoprolol (Lopressor)

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non-cardioselective beta blocker

generic + brand

carvedilol (Coreg)

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potassium channel blockers

generic + brand

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

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Non-DHP CCB generic/brand

diltiazem (Cardizem)

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Type I antiarrhythmics

sodium channel blockers

active during systole but dissociate during diastole

effect Phase 0 of cardiac AP

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type Ia drug used

Procainamide

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type Ia indication

Procainamide

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

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Procainamide MOA

block Na (and small extent K)

decreased conduction velocity

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Procainamide side effects

Type Ia

cardiac toxicity (Hypotension, Torsades)
bone marrow suppression
lupus

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Type Ib drug

lidocaine

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lidocaine indication

2nd line to Amiodarone in pulseless VF or VT

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lidocaine MOA

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

decrease duration of AP

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lidocaine side effects

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

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lidocaine CI

patients with WPW

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dosing with VT/VF lidocaine

IV 1mg/kg
MAX 3mg/kg

no renal dosing, pregnancy category B

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lidocaine toxicity

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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type Ic

flecainide

propafenone

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Flecainide indication

3rd line agent in persistent ventricular arrythmias

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Flecainide moa

blocks BOTH Na and K

slowest dissociation = slowing conduction

no effect on refractory period, no effect on ectopic pacemakers

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Flecainide side effects

visual disturbances
dyspnea
PRO-ARRHYTHMIC

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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