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Pharmacology > Anti-arrythmics > Flashcards

Anti-arrythmics Flashcards

1
Q

What are the main classes of anti-arrhythmics?

A

Class 1 = Na channel blockers
Class 2 = β blocker
Class 3 = potassium channel blocker
Class 4 = calcium channel blocker

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2
Q

How can class 1 be further divided?

A

1a
1b
1c

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3
Q

What is an example of drugs from class 1a?

A

Quinidine

Procainamide

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4
Q

What is the route of administration for class 1a drugs?

A

Oral

IV

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5
Q

What is the mechanism of class 1a drugs?

A

Moderate phase 0 of the action potential

Reduce conduction
Increase refractory period
Decrease automaticity
Increase Na+ threshold

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6
Q

What are the uses of quinidine?

A

Maintain sinus rhythm in AF/flutter

Brugada syndrome

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7
Q

What are the uses of procainamide?

A

Acute IV treatment of supraventricular + ventricular arryhtmias

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8
Q

What are the side effects of class 1a drugs?

A 
Hypotension 
Reduced CO
Proarrythmia 
Dizziness
Confusion 
GI upset

Procainamide - lupus-like syndrome

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9
Q

What is an example of a class 1b drug?

A

Lidocaine

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10
Q

What is the route of administration of lidocaine?

A

IV

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11
Q

What is the mechanism of lidocaine?

A

Slow conduction in tissue

Increase Na+ threshold
Decrease phase 0 conduction in fast beating tissue

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12
Q

What are the uses of lidocaine?

A

Acute VT

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13
Q

What are the side effects of lidocaine?

A

Dizziness
Drowsiness
Abdominal upset

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14
Q

What is an example of a class 1c drug?

A

Flecainide

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15
Q

What is the route of administration for flecainide?

A

Oral

IV

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16
Q

What is the mechanism of flecainide?

A

Na channel blocker - slows conduction

Increases action potential duration
Increases refractory period

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17
Q

What are the uses of flecainide?

A

Supraventricular arrhythmias

  • AF
  • atrial flutter

Premature ventricular contractions

Wolff-Parkinson-White syndrome

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18
Q

What are the side effects of flecainide?

A

Proarrythmia
Dizziness
Drowsiness
GI upset

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19
Q

What are examples of class 2 drugs?

A

Propranolol

Bisoprolol

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20
Q

What is the route of administration of propranolol?

A

Oral

IV

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21
Q

What is the mechanism of propranolol?

A

Slows conduction

Increases action potential duration in AVN
Increases refractory period in AVN

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22
Q

What are the uses of propranolol?

A

Treating sinus + catecholamine dependant tachycardia

Converting re-entrant arrhythmias at AVN

Protecting ventricles from high atrial rates

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23
Q

What are the side effects of propranolol?

A

Bronchospasm

Hypotension

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24
Q

What are the routes of administration for bisoprolol?

A

Oral

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25
What is the mechanism of bisoprolol?
Slows conduction Increases action potential duration in AVN Increases refractory period in AVN
26
What are the uses of bisoprolol?
Treating sinus + catecholamine dependant tachycardia Converting re-entrant arrhythmias at AVN Protecting ventricles from high atrial rates
27
What are the side effects of bisoprolol?
Bronchospasm | Hypotension
28
What are examples of class 3 drugs?
Amiodarone | Sotalol
29
What are the routes of administration of amiodarone?
Oral | IV
30
What is the mechanism of amiodarone?
Potassium channel blocker - slows conduction Increases action potential duration Increases refractory period Slows AVN conduction
31
What are the uses for amiodarone?
Arrhythmias - VT - AF - atrial flutter - VF - WPW
32
What are side effects of amiodarone?
``` Pulmonary fibrosis Hepatic injury Increases LDL cholesterol Thyroid disease Photosensitivity Nausea ```
33
What is the route of administration for sotalol?
Oral
34
What is the mechanism of sotalol?
Potassium channel blocker - slows conduction Increases action potential duration Increases refractory period Slows AVN conduction
35
What are the uses of sotalol?
Supraventricular tachycardias - AF - atrial flutter Ventricular tachycardias
36
What are the side effects of sotalol?
Proarrhythmia Fatigue Insomnia
37
What are examples of class 4 drugs?
Verapamil | Diltiazem
38
What are the routes of administration of verapamil?
Oral | IV
39
What is the mechanism of verapamil?
Calcium channel blocker - prolongs action potential Slows conduction through AVN Increases refractory period in AVN
40
What are the uses of verapamil?
Supraventricular tachycardia Convert supraventricular tachycardia Angina Hypertension
41
What are the side effects of verapamil?
``` Constipation Abdo pain Dizziness Drowsiness N+V ```
42
What are the routes of administration of diltiazem?
Oral
43
What is the mechanism of diltiazem?
Calcium channel blocker - prolongs action potential Slows conduction through AVN Increases refractory period in AVN
44
What are the uses of diltiazem?
Supraventricular tachycardia Convert supraventricular tachycardia Angina Hypertension
45
What are the side effects of diltiazem?
``` Constipation Abdo pain Dizziness Drowsiness N+V ```
46
What are additional anti-arrhythmic agents?
``` Adenosine Vernakalant Ivabradine Digoxin Atropine ```
47
What class is adenosine?
Natural nucleoside
48
What is the route of administration of adenosine?
Rapid IV bolus
49
What is the mechanism of adenosine?
Potassium current activation in SAN + AVN Decreases action potential duration Slows heart rate Increases refractory period in AVN
50
What are the uses of adenosine?
Convert re-entrant supraventricular arrhythmias
51
What are the side effects of adenosine?
``` Abdo discomfort Arrhythmiass Chest pain Dizziness Dry motuh Dyspnoea Hypotension ```
52
What are the routes of administration of vernakalant?
IV
53
What is the mechanism of vernakalant?
Slows atrial conduction Blocks atrial specific K+ channels
54
What are the uses of vernakalant?
Convert recent onset AF to sinus rhythm
55
What are the side effects of vernakalant?
Hypotension AV block Sneezing Taste disturbances
56
What is the route of administration of ivabradine?
Oral
57
What is the mechanism of ivabradine?
Slows sinus node conduction Blocks If ion current in sinus node
58
What are the uses of ivabradine?
Reduce inappropriate sinus tachy Reduce HR in angina + HF
59
What are the side effects of ivabradine?
``` Arrhythmias AV block Dizziness Flashing lights Hypertension Headache ```
60
What class is digoxin?
Cardiac glycoside
61
What are the routes of administration of digoxin?
Oral | IV
62
What is the mechanism of digoxin?
Slows AV conduction Slows HR Enchances vagal activity - increases K+ currents - reduces Ca2+ currents - increases refractory period
63
What are the uses of digoxin?
Reduce ventricular rates in AF + flutter
64
What are the side effects of digoxin?
Arrhythmias V+D Dizziness Eosinophilia
65
What class is atropine?
Muscarinic antagonist
66
What is the route of administration of atropine?
IV
67
What is the mechanism of atropine?
Blocks vagal activity Speeds AV conduction Increases HR
68
What is the use of atropine?
Vagal bradycardia
69
What are the side effects of atropine?
``` Abdo distension Arrhythmias Dysphagia GI disorders Hyperthermia ```
70
What is the order of efficacy of common anti-arrhythmics?
Amiodarone Sotalol Flecainide Bisoprolol Verapamil Diltiazem
71
What is the order of safety/tolerability of common anti-arrhythmics?
Bisoprolol Verapamil Diltiazem Sotalol Flecainide Amiodarone
72
Which drugs are used for rate control in AF?
Bisoprolol Verapamil Diltiazem +/- digoxin
73
What drugs are used for rhythm control in AF?
Sotalol Flecainide + bisoprolol Amiodarone
74
What are the best drugs for WPW?
Flecainide | Amiodarone
75
What drugs are used acutely in re-entrant SVT?
IV - adenosine - verapamil - flecainide
76
What drugs are used for chronic re-entrant SVT?
Oral - bisoprolol, verapamil - sotalol - flecainide, procainamide - amiodarone
77
What is the first line drug for ectopic beats?
Bisoprolol
78
What drugs are used to treat sinus tachy?
Ivabradine Bisoprolol, verapamil

Pharmacology (27 decks)

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