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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
Q

What is the mechanism of bisoprolol?

A

Slows conduction

Increases action potential duration in AVN
Increases refractory period in AVN

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26
Q

What are the uses of bisoprolol?

A

Treating sinus + catecholamine dependant tachycardia

Converting re-entrant arrhythmias at AVN

Protecting ventricles from high atrial rates

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27
Q

What are the side effects of bisoprolol?

A

Bronchospasm

Hypotension

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28
Q

What are examples of class 3 drugs?

A

Amiodarone

Sotalol

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29
Q

What are the routes of administration of amiodarone?

A

Oral

IV

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30
Q

What is the mechanism of amiodarone?

A

Potassium channel blocker - slows conduction

Increases action potential duration
Increases refractory period
Slows AVN conduction

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31
Q

What are the uses for amiodarone?

A

Arrhythmias

  • VT
  • AF
  • atrial flutter
  • VF
  • WPW
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32
Q

What are side effects of amiodarone?

A 
Pulmonary fibrosis 
Hepatic injury 
Increases LDL cholesterol 
Thyroid disease
Photosensitivity 
Nausea
33
Q

What is the route of administration for sotalol?

A

Oral

34
Q

What is the mechanism of sotalol?

A

Potassium channel blocker - slows conduction

Increases action potential duration
Increases refractory period
Slows AVN conduction

35
Q

What are the uses of sotalol?

A

Supraventricular tachycardias

  • AF
  • atrial flutter

Ventricular tachycardias

36
Q

What are the side effects of sotalol?

A

Proarrhythmia
Fatigue
Insomnia

37
Q

What are examples of class 4 drugs?

A

Verapamil

Diltiazem

38
Q

What are the routes of administration of verapamil?

A

Oral

IV

39
Q

What is the mechanism of verapamil?

A

Calcium channel blocker - prolongs action potential

Slows conduction through AVN
Increases refractory period in AVN

40
Q

What are the uses of verapamil?

A

Supraventricular tachycardia

Convert supraventricular tachycardia

Angina
Hypertension

41
Q

What are the side effects of verapamil?

A 
Constipation 
Abdo pain 
Dizziness
Drowsiness
N+V
42
Q

What are the routes of administration of diltiazem?

A

Oral

43
Q

What is the mechanism of diltiazem?

A

Calcium channel blocker - prolongs action potential

Slows conduction through AVN
Increases refractory period in AVN

44
Q

What are the uses of diltiazem?

A

Supraventricular tachycardia

Convert supraventricular tachycardia

Angina
Hypertension

45
Q

What are the side effects of diltiazem?

A 
Constipation 
Abdo pain 
Dizziness
Drowsiness
N+V
46
Q

What are additional anti-arrhythmic agents?

A 
Adenosine 
Vernakalant
Ivabradine
Digoxin 
Atropine
47
Q

What class is adenosine?

A

Natural nucleoside

48
Q

What is the route of administration of adenosine?

A

Rapid IV bolus

49
Q

What is the mechanism of adenosine?

A

Potassium current activation in SAN + AVN

Decreases action potential duration
Slows heart rate
Increases refractory period in AVN

50
Q

What are the uses of adenosine?

A

Convert re-entrant supraventricular arrhythmias

51
Q

What are the side effects of adenosine?

A 
Abdo discomfort
Arrhythmiass
Chest pain 
Dizziness
Dry motuh 
Dyspnoea
Hypotension
52
Q

What are the routes of administration of vernakalant?

A

IV

53
Q

What is the mechanism of vernakalant?

A

Slows atrial conduction

Blocks atrial specific K+ channels

54
Q

What are the uses of vernakalant?

A

Convert recent onset AF to sinus rhythm

55
Q

What are the side effects of vernakalant?

A

Hypotension
AV block
Sneezing
Taste disturbances

56
Q

What is the route of administration of ivabradine?

A

Oral

57
Q

What is the mechanism of ivabradine?

A

Slows sinus node conduction

Blocks If ion current in sinus node

58
Q

What are the uses of ivabradine?

A

Reduce inappropriate sinus tachy

Reduce HR in angina + HF

59
Q

What are the side effects of ivabradine?

A 
Arrhythmias
AV block 
Dizziness
Flashing lights
Hypertension 
Headache
60
Q

What class is digoxin?

A

Cardiac glycoside

61
Q

What are the routes of administration of digoxin?

A

Oral

IV

62
Q

What is the mechanism of digoxin?

A

Slows AV conduction
Slows HR

Enchances vagal activity

  • increases K+ currents
  • reduces Ca2+ currents
  • increases refractory period
63
Q

What are the uses of digoxin?

A

Reduce ventricular rates in AF + flutter

64
Q

What are the side effects of digoxin?

A

Arrhythmias
V+D
Dizziness
Eosinophilia

65
Q

What class is atropine?

A

Muscarinic antagonist

66
Q

What is the route of administration of atropine?

A

IV

67
Q

What is the mechanism of atropine?

A

Blocks vagal activity
Speeds AV conduction
Increases HR

68
Q

What is the use of atropine?

A

Vagal bradycardia

69
Q

What are the side effects of atropine?

A 
Abdo distension 
Arrhythmias
Dysphagia 
GI disorders
Hyperthermia
70
Q

What is the order of efficacy of common anti-arrhythmics?

A

Amiodarone

Sotalol
Flecainide

Bisoprolol
Verapamil
Diltiazem

71
Q

What is the order of safety/tolerability of common anti-arrhythmics?

A

Bisoprolol
Verapamil
Diltiazem

Sotalol
Flecainide

Amiodarone

72
Q

Which drugs are used for rate control in AF?

A

Bisoprolol
Verapamil
Diltiazem

+/- digoxin

73
Q

What drugs are used for rhythm control in AF?

A

Sotalol
Flecainide + bisoprolol
Amiodarone

74
Q

What are the best drugs for WPW?

A

Flecainide

Amiodarone

75
Q

What drugs are used acutely in re-entrant SVT?

A

IV

  • adenosine
  • verapamil
  • flecainide
76
Q

What drugs are used for chronic re-entrant SVT?

A

Oral

  • bisoprolol, verapamil
  • sotalol
  • flecainide, procainamide
  • amiodarone
77
Q

What is the first line drug for ectopic beats?

A

Bisoprolol

78
Q

What drugs are used to treat sinus tachy?

A

Ivabradine

Bisoprolol, verapamil

Pharmacology (27 decks)

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