Antiarrhythmias

Question 1

How does an impulse travel in normal sinus rhythm?

Answer 1

This generated by the SA node and travels to the atria to converge at the AV node, where the speed of conduction is reduced, and the impulse of the AV node travels into the ventricles via the bundle of his and then into the left and right bundle branches, the terminal perkinje fiber, and finally the ventricular myocytes. 

Question 2

What are the three categories of arrhythmias

Answer 2

Altered rate, premature beats, and altered conduction

Question 3

What are the two typical causes of altered rate like bradycardia or tachycardia?

Answer 3

Either excessive vagal stimulation (Brady) or excessive sympathetic nerve stimulation (tachy)

Question 4

What is a common cause of premature beats

Answer 4

They are generally caused by disturbances that increase the excitability in cardiac cells

Question 5

What does altered conduction typically caused by?

Answer 5

Excessive vagal stimulation, decreased sympathetic stimulation damage to the conduction system due to ischemia trauma infection, inflammation age or disease.

Question 6

What part of arrhythmias does sodium channel blockers affect?

Answer 6

It reduces the conduction velocity

Question 7

How did drugs affect affecting the potassium channels affect arrhythmias?

Answer 7

They delay polarization of action potentials that occurs in phase 3

Question 9

What drugs are used in the case of an AV block and how?

Answer 9

They affect vagal influences and drugs like atropine Municarinic receptor antagonist are used

Question 10

What action should you take with patients that have an AV block and are taking a beta blocker?

Answer 10

Since you’re moving, the beta blocker can sometimes normalize the AV conduction

Question 11

What drugs are useful in ventricular tachycardia?

Answer 11

Calcium channel blockers and beta blockers

Question 12

Which drug can be used to normalize ventricular rate during a flutter or fibrillation

Answer 12

Digitals because it activates the vagus nerve

Question 13

What are class one drugs for anti-arrhythmias

Answer 13

Calcium channel blockers that work at phase 0 of the action potential

Question 14

What is class two antiarrhythmic drug classes?

Answer 14

Beta blockers

Question 15

What is class three of antiarrhythmic drug classes?

Answer 15

Potassium channel blockers, which works in phase 3 of an action potential

Question 16

What is class four antiarrhythmic drug classes?

Answer 16

Calcium channel blockers, and they prolong the AV node refractory period

Question 17

What are the miscellaneous antiarrythmic drugs

Answer 17

Adenosine, digoxin, mag sulfate, atropine, ivabradine ranolazine

Question 18

What happens at each phase of action

Answer 18

Phase 0 is rapid depolarization due to an influx of sodium ions
Phase one is an flex of potassium through fast potassium channels which causes polarization phase 2 as calcium influx and phase 3 is flex of potassium through delayed potassium channels

Question 19

What meds are used in a fib/flutter

Answer 19

All of the classes and digitalis and adenosine and anticoagulation will be needed

Question 20

What meds are indicated for peroxysmal SVT

Answer 20

All the classes and adenosine

Question 21

What drugs are indicated for an AV block?

Answer 21

Atropine

Question 22

What drugs are indicated for PVC

Answer 22

Class two and four and magnesium sulfate

Question 23

What drugs are given for digitalis toxicity?

Answer 23

Class one B magnesium sulfate and potassium chloride

Question 24

What are the three types of sodium channel blockers?

Answer 24

Class one a is quinidine
Class one B is lidocaine
Class one C is flecainide

Question 25

What are the class one a sodium channel blockers and when are they used?

Answer 25

Quinidine procainamide and disoPyramide They are used only for life-threatening arrhythmias because they have severe side effects

Question 26

What class one a antiarrhythmic is used for vaguely mediated atrial fibrillation, like sleep induced a fib or a fib and athletes due to its anticholinergic activity

Answer 26

Disopyramide

Question 27

Which class IA sodium channel blocker is used for a fib associated with Wolff-Parkinson-White syndrome and occasionally with VTACH

Answer 27

Procainamide

Question 28

Which class one a antiarrhythmic is primarily used for malaria, but not for arrhythmias due to its side effects and pro dysrhythmic tendencies

Answer 28

Quinidine

Question 29

What are the adverse effects of procainamide?

Answer 29

Lupus like syndrome, rashes, myalgia, Reynards phenomenon, and agranulocytosis

Question 30

What are the side effects of disopyramide?

Answer 30

Anticholinergic affects, acute psychosis, agranulocytosis

Question 31

What are the side effects of quinidine

Answer 31

Diarrhea it has the highest pro rhythmic effect of the class prolonged QT interval in CNS effects. Torsades

Question 32

How do class one B sodium channel blockers work

Answer 32

They were gone phase 0 and the overall effect is to slow conduction, velocity and suppress spontaneous depolarization in the ventricle

Question 33

What are the class one B sodium channel blockers

Answer 33

Lidocaine phenytoin mexiletine

Question 34

What is phenytoin useful for in arrhythmias

Answer 34

To reverse digitalis induced arrhythmias

Question 35

What is the drug of choice for termination of ventricular tachycardia and prevention of ventricular fibrillation following a cardioversion in the setting of acute ischemia

Answer 35

Lidocaine

Question 36

What can routine prophylactic use of lidocaine lead to?

Answer 36

The incident of asystole and total overall mortality

Question 37

What is the least cardiotoxic of all the sodium channel blockers?

Answer 37

Lidocaine

Question 38

What is the first line drug used in pulse ventricular tachycardia or ventricular fibrillation?

Answer 38

Amiodarone

Question 39

What are the adverse effects of lidocaine and mexiletine

Answer 39

Drowsiness, peresthesia, agitation, confusion, slurred, speech, seizures, orthostatic hypotension, numbness, tingling of the lips and tongue and blurred vision

Question 40

What type of pain can Mexiletine be effective in treating?

Answer 40

Chronic pain like diabetic neuropathy

Question 41

What is the class one C antiarrhythmics and how do they work?

Answer 41

Flecainide and propafenone and they work by inhibiting voltage, dependent fast, sodium channels and prolonged depolarization phase. They caused QRS widening and have a negative inotropic effect.

Question 42

What is flecainide used to treat

Answer 42

Refractory ventricular arrhythmias and to suppress PVCs. Typically only used in life-threatening sustained ventricular tachycardia.

Question 43

What are the adverse effects of flecainide

Answer 43

Headache, dizziness, dyspnea, and tremors

Question 44

What is a broad spectrum anti-arrhythmic used an SVT and life-threatening ventricular arrhythmias

Answer 44

Propafenone

Question 45

What are the adverse effects of propafenone?

Answer 45

Dizziness, bradycardia, and bronchospasm

Question 46

What drugs are in class two antiarrhythmics

Answer 46

Beta blockers, including propanolol carvedilol acebutolol esmolol metoprolol and atenolol

Question 47

What is acebutolol indicated in

Answer 47

PVCs

Question 48

Which beta blockers are indicated in post MI SVT and ventricular tachycardia

Answer 48

Metoprolol timolol propanolol and carvedilol

Question 49

Which beta blocker is indicated for a flutter or fibrillation and acute SVT

Answer 49

Esmolol

Question 50

What are the potassium channel blockers that are in class three

Answer 50

Amiodarone dronedarone dofetilide sotalol and ibutilide

Question 51

Which potassium channel blocker is contraindicated with an iodine allergy

Answer 51

Amiodarone

Question 52

What are the adverse of effects of amiodarone?

Answer 52

Peripheral neuropathy, optic neuropathy, vision, impairment, hepatic, injury, or send arrhythmias photos, sensitivity, blue grey, color, interstitial , pneumonitis, thyrotoxicosis, and hypothyroidism.

Question 53

Why does amiodarone have a high risk for thyroid dysfunction?

Answer 53

It has high levels of iodine in the drug

Question 54

Which anti-arrhythmic drug is in class two and class three

Answer 54

Sotalol

Question 55

What is sotalol indicated for?

Answer 55

Super ventricular and ventricular arrhythmias

Question 56

What is the most important adverse effect of sotalol?

Answer 56

Other new ventricular, arrhythmias and torsades de pointes

Question 57

What CCB are typically used for anti-arrhythmias

Answer 57

Non DHP CCB is like verapamil and ditiazem

Question 58

When are the non-DHPCCB’s contraindicated?

Answer 58

And patient with pre-existing bradycardia SA node dysfunction, AV block, heart failure, and beta blocker use