Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm 2 > Antiarrhythmic Agents > Flashcards

Antiarrhythmic Agents Flashcards

1
Q

Class 1 Agents

A

Sodium Channel Blockers
treat: SVT, afib, WPW (re-entry)
depression of phase 0 depolarization
slows conduction and decreases rate of depolarization in phase 0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Class 1A Agents

A

moderate depression and prolonged repolarization
not used much anymore d/t toxicity & may precipitate HF
quinidine, procainamide, disopyramide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Class 1C Agents

A

strong depression with little effect on repolarization

flecainide, propafenone, moricizine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Class 1B Agents

A

weak depression and shortened repolarization

lidocaine, mexiletine, phenytoin, tocainide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Class 2 Agents

A

Beta Adrenergic Blockers
work at phase 4
esmolol, propranolol, metoprolol, timolol, pindolol, atenolol, acebutolol, nadolol, and carvedilol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Class 3 Agents

A

Potassium Channel Blockers
work at phase 2 & 3
amiodarone, bretylium, sotalol, ibutilide, dofetilide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Class 4 Agents

A

Calcium Channel Blockers
work at phase 2
verapamil, diltiazem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Adenosine (class v)

A

binds to A1 purine nucleotide receptors to open K+ channels and increase K+ currents
used for SVT (ACUTE RX ONLY)
slows AV node conduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Digoxin (class v)

A 
cardiac glycoside (foxglove plant) 
increases vagal activity 
decreases HR, preload and afterload 
decrease AV conduction 
positive inotrope (treats CHF, increases contractility) 
narrow therapeutic range
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Phenytoin

A

1B agent
effects resemble lidocaine
used in suppression of ventricular arrhythmias associated with digitalis toxicity, Vtach or tosades

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Atropine (class v)

A 
muscarinic receptor antagonist
used to treat unstable bradyarrhythmias 
0.4-1 mg and repeat as needed
liver metabolism 
onset: <1 min 
DOA: 30-60 min 
using <0.4 mg --> paradoxical response
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Magnesium (class v)

A

works at sodium, potassium, and calcium channels
used w/ torsades
1g IV over 20 min, can be repeated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Procainamide Dosing

A

Loading 100 mg IV every 5 min until rate controlled (max 15 mg/kg); then infusion 2-6 mg/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Class 1C Agents

A 
slow dissociation agent 
decrease depolarization rate of phase 0 
decrease conduction rate 
increased AP 
inhibit conduction through HIS-purkinje system 
good for PVCs & Vtach
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Flecainide

A

Class 1C prototype
suppresses vtach & PVCs, also WPWS (reentry rhythm)
oral agent
pro-arrhythmic side effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Propafenone

A

suppression of ventricular & atrial tachyarrhythmias
oral agent
pro-arrhythmic side effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Class 1B Agents

A

fast dissociation, binds to OPEN channels
alters AP by inhibiting Na ion influx via rapidly binding to and blocking Na channels
shortens AP duration and refractory period
decreases automaticity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Propafenone

A

suppression of ventricular & atrial tachyarrhythmias
oral agent
pro-arrhythmic side effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Pro-arrhythmic side effects

A

potentially torsades occuring

sudden death associated with V fib.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Lidocaine

A

Class 1B Agent prototype

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Lidocaine

A

Class 1B Agent prototype
Use: treat ventricular arrhythmias, effective in suppression of reentry rhythms, Vtach, Vfib, and PVCs
PPB: 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Mexiletine

A

oral class 1b agent
chronic suppression of ventricular cardiac tachyarrhythmias
150-200 mg Q 8hrs
used for neuropathic pain
amine side group that promotes oral admin and avoids first pass hepatic metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Lidocaine dosing

A

1-1.5 mg/kg IV
1-4 mg/min infusion
(max dose 3 mg/kg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Lidocaine metabolism

A

hepatic metabolism
active metabolite that prolongs elimination half time
Cimetidine & propranolol can impair metabolism of lidocaine
barbs, phenytoin or rifampin can induce metabolism of lidocaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Lidocaine adverse effects

A

hypotension, bradycardia, seizures, CNS depression, drowsiness, dizziness, lightheadedness, tinnitus, confusion, apnea, myocardial depression, sinus arrest, heart block, ventilatory depression, cardiac arrest and can augment preexisting neuromuscular blockade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Phenytoin dosing

A

1.5 mg/kg IV every 5 min
up to 10-15 mg/kg
therapeutic blood levels: 10-18 mcg/mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Phenytoin dosing

A 
1.5 mg/kg IV every 5 min 
up to 10-15 mg/kg 
therapeutic blood levels: 10-18 mcg/mL
mixed in NS and NS line!!
can cause pain on injection 
severe hypotension if given rapidly!!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Phenytoin Toxicity

A

mainfests as CNS disturbances, vertigo, slurred speech, and ataxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Phenytoin Metabolism

A

liver

E 1/2 time: 24hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Phenytoin Adverse effects

A

CNS disturbances, partially inhibits insulin secretion, bone marrow depression and nausea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Class 2 Agents

A 
Block beta adrenergic receptors  (phase 4)
decreases SA node discharge 
decreases rate of depolarization 
slow HR 
prolongation of PR interval 
decreases automaticity of heart
32
Q

Class 2 Agents Uses

A

CAD, MI decreases myocardial O2 demands
prevents catecholamines from binding to beta receptors
SVT, atrial and ventricular arrhythmias
suppresses/treats ventricular dysrhythmias during MI and reperfusion
Tachyarrhythmias secondary to digoxin toxicity, and atrial fib or flutter

33
Q

Propranolol

A

Class 2 Agent prototype
nonselective antagonist
prevents recurrence of tachyarrhythmias both SVT and ventricular precipitated by sympathetic stimulation

34
Q

Esmolol

A

Class 2 Agent
selective for beta 1
dose: 0.5 mg/kg IV bolus over 1 min followed by 50-300 mcg/kg/min infusion
DOA: <10 mins
effects HR without decreasing BP significantly in small doses

35
Q

Metoprolol

A 
Class 2 Agent
selective for beta 1 
dose: 5 mg IV over 5 min 
max dose: 15 mg over 25 min
onset: 2.5 min 
half-life: 3-4 hours 
used in mild CHF
36
Q

Propranolol facts

A 
onset: 2-5 min 
peak effect: 10-15 min
DOA: 3-4 hours 
E 1/2 time: 2-4 hours 
CV effects: decreased HR, contractility, CO, increased PVR, coronary vascular resistance, O2 demand lowered
37
Q

Propranolol facts

A 
onset: 2-5 min 
peak effect: 10-15 min
DOA: 3-4 hours 
E 1/2 time: 2-4 hours 
CV effects: decreased HR, contractility, CO, increased PVR, coronary vascular resistance, O2 demand lowered
38
Q

Class 3 Agents

A

block potassium ion channels work at phase 3 of repolarization
increases repolarization and extends AP duration
Reduces membrane excitability in all myocardial tissue

39
Q

Class 3 Agent Uses

A

treat supraventricular and ventricular arrhythmias
can prolong QT interval –> torsades (proarrhythmic)
prophylaxis in CV surg r/t high incidence of afib
preventative for sudden cardiac death survivors and not candidate for ICD
Rhythm control for Afib

40
Q

Amiodarone

A 
Class 3 prototype 
also has class 1, 2, and 4 antiarrhythmic properties (potassium, sodium, calcium channel blocker, alpha and beta adrenergic antagonist) 
1st line for VT/Vfib when resistant to electrical defib
Can develop thyroid dysfunction due to iodine component
41
Q

Dronedarone

A 
oral class 3 agent 
lacks iodine 
less lipophilic (less side effects)
42
Q

Amiodarone Uses

A

prophylaxis or acute treatment of atrial and ventricular arrhythmias (refractory SVT, VT/VF, and AF)
patient with recent MI or abnormal heart tissue (irritable)
LONG LASTING

43
Q

Amiodarone Dosing

A

bolus 150-300 mg IV over 2-5 mins, up to 5 mg/kg
then 1 mg/hr x6hrs
then 0.5 mg/hr x18 hrs

44
Q

Amiodarone Facts

A 
Prolong E 1/2 time: 29 days
hepatic metabolism with active metabolite 
biliary/intestinal excretion 
Therapeutic plasma level 1-3.5 ug/mL
PBB: 98%, large Vd
45
Q

Amiodarone Uses

A

prophylaxis or acute treatment of atrial and ventricular arrhythmias (refractory SVT, VT/VF, and AF)
patient with recent MI or abnormal heart tissue (irritable)
monitor K level

46
Q

Amiodarone Facts

A

Prolong E 1/2 time: 29 days
hepatic metabolism with active metabolite
biliary/intestinal excretion
Therapeutic plasma level 1-3.5 ug/mL
PBB: 98%, large Vd
give in central vein
PO preop cardiac surge to decrease afib incidence

47
Q

Amiodarone Adverse Effects

A

long time, high doses can cause pulmonary toxicity, pulmonary edema, ARDS, hypotension, heart block, abnormal LFT 20%, inhibits hepatic P450!

48
Q

Sotalol

A

Class 2 and 3 agent
nonselective beta blocker and potassium channel blocker
treats severe VT/Vfib, prevent reoccurrence of tachyarrhythmias, especially aflutter and AF

49
Q

Sotalol Side Effects

A

prolonged QT interval (proarrhythmic), bradycardia, myocardial depression, fatigue, dyspnea, AV block
caution in asthma patients, excreted in urine

50
Q

Dofetilide & Ibutilide

A

Class 3 agents
used for conversion of afib or flutter to NSR
used for maintenance of sinus rhythm after afib conversion to sinus
proarrhythmic

51
Q

Dofetilide & Ibutilide

A

Class 3 agents
used for conversion of afib or flutter to NSR
used for maintenance of sinus rhythm after afib conversion to sinus
proarrhythmic

52
Q

Calcium Channel Blockers MOA

A

bind to receptor on voltage gated calcium ion channel
and maintain channel in an inactive or closed state
focused on L-type (alpha 1 subunit) slow channel
located in skeletal, cardiac, and mesenteric muscles, neurons, and glandular cells
GOOD AT CORONARY ARTERY DILATION!

53
Q

CCB Vascular Uses

A 
angina (complementary to nitrates) 
systemic HTN
pulmonary HTN 
cerebral arterial spasm 
raynaud's disease 
migraines
54
Q

Verapamil

A

Class 4 Agent Prototype
Phenyl-alkyl-amines-AV node: blocks the channel at the binding site
depresses AV node and negative chronotropic effect on SA node
primarily used as antiarrhythmic

55
Q

Diltiazem

A 
Benzothiaxepines-AV node
MOA unclear
1st line treatment for SVT 
primary site of action is AV node 
intermediate potency b/w verapamil and nifed 
minimal CV depressant effects
56
Q

Nifedipine

A

1, 4-dihydropyridines-arterial beds
modulation of channel at binding site
Clinical use: angina d/t coronary artery dilation

57
Q

CCB Non-Vascular Uses

A

bronchial asthma
esophageal spasm
dysmenorrhea
premature labor

58
Q

Class IV Agents

A

block slow calcium channels
phase 2 to slow conduction at AV node and SA node
shortens phase 2 (plateau) and rate of conduction
decreases AP
decreases contractility of heart

59
Q

CCB Effects

A

decreases contractility, HR, activity at SA node, rate of conduction of impulses via AV node
vascular smooth muscle relaxation (decreased SVR and BP arterial greater than venous)

60
Q

CCB Treatment

A

SVT & ventricular rate control in afib and flutter
prevent reoccurrence of SVT
NOT USED IN VENTRICULAR ARRHYTHMIAS

61
Q

Verapamil PK

A 
PPB: 87-90% 
Large PO doses, extensive 1st pass in liver 
Oral peaks: 30-45 min 
IV peaks: 15 min 
E 1/2: 6-12 hrs 
active metabolite: norverapamil 
excreted in urine and bile
62
Q

Verapamil Dosing

A

2.5-10 mg IV over 1-3 min (max dose 20mg)
Infusion: 5mcg/kg/min
DO NOT USE WITH BETA BLOCKER

63
Q

CCB side effects

A

myocardial depression, hypotension, constipation, bradycardia, nausea, prolongation of NMBDs
risk of cancer, cardiac problems (heart block) and bleeding time prolonged
vertigo, HA, flushing, paresthesias, induces renal dysfunction, coronary vasospasm with abrupt d/c

64
Q

Diltiazem Dosing

A

PO or IV
0.25-0.35mg/kg over 2 min can repeat in 15 min
IV infusion 10 mg/hr

65
Q

Diltiazem Facts

A

PO onset: 15 min, peak at 30 min
PPB: 70-80%
E 1/2 time: 4-6 hrs
liver disease may need to decrease dose

66
Q

Nifedipine

A

primary site of action peripheral arterioles
decreases SVR and BP
Reflex tachycardia
no effect at SA or AV node

67
Q

Nifedipine Dosing

A

IV, oral, or sublingual
Oral effects in 20 min, peaks 60-90 min
E 1/2 time: 3-7 hrs

68
Q

Nifedipine Facts

A

PPB: 90%
hepatic metabolism
excreted in urine

69
Q

CCB Drug interactions

A

inhalation agents can cause myocardial depression and vasodilation
NMBD prolong
beta-blockers (verapamil)
verapamil increases LA toxicity
dantrolene and verapamil causes hyperkalemia
Digoxin & CCB increases digoxin plasma concentration
H2 antagonists: increase plasma concentration of CCB

70
Q

CCB Toxicity

A

IV calcium or dopamine

71
Q

Adenosine Dosing

A

6mg IV, rapid bolus
repeated if needed after 3 mins with 6-12 mg IV
E 1/2 T: <10 secs
eliminated by plasma and vascular endothelial cell enzymes

72
Q

Adenosine Side Effects

A

CONTRAINDICATED IN ASTHMA & HEART BLOCK

excessive AV or SA nodal inhibition, facial flushing, HA,, dyspnea, chest disomfort, nausea, and bronchospasm

73
Q

Digoxin dosing

A 
0.5-1 mg in divided doses over 12-24 hrs 
Onset: 30-60 min
E 1/2t: 36 hrs 
Therapeutic levels: 0.5-1.2 ng/mL 
reduce dose in elderly/renal impairment
74
Q

Digoxin Adverse Effects

A

arrhythmias, heart block, confusion, agitation, anorexia, nausea, and diarrhea
MUST MAINTAIN NORMAL ELECTROLYTE BALANCE (hypokalemia, hypomagnesemia)

75
Q

Digoxin Uses

A

management of atrial fibrillation or flutter (controls ventricular rate) especially with impaired heart fxn

76
Q

Digoxin Toxicity Tx

A

Phenytoin for ventricular arrhythmias

pacing and atropine

Pharm 2 (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions