Antiarrhythmic Drugs

Question 1

What is arrhythmias

Answer 1

Arrhythmias is a problem of rate or rhythm of the heartbeat as a result of electrical impulses generation and conduction

Question 2

Causes of arrhythmias

Answer 2

*drugs(antiarrythmic drugs)
*electrolyte imbalance
*smoking
*intoxications
*Thyrotoxicosis

Question 3

Mechanism of arrhythmias

Answer 3

*Abnormal disorders of electrical conduction
*disorder of impulse generation and conduction

Question 4

Classification of anti-arrhythmias drugs

Answer 4

*class 1A (sodium channel blockers)
-quinidine
-procainamide
-disopyramide
*class 1B
-Lidocaine
-mexiletine
*class 1c
-flecainide
-propafenone

Class II( Beta blockers)
-propranolol
-Bisoprolol
Class III (potassium channel blockers)
-Amiodarone
-Sotalol
Class IV (calcium channel blockers)
-Verapamil
-Diltiazem

Question 5

Which method of proarrhythmic effects of antiarrhythmic drugs

Answer 5

Noninvasive methods
*ECG monitoring
*24 hour hooter monitoring
*Exercise stress tests
Invasive methods
* Electrophysiology study of heart (cardiac stimulation induce arrhythmias)

Question 6

Indications of class 1A

Answer 6

*supraventricular arrhythmias
- paroxysmal Av nodal tachycardia
-Atrial fibrillation and flutter in patients
* ventricular arrhythmias
- ventricular extrasytole

Question 7

Side effects of quinidine

Answer 7

• haemolytic anaemia
  *thrombocytopenia
  *quininism
  *idioventricular rhythms

Question 8

Contraindications quinidine

Answer 8

*Torsade de pointes
*Av block ,his bundle branch block
* myasthenia
*myocarditis

Question 9

Sides of procainamide

Answer 9

*lupus like syndrome
*Agranulocytosis
*Arterial hypotonia

Question 10

Contraindications of procainamide

Answer 10

*systemic lupus erythematosis
*Torsade de pointes in past medical
*Av block II-III degree

Question 11

Which kind of arrhythmias does class 1B (lidocaine,flecainide)

Answer 11

Ventricular arrhythmias

Question 12

Indications of class 1 C sodium channel blockage

Answer 12

*Effective for the treatment of both atrial and ventricular arrhythmias
* it’s a rescue medications because they increase the risk of death in patients

Question 13

Indications of flecainide

Answer 13

*Drug of choice for atrioventricular (AV)re-entrant tachycardia
*Paroxysmal atrial fibrillation

Question 14

Contraindications of flecainide

Answer 14

*Atrioventricular block II-III grade
*Sick sinus syndrome
*hemifascicular block

Question 15

Propafenone indication

Answer 15

*suppress non-sustained ventricular arrhythmias

Question 16

Contraindications of propafenone

Answer 16

*cardiogenic shock,severe chronic heart failure
*atrioventricular block II-III
*severe electrolyte disturbances
*myasthenia
*sick sinus syndrome

Question 17

Beta blockers indication for arrhythmias

Answer 17

Both supraventricular arrhythmias and ventricular arrhythmias
Prophylaxis of cardiac arrhythmias

Question 18

Commonly used beta blockers in arrthymias

Answer 18

• Esmolol
  *sotalol

Question 19

Class III ( potassium channel blockers) drug and indication

Answer 19

Amiodarone
*indication -they are used both supraventricular arrhythmias and ventricular arrhythmias

Question 20

Which drug is the most powerful drug for treatment and prevention of both atrial and ventricular arrhythmias

Answer 20

Amiodarone

Question 21

Side effects of Amiodarone

Answer 21

• Qt prolongation
  *bradycardia
  *ventricular arrhythmias
  *pulmonary fibrosis

Question 22

Interaction of Amiodarone and digoxin and warfarin

Answer 22

Increases the plasma level of Amiodarone,digoxin and warfarin leading to bleeding and digoxin toxicity

Question 23

Class IV (calcium channel blockade)

Answer 23

*verapamil
*diltiazem

Question 24

Adenosine have which half life

Answer 24

Less than 10 seconds

Question 25

Adenosine is used for treatment

Answer 25

*Terminating paroxysmal supraventricular (re-entrant) tachycardias,including episodes

Question 26

Contraindications of adenosine

Answer 26

*adenosine should not be given to asthmatics
*2-3 Av block or sick sinus syndrome (unless a pacemaker is in place)