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D&T3 Test 1 > Antiarrhythmic drugs > Flashcards

Antiarrhythmic drugs Flashcards

1
Q

what are 3 proarrhythmic effects

A
  • increase automaticity
  • conduction block or slowing
  • Effective refractory period same
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2
Q

what are antiarrhythmic effects

A
  • decrease automaticity and excitability
  • restoration of conduction or block conduction
  • ERP same
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3
Q

What is the main role of Class I drugs

A

Na channel block

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4
Q

What is the main role of Class II drugs

A

Beta-receptor block

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5
Q

What is the main role of Class III drugs

A

Prolong APD

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6
Q

What is the main role of Class IV drugs

A

Ca channel block

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7
Q

how is class I divided?

A

Class IA- moderate dissociation rate
Class IB- rapid dissociation rate
Class IC- slow dissociation rate

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8
Q

Name Class IA drug

A

Procainamide

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9
Q

which Class A class has the most marked depression of phase 0 and conduction velocity

A

Class IC- slow dissociation

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10
Q

what are direct effects of Procainamide

A
  • decrease automaticity
  • decrease conduction velocity
  • increase APD and ERP
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11
Q

who should you not prescribe Procainamide to

A

people with prolonged QT

- torsades de pointes

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12
Q

what is the anticholinergic effect Class 1A might give

A

increase AV nodal conduction

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13
Q

what are indications of Procainamide

A

life-threatening ventricular arrrhythmias

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14
Q

kinetics of Class1A

A
  • orally well absorbed
  • IV
  • active metabolite, NAPA N-acetyl-procainamide
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15
Q

Adverse effects of Procainamide

A

+ANA with chronic treatment

  • lupus-like syndrome
  • agranulocytosis/leukopenia
  • proarrhythmic effect
  • conduction block
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16
Q

major contraindications of class1A

A
  • prolonged QT
  • hypokalemia
  • SLE
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17
Q

Name 2 drugs in Class 1B

A

Lidocaine

Mexiletine

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18
Q

What are direct effects of Lidocaine

A
  • minimal in normal cardiac tissue

- similar to class 1A in diseased tissue

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19
Q

what are indications of Class IB durgs

A

left-threatening V arrhythmias

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20
Q

kinetics of Lidocaine

A
  • first pass HM
  • IV only
  • decrease dose in liver disease and CHF
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21
Q

What are adverse effects of Class IB drugs

A
  • CNS disorientation - seizures
  • hypotension
  • decrease cardiac contractility
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22
Q

contraindications and precaustions with Lidocaine

A
  • hypersenstivity to amide-type local anesthetics
  • severe hepatic dysfunction
  • history of lidocaine-induced siezures
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23
Q

what is the difference between Lidocaine and MExilitine

A

Mexilitine is orally effective

24
Q

Name Class IC drugs

A

Flecainide

Propafenone

25
Q

what are indications of Class IC

A
  • life threatening V arrhythmias in absence of organic heart disease
  • disabling supraventricular arrhythmias in absence of organic heart disease
26
Q

What are adverse effects of FLecainide

A
  • increase mortality with pre-existing heart disease

- conduction block

27
Q

Contraindications and precautions with Flecainide

A
  • pre-existing heart disease
28
Q

What is the difference between Flecaindide and Proppafenone

A
  • Propafenone has weak beta-blockade
29
Q

What are the effects of Class II beta blockers

A
  • inhibit sympathetic input ( AV/SA node)
    • decrease autamaticity and conduction velocity
  • -increase refractoriness
  • decrease contractility
30
Q

when are Class II beta blockers used

A
  • supraventricular arrhythmias
  • control of V rate in A flutter and A fib
  • symptomatic PVCs
  • Post MI
  • CHF
31
Q

adverse effects of Beta blockers

A
  • bronchoconstriction

- Insulin induced hypoglycemia

32
Q

what type of drug isEsmolol? when is it used

A
  • cardioselective beta blocker
  • short half life
  • short term treatment
  • emergency control of V rate in A flutter and A fib
  • sinus tachycardia
33
Q

what is Metoproplol

A

cardioselective Beta blocker

34
Q

what is propanolol

A

non-specific beta blocker

35
Q

General effect of Class III drugs

A

Homogeneous prolongation of ADP

-proarrhythmic

36
Q

Amiodarone falls into what classes

A

III
I
IV

37
Q

what is Amiodarone used for

A
  • DOC acute suppression of V arrhythmias
  • refractory, life-threatening V tach
  • highly efficacious in sustained V tach
38
Q

Kinetics of Amiodarone

A
  • extremely lipid soluble

- long half life

39
Q

Adverse effects of Amiodarone

A
  • pulmonary fibrosis, mortality, high dose
  • hyper/hypothyroidism
  • hepatic dysfunction
  • monitor pulmonary, hepatic, thyroid function
  • AV block, sinus bradycardia
40
Q

Name 3 other Class III drugs

A

Dronedarone
Ibutilide
Dofetilide

41
Q

Sotolol is what kind of drug? adverse effect

A

Class III and non-selective beta blocker

- proarrhythmic, prolongs QT, torsades de pointes

42
Q

what is Sotolol used for

A

life-threatening ventricular arrhythmias

- prevent recurrence of symptomatic A flutter and A fib

43
Q

Name Class IV drugs

A

Verapamil

44
Q

what are the effects of Verapamil

A
  • SA an AV node
    • decrease SA node, decrease HR
    • decrease conduction in AV node
    • increase ERP
  • A and V muscle contractility decreased
  • vasodilation , decreases TPR
45
Q

When is Verapamil used

A
  • control V rate in A flutter and fib
  • supraventricular tachyarrhythmias
  • PSVT due to AV nodal reentry
46
Q

what are adverse effects of Verapamil

A

hypotension
CHF
AV block
Constipation

47
Q

what does Adenosine treat

A

tachyarrhythmias

48
Q

how does Adenosine work

A
  • decrease automaticity and AV conduction

- acute termination of PSVT

49
Q

who metabolizes Adenosine

A
  • adenosine deaminase
50
Q

how is Adenosine administered

A

IV only

- short half life

51
Q

who should not be given Adenosine

A

Asthmatics and COPD

52
Q

how do Vagomimetics work

A

decrease AV nodal conduction

53
Q

what do vagomimetic treat

A
  • terminate PSVT ( carotid sinus massage)

- control V rate in A fib and flutter ( digoxin)

54
Q

What agents are used to treat bradyarrythmias and AV block

A

atropine

isoproterenol

55
Q

how does atropine work

A

vagolytic

-increase rate and AV conduction

56
Q

how does isoproterenol work

A
  • increase AV conduction

- treats 2 and 3 degree AV block prior to pacing

D&T3 Test 1 (11 decks)

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