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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
what are indications of Class IC
- life threatening V arrhythmias in absence of organic heart disease - disabling supraventricular arrhythmias in absence of organic heart disease
26
What are adverse effects of FLecainide
- increase mortality with pre-existing heart disease | - conduction block
27
Contraindications and precautions with Flecainide
- pre-existing heart disease
28
What is the difference between Flecaindide and Proppafenone
- Propafenone has weak beta-blockade
29
What are the effects of Class II beta blockers
- inhibit sympathetic input ( AV/SA node) - - decrease autamaticity and conduction velocity - -increase refractoriness - decrease contractility
30
when are Class II beta blockers used
- supraventricular arrhythmias - control of V rate in A flutter and A fib - symptomatic PVCs - Post MI - CHF
31
adverse effects of Beta blockers
- bronchoconstriction | - Insulin induced hypoglycemia
32
what type of drug isEsmolol? when is it used
- cardioselective beta blocker - short half life - short term treatment - emergency control of V rate in A flutter and A fib - sinus tachycardia
33
what is Metoproplol
cardioselective Beta blocker
34
what is propanolol
non-specific beta blocker
35
General effect of Class III drugs
Homogeneous prolongation of ADP | -proarrhythmic
36
Amiodarone falls into what classes
III I IV
37
what is Amiodarone used for
- DOC acute suppression of V arrhythmias - refractory, life-threatening V tach - highly efficacious in sustained V tach
38
Kinetics of Amiodarone
- extremely lipid soluble | - long half life
39
Adverse effects of Amiodarone
- pulmonary fibrosis, mortality, high dose - hyper/hypothyroidism - hepatic dysfunction - monitor pulmonary, hepatic, thyroid function - AV block, sinus bradycardia
40
Name 3 other Class III drugs
Dronedarone Ibutilide Dofetilide
41
Sotolol is what kind of drug? adverse effect
Class III and non-selective beta blocker | - proarrhythmic, prolongs QT, torsades de pointes
42
what is Sotolol used for
life-threatening ventricular arrhythmias | - prevent recurrence of symptomatic A flutter and A fib
43
Name Class IV drugs
Verapamil
44
what are the effects of Verapamil
- 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
When is Verapamil used
- control V rate in A flutter and fib - supraventricular tachyarrhythmias - PSVT due to AV nodal reentry
46
what are adverse effects of Verapamil
hypotension CHF AV block Constipation
47
what does Adenosine treat
tachyarrhythmias
48
how does Adenosine work
- decrease automaticity and AV conduction | - acute termination of PSVT
49
who metabolizes Adenosine
- adenosine deaminase
50
how is Adenosine administered
IV only | - short half life
51
who should not be given Adenosine
Asthmatics and COPD
52
how do Vagomimetics work
decrease AV nodal conduction
53
what do vagomimetic treat
- terminate PSVT ( carotid sinus massage) | - control V rate in A fib and flutter ( digoxin)
54
What agents are used to treat bradyarrythmias and AV block
atropine | isoproterenol
55
how does atropine work
vagolytic | -increase rate and AV conduction
56
how does isoproterenol work
- increase AV conduction | - treats 2 and 3 degree AV block prior to pacing

D&T3 Test 1 (11 decks)

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