antiarrhythmic drugs Flashcards
1
Q
ARRHYTHMIA An abnormal heartbeat – -Too fast (\_\_\_\_\_) -Too slowly (\_\_\_\_\_) -Irregularly (\_\_\_\_\_/\_\_\_\_\_) -\_\_\_\_\_ (Skipped or too early- premature contraction)
- _____ not working properly
- Abnormal _____ and contraction
A
Tachycardia Bradycardia Flutter/Fibrillation Ectopic Electrical signals coordination
2
Q
SYMPTOMS
- No associated symptoms
- _____in thechest
- _____ pain
- _____
- _____ordizziness
- Sweating
- _____(syncope) or nearfainting
- Cardiac arrest
A
Fluttering chest SOB Lightheadedness Fainting
3
Q
CAUSES & RISK FACTORS
- _____ Disorders (_____/_____)
drugs: _____
A
Thyroid
hyper/hypo
antiarrythmics
4
Q
DIAGNOSIS
-PHYSICAL EXAM – _____ and _____ (Fast or slowheartrate, irregular rhythm, extra sounds, long pauses, or abnormalheartsounds)
DEFINITIVE TEST –
- _____ (ECG/EKG)
- Blood and Urine Tests
- _____ Monitor - a wearable device that records the heart for 1-2 days
- Echocardiogram
- Chest X-ray
- _____ Testing (or EP studies)
- _____ (CABG) and PCI
- Exercise Stress Testing- a contraindication
A
Pulse Auscultation Electrocardiogram Holter Electrophysiologic Cardiac Catheterization
5
Q
WHAT IS cardiac ARRHYTHMIAS?
- Disturbance of _____, _____ or _____
- Incidental (premature atrial beats), life threatening (ventricular fibrillation) or lethal
- Classification –
- _____ beats
- Slowing of heart (_____)
- Speeding (_____)
- _____
A
rhythm rate conduction Ectopic sinus bradycardia sinus tachycardia Arresting
6
Q
Reentry – a Mechanism Underlying a Majority of Clinically Significant Arrhythmias
-_____ excitation can occur under conditions of_____ conduction&/or in regions having a dispersion of _____ (an increased heterogeneity of refractory periods in tissue, where _____ values differ greatly in neighboring areas
A
reentrant
slow
refractoriness
ERP
7
Q
WOLF-PARKINSON-WHITE SYNDROME
- An anatomical accessory _____ pathway for a _____
- Symptoms - _____, dizziness, _____, and angina.
- _____ and _____ (SVTs) may be leading to ventricular fibrillation and death
A
AV reentrant tachycardia fatigue syncope Paroxysmal atrial fibrillation flutter
8
Q
LIDOCAINE
- Drug of 2nd choice (vs Amiodarone) to terminate _____ and prevent _____ after _____
- Cardiac arrest –100 mg bolus every 5-10 mins
- Used only in hospital setting
- Ineffective against _____
- _____ (Extensive first pass metabolism)
A
V tach V fib DC cardioversion atrial arrhythmias IV
9
Q
BETA BLOCKERS
- Reduce the automaticity of _____ (by blocking the effect of _____ stimulation)
- Direct _____ effects
- Decrease conduction velocity at _____ node
- Decrease _____ by increasing action potential duration and effective _____ period
- Augment coronary perfusion due to increased _____ time
- Uses-
- _____ induced arrhythmias,
- Decreases incidence of _____(PSVT) + Prophylaxis
- First line drugs for A fib along with _____
A
pacemaker catecholamine membrane AV non-pacemaker action potentials refractory diastolic Exercise AVN reentry CCBs
10
Q
K CHANNEL BLOCKERS
- _____ is highly bound to body tissues (very long t1/2)
- Very _____ soluble
- Cardiac concentration is _____ times that of plasma
- Effective against both _____ and _____ (blocks Na, K, Ca channels & alpha + beta receptors)
- May increase levels of _____, _____, Procainamide due to inhibition of CYP 450 enzymes
- _____ – 2nd choice for recurrence of Afib
A
Amiodarone lipid 50 Atrial Ventricular arrhythmias Warfarin digitalis Sotalol
11
Q
CA CHANNEL BLOCKERS
- Channels – _____ and _____
- _____ and _____ block long lasting type (Non-dihydropyridines)
- Slow down _____ conduction and increase _____
- Negative _____ and negative _____
- Uses:
- PSVT (2nd choice) and control _____ rate in A fib & A flutter
- PSVT (_____) Prophylaxis
- Prevent acute _____ secondary to _____
- _____ (____pine): Smooth muscles of blood vessels
- Side effect – Severe _____ due to inhibition of colonic motor activity
A
L type T type Verapamil Diltiazem AVN AVN ERP chronotropic inotropic ventricular Paroxysmal supraventricular tachycardia MI coronary artery spasm Dihydropyridines constipation
12
Q
ADENOSINE
- IV, Half life- _____
- Similar effect to _____
- When it is administered intravenously, adenosine causes _____in theAV node via the_____receptor, inhibiting _____, decreasing _____ and so causing cell _____ by increasing K+efflux (increases AVN ERP)
- USE – Acute drug induced conversion of _____ node re-entry to sinus rhythm and to treat _____
- Increase in _____ tone decreases SA and AV nodal activity.
- DC cardioversion can be used if the patient is _____ unstable, and requires immediate treatment
A
few seconds ACH transientheart block Adenosine A1 adenylyl cyclase cAMP hyperpolarization AV PSVT vagal hemodynamically
13
Q
LIDOCAINE TOXICITY
- _____
- _____ taste
- _____ speech
- _____ and _____ disturbance
- _____ (numb lips)
- Tremors
- _____ and coma (CNS excitation and /or depression)
- Impaired _____ function- higher incidence
- _____, _____ and _____
A
Tinnitus metallic slurred Visual hearing Paresthesias seizures liver Metronidazole clarithromycin tetracyclines
14
Q
AMIODARONE
- _____
- Peripheral neuropathy
- Disturbance in _____ function (hypo/hyper)
- _____ (blue-gray discoloration – Blue man syndrome)
- _____
- Pulmonary fibrosis (Bleomycin)
- Drug-induced photosensitivity –
- _____ (Doxycycline)
- NSAIDs (Naproxen)
- _____ (Voriconazole)
A
Corneal microdeposits thyroid Photosensitivity Torsades de pointe Tetracyclines NSAIDs antifungals
15
Q
calcium channel blockers
- _____ hypertrophy/hyperplasia
- Constipation
- Peripheral _____
- _____
- _____ and _____
A
Gingival vasodilation syncope Phenytoin cyclosporine
