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Pharm 4 Test (mine) > Antiarrhythmic Drugs & Cardiac Glycosides > Flashcards

Antiarrhythmic Drugs & Cardiac Glycosides Flashcards

0
Q

Procainamide

A
  • Block Na+ channel
  • Weaker K+ channel effects than Quinidine
  • Metabolized into NAPA increases K+ blocking effects
  • Used for:
    1. Atrial & vent arrhythmias
    2. Not usually used long term (due to lupus)
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1
Q

Quinidine

A
  • Blocks Na+ channels, decreasing excitability & conduction velocity in fast tissue (vent & atrium)
  • Block of K+ channels prolonging refractory period which can inhibit re-entry arrhythmias
  • Used for:
    1. Aflutter
    2. Afib
    3. Supravent arrhythmias
    4. Vtachy
  • not first line due to effects
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2
Q

Lidocaine

A
  • Slows conduction in depolarized fast tissue (ischemic)
  • Blocks Na+ channel (open & inactivated Na+ channels more than closed)
  • Used for:
    1. Vtach & arrhythmias s/p MI
  • Must be IV or IM due to first pass metabolism
  • Prophylactic use with MI lowers survival rate
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3
Q

Flecainide

A
  • Potent Na+ blocker reducing excitability in fast tissue
  • Strong effects on his/purkinje fibers
  • Used for:
    1. Supravent arrhythmias (Afib)
  • Adverse reactions:
    1. Proarrhythmic causing death in prolonged use
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4
Q

Propranolol

A
  • Blocks beta stimulation of Ca+2 channels
  • Negative inotropic & chronotropic effects
  • Block Na+ & K+ at high doses
  • Used for:
    1. Vent arrhythmias due to exercise or emotion
    2. After MI to prevent recurrent
    3. Supravent arrhythmias (Afib, Aflutter & supravent tachy)
    4. CHF (Metoprolol)
  • No effect on fast tissue
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5
Q

Amiodoraone

A
  • K+ blocker = prolonged APs duration
  • Na+ blocker in inactivated state
  • Ca+2 blocker
  • Long half life (13-103 days)
  • Used for:
    1. Supravent and vent tachycardia
    2. Small beneficial effect on mortality for Tx of AMI
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6
Q

Sotalol

A
  • L isomer=non selective B blocker decreasing AV transmission (reduced Ca channels); negative inotropic & chronotropic effects
  • D isomer=blocks K+ increasing APs
  • Used for:
    1. Aflutter & Afib
    2. Vtach
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7
Q

Dofetilide

A
  • Selective blocker of delayed K+ channels (cardiac K channels) so APs prolonged
  • Used for:
    1. Only physicians that have special training
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8
Q

Verapamil & Diltiazem

A
  • Ca+2 channel antagonist on cardiac cells (decrease excitability & conduction velocity in SA/AV node)
  • direct action on SA nodal cells slowing HR
  • Used for:
    1. First choice for supravent tachy due to AV nodal reentry
    2. Reduce vent rate in Aflutter
  • 4 min half life
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9
Q

Verapamil & Diltiazem side effects

A
  • VFib & hypotension if Vtachy is misdiagnosed as supravent tachy
  • lead to AV block in high doses
  • negative inotropic effect (limit use in diseased hearts)
  • constipation, peripheral edema & CNS effects
  • bradycardia or AV block with B blockers or Digoxin
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10
Q

Adenosine

A
  • Adenosine receptor activation leads to opening K+ channels which hyperpolarizes AV nodal tissue
  • shorter half life than verapamil (seconds)
  • IV terminates supravent tachy
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11
Q

Quinidine cardiac side effects

A
  • Risk of arrhythmias increases with lengthening QRS & Q-T interval
  • Syncope (torsade de pointes where APs travel different direction); can degenerate into VFib.
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12
Q

Quinidine extra cardiac side effects

A

GI disturbances
Cinchonism (tinnitus, dizzy, HA)
Fever, angioedena, thrombocytopenia & hepatitis

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13
Q

Class 1a

A

Quinidine
Procainamide
(Na+ & K+ blockers)

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14
Q

Class 1b

A

Lidocaine

Block Na+ channels in depolarizer tissue

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15
Q

Class 1c

A

Flecainide

Potent/selective Na+ channel blockers

16
Q

Class 2

A

Propranolol

Block beta receptor; blocks NE stimulation of Ca+2 channels

17
Q

Class 3

A

Amiodarone
Sotalol
Difetilide
(K+ blockers)

18
Q

Class 4

A

Verapamil
Diltiazem
(Ca+2 blocker)

19
Q

Procainamide cardio effects

A
  1. Torsades de pointe less common than Quinidine (increases with elevated NAPA)
  2. Hypotension
20
Q

Procainamide non cardiac side effects

A
  1. Drug induced lupus (reversible)

2. N/D, rash, hepatitis, fever & agranulocytosis

21
Q

Lidocaine side effects:

A

CNS: paresthesias, drowsy, tinnitus & blurred vision

22
Q

Adverse side effects of beta blockers

A
  1. SA & AV block = bad
  2. Sudden withdrawal may worsen angina & arrhythmias
  3. SOB
23
Q

Amiodoraone side effects

A
  1. Yellow/brown corneal microdeposits
  2. Cutaneous sensitivity or blue-gray skin
  3. GI
  4. Neuro = neuropathy, fatigue and motor issues
  5. Hypotension
  6. Life threatening pulmonary toxicity
  7. Hepatotoxicity
  8. Thyroid dysfunction
24
Q

Amiodoraone drug interactions

A
  • increase plasma anti arrhythmia drugs

- with B or Ca blockers, worsen CHF (sinus arrest or AV block)

25
Q

Sotalol side effects

A
  1. Torsade de pointes
  2. SA/AV block
  3. Sudden withdrawal worsens angina & arrhythmias
  4. SOB
26
Q

Dofetilide side effects

A
  1. Torsade de pointes

2. Few extra cardiac effects due to selectivity

27
Q

Digoxin Overview

A
  • From foxglove & lily of the valley
  • Used for CHF
  • Reduces hospitalization for CHF & does not improve mortality
28
Q

Digoxin Use:

A
  • Direct effects on cardiac muscle (CHF)

- Indirect effects mediated by autonomic nervous system (arrhythmias)

29
Q

Digoxin Effects:

A
  • Positive inotropic effect by inhibiting Na+/K+ ATPase

- Low doses = increase PNS & decrease ventricular rate during Aflutter & Afib.

30
Q

Digoxin contraindicated in:

A
  • WPW

- Worsens Vtachy

31
Q

Digoxin pharmacokinetics:

A

Do not use with Abx which can lead to sudden increase in Digoxin availability & toxicity ( since Abx kill off normal GI flora which degraded Digoxin)

32
Q

Direct membrane effects of Digoxin

A
  • inhibits Na/K ATPase ( increasing Intracellular Na)
  • decreases Na/Ca exchanger (increase Intracellular Ca)
  • increase myocyte contractility
  • increase cardiac output
33
Q

Digoxin toxicity

A
  • serious and common
  • 3x the therapeutic dose
  • due to K depletion from diuretics combined with Digoxin ( low K enhances digoxin binding to ATPase)
34
Q

Cardiac Toxicity in Digoxin:

A
  1. Premature ventricular beat (Ca overload)
  2. Vtachy & fib
  3. AV junctional rhythm (block Na/K ATPase~membrane depolarization)
  4. AV block (PNS too great)
35
Q

Other Digoxin effects:

A
  1. GI
  2. Neuro/visual at high []
  3. Gynecomastia

Pharm 4 Test (mine) (5 decks)

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