Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardio > Antiarrhythmic Drugs- Exam 3 > Flashcards

Antiarrhythmic Drugs- Exam 3 Flashcards

1
Q

**What is happening at each of the boxes? What type of cell?

A

blue: Na coming IN

red: Ca coming IN

purple: K leaving

cardiac pacemaker cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

**What phase is happening at each colored box?

A

blue: phase 4: slow Na coming IN- depolarization

red: phase 0: rapid Ca coming IN- depolarization

purple: phase 3: K leaving and cell repolarization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

**What phase number does each colored circle represent?

A

yellow: 4

red: 0

green: 1

blue: 2

pink: 3

yellow: 4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

**What is happening at each number phase 4, 0, 1, 2, 3, 4?

A

4: K

0: rapid Na IN

1: K and Cl out

2: Ca IN and K out

3: K out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

** When Ca is blocked, the electrical conduction is (longer/shorter)

A

block Ca and the electrical conduction takes LONGER

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

The aim of therapy of the arrhythmias is to ______ activity and modify conduction or refractoriness in _____ to disable ______

A

reduce ectopic pacemaker

reentry circuits

circus movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Antiarrhythmic drugs decrease the _____ of _______ more than that of the _____. They also reduce _______ and ______ and increase the _______ to a greater extent in depolarized tissue than in normally polarized tissue

A

automaticity

ectopic pacemakers

SA node

conduction

excitability

refractory period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How are AAD classified? What are the different drug classes?

A

Vaughan-Williams Classification system

Class I-IV

class I: drugs that block fast sodium channels
class II: BB
class III: block potassium channels
class IV: calcium channel blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Maybe consider looking at this summary table again??

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What drug class?

quinidine, procainamide, disopyramide

A

Class Ia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what drug class? slow the rate of rise of the action potential and prolong its duration, thus slowing conduction and increasing refractoriness (moderate depression of phase 0 upstroke of the action potential)

A

class Ia: quinidine, procainamide, disopyramide)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What drug class?

lidocaine, mexiletine

A

class Ib agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what drug class? shorten action potential duration; they do not affect conduction or refractoriness (minimal depression of phase 0 upstroke of the action potential)

A

class Ib agents: lidocaine, mexiletine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What drug class?

flecainide, propafenone

A

Class Ic agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What drug class? Dissociates from channel with slow kinetics (no change in action potential duration)

A

class Ic: (flecainide, propafenone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How are the class I drugs further subdivided?

A

Three subclasses are further defined by the effect of the agents on the Purkinje fiber action potential:

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What drug class does this represent?

A

class Ia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What drug class does this represent?

A

class Ib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What drug class does this represent?

A

class Ic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

______ has potent anticholinergic properties that affect the SA and AV nodes, which can increase the SA nodal discharge rate and AV nodal conduction. What does it lead to?

A

quinidine

This may lead to increased ventricular rates with afib or aflutter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

**What also needs to be prescribed concurrently with quinidine? What drug class?

A

Addition of a beta blocker, non-dihydropyridine CCB, or digoxin protects against increased ventricular rates with afib or aflutter

Ia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

quinidine can also lead to ______ and interacts with ______

A

torsades

CYP3A4 inducers or inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

_____ is similar to quinidine but without the anticholinergic effects.

A

procainamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

procainamide also carries a risk of ______ because of ______. What are the SE?

A

torsades

prolongs the QT interval

SLE like s/s- MC adverse effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

_______ is a potent anticholinergic and negative inotropic effects limits uses clinically. When is it used clinically?

A

Disopyramide (Norpace)

hypertrophic cardiomyopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Disopyramide (Norpace) also increases risk of ______ due to _______. When is it CI?

A

Prolongs QT, increasing risk of torsades

Contraindicated in patients with reduced LV EF (<40%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the adverse events associated with Disopyramide (Norpace)?

A

Precipitation of CHF

Anticholinergic effects – dry mouth, urinary retention, constipation, blurred vision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

______ is selective to ischemic tissue, and especially to active fast sodium channels in the bundle of HIS, Purkinje fibers, and ventricular myocardium. What drug class?

A

lidocaine

class Ib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How is lidocaine administered? What is the typical pt?

A

continuous IV infusion following an MI

need to check levels because it can be toxic especially in pts with liver failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the adverse effects of lidocaine?

A

CNS effects: dizzy, paresthesia, disorientation, tremor etc etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

_______ is similar to lidocaine but in oral form. What drug class?

A

Mexiletine

class Ib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

_______ can be used in combination with class IA and III drugs for the treatment of refractory ventricular dysrhythmias. NOT as a single agent

A

mexiletine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the SE of mexiletine?

A

GI and neuro SE

34
Q

________ slows conduction velocity in the Purkinje fibers and the AV node. May lengthen PR interval and QRS duration. What drug class? When is it commonly used?

A

Flecainide (Tambacor)

class Ic

afib/flutter

35
Q

What kind of pt is Flecainide (Tambacor) and Propafenone (Rythmol) good for? Why?

A

MUST have a structurally normal heart!! no hypertrophy, valvular dz or ischemia

high risk of vent tachy in pts without normal hearts

36
Q

Blurred vision, dizziness, headache, tremor, N/V

A

What are the SE of Flecainide (Tambacor)?

37
Q

_______ slows conduction velocity in the Purkinje fibers and the AV node; also has a mild nonselective beta blocking effect
May lengthen PR interval and QRS duration, leading to conduction disturbances such as bradycardia and heart block. What drug class?

A

Propafenone (Rythmol)

class Ic

38
Q

Propafenone (Rythmol) may _____ PR interval and ____ duration, leading to ______ disturbances such as ______ and heart block. When is it commonly used?

A

lengthen

QRS

conduction

bradycardia

afib/flutter

39
Q

Blurred vision, dizziness, headache, N/V, bronchospasm, and taste disturbances METALLIC TASTE

A

What are the SE of Propafenone (Rythmol)?

40
Q

______ decrease automaticity, prolong AV conduction, and prolong refractoriness.
Negative chronotropic and inotropic effects. What drug class?

A

Beta Blockers

class II

41
Q

What BB is used MC in arrhythmias? how? ______ can be used as a continuous IV infusion for rapid afib/flutter

A

Metoprolol

given in IV bolusus NOT continuous drip

Esmolol

42
Q

_____ are useful in suppressing ventricular dysrhythmias, as well as supraventricular dysrhythmias. Especially helpful when used in COMBO with other AAD

A

Beta blockers

43
Q

_______ block POTASSIUM channels and _____ repolarization, widening the QRS and prolonging the QT interval.
Decrease automaticity and conduction and prolong refractoriness

A

class III

prolong

44
Q

Avoid concomitant use of _____ with other drugs that can ______ to minimize the risk of torsades

A

class III AADs

prolong the QT interval

45
Q

NEVER use class III AAD with ______ due to _____

A

class Ia : quinidine, procainamide, disopyramide)

risk of torsades

46
Q

What are the 4 class characteristics that amiodarone processes?

A

Primarily a potassium channel blocker, but also blocks sodium channels, has non-selective beta blocking activity, and has weak calcium channel blocking properties

Works on all cardiac cells (SA node, AV node, atria, ventricles and Purkinjes)

47
Q

amiodarone has minimal to no _____ effects and can safely be used in patients with ______

A

no negative inotropic effects

LV dysfunction

48
Q

What is the generic dosing for amiodarone? What kind of heart pt is amiodarone good for?

A

start amiodarone dosing at HIGH levels then go down

good for structurally weak hearts

49
Q

_______ is an uncommon, but possibly life-threatening adverse event of amiodarone. What is the screening?

A

Pulmonary toxicity

annual chest xrays, if fibrosis is seen on xray need to stop amiodarone immediately

50
Q

_____ is also a common SE of amiodarone. why? what is the monitoring?

A

thyroid problems:
hypo give synthroid
hyper-> need to stop immediately

because amiodarone is 38% iodine by weight

obtain baseline TSH and repeat q6 months while the pt is taking it

51
Q

amiodarone can also build up in the eyes causing ____ and _____. What is the screening?

A

corneal and lens opacities

annual eye exams

52
Q

What derm reactions are possible with amiodarone?

A

blue/gray skin and photosensitivity

53
Q

What are the monitoring requirements for a pt on amiodarone?

A

pulm toxicity -> annual chest xray

TSH at baseline and Q6 months

yearly eye exam

GI: liver toxicity -> screening LFTs every 6 months

neuro: tremor, ataxia, fatigue, insomnia

derm: photosensitivity and blue/gray skin discoloration, need to wear sunscreen

54
Q

amiodarone is also a potent inhibitor of _______. Potentiates the effects of ______ and can double serum ______ concentrations

A

CYP3A4 enzymes

warfarin

digoxin

55
Q

______ A class III AAD that also has nonselective beta-adrenergic blocking properties. May decrease cardiac contractility and therefore should be avoided in patients with LV dysfunction

A

Sotalol (Betapace)

56
Q

QT prolongation is common with _______ and should be monitored for closely.
Discontinue if QT interval _______.
Avoid combining with other QT prolonging drugs

A

Sotalol (Betapace) is a potassium channel blocker

greater 550 ms

57
Q

_______ is a potassium channel blocker that does NOT have any BP lower effects and must be given at the same time everyday. What are the SE?

A

Sotalol (Betapace)

tired, sluggish

58
Q

_______ results in a prolonged action potential and an increased QT interval.
Affects the ____ more than the ______
No negative inotropic effects, therefore is safe to use in patients with LV dysfunction

A

Dofetilide (Tikosyn)

atria

ventricles

59
Q

What is the main concern for pts taking Dofetilide (Tikosyn)? What is the monitoring?

A

torsades de pointes

Patients should be in the hospital, on telemetry with Q12 hour EKG’s for first 3 days of loading Tikosyn to monitor QT interval and adjust dose

60
Q

What 6 medications are CI with concurrent use of Dofetilide (Tikosyn)?

A

cimetidine
ketoconazole
megestrol
prochlorperazine
Bactrim
verapamil

61
Q

Need to avoid Dofetilide (Tikosyn) and ________ and cleared ______ so do not use in patients _______

A

inhibitors of the CYP3A4 isoenzyme

renally

so do not use in patients with CrCl < 20 mL/min

62
Q

_____ is considered it the “safe cousin of amiodarone”; but not nearly as effective, and side effects and toxicities are still common. What drug class?

A

Dronedarone (Multaq)

class III

63
Q

dronedarone has very simliar SE profile to amiodarone except _______

A

dronedarone has NO effect on the thyroid

still cannot use it in HF pts and those with bad livers

64
Q

_______ is structurally similar to sotalol, but no beta-blocking activity. What drug class?

A

Ibutilide (Corvert)

65
Q

** _____ is available only in IV form, and indicated only for afib/flutter cardioversion in the acute setting only. What is the major adverse effect? When should you NOT use it?

A

Ibutilide (Corvert)

torsades

Should be avoided in patients with LV dysfunction and electrolyte abnormalities (especially hypokalemia and hypomagnesemia)

66
Q

______ and ______ are the only CCB used in arrhythmias. What drug class?

A

Verapamil and Diltiazem

class IV

67
Q

______ and _______ decrease automaticity and AV conduction and have potent negative inotrophic effects. Should be avoided in pts with LV dysfunction

A

verapamil and diltiazem

class IV

68
Q

______ predominant AA effect is on the AV node. Inhibits Calcium currents in the AV node and activates acetylcholine-mediated K+ currents in the atrium

A

Digoxin

69
Q

______ is mainly used for slowing the ventricular rate in afib/flutter, as well as terminating reentrant arrhythmias involving the AV node

A

digoxin

70
Q

What are the changes seen on EKG when a pt is on digoxin?

A

PR prolongation and ST segment depression

71
Q

What are 2 important things to note about digoxin?

A

intestinal microflora may metabolize digoxin so if pt is taking abx, pt is at risk for toxicity because of the lack of intestinal microflora metabolizing digoxin

digoxin has a slow distribution to effector sites so need a higher IV loading dose to begin

72
Q

What should you do if your pt is taking digoxin and is renally impaired? What is the half life?

A

Renal elimination accounts for 80%, therefore doses should be reduced or dosing interval increased with renal insufficiency

half life is 36 hours

73
Q

Amiodarone, quinidine, verapamil, diltiazem, itraconazole, propafenone, and flecainide (increase/decrease) digoxin clearance. so the dose need to be (increased/decreased) if combining with any of these drugs

A

decrease digoxin clearance

so dose needs to be decreased if combined with any of these drugs

74
Q

Visual disturbances, dizziness, weakness, N/V/D, anorexia

What am I?
What should you do next?

A

digoxin toxicity

IV hydration, electrolyte correction AND
Digoxin immune Fab (digoxin reversal agent)

75
Q

What are some factors that can contribute to a digoxin toxicity?

A

declining/poor renal function

electrolyte abnormalities

hypoxia

drug interactions

76
Q

_______ ACTIVATES potassium channels and by increasing the outward potassium current hyperpolarizes the membrane potential, decreasing spontaneous SA nodal depolarization. When is it commonly used?

A

adensosine

Used for converting SVT to sinus rhythm; essentially causing sinus arrest

77
Q

What is the 1/2 life of adenosine? What are some SE?

A

VERY SHORT so the sinus arrest does NOT last long

Chest discomfort, dyspnea, flushing, and headache

78
Q

______ A parasympatholytic drug that enhances both sinus nodal automaticity and AV nodal conduction through direct vagolytic action. Blocks acetylcholine at parasympathetic neuroeffector sites

A

atropine

79
Q

When is atropine used? What may it induce? What type of patient should you use it cautiously in?

A

emergent setting of SYMPTOMATIC bradycardia

May induce tachycardia,

which may result in poor outcomes in patients with MI, so use cautiously

80
Q

atropine has been reported to cause a paradoxical slowing of the heart rate when used in patients with _____ and ______. So monitor patient closely if using atropine in this setting

A

Mobitz type II AVB

third degree AVB

81
Q
A

Cardio (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions