Antiarrhythmics Flashcards
1
Q
what is the primary MOA of class I antiarrhythmic drugs?
A
Na+ channel blocker
2
Q
what medications are Class Ia antiarrhythmic drugs?
A
- quinidine
- procainamide
- disopyramide
3
Q
what is the specific MOA for quinidine, procainamide, disopyramide?
A
class IA
- decrease conduction velocity and automaticity
- increase refractory period
4
Q
what medications are class Ib antiarrhythmic drugs?
A
- lidocaine
- mexiletine
5
Q
what is the specific MOA of Class IIB antiarrhythmic drugs?
A
- decrease refractory period and automaticity
6
Q
what medications are class IC antiarrhythmic drugs?
A
- flecainide
- propafenone
7
Q
what is the specific MOA for class IC antiarrhythmic drugs?
A
- decrease conduction velocity
- decrease automaticity
8
Q
what is the MOA of class II antiarrhythmic drugs?
A
BB
- block circulating catecholamines and slows AV conduction
9
Q
what is the use of class II antiarrhythmics?
A
- control venitcular rate in Afib and atrial flutter
10
Q
what is the effects of class II anitarrhythmics on the conduction cycle?
A
- decrease conduction velocity and automaticity
- increase refractory period
11
Q
what is the MOA of class III antiarrhythmic drugs?
A
- prolongs refractoriness in atrial and ventricular tissues
- acts on K+ channels
12
Q
what medications are class III antiarrhythmics?
A
- amiodarone
- dofetilide
- dronedarone
- sotalol
- ibutilide
13
Q
what is the MOA of class IV antiarrhythmics?
A
- decrease Ca2+ during AP and phase 4 = slows conduction velocity in the AV node
- prolongs refractory period
14
Q
what is the use of class IV antiarrthymics?
A
- supraventricular arrhythmias
- Afib and Aflutter
15
Q
what medications are class IV antiarrhythmics?
A
- verapamil
- diltiazem
16
Q
what class is quinidine and what are the ADE?
A
Class IA
- cinchonism
- thrombocytopenia
- increases risk for mortality
17
Q
what class is procainamide? what are the ADE?
A
Class 1A
- drug induced lupus
- agranulocytosis
18
Q
what class is disopyamide? what are the ADE?
A
Class 1A
- anticholinergic symptoms like xerostomia
19
Q
what medication class is lidocaine? what are ADE?
A
Class 1B
- neurotoxicity
20
Q
what drug class is mexiletine? ADE?
A
Class IB
- dizziness
- N/V
- hepatotoxicity
21
Q
what drug class is flecainide? ADE?
A
Class IC
- dizziness
- blurred vision
22
Q
what drug class is propafenone? ADE?
A
1C
- taste disturbances
- HF exacerbation
23
Q
What drug class is amiodarone? ADE?
A
Class III
- severe bradycardia
- hypo/hyperthyroidism
- peripheral neuropathy
- GI discomfort
- photosensitivity
- blue-gray skin discoloration
- fulminant hepatitis
- pulmonary fibrosis
- optic neuropathy
- corneal microdeposits
24
Q
what drug class is dofetilide? ADE?
A
Class III
- H/A
- dizziness
- torsades de pointes
25
what class is sotalol? ADE?
Class III
- bradycardia
- AV block
- torsades de pointe
- fatigue
- bronchospasm
26
what drug class is ibutilide? ADE?
Class III
- H/A
- Torsades
- hypotension
27
what are the DD interactions for amiodarone?
- warfarin: increased efficacy
| - digoxin: increased level
28
what is the monitoring for amiodarone?
- ECG baseline then 6-12 months
- TSH & TF4 baseline then 6-12 months
- PE for photosensitivity, peripheral neuropathy, and blue-gray skin discoloration
- LFTs baseline then every 6 months
- CXR baseline then every 12 months
- Opthlamic exam baseline, then when symptoms
- slit lamp exam
29
what antiarrhythmic medications prolong QT interval and cause torsades?
- dofetilide: Class III
- sotalol: Class III
- ibutlitide: Class III
- antibiotics, antipsychotics, N/V drugs, antidepressants
30
what antiarrthytmic medication controls rate and rhythm?
amiodarone
31
what anitarrhythmis are used to convert patients from afib to sinus rhythm when there is no structural heart diease? (rhythm control)
- amiodarone
- dofetilide
- ibutilide
- flecainide
- propafenone
32
what anitarrhythmis are used to maintain sinus rhythm? (rhythm control)
- amiodarone
- dofetilide
- flecainide
- propafenone
- sotalol
- dronedarone
33
what anitarrhythmis are used to convert patients from persistent afib/paroxysmal to sinus rhythm when there is CAD? (rhythm control)
- dofetilide
- dronedarone
- sotalol
- amiodarone
34
what anitarrhythmis are used to convert patients from persistent afib/paroxysmal to sinus rhythm when there is HF?
- amiodarone
| - dofetilide
35
what is the strict goal for patients with afib?
HR<80 bpm for patients who are symptomatic +/- HFrEF
36
what is the lenient goal for rate control in patients with Afib?
HR <110 bpm for patients who are asymptomatic and have preserved LV systolic function
37
what is CHAD2VA2SC?
used to assess stroke risk with atrial fibrillation
- CHF
- HTN
- Age >75
- DM
- Vascular disease
- Age
- Sex
38
what medications are used to control rate with Afib when there is no other CV disease?
- verapamil
- ditiazem
- amiodarone
39
what medications are used to control rate with Afib when there is HTN or HFpEF?
- verapamil
- diltiazem
- amiodarone
40
what medications are used to control rate with Afib when there is LV dysfunction or HF?
- diltiazem
- verapamil
- digoxin
- amiodarone
41
what medications are used to control rate with Afib when there is COPD?
- diltiazem
| - verapamil
42
what is the difference between CHAD2VASC and HASBLED?
- CHAD: assess stroke risk
| - HADBLED: bleeding risk
43
what are the indications for anticoagulants in treating arrhythmias?
CHADS2VASC >1
- DOAC > warfarin
- warfarin preferred in mechanical valves
44
what is the anticoagulation recommendation for Afib/flutter when >48hr or unknown duration with hemodynamically stable?
- at least 3 weeks prior to CV or TEE to confirm no thrombus
- at least 4 weeks after CV
- long term depends on CHADS2VA2SC
45
what is the anticoagulation recommendation for Afib/flutter when >48hr or unknown duration with hemodynamically UNstable?
- immediate CV
- anticoagulants ASAP
- at least for 4 weeks after
- long term depends on CHAD
46
what is the anticoagulation recommendation for Afib/flutter when <48 hours?
- CHAD score 0/1: risk benefit assessment
| - CHAD 2/3: anticoagulants ASAP with long term use
47
what is the INR goal of warfarin for stroke prevention in afib?
2-3
48
what is the treatment for sinus bradycardia?
atropine
49
what is the treatment for refratory sinus bradycardia?
- IV dopamine
- epinephrine
- transcutaneous/transvenous pacing
50
what is the treatment for AV node block that is stable and asymptomatic?
none needed
51
what is the treatment for unstable AV node block?
atropine
52
what is the treatment for unstable, refractory AV node block?
- IV dopeamine
- epinephrine
- transcutaneous/transvenous pacing
- pacemaker needed for long term control
53
what is the treatment for unstable SVT?
- immediate synchronication DCC
54
what is the treatment for stable SVT?
- vagal maneuver
- medications: adenosine 6mg IV rapid push + 20 mL saline flush
- if no response, 12mg IV adenosine
55
what is the treatment for asymptomatic premature ventricular contractions?
- no drugs
56
what is the treatment for symptomatic premature ventricular contractions?
BB
57
what is the treatment for ventricular fibrillation?
- CPR/ACLS
- amiodarone
- lidocaine
- epinephrine + vasopressin + methylprednisolone
58
what is the treatment for unstable ventricular tachycardia?
ACLS and synchronized DCC
59
what is the treatment for stable ventricular tachycardia with no structural heart disease?
- verapamil
| - other BB
60
what is the treatment for stable ventricular tachycardia with structural heart diease?
DCC → IV procainamide → IV amiodarone → IV sotalol
61
what is the treatment for torsades? stable patient
- discontinue QT prolongation medication
- correct electrolyte imbalance
- Mg Sulfate
62
what is the treatment for torsades? unstable patient
ACLS and synchronized DCC
63
what antiarrhythmics are safe for HF?
- amiodarone
| - dofetilide
64
what antiarrhythmic is safe for a h/o of MI?
sotalol
