Antiarrhythmics Flashcards
what is the primary MOA of class I antiarrhythmic drugs?
Na+ channel blocker
what medications are Class Ia antiarrhythmic drugs?
- quinidine
- procainamide
- disopyramide
what is the specific MOA for quinidine, procainamide, disopyramide?
class IA
- decrease conduction velocity and automaticity
- increase refractory period
what medications are class Ib antiarrhythmic drugs?
- lidocaine
- mexiletine
what is the specific MOA of Class IIB antiarrhythmic drugs?
- decrease refractory period and automaticity
what medications are class IC antiarrhythmic drugs?
- flecainide
- propafenone
what is the specific MOA for class IC antiarrhythmic drugs?
- decrease conduction velocity
- decrease automaticity
what is the MOA of class II antiarrhythmic drugs?
BB
- block circulating catecholamines and slows AV conduction
what is the use of class II antiarrhythmics?
- control venitcular rate in Afib and atrial flutter
what is the effects of class II anitarrhythmics on the conduction cycle?
- decrease conduction velocity and automaticity
- increase refractory period
what is the MOA of class III antiarrhythmic drugs?
- prolongs refractoriness in atrial and ventricular tissues
- acts on K+ channels
what medications are class III antiarrhythmics?
- amiodarone
- dofetilide
- dronedarone
- sotalol
- ibutilide
what is the MOA of class IV antiarrhythmics?
- decrease Ca2+ during AP and phase 4 = slows conduction velocity in the AV node
- prolongs refractory period
what is the use of class IV antiarrthymics?
- supraventricular arrhythmias
- Afib and Aflutter
what medications are class IV antiarrhythmics?
- verapamil
- diltiazem
what class is quinidine and what are the ADE?
Class IA
- cinchonism
- thrombocytopenia
- increases risk for mortality
what class is procainamide? what are the ADE?
Class 1A
- drug induced lupus
- agranulocytosis
what class is disopyamide? what are the ADE?
Class 1A
- anticholinergic symptoms like xerostomia
what medication class is lidocaine? what are ADE?
Class 1B
- neurotoxicity
what drug class is mexiletine? ADE?
Class IB
- dizziness
- N/V
- hepatotoxicity
what drug class is flecainide? ADE?
Class IC
- dizziness
- blurred vision
what drug class is propafenone? ADE?
1C
- taste disturbances
- HF exacerbation
What drug class is amiodarone? ADE?
Class III
- severe bradycardia
- hypo/hyperthyroidism
- peripheral neuropathy
- GI discomfort
- photosensitivity
- blue-gray skin discoloration
- fulminant hepatitis
- pulmonary fibrosis
- optic neuropathy
- corneal microdeposits
what drug class is dofetilide? ADE?
Class III
- H/A
- dizziness
- torsades de pointes
what class is sotalol? ADE?
Class III
- bradycardia
- AV block
- torsades de pointe
- fatigue
- bronchospasm
what drug class is ibutilide? ADE?
Class III
- H/A
- Torsades
- hypotension
what are the DD interactions for amiodarone?
- warfarin: increased efficacy
- digoxin: increased level
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
what antiarrhythmic medications prolong QT interval and cause torsades?
- dofetilide: Class III
- sotalol: Class III
- ibutlitide: Class III
- antibiotics, antipsychotics, N/V drugs, antidepressants
what antiarrthytmic medication controls rate and rhythm?
amiodarone
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
what anitarrhythmis are used to maintain sinus rhythm? (rhythm control)
- amiodarone
- dofetilide
- flecainide
- propafenone
- sotalol
- dronedarone
what anitarrhythmis are used to convert patients from persistent afib/paroxysmal to sinus rhythm when there is CAD? (rhythm control)
- dofetilide
- dronedarone
- sotalol
- amiodarone
what anitarrhythmis are used to convert patients from persistent afib/paroxysmal to sinus rhythm when there is HF?
- amiodarone
- dofetilide
what is the strict goal for patients with afib?
HR<80 bpm for patients who are symptomatic +/- HFrEF
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
what is CHAD2VA2SC?
used to assess stroke risk with atrial fibrillation
- CHF
- HTN
- Age >75
- DM
- Vascular disease
- Age
- Sex
what medications are used to control rate with Afib when there is no other CV disease?
- verapamil
- ditiazem
- amiodarone
what medications are used to control rate with Afib when there is HTN or HFpEF?
- verapamil
- diltiazem
- amiodarone
what medications are used to control rate with Afib when there is LV dysfunction or HF?
- diltiazem
- verapamil
- digoxin
- amiodarone
what medications are used to control rate with Afib when there is COPD?
- diltiazem
- verapamil
what is the difference between CHAD2VASC and HASBLED?
- CHAD: assess stroke risk
- HADBLED: bleeding risk
what are the indications for anticoagulants in treating arrhythmias?
CHADS2VASC >1
- DOAC > warfarin
- warfarin preferred in mechanical valves
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
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
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
what is the INR goal of warfarin for stroke prevention in afib?
2-3
what is the treatment for sinus bradycardia?
atropine
what is the treatment for refratory sinus bradycardia?
- IV dopamine
- epinephrine
- transcutaneous/transvenous pacing
what is the treatment for AV node block that is stable and asymptomatic?
none needed
what is the treatment for unstable AV node block?
atropine
what is the treatment for unstable, refractory AV node block?
- IV dopeamine
- epinephrine
- transcutaneous/transvenous pacing
- pacemaker needed for long term control
what is the treatment for unstable SVT?
- immediate synchronication DCC
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
what is the treatment for asymptomatic premature ventricular contractions?
- no drugs
what is the treatment for symptomatic premature ventricular contractions?
BB
what is the treatment for ventricular fibrillation?
- CPR/ACLS
- amiodarone
- lidocaine
- epinephrine + vasopressin + methylprednisolone
what is the treatment for unstable ventricular tachycardia?
ACLS and synchronized DCC
what is the treatment for stable ventricular tachycardia with no structural heart disease?
- verapamil
- other BB
what is the treatment for stable ventricular tachycardia with structural heart diease?
DCC → IV procainamide → IV amiodarone → IV sotalol
what is the treatment for torsades? stable patient
- discontinue QT prolongation medication
- correct electrolyte imbalance
- Mg Sulfate
what is the treatment for torsades? unstable patient
ACLS and synchronized DCC
what antiarrhythmics are safe for HF?
- amiodarone
- dofetilide
what antiarrhythmic is safe for a h/o of MI?
sotalol
