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Pharm > Antiarrhythmics > Flashcards

Antiarrhythmics Flashcards

1
Q

what is the primary MOA of class I antiarrhythmic drugs?

A

Na+ channel blocker

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2
Q

what medications are Class Ia antiarrhythmic drugs?

A
  • quinidine
  • procainamide
  • disopyramide
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3
Q

what is the specific MOA for quinidine, procainamide, disopyramide?

A

class IA

  • decrease conduction velocity and automaticity
  • increase refractory period
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4
Q

what medications are class Ib antiarrhythmic drugs?

A
  • lidocaine

- mexiletine

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5
Q

what is the specific MOA of Class IIB antiarrhythmic drugs?

A
  • decrease refractory period and automaticity
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6
Q

what medications are class IC antiarrhythmic drugs?

A
  • flecainide

- propafenone

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7
Q

what is the specific MOA for class IC antiarrhythmic drugs?

A
  • decrease conduction velocity

- decrease automaticity

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8
Q

what is the MOA of class II antiarrhythmic drugs?

A

BB

- block circulating catecholamines and slows AV conduction

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9
Q

what is the use of class II antiarrhythmics?

A
  • control venitcular rate in Afib and atrial flutter
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10
Q

what is the effects of class II anitarrhythmics on the conduction cycle?

A
  • decrease conduction velocity and automaticity

- increase refractory period

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11
Q

what is the MOA of class III antiarrhythmic drugs?

A
  • prolongs refractoriness in atrial and ventricular tissues

- acts on K+ channels

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12
Q

what medications are class III antiarrhythmics?

A
  • amiodarone
  • dofetilide
  • dronedarone
  • sotalol
  • ibutilide
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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
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14
Q

what is the use of class IV antiarrthymics?

A
  • supraventricular arrhythmias

- Afib and Aflutter

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15
Q

what medications are class IV antiarrhythmics?

A
  • verapamil

- diltiazem

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16
Q

what class is quinidine and what are the ADE?

A

Class IA

  • cinchonism
  • thrombocytopenia
  • increases risk for mortality
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17
Q

what class is procainamide? what are the ADE?

A

Class 1A

  • drug induced lupus
  • agranulocytosis
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18
Q

what class is disopyamide? what are the ADE?

A

Class 1A

- anticholinergic symptoms like xerostomia

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19
Q

what medication class is lidocaine? what are ADE?

A

Class 1B

- neurotoxicity

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20
Q

what drug class is mexiletine? ADE?

A

Class IB

  • dizziness
  • N/V
  • hepatotoxicity
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21
Q

what drug class is flecainide? ADE?

A

Class IC

  • dizziness
  • blurred vision
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22
Q

what drug class is propafenone? ADE?

A

1C

  • taste disturbances
  • HF exacerbation
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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
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24
Q

what drug class is dofetilide? ADE?

A

Class III

  • H/A
  • dizziness
  • torsades de pointes
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25
Q

what class is sotalol? ADE?

A

Class III

  • bradycardia
  • AV block
  • torsades de pointe
  • fatigue
  • bronchospasm
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26
Q

what drug class is ibutilide? ADE?

A

Class III

  • H/A
  • Torsades
  • hypotension
27
Q

what are the DD interactions for amiodarone?

A
  • warfarin: increased efficacy

- digoxin: increased level

28
Q

what is the monitoring for amiodarone?

A
  • 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
Q

what antiarrhythmic medications prolong QT interval and cause torsades?

A
  • dofetilide: Class III
  • sotalol: Class III
  • ibutlitide: Class III
  • antibiotics, antipsychotics, N/V drugs, antidepressants
30
Q

what antiarrthytmic medication controls rate and rhythm?

A

amiodarone

31
Q

what anitarrhythmis are used to convert patients from afib to sinus rhythm when there is no structural heart diease? (rhythm control)

A
  • amiodarone
  • dofetilide
  • ibutilide
  • flecainide
  • propafenone
32
Q

what anitarrhythmis are used to maintain sinus rhythm? (rhythm control)

A
  • amiodarone
  • dofetilide
  • flecainide
  • propafenone
  • sotalol
  • dronedarone
33
Q

what anitarrhythmis are used to convert patients from persistent afib/paroxysmal to sinus rhythm when there is CAD? (rhythm control)

A
  • dofetilide
  • dronedarone
  • sotalol
  • amiodarone
34
Q

what anitarrhythmis are used to convert patients from persistent afib/paroxysmal to sinus rhythm when there is HF?

A
  • amiodarone

- dofetilide

35
Q

what is the strict goal for patients with afib?

A

HR<80 bpm for patients who are symptomatic +/- HFrEF

36
Q

what is the lenient goal for rate control in patients with Afib?

A

HR <110 bpm for patients who are asymptomatic and have preserved LV systolic function

37
Q

what is CHAD2VA2SC?

A

used to assess stroke risk with atrial fibrillation

  • CHF
  • HTN
  • Age >75
  • DM
  • Vascular disease
  • Age
  • Sex
38
Q

what medications are used to control rate with Afib when there is no other CV disease?

A
  • verapamil
  • ditiazem
  • amiodarone
39
Q

what medications are used to control rate with Afib when there is HTN or HFpEF?

A
  • verapamil
  • diltiazem
  • amiodarone
40
Q

what medications are used to control rate with Afib when there is LV dysfunction or HF?

A
  • diltiazem
  • verapamil
  • digoxin
  • amiodarone
41
Q

what medications are used to control rate with Afib when there is COPD?

A
  • diltiazem

- verapamil

42
Q

what is the difference between CHAD2VASC and HASBLED?

A
  • CHAD: assess stroke risk

- HADBLED: bleeding risk

43
Q

what are the indications for anticoagulants in treating arrhythmias?

A

CHADS2VASC >1

  • DOAC > warfarin
  • warfarin preferred in mechanical valves
44
Q

what is the anticoagulation recommendation for Afib/flutter when >48hr or unknown duration with hemodynamically stable?

A
  • 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
Q

what is the anticoagulation recommendation for Afib/flutter when >48hr or unknown duration with hemodynamically UNstable?

A
  • immediate CV
  • anticoagulants ASAP
  • at least for 4 weeks after
  • long term depends on CHAD
46
Q

what is the anticoagulation recommendation for Afib/flutter when <48 hours?

A
  • CHAD score 0/1: risk benefit assessment

- CHAD 2/3: anticoagulants ASAP with long term use

47
Q

what is the INR goal of warfarin for stroke prevention in afib?

A

2-3

48
Q

what is the treatment for sinus bradycardia?

A

atropine

49
Q

what is the treatment for refratory sinus bradycardia?

A
  • IV dopamine
  • epinephrine
  • transcutaneous/transvenous pacing
50
Q

what is the treatment for AV node block that is stable and asymptomatic?

A

none needed

51
Q

what is the treatment for unstable AV node block?

A

atropine

52
Q

what is the treatment for unstable, refractory AV node block?

A
  • IV dopeamine
  • epinephrine
  • transcutaneous/transvenous pacing
  • pacemaker needed for long term control
53
Q

what is the treatment for unstable SVT?

A
  • immediate synchronication DCC
54
Q

what is the treatment for stable SVT?

A
  • vagal maneuver
  • medications: adenosine 6mg IV rapid push + 20 mL saline flush
  • if no response, 12mg IV adenosine
55
Q

what is the treatment for asymptomatic premature ventricular contractions?

A
  • no drugs
56
Q

what is the treatment for symptomatic premature ventricular contractions?

A

BB

57
Q

what is the treatment for ventricular fibrillation?

A
  • CPR/ACLS
  • amiodarone
  • lidocaine
  • epinephrine + vasopressin + methylprednisolone
58
Q

what is the treatment for unstable ventricular tachycardia?

A

ACLS and synchronized DCC

59
Q

what is the treatment for stable ventricular tachycardia with no structural heart disease?

A
  • verapamil

- other BB

60
Q

what is the treatment for stable ventricular tachycardia with structural heart diease?

A

DCC → IV procainamide → IV amiodarone → IV sotalol

61
Q

what is the treatment for torsades? stable patient

A
  • discontinue QT prolongation medication
  • correct electrolyte imbalance
  • Mg Sulfate
62
Q

what is the treatment for torsades? unstable patient

A

ACLS and synchronized DCC

63
Q

what antiarrhythmics are safe for HF?

A
  • amiodarone

- dofetilide

64
Q

what antiarrhythmic is safe for a h/o of MI?

A

sotalol

Pharm (2 decks)

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