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Antiarrhythmics 2 Flashcards

1
Q

General MOA of antiarrhythmic drugs:

Alter cardiac rhythm by altering what 4 things?

A
  1. Maximum diastolic potential of pacemaker cells (the most negative transmembrane potential achieved by a cardiac cell)
  2. The rate of phase 4 depolarization
  3. The threshold potential
  4. The action potential duration
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2
Q

Which group of antiarrhythmic drugs (AADs) alters cardiac rhythm by altering the threshold potential?

A

Na and Ca channel blockers

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3
Q

Which group of antiarrhythmic drugs (AADs) alters cardiac rhythm by altering the action potential duration?

A

K channel blockers

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4
Q

What are the 4 classes of AADs?

A

Class I- Na channel blockers (procainamide, lidocaine, flecanide)

Class II- Beta adrenergic receptor antagonists (Propanolol)

Class III- K channel blockers (amiodarone)

Class IV- Ca channel blockers (verapamil, diltiazem)

miscellaneous- Adenosine, Mag, Potassium

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5
Q

All class 1 drugs reduce which currents in both phase ___ and phase ___

A

Sodium currents

Phase 0 and 4

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6
Q

In addition to reducing both phase 0 and phase 4 sodium currents, what do Group 1A drugs also reduce? (2 things)

What is the result of this?

A
  1. reduce phase 3 potassium current
  2. prolong the action potential duration

Result= significant prolongation of the effective refractory period

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7
Q

•Group 1B and group 1C drugs have different (or no) effects on______ current and thus shorten or have no effect on the ____ duration.

A

Potassium current

Action potential duration

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8
Q

All group 1 drugs prolong the_____ by slowing recovery of sodium channels from inactivation.

A

ERP (effective refractory period)

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9
Q

What is the MOA of Procainamide (class 1A)

A

INa (primary) and IKr (secondary) blockade

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10
Q

Which drug has the following 3 effects?

  1. **Slows conduction velocity and pacemaker rate
  2. prolongs action potential duration
  3. direct depressant effects on sinoatrial (SA) and atrioventricular (AV) nodes
A

Procainamide (Group 1A)

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11
Q

Which med has the following clinical applications?

  1. **Most atrial and ventricular arrhythmias
  2. second choice for most sustained ventricular arrhythmias associated with acute MI
A

Procainamide (class 1A)

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12
Q

Pharmacokinetics of which drug?

Oral, IV, IM

• eliminated by hepatic metabolism and renal elimination

A

Procainamide (class 1A)

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13
Q

What could happen if you prescribe Procainamide (Class 1A) to a patient with renal failure?

A

**Torsades de Pointes in patients with renal failure

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14
Q

What are the 2 toxicities of procainamide (Class 1A)?

A
  1. **Hypotension
  2. **long-term therapy produces reversible lupus-related symptoms
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15
Q

MOA of which drug?

  1. Highly selective INa block
  2. **minimal effect in normal tissue
  3. no effect on IK
A

Lidocaine

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16
Q

What are the 2 clinical applications of Lidocaine (class 1B)

A
  1. **Ventricular arrhythmias post-MI
  2. Digitalis induced arrhythmias
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17
Q

pharmacokinetics of which drug?

IV and IM

Duration: 1-2

A

Lidocaine (class 1B)

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18
Q

in what patients should you reduce the dose of Lidocaine?

A

patients with heart failure or liver disease

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19
Q

Toxicity of which drug?

**Central nervous system (CNS) sedation or excitation

A

Lidocaine (Class 1B)

*this is a lipophilic drug so it can cross the blood brain barrier)

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20
Q

What is the MOA of Flecainide (class 1C)?

A

Sodium channel blockade

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21
Q

The following is the effects of which drug?

  1. Dissociates from channel with slow kinetics
  2. no change in action potential duration
A

Flecainide (class 1C)

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22
Q

The following are clinical applications of which med?

  1. Supraventricular arrhythmias in patients with normal heart
  2. do not use in ischemic conditions (post-myocardial infarction)
A

Flecainide (class 1C)

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24
Q

pharmacokinetics of which drug?

  • Oral
  • hepatic and kidney metabolism
  • half life ∼ 20 h
A

Flecainide (class 1C)

25
Q

What toxicity does Flecainide have?

A

proarrhythmic

26
Q

If you were going to prescribe a patient an antiarrhythmic drug and they are post-MI, would you prescribe them lidocaine or flecainide?

A

Lidocaine

(This is used for ventricular arrhythmias post-MI)

*you do NOT use Flecainide in ischemic conditions (post-MI)

28
Q

By blocking the adrenergic effects on the SA and AV nodal action potentials, Beta Blockers (class II) do what 2 things?

A
  1. **decrease the slope of phase 4 depolarization (especially important at the SA node)
  2. **prolong repolarization (especially important at the AV node)
29
Q

Which class of antiarrhythmics are useful in the tx of supraventricular and ventricular arrhythmias precipitated by sympathetic stimulation

A

Class II antiarrhythmics (Beta blockers)

30
Q

What is the MOA of Propanolol?

A

β-Adrenoceptor blockade

31
Q

Effects of which med?

  1. **Direct membrane effects (sodium channel block) and prolongation of action potential duration
  2. **_slows SA node automaticity and AV nodal conduction velocit_y
A

Propanolol (Class 2)

32
Q

What are the 2 clinical applications of Propanolol (class 2)?

A
  1. **Atrial arrhythmias
  2. **prevention of recurrent infarction and sudden death
33
Q

pharmacokinetics of what med?

Oral, parenteral

• duration 4–6 h

A

Propanolol (class 2)

34
Q

What are the 3 toxicities of propanolol (class 2)?

A
  1. *Asthma,
  2. *AV blockade,
  3. *acute heart failure
35
Q

Which med?

Interaction with other cardiac depressants and hypotensive drugs

A

Propanolol (class 2)

36
Q

Metoprolol is similar to propanolol but ____ selective

37
Q

Which drug is used in perioperative and thyrotoxicosis arrhythmias

A

Esmolol (class 2)

38
Q

Which med is similar to lidocaine but oral activity and longer duration of action

A

Lidocaine (class 1B)

39
Q

Which med is similar to procainamide but toxicity includes antimuscarinic effects and heart failure

A

Disopyramide (class 1A)

40
Q

Which med is similar to procainamide but toxicity includes:

  1. cinchonism (tinnitus, HA, GI disturbance)
  2. thrombocytopenia
41
Q

Side effects of which drug?

  1. anticholinergic sxs (dry mouth, urinary retention, constipation, blurred vision)
  2. nausea
  3. anorexia
  4. torsades de pointes
  5. HF
  6. conduction disturbances
  7. ventricular arrhythmias
A

Disopyramide

42
Q

Side effect of which drug?

  1. hypotension
  2. Torsades de pointes
  3. worsening HF
  4. conduction disturbances
  5. ventricular arrhythmias
A

Procainamide

43
Q

Side effects of which drug?

  1. Cinchonism
  2. diarrhea
  3. abdominal cramps
  4. N/V
  5. hypotension
44
Q

Side effects of which drug?

  1. Torsades, de pointes
  2. worsening HF
  3. conduction disturbances
  4. ventricular arrhythmias
  5. fever
45
Q

Side effects of which drug?

  1. dizziness
  2. sedation
  3. slurred speech
  4. blurred vision
  5. paresthesia
46
Q

SIde effect of which med?

  1. muscle twitching
  2. confusion
  3. N/V
  4. seizures
  5. psychosis
  6. sinus arrest
  7. conduction disturbances
47
Q

Side effects of which medication?

  1. Dizziness
  2. sedation,
  3. anxiety,
  4. confusion,
  5. paresthesia,
A

Mexiletine

48
Q

Side effects of which drug?

  1. tremor,
  2. ataxia,
  3. blurred vision,
  4. N/V
  5. anorexia,
  6. conduction disturbances,
  7. ventricular arrhythmias
A

Mexiletine

49
Q

Side effects of which drug?

  1. Blurred vision,
  2. dizziness,
  3. dyspnea,
  4. headache,
  5. tremor,
  6. nausea,
  7. worsening HF,
  8. conduction disturbances,
  9. ventricular arrhythmias
A

Flecainide

50
Q

Side effects of which drug?

  1. Dizziness,
  2. fatigue,
  3. blurred vision,
  4. bronchospasm,
  5. headache,
  6. taste disturbances,
  7. N/V,
  8. bradycardia or AV block,
  9. worsening HF,
  10. ventricular arrhythmias
A

Propafenone

51
Q

Some Side effect of which drug?

  1. Tremor,
  2. ataxia,
  3. paresthesia,
  4. insomnia,
  5. corneal microdeposits,
  6. optic neuropathy/neuritis,
  7. N/V
  8. anorexia,
  9. constipation,
A

Amiodarone

52
Q

Side effects of which drug

  1. TdP (<1%),
  2. bradycardia or AV block
  3. pulmonary fibrosis,
  4. LFT abnormalities,
  5. hypo/hyperthyroidism
  6. photosensitivity
  7. blue-gray skin discoloration
  8. hypotension (IV use),
  9. phlebitis (IV use)
A

Amiodarone

53
Q

Side effects of which drug?

  1. HA
  2. Dizziness
  3. Torsades de pointes
A

Dofetilide

54
Q

Side effects of which med?

  1. N/V/D,
  2. serum creatinine elevations,
  3. bradycardia,
  4. worsening HF,
  5. hepatotoxicity,
  6. pulmonary fibrosis,
  7. acute renal failure
  8. TdP (<1%)
A

Dronedarone

55
Q

Side effects of which drug?

  1. HA
  2. TdP
  3. bradycardia or AV block
  4. hypotension
56
Q

Side effects of which drug?

  1. dizziness
  2. weakness
  3. fatigue
  4. N/V/D
  5. bradycardia or AV block
  6. TdP
  7. bronchospasm
  8. Worsening HF

MJ- Pharm exam 2 (19 decks)

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