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Antiarrhythmics > Antiarrhythmics > Flashcards

Antiarrhythmics Flashcards

1
Q

Atrial Fibrillation (common mechanism)

A
  • disorganized “functional” reentry

- continual AV node stimulation –> irregular, often rapid ventricular rate

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2
Q

Atrial Fibrillation (acute therapy)

A
  1. control ventricular response: AV nodal block (adenosine, Ca++ channel block, beta-blockers)
  2. restore sinus rhythm: DC cardioversion
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3
Q

Atrial Fibrillation (chronic therapy)

A
  1. control ventricular response: AV nodal block

2. maintain normal rhythm (amiodarone, dronedarone, dofetilide, flecainide, propafenone, sotalol)

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4
Q

Atrial Flutter (common mechanism)

A
  • stable reentrant circuit in the right atrium
  • continual AV node stimulation and irregular, often rapid, ventricular rate
  • ventricular rate often rapid and irregular
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5
Q

Atrial Flutter (acute therapy)

A

-same as atrial fibrillation

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6
Q

Atrial Flutter (chronic therapy)

A

-ablation

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7
Q

Atrial Tachycardia (common mechanism)

A

-enhanced automaticity, DAD-related automaticity, or reentry within the atrium

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8
Q

Atrial Tachycardia (acute therapy)

A

-AV node block until ablation can be performed

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9
Q

Atrial Tachycardia (chronic therapy)

A

-ablation

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10
Q

AV nodal reentrant tachycardia (PSVT) (common mechanism)

A

-reentrant circuit within or near AV node

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11
Q

AV nodal reentrant tachycardia (acute therapy)

A
  • adenosine

- AV nodal block

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12
Q

AV nodal reentrant tachycardia (chronic therapy)

A
  • AV nodal block

- ablation

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13
Q

VT in patients with remote myocardial infarction (common mechanism)

A

-reentry near the healed myocardial infarction

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14
Q

VT in patients with remote MI (acute therapy)

A
  • lidocaine
  • procainamide
  • DC cardioversion
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15
Q

VT in patients with remote MI (chronic therapy)

A
  • ICD
  • Amiodarone
  • K+ channel block
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16
Q

VT in patients without structural heart disease (mechanism)

A

-DADs triggered by increased sympathetic tone

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17
Q

VT in patients without structural heart disease (acute therapy)

A
  • adenosine
  • verapamil
  • beta-blockers
  • DC cardioversion
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18
Q

VT in patients without structural heart disease (chronic therapy)

A
  • verapamil
  • beta blockers
  • ablation
19
Q

VF (common mechanism)

A

-disorganized reentry

20
Q

VF (acute therapy)

A

-DC cardioversion

21
Q

VF (chronic therapy)

A
  • ICD

- amiodarone to block reoccurance

22
Q

Torsades de Pointes congenital or acquired (common mechanism)

A

-early afterdepolarization-related triggered activity

23
Q

Torsades de Pointes congenital or acquired (acute therapy)

A
  • magnesium

- pacing

24
Q

Torsades de Pointes congenital or acquired (chronic therapy)

A
  • beta-blockade

- pacing

25
Q

Procainamide

A
  • Class 1A
  • use- and state-dependent block of sodium channels - some block of potassium channels
  • slowed conduction velocity and pacemaker activity
  • prolonged action potential duration and refractory period
  • treatment in atrial and ventricular arrhythmias, especially after MI
  • oral and parenteral - oral slow release forms available
  • duration: 2-3 hrs
  • Toxicity: increased arrhythmias, hypotension, lupus-like syndrome
26
Q

Disopyramide

A
  • similar to procainamide, but longer duration of action

- toxicity includes antimuscarinic effects and heart failure

27
Q

Quinidine

A

-similar to procainamide, but toxicity includes cinchonism (tinnitus, headache, GI disturbance) and thrombocytopenia

28
Q

Lidocaine

A
  • Class 1B
  • highly selective use- and state-dependent sodium block
  • minimal effect in normal tissue
  • no effect on potassium channel
  • used to treat ventricular arrhythmias, post-MI and digital induced arrhythmias
  • IV and IM
  • duration: 1-2 hrs
  • Toxicity: CNS sedation or excitation
29
Q

Mexiletine

A

similar to lidocaine, but oral activity and longer duration of action

30
Q

Flecainide

A
  • Class IC
  • selective use- and state-dependent block of sodium channel
  • slowed conduction velocity and pacemaker activity
  • treats refractory arrhythmias
  • oral duration: 20 hours
  • Toxicity: increased arrhythmias, CNS excitation
31
Q

Metoprolol

A
  • Class 2

- similar to propranolol, but beta-1 selective

32
Q

Esmolol

A
  • Class 2
  • selective beta-1 receptor blockade
  • IV only, 10 min duration
  • used in perioperative and thyrotoxicosis arrhythmias
33
Q

Propranolol

A
  • Class 2
  • block of beta receptors
  • slowed pacemaker activity
  • post MI as prophylaxis against sudden death, ventricular fibrillation; thyrotoxicosis
  • oral, parenteral duration: 4-6 hrs
  • Toxicities: bronchospasm; cardiac depression; AV block; hypotension
34
Q

Sotalol

A
  • Class 2
  • beta adrenoceptor block and potassium block (class III activity)
  • treats ventricular arrhythmias and atrial fibrillation
  • oral duration: 7 hrs
  • Toxicity: dose-related Torsades de Pointes; cardiac depression
35
Q

Amiodarone

A
  • Class III
  • strong potassium block produces marked prolongation of action potential and refractory period
  • Group I activity slows conduction velocity
  • Group 2 and 4 activity confer additional antiarrhythmic activity
  • treats refractory arrhythmias - used off-label in many arrhythmias (broad spectrum of therapeutic action)
  • oral and parenteral
  • half-life and duration of action: 1-10 weeks
  • Toxicities: thyroid abnormalities, deposits in skin and cornea, pulmonary fibrosis, optic neuritis
  • torsades de pointes is rare with amiodarone
36
Q

Dronedarone

A
  • Class III
  • structural analog of amiodarone lacking iodine
  • half-life: 24 hrs
  • lacks major side effects of amiodarone
  • diarrhea, nausea, vomiting, abd pain, photosensitivity, QT prolongation
37
Q

Ibutilide

A
  • Class III
  • selective potassium block
  • prolonged action potential and QT interval
  • treatment of acute atrial fibrillation
  • IV only
  • duration: 6 hrs
  • Toxicity: Torsades de Pointes
38
Q

Dofetilide

A
  • Class III
  • like ibutilide
  • treatment and prophylaxis of atrial fibrillation
  • oral
  • duration: 7 hrs
  • Toxicity: Torsades de Pointes
39
Q

Verapamil

A
  • Class IV
  • state and use-dependent calcium channel block
  • slows conduction in AV node and pacemaker activity
  • PR interval prolongation
  • treats AV nodal arrhythmias, especially in prophylaxis
  • oral and parenteral
  • Duration: 7 hours
  • Toxicity: cardiac depression; constipation; hypotension
40
Q

Diltiazem

A
  • Class IV
  • like verapamil
  • rate control in atrial fibrillation
  • oral and parenteral
  • duration: 6 hrs
  • Toxicity: cardiac depression; constipation; hypotension
41
Q

Dihydropyridines

A
  • Class IV

- calcium channel blockers but not useful in arrhythmias; sometimes precipitate them

42
Q

Adenosine

A
  • miscellaneous
  • increase in diastolic potassium channel of AV node that causes marked hyperpolarization and conduction block
  • reduced calcium channel
  • treats acute nodal tachycardias
  • IV only
  • Toxicity: flushing, bronchospasm, chest pain, headache
43
Q

Potassium ion

A
  • miscellaneous
  • increase in all potassium currents
  • decreased automaticity
  • decreased digitalis toxicity
  • treats digitalis toxicity and other arrhythmias if serum potassium is low
  • oral and IV
  • Toxicity: both hypokalemia and hyperkalemia are associated with arrhythmogenesis; severe hyperkalemia causes cardiac arrest
44
Q

Magnesium ion

A
  • miscellaneous
  • poorly understood
  • possible increase in Na/K ATPase activity
  • treats digitalis arrhythmias or other arrhythmias if serum Mg is low
  • IV only
  • Toxicity: muscle weakness, respiratory paralysis

Antiarrhythmics (1 decks)

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