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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
Procainamide
- 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
Disopyramide
- similar to procainamide, but longer duration of action | - toxicity includes antimuscarinic effects and heart failure
27
Quinidine
-similar to procainamide, but toxicity includes cinchonism (tinnitus, headache, GI disturbance) and thrombocytopenia
28
Lidocaine
- 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
Mexiletine
similar to lidocaine, but oral activity and longer duration of action
30
Flecainide
- 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
Metoprolol
- Class 2 | - similar to propranolol, but beta-1 selective
32
Esmolol
- Class 2 - selective beta-1 receptor blockade - IV only, 10 min duration - used in perioperative and thyrotoxicosis arrhythmias
33
Propranolol
- 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
Sotalol
- 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
Amiodarone
- 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
Dronedarone
- 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
Ibutilide
- 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
Dofetilide
- Class III - like ibutilide - treatment and prophylaxis of atrial fibrillation - oral - duration: 7 hrs - Toxicity: Torsades de Pointes
39
Verapamil
- 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
Diltiazem
- Class IV - like verapamil - rate control in atrial fibrillation - oral and parenteral - duration: 6 hrs - Toxicity: cardiac depression; constipation; hypotension
41
Dihydropyridines
- Class IV | - calcium channel blockers but not useful in arrhythmias; sometimes precipitate them
42
Adenosine
- 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
Potassium ion
- 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
Magnesium ion
- 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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