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Antiarrhythmics Flashcards

0
Q

Class 2 antiarrhythmics

A

Beta blockers

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1
Q

Class 1 antiarrhythmics

A

Sodium channel blockers

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2
Q

Class 3 antiarrhythmics

A

Potassium channel blockers

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3
Q

Class 4 antiarrhythmics

A

Calcium channel blockers

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4
Q

Class 1a antiarrhythmics effect on heart

A 
Sodium channel blockers
Decrease conduction
Increase refractory period
Decrease automaticity - decrease slope of phase 4, fast potentials 
Increase threshold
Quinidine has anticholinergic properties
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5
Q

Class 1a antiarrhythmics effect on ECG

A

Longer QRS, with or without long PR and long QT

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6
Q

Class 1a antiarrhythmics uses

A

Quinidine - maintain sinus rhythm in AF and flutter, to prevent recurrent tachycardia and AF
Procainamide - acute treatment of SV and ventricular arrhythmias

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7
Q

Quinidine

A

Class 1a antiarrhythmic
Oral or IV
Anticholinergic effect

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8
Q

Procainamide

A

Class 1a antiarrhythmic

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9
Q

Class 1a antiarrhythmics ADRs

A 
Reduced CO
Torsades de Points 
Dizziness, confusion, insomnia, seizure
Lupus like syndrome
GI
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10
Q

Class 1B antiarrhythmics effects on heart

A

Fast binding offset kinetics
No change in phase 0 in normal tissue (no tonic block), no ECG changes in these tissues
APD slightly decreases
Reduced phase 0 conductance in ischaemic or fast beating tissue
Increased QRS in these tissues

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11
Q

Class 1B antiarrhythmics uses

A

Acute VT and VF, especially during ischaemia

Not atrial or AV junctional arrhythmias

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12
Q

Lidocaine

A

Sodium channel blocker
Class 1B antiarrhythmic - IV only
Local anaesthetic

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13
Q

Phenytoin

A

Sodium channel blocker
Class 1B antiarrhythmic - oral
Anti epileptic

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14
Q

Class 1B antiarrhythmics ADRs

A

CNS- dizziness, drowsiness

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15
Q

Class 1c antiarrhythmic effects

A 
Slow binding offset kinetics (>10s)
Decreases phase 0 in normal tissue 
Decreases automaticity
Increased threshold
Increased APD
Increased refractory period, especially in rapidly depolarising atrial tissue
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16
Q

Class 1c antiarrhythmic effects on ECG

A

Longer PR, long QRS, long QT

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17
Q

Class 1c antiarrhythmic uses

A

Super ventricular arrhythmias (fib and flutter)
Premature ventricular contraction
Wollf-Parkenson White

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18
Q

Flecainide

A

Class 1c antiarrhythmic

IV or oral

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19
Q

Propafenone

A

Class 1c antiarrhythmic

IV or oral

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20
Q

Class 1c antiarrhythmic ADRs

A

Proarrhythmic
Sudden death with chronic use
Increased ventricular response to supraventricular arrhythmias
CNS and GI

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21
Q

Class 2 antiarrhythmics effect

A

Beta blockers

Increase APD and refractory period in AVN, reduced AV conduction velocity

22
Q

Class 2 antiarrhythmics effect on ECG

A

Longer PR interval

Lower HR

23
Q

Class 2 antiarrhythmics uses

A

Sinus and catecholamine dependent tachyarrhythmias
Converting re entrant arrhythmias in AV
Protecting ventricles from high atrial rates

24
Q

Propanolol

A

Beta blocker
Non selective
Oral or IV

25
Q

Esmolol

A

Beta blocker

IV only

26
Q

Class 2 antiarrhythmics ADRs

A

Bronchospasm

Hypotension

27
Q

Class 2 antiarrhythmics contraindications

A

Ventricular failure

Partial AV block

28
Q

Class 3 antiarrhythmics effects

A

Potassium channel blockers

29
Q

Amiodarone

A

Potassium channel blocker

30
Q

Amiodarone pharmacokinetics

A

Oral or IV
T1/2 3 months
Very lipid soluble - large volume of distribution

31
Q

Amiodarone effects on heart

A 
Increased refractory period
Increased action potential duration
Increased threshold
Decreases phase 4
Decreased AV conduction speed
32
Q

Amiodarone uses

A

Effective in most arrhythmias

Wolff Parkenson White

33
Q

Amiodarone ADRs

A 
Hepatic injury
Pulmonary fibrosis 
Thyroid disease
Increased LDLs
Photosensitivity leading to sunburn
Crystals laid down in eyes
34
Q

Sotalol

A

Potassium channel blocker

35
Q

Sotalol administration

36
Q

Sotalol effects

A

Slow phase 4
Increased APD, refractory period in atrial and ventricular tissue
Slows AV conduction
Lengthens QT, decreases HR

37
Q

Sotalol uses

A

Wide spectrum
SVT
VT

38
Q

Sotalol ADRs

A

Insomnia
Fatigue
Proarrhythmic

39
Q

Class 4 antiarrhythmics effects

A

Slow AV conduction
Increase refractory time in AVN
Increase slope of phase 4 in SA to slow HR
ECG shows longer PR, heart rate up or down depending on baroreceptor reflex

40
Q

Class 4 anti arrhythmics uses

A 
Control ventricles during SVT
Convert SVT (reentry around AV)
41
Q

Class 4 anti arrhythmics ADRs

A

GI

Caution in hypertension, low CO or sick sinus

42
Q

Diltiazem

A

Class 4 anti arrhythmics

Oral

43
Q

Adenosine mechanism

A

Binds A1 receptor
Activates potassium currents in AVN and SAN, causing hyperpolarisation
Reduces APD
Decreases calcium currents, slowing AV conduction

44
Q

Adenosine pharmacokinetics

A

Short T1/2 (few seconds)

Rapid IV bolus

45
Q

Atropine mechanism

A

Muscarinic antagonist

Blocks vagal activity, increasing heart rate

46
Q

Atropine uses

A

Vagal bradycardia

47
Q

Digoxin mechanism in antiarrhythmics

A

Enhances vagal activity

Slows AV conduction and HR

48
Q

Magnesium antiarrhythmic

A

Treatment of tachycardia resulting from long QT

49
Q

Atenolol

A

Beta 1 selective beta blocker

50
Q

Bisoprolol

A

Beta 1 selective beta blocker

51
Q

Carvedilol

A

Mixed beta 1 alpha1 antagonist

52
Q

Digoxin used

A

Rapid atrial fibrillation

Pharmacology (20 decks)

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