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Cardiology > Antiarrhythmics > Flashcards

Antiarrhythmics Flashcards

1
Q

Class IA MOA, Effect, and Uses

A
  • MOA:
    • Na+ and slight K+ channel blockade
  • EFFECT:
    • slows phase 0 depolarization
    • prolongs repolarization/refractory period
    • elevates resting membrane potential
  • USES:
    • Reentry
    • ectopic supraventricular and ventricular tachycardias
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2
Q

Quinidine

A
  • Class IA
  • anticholinergic effects speed up AV conduction
  • need to be combined with neg. inotrope
  • alpha blockade causes hypotension
  • used for: PACs, PVCs, AF/AF to NSR, Preventing SVT, WPW with atrial fibrillation
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3
Q

Quinidine adverse effects

A
  • GI
  • Dig toxicity
  • Prolongs QT interval, which may cause Torsades
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4
Q

Procainamide

A
  • Class IA
  • DOC for WPW with Afib
  • also used for: SVT (Afib, reentry)
  • kidneys convert 50% of dose to NAPA
  • Stop treatment until: rhythm suppressed, QT prolonged >50%, or you’ve reached maximum dose
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5
Q

Procainamide adverse effects

A
  • lupus like syndrome
  • agrunulocytosis
  • fever
  • QT prolongation
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6
Q

Class IB MOA, Effects, Uses

A
  • MOA:
    • Rapidly blocks and un-blocks Na+ channels (best when cells fire rapidly)
  • EFFECT:
    • shorten phase 3 repolarizaiton
    • decrease AP duration
  • Use:
    • venricular arrhythmias
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7
Q

Lidocaine

A
  • Class IB

- used to be DOC for ventricular arrhythmias

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8
Q

Lidocaine adverse effects

A
  • mental status change

- arrhythmias (sinus arrest, AV block, asystole)

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9
Q

Class IC MOA, Effects, Uses

A
  • MOA:
    • potently blocks Na+ channels
  • EFFECTS:
    • markedly slows phase 0
    • significantly prolongs AV refractory period
  • USE:
    • prevents supraventricular arrhythmias in structurally normal hearts
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10
Q

Flecainide

A
  • Class IC
  • used for SVT (Afib and paroxysmal SVT)
  • only use in structurally normal hearts!!
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11
Q

Flecainide adverse effects

A
  • aggravation of ventricular arrhythmias
  • heart failure
  • altered mental status
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12
Q

Class II MOA, Effects, Uses

A
  • MOA:
    • beta blockers
  • EFFECTS:
    • depresses automaticity
    • prolongs AV conduction
    • decreases heart rate and contractility
  • USES:
    • SVT
    • Vtach
    • thyrotoxicosis
    • pheochromocytoma
    • palpitation prophylaxis
    • Vtach after MI prophylaxis
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13
Q

Caution using Class II with…?

A
  • diabetes (masks signs of hypoglycemia)
  • PVD (can cause vasospasm)
  • Impotence (exaggerates)
  • Asthma/COPD (bronchospasms)
  • SSS (further depresses heart rate)
  • AV blocks (can make block worse)
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14
Q

Class III MOA, Effects, Uses

A
  • MOA:
    • blocks K+ channels
  • EFFECTS:
    • prolongs phase 3, prolonging AP
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15
Q

Amiodarone

A
  • Class III
  • Also has Na+, Ca++, and Beta blockade
  • Decreases conduction velocity, reentry, rate of fire, automaticity, and inotropy
  • DOC for ventricular arrhythmias during resuscitation
  • also used for supraventricular arrhythmias and reentrant tachycardia
  • low dose for Afib/Aflutter suppression
  • Long half-life!!!
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16
Q

Amiodarone toxicities

A

-pulmonary, hepatic, thyroid, cardiac, GI, and neuro toxicities

17
Q

Ibutilide

A
  • Class III
  • affects the slow influx of Ca++ during phase 2, rather than K+ channels
  • prolongs AP and increases atrial and ventricular refractoriness
  • used for IV chemical cardioversion of Afib
18
Q

Ibutilide toxicites

A
  • can cause Torsades de Pointes, so you must check electrolytes (K and Mg) before drug administration
  • short half-life
19
Q

Sotalol

A

-Class III
-Also has nonselective Beta-blockade
prolongs AP, increases atrial/ventricular refractoriness, and inhibits conduction in accessory pathways
-Used for SVT and ventricular arrhythmias

20
Q

Sotalol adverse effects

A

-prolongs action potential which can cause development of Torsades

21
Q

Class IV MOA, Effects, Uses

A
  • MOA:
    • Ca++ channel blockade
  • EFFECTS in nodal tissue:
    • elevates threshold potential
    • slows phase 0 depolarization
    • decreases conduction velocity
    • lengthens refractory period
    • decreases HR
    • terminates reentry rhythms through AV node
  • Uses:
    • AVNRT
    • Afib/Aflutter
    • MAT
22
Q

Class IV side effects

A
  • AVN delays
  • bradycardia
  • constipation
23
Q

Verapamil

A

Class IV Calcium Channel blocker

24
Q

Diltiazem

A

Class IV calcium channel blocker

25
Q

Do not use Class IV in…?

A
  • wide complex tachycardias of unknown origin
  • Afib with WPW
  • SSS
  • AV blocks without a pacemaker
26
Q

Adenosine

A
  • MOA: K+ channel agonist
  • EFFECT: rapid efflux of K+ hyperpolarizes the cells of the SA and AV nodes
  • Net effect: slows SA firing and AV node conduction
  • DOC for reentrant tachycardias
  • DOC for SVT
  • must slam and chase due to half-life of only 10 seconds!
  • caffeine and theophylline are competitive antagonists - need to use higher dose
27
Q

Adenosine toxicities

A
  • facial flushing
  • atrial arrhythmias
  • nausea
  • shortness of breath
  • chest tightness
  • caution with asthma and COPD because of bronchospasms
28
Q

Digoxin

A
  • blocks the Na+/K+ pump, increasing intracellular Na+
  • Na+ competes with Ca++ for eflux from cell, so intracellular Ca++ is increased
  • Used when there’s a slow ventricular response with Afib, Aflutter, and Atach
  • 3rd choice for SVT
29
Q

Digoxin toxicities

A
  • can make a ladle ST segment depression
  • arrhythmias
  • GI
  • ENT
  • do not use with renal failure, hypokalemia, or Afib with WPW
30
Q

DOC for Wolff-Parkinson-White syndrome

A

Procainamide

31
Q

Old DOC for ventricular arrhythmias

A

Lidocaine

32
Q

Current DOC for ventricular arrhythmias

A

Amiodarone

33
Q

2nd DOC for SVT

A

Verapamil

34
Q

DOC for SVT

A

Adenosine

35
Q

DOC for reentrant tachycardias (although there are several ways to treat)

A

Adenosine

36
Q

3rd DOC for SVT

A

Digoxin

37
Q

Usually the 1st line drug for Afib/Aflutter ventricular rate control

A

Diltiazem

Cardiology (8 decks)

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