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Pharm Exam 4 > Antiarrhythmics > Flashcards

Antiarrhythmics Flashcards

1
Q

Which class increases action potential duration (lengthens)

DOUBLE QUARTER POUNDER

A

Class IA prolongs QRS, QT

NONE ARE FIRST LINE FOR ANYTHING

Disopyramide - Not first line, not for HF VentArrhythmias
Quinidine (not used)
Procainamide - Only 1st line for WolfParkWhite Afib/flutte

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2
Q

Which class has little/no effect on duration of action potential or refractory period

FRIES PLEASE

A

Class IC

Flecainide - A Fib in Normal hearts. Suppresses PVCs
Propafenone - A Fib, A flutter

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3
Q

Which class shortens duration of action potential AND refractory period

LETTUCE MAYO

A

Class IB

Lidocaine - 1st line Ventricular Arrhythmias from MI
Mexiletine (not used)

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4
Q

Which class are beta blockers

A

Class II

Metropolol, Propanolol, Esmolol

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5
Q

Which class are K channel blockers - and prolong duration of action potential in tissue with fast-response action potentials

BIG ONES

DONUTS AND SOME ICECREAM DOES IT

A

Class III

Dofetilide
Amiodarone
Solatol
Ibutilide 
Dronedarone
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6
Q

Which class are Ca channel blockers

A

Class IV

Verapamil
Diltiazam

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7
Q

Describe Class I as a whole

A

Na Channel blockers

Local anesthetic

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8
Q

Patients presenting with exacterbation of HF symptoms use

A

IV Digoxin or Amiodarone, 1st line for Ventricular Rate control

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9
Q

Hemodynamically stable, normal LV function, with A Fib

A

1st line, use IV Beta Blockers or Ca Channnel (Verapamil, Diltiazam)

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10
Q

Afib / Aflutter due to WolfParkWhite Synd

A

Procainamide, IA
Blocks sodium channels
Slows the upstroke of action potential, conduction, and prolongs QRS duration
Direct depressant actions on SA and AV nodes

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11
Q

First drug of choice for Ventricular Arrhythmias due to MI

A

LIDOCAINE

Routine prophylactic use of lidocaine in this setting may increase total mortality, possibly increasing the incidence of asystole
Usually only administer in presence of arrhythmia

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12
Q

LIDOCAINE also used for

A

Digitalis toxicity
Anesthesia
Open heart surgery
Recurrent V-Tach add-on

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13
Q

Lidocaine ADRs

A

Neurologic - lightheaded, tingling, tremor, slurred speech, hearing things, convulsions

Hypotension

Contraindiated for EPILEPTIC patients

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14
Q

Which anti arrhythmic is contraindicated for Eplieptic patients?

A

LIDOCAINE IB

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15
Q

Least cardiotoxic Anti arrhytmic

A

LIDOCAINE IB

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16
Q

Can be used for A fib in NORMAL hearts

Suppresses PVCs

May cause severe exacerbation of arrhythmia in patients with pre-existing ventricular tachyarrhythmias and previous MI and/or ventricular ectopy

A

Flecainide

Class IC

17
Q

Used to maintain sinus rhythm in patients with supraventricular arrhythmias including A. Fibrillation and A. Flutter

Adverse effects:
Metallic taste, constipation

A

Propafenone

IC

18
Q

Compare classes IA, IB, IC regarding extent of Na channel blockade and effect on ERP

A

Na Channel Blockade:

IC > IA > IB

Increasing ERP
IA > IC > IB

19
Q

A non-selective beta agonist used for

Life- threatening ventricular arrhythmias BUT NOT FOR CHF PATIENTS

To maintain sinus rhythm in patients with atrial fibrillation

For treatment of supra & ventricular arrhythmias in pediatric age group

A

CLASS III

SOLATOL (BETAPACE)

20
Q

Ibutilide - Class III uses

A

Used for the acute conversion of Atrial Flutter or Atrial Fibrillation to normal sinus rhythm

21
Q

Dofetilide - Class III uses

A

A fib

100% bioavailability

22
Q

Amiodarone and CYP450***

A

Drugs that inhibit CYP3A4 increase levels; cimetidine
Drugs that induce CYP3A4 decrease levels; rifampin

Inhibits Cytochrome P450 enzymes increasing their levels; statins, digoxin, warfarin
Warfarin dose should be cut in half and closely monitored

23
Q

Amiodarone and Warfarin

A

BC of the damn CYP3450

Warfarin dose should be cut in half

24
Q

Amiodarone and Statins

A

Amio inhibits CYP3450 so increases statin levels

25
Amiodarone and Digoxin
Amio inhibits CYP3450 so increases digoxin levels
26
Amiodarone uses
Ventricular and Supraventricular Arrhythmias Maintainng NSR in A FIb
27
Amiodarone ADRs
Abnormal LFTs Grey-blue skin Eye problems (corneal, optic neuritis, blindness) Blocks conversion os T4 to T3 (other thyroid problems) Symptomatic Bradycardia Heartblock if there's an SA or AV node problem **Rare fatal Pulmonary Fibrosis 1%**
28
Tests for monitoring Amiodarone
Chest X-ray, PFTs, TSH, LFTs, Eye Exam
29
Structural analog of amiodarone | Iodine atoms have been removed
Dronedarone
30
Dronedarone Black Box Warning
Contraindicated for patients w CHF Class IV, or symptomatic, or recently needing hospitalization - DOUBLE RISK OF DEATH Contraindicated for patients with A Fib who can NOT be cardioverted into NSR **so patients with PERMANENT AFIB** DOUBLES RISK OF DEATH
31
Uses for Verapamil and Diltiazam (CLASS IV)
Supraventricular Arrhythmias Controls Ventricular rate with A Fib
32
Nucleotide that occurs naturally in the body Drug of choice for prompt conversion of paroxysmal supraventricular tachycardia (PSVT) to sinus rhythm
ADENOSINE
33
Adenosine ADRs
``` Bronchospasm Chest pain Shortness of breath Flushing A-V block Hypotension Atrial Fibrillation Headache, nausea, paresthesias ```
34
Magnesium uses
Digitalis induced Arrhythmias Tosades de Pointes Sinus Tachy 1g IV over 20 mins
35
decreases conduction of electrical impulses through the AV node and increases vagal activity via its central action on the CNS
Digoxin
36
Most of these drugs are not safe to be used in patients with CHF or CAD
Amiodarone, Dofetilide can be used in patients with CHF and CAD Amiodarone, Dofetilide and Sotalol can be used in patients with CAD Class IC used in patients with structurally normal heart
37
Can be used in patients with CHF and CAD
Amiodarone, Dofetilide
38
Can be used in patients with CAD
Amiodarone, Dofetilide, Sotalol
39
Class IC can be used with which patients
Structurally sound heart

Pharm Exam 4 (3 decks)

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