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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
Q

Amiodarone and Digoxin

A

Amio inhibits CYP3450 so increases digoxin levels

26
Q

Amiodarone uses

A

Ventricular and Supraventricular Arrhythmias

Maintainng NSR in A FIb

27
Q

Amiodarone ADRs

A

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
Q

Tests for monitoring Amiodarone

A

Chest X-ray, PFTs, TSH, LFTs, Eye Exam

29
Q

Structural analog of amiodarone

Iodine atoms have been removed

A

Dronedarone

30
Q

Dronedarone Black Box Warning

A

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
Q

Uses for Verapamil and Diltiazam (CLASS IV)

A

Supraventricular Arrhythmias

Controls Ventricular rate with A Fib

32
Q

Nucleotide that occurs naturally in the body

Drug of choice for prompt conversion of paroxysmal supraventricular tachycardia (PSVT) to sinus rhythm

A

ADENOSINE

33
Q

Adenosine ADRs

A 
Bronchospasm
Chest pain
Shortness of breath
Flushing
A-V block
Hypotension
Atrial Fibrillation
Headache, nausea, paresthesias
34
Q

Magnesium uses

A

Digitalis induced Arrhythmias
Tosades de Pointes
Sinus Tachy

1g IV over 20 mins

35
Q

decreases conduction of electrical impulses through the AV node and increases vagal activity via its central action on the CNS

A

Digoxin

36
Q

Most of these drugs are not safe to be used in patients with CHF or CAD

A

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
Q

Can be used in patients with CHF and CAD

A

Amiodarone, Dofetilide

38
Q

Can be used in patients with CAD

A

Amiodarone, Dofetilide, Sotalol

39
Q

Class IC can be used with which patients

A

Structurally sound heart

Pharm Exam 4 (3 decks)

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