Antiarrhythmics Flashcards
1
Q
Class 1 MOA
A
Membrane stabilizing or anesthetic effect on the cells of the myocardium
2
Q
Class 1 indications
A
Arrhythmia, local anesthesia
3
Q
Class 1 restrictions
A
Not for people with hyperkalemia
4
Q
Class 1A indication and considerations
A
Arrhythmia, increase AP, QT, and ERP interval
5
Q
Class 1A ex
A
Disopyramide, procainamide (SE: lupus), quinidine (SE: cinchonism)
6
Q
Class 1A general side effects
A
Thrombocytopenia
7
Q
Class 1B indications
A
Arrhythmia, post myocardial infections
8
Q
Class 1B considerations
A
Decrease AP duration, effect ischemic tissue
9
Q
Class 1B ex
A
Mexiletine (SE: GI upset), lidocaine (SE: CNS depression), phenytoin (SE: hirsutism)
10
Q
Class 1C considerations
A
Used as last resort, no effect on AP duration
11
Q
Class 1C ex
A
Propafenone, flecainide
12
Q
Class 1C restrictions
A
Not for post myocardial infarction
13
Q
Class 3 indications
A
Arrhythmia
14
Q
Class 3 considerations
A
Increase AP duration, ERP, and QT interval
15
Q
Class 3 ex
A
Amiodarone (LFT, dirty drug), ibutilide, dofetilide, sotalol (beta blocker), dronedarone
16
Q
Class 4 indications
A
SVT, subarachnoid hemorrhage
17
Q
Class 4 considerations
A
Decrease conduction velocity, increase PR interval, and ERP
18
Q
Class 4 ex
A
Verapmil, dilitazem, nimodipine
19
Q
Class 4 side effects
A
Cardiovascular, constipation, swelling in lower limbs
20
Q
Adenosine MOA
A
Slows AV conduction
21
Q
Adenosine indications
A
Bradycardia, flushing, dyspnea
22
Q
Adenosine interactions
A
Caffeine and theophylline decrease effects, dipyridamole increases effects
23
Q
Lidocaine indications
A
Ventricular arrhythmia, anesthetic
24
Q
Lidocaine side effects
A
Paresthesias, seizures, respiratory depression, drowsy
25
Lidocaine interactions
Anesthetic effect increase with epinephrine
26
Magnesium sulfate MOA
Muscle relaxant
27
Magnesium sulfate indications
Preterm labor contractions, preeclampsia
28
Magnesium sulfate side effects
Warm feeling, low blood pressure, less deep tendon reflexes, decreased respiratory rate, decreased urine output, paralytic ileus
29
Magnesium sulfate antidote
Calcium gluconate
30
Atrial flutter
Type of arrhythmia, rapid contraction of the atria at a rate too fast for the ventricles to pump efficiently
30
Atrial fibrillation
Type of arrhythmia, irregular and rapid atrial contraction, resulting in a quivering of the atria and causing an irregular and inefficient ventricular contraction
30
PVCs
Type of arrhythmia, beats originating in the ventricles instead of the SA node in the atria, causing the the ventricles to contract before the atria, and resulting in a decrease in the amount of blood pumped to the body
30
Ventricular tachycardia
Thyme of arrhythmia, a rapid heartbeat of usually more than 100 bpm, usually originating in the ventricles
31
Ventricular fibrillation
Type of arrhythmia, rapid, disorganized contractions of the ventricles, resulting in the inability of the heart to pump any blood to the body, which will result in death unless treated immediately
32
Class 1A MOA
Prolong action potential, produce moderate slowing of cardiac conduction
33
Disopyramide MOA
Decreases depolarization of myocardial fibers, prolongs the refractory period, and increased the action potential duration of cardiac cells
34
Qunidine MOA
Depresses myocardial excitability, decreasing the pulse rate and correcting the heartbeat
35
Class 1B MOA
Shorten the action potential duration, and selectively depress cardiac conduction
36
Lidocaine antiarrhythmic MOA
Decreases diastolic depolarization, decreases automaticity of ventricular cells and raises the threshold of the ventricular myocardium
37
Class 1C MOA
Slight effect on repolarization, and profound slowing of conduction
38
Flecainide MOA
Depresses fast sodium channels, decreases the height and rate of rise of action potentials and slows conduction of all areas of the heart
39
Propafenone MOA
Direct membrane stabilizing effect on the myocardial membrane, prolongs the refractory period
40
Class 2 MOA
Beta blockers, indirectly block calcium channels and block catecholamine caused arrhythmias, and also have membrane stabilizing effects
41
Class 3 MOA
Prolongation of repolarization
42
Amiodarone MOA
Acts directly of the cardiac cell membrane, prolonging the refractory period and repololarization and increasing the ventricular fibrillation threshold
43
Inutilice MOA
Prolonging the action potential, producing a mild slowing of the sinus rate and AV conduction
44
Class 4 MOA
Depressing depolarization, lengthening phase 1 and 2 of repolarization
45
Verapmil MOA
Inhibit the movement of calcium through channels across the myocardial cell membranes and vascular smooth muscle, and slows conduction through the SA and AV nodes
46
Antiarrhythmics use
Premature ventricular contractions (PVCs), ventricular tachycardia, premature atrial contractions, paroxysmal atrial tachycardia, other atrial arrhythmias (atrial fibrillation or flutter), tachycardia when rapid, but short term control of ventricular rate is desirable
47
Propanolol use
Myocardial infarction
48
Antiarrhythmics general side effects
Lightheadedness, weakness, somnolence, hypotension, arrhythmias, bradycardia, urinary retention, local inflammation
49
Who is at the highest risk for proarrhythmic effect
People that are given excessive dosages, when pre-existing arrhythmia is life threatening or when the drug is given IV
50
Antiarrhythmics contraindications
```
Pregnancy and lactation, 2nd or 3rd degree
AV block (if there is no pacemaker), severe heart failure, aortic stenosis, hypotension and cardiogenic shock
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51
Quinidine contraindications
Myasthenia gravis, systemic lupus erythematosus
52
Amiodarone pregnancy cat
D
53
Antiarrhythmics precautions
Hepatic disease, electrolyte disturbances, renal impairment, pregnancy (cat B or C), lactation, children
54
Disopyraminde precautions
Heart failure, myasthenia gravis, urinary retention, glaucoma, men with prostate enlargement
55
Quinidine precautions
Heart failure
56
Flecainide precautions
Heart failure
57
Disopyramide interactions
Clarithromycin and erythromycin and quinidine increase serum disopyramide levels, flouroquinolones and thioridazine and ziprasidone increase risk of life threatening arrhythmias, rifampin decreases disopyramide serum levels,
58
Quinidine interactions
Cholinergic cause failure to terminate paroxysmal supraventricular tachycardia, cimetidine increases serum quinidine levels, hydantoins decrease therapeutic effect of quinidine, nifedipine decreases quinidine action and serum level, and cholinergic blocking drugs have an additive vagolytic effect
59
Lidocaine interactions
Beta blockers increase lidocaine levels, and cimetidine decreases lidocaine clearance with possible toxicity
60
Flecainide interactions
Amiodarone and cimetidine increase serum flecainide levels, disopyramide and verapmil May increase negative inotropic properties, increased serum level of beta blockers, which also results in increased serum levels of flecainide, and additive negative inotropic effects, local anesthetics increase risk of CNS reactions, anticoagulants increase prothrombin time and increase plasma anticoagulant levels, increased serum digoxin level, and increased serum theophylline level
61
Propafenone interactions
Quinidine and SSRIs increase serum propafenone levels,
62
When to withhold oral antiarrhythmics
When pulse rate is above 120 or below 60
63
Antiarrhythmics elderly considerations
Greater risk for side effects, such as, additional arrhythmias, aggravation of existing arrhythmias, hypotension and heart failure
64
Signs of cinchonism
Tinnitus, hearing loss, headache, nausea, dizziness, vertigo, and lightheadedness
65
Class 2 ex
Beta blockers (acebutolol, propanolol)
