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Antiarrhythmics Flashcards

1
Q

What is a general class side effect to be aware of?

A
  • several different effects on AP generation and propagation –> may affect autonomic NS**
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2
Q

Why does TdP result? When is it most commonly seen?

A

TdP results from QT prolongation (d/t blockade of K current)

MC with hypokalemia, hypomagnesemia, bradycardia

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3
Q

What is the physio behind each Vaughan-Williams class?

A

I: modulate or block Na+ channels

II: inhibit sympathetic activity

III: block K+ channels

IV: block Ca2+ channels

Other: digoxin

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4
Q

What drugs are in Class I?

A

Modulate or block Na+ channels

Ia: quinidine, procainamide, disopyramide

Ib: lidocaine, mexiletine

Ic: flecainide, propafenone

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5
Q

What drugs are in Class II?

A

Inhibit sympathetic activity

B-blockers

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6
Q

What drugs are in Class III?

A

Block K+ channels

  • sotalol
  • dofetilide
  • ibutilide
  • amiodarone
  • dronedarone
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7
Q

What drugs are in Class IV?

A

Block Ca2+ channels

  • verapamil
  • diltiazem
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8
Q

What are “class” interactions?

A
  • careful w/other QT prolongers
  • most metabolized by 3A4 or 2D6
  • drugs causing hypokalemia or hypomagnesemia (loop diuretics) INC risk
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9
Q

What are “class” ADRs?

A

Dysrhythmia

  • QT prolongation / proarrhythmic potential
  • careful with brady and heart blocks
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10
Q

What is Quinidine syncope?

A

Recurrent lightheadedness and fainting secondary to self-terminating TdP

[drug] usually normal or even subtherapeutic

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11
Q

What is cinchonism and which drug is it related to with high concentrations?

A

Quinidine

Dry as a bone (urinary retention) 
Red as a beet (vascular flushing) 
Blind as a bat (blurred vision) 
Mad as a hatter (delirium, psychosis) 
Hotter than hell (anhidrosis, hot skin)
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12
Q

What are two ADRs of procainamide?

A
  1. Reversible lupus-like syndrome**

2. potentially severe bone marrow suppression

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13
Q

What ADRs are related to disopyramide?

A

Anticholinergic, esp urinary retention

- careful w/glaucoma and BPH

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14
Q

What ADRs are related to Mexiletine?

A

CNS tox

  • dizzy, lightheaded, unsteady gait
  • tremor
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15
Q

What ADRs are related to Lidocaine?

A

CNS tox

  • tremor MC
  • seizure possible
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16
Q

What ADRs are related to Flecainide?

A

** mostly proarrhythmic –> make sure K is normal **

BBW: do not use in pt w/h/o AMI

** need echo to ensure structurally normal heart **

17
Q

What ADRs are related to Propafenone?

A
  • dysguesia (altered taste)
  • lupus-like reaction

** BBW - need echo to ensure structurally normal heart **

18
Q

Sotalol interactions?

A

Avoid concurrent B-blockers and CCBs

Has some b-blocking activity (same precautions)

19
Q

What is ibutilide main ADR?

A

proarrhythmic activity

20
Q

What is Dofetilide main ADR?

A

** dysrhythmia is problematic - death possible **

start med in hospital

21
Q

What are two specifics related to Amiodarone chemistry?

A
  • Iodine containing compound (like thyroxine)

- highly lipid soluble and very long half life (55 days)

22
Q

What are Amio clinical indications?

A

FDA: life threatening recurrent VF or hemodynamically-unstable VT (ACLS)

Common unlabeled: A-fib

  • AF pharm cardioversion
  • AF prophylaxis following open heart surgery
  • Recurrent AF
23
Q

Describe the Pk Interactions of Amio?

A

3A4 substrate
** inhibits multiple isoenzymes moderately**

Pgp substrate & inhibitor
- may INC [digoxin] for up to 3 mo

24
Q

Describe the Pd interactions of Amio?

A
  • additive QTc drugs
  • additive AV block/bradycardia
  • drugs that induce INC K or Mg
25
** Review all interaction alerts closely for Amio ** What are the five examples given?
1. DEC warfarin dose 2. DEC PO digoxin 3. Avoid with HCV drugs 4. Avoid macrolides, FQ, fluconazole 5. Careful w/statin (use rosuva)
26
What are the ADRs of Amio?
1. Pulm - IPF --> ARDs (interstitial infiltrates on imaging) 2. Thyroid (hypo) 3. Ocular - corneal microdeposits - optic neuropathy/neuritis 4. Derm - photosensitivity - bluish skin discoloration 5. CNS - gait, ataxia, dizzy, memory, peripheral neuropathy 6. Cardiac - brady, AV nodal block
27
How does Dronedarone compare and contrast to Amiodarone?
Some MOA but - **non-iodinated analog** - shorter half life and less tissue accumulation Clinical: - AF, a flutter [less effective at maintaining NSR compared to amio]
28
Who is Dronedarone C.I. in?
1. HF class IV or II-III w/recent decompensation 2. Pt who cannot stay in NSR 3. 2/3 deg AV block 4. SSS 5. Brady pt
29
What are 4 drug interactions to be aware of with Dronedarone?
1. strong 3A4 substrate; moderate 3A4/2D6 inhibitor (remember Metoprolol, statins) 2. Pgp inhibitor (remember digoxin) 3. QTc prolonger 4. Elevated INR with Warfarin**
30
What ADRs are related to Dronedarone?
Initial - NVD - photosensitivity (not blue though) Emerging - acute liver, renal failure, exacerbation of HF
31
Digoxin has 2 MOA depending on clinical use. What is it for HF? SV arrhythmias?
HF - reversible inhibition of Na/K ATPase results in INC intracellular Ca - increased contractility SV arrhythmias - INC vagal tone - DEC conduction through SA, AV nodes
32
What are the two clinical uses of digoxin?
1. Advanced systolic HF - does not alter mortality** 2. 2nd line for AF in HF pts
33
What are three general things to monitor while on digoxin?
- ECGs (baseline, periodic) - SCr - renal excretion (baseline, periodic) - Cations
34
How can bile acid sequestrants affect digoxin?
Bile acid sequestrants may bind and impair absorption of digoxin**
35
How might acute dig tox manifest?
Cardiac (greatest concern)** - PVCs** - various degrees of AV nodal blockade** - other electrical problems GI: anorexia, NV, abd pain Neuro: confusion, weakness
36
How might chronic dig tox manifest?
- more difficult to dx, sxs develop over days to months ** cardiac effects (rhythm disturbances) - greatest concern ** Neuro: lethargy, delirium, weak ** visual changes - color vision, development of scotomas, blindness **
37
How do you diagnose Dig Tox?
Clinical manifestations + ECG Not isolated INC serum [digoxin]
38
How do you treat Dig Tox?
1. ABCs 2. Continuous tele & Pox 3. Place IV 4. Check BS 5. Digoxin Immune Fab - used for clinically significant arrhythmia or hypotension

Clinical Pharmacology (54 decks)

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