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Cardiovascular > Antiarryhthmics > Flashcards

Antiarryhthmics Flashcards

1
Q

action Class 1A Na channel blockers

(quinidine, procainamide, dispyramide)

A

moderate 0 deepression

slowed conduction (+2)

shorten repol

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1
Q

phase 2 =

A

plateau phase

blanced inward Ca and outward K

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1
Q

action of Sotalol

A

block IKr channel

B block

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2
Q

Ic na channel blockers

A

flecainide

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3
Q

action class IV drugs

verapamil, diltiazem

A

Ca channel blockers

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3
Q

side effects Lidocaine

A

dizziness

seizures

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4
Q

side effects Beta blockers

A

negative ionotropic

heart block,

bradycardia

bronchospasm

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5
Q

catecholamine impact on depolarization

A

enhance depl in slow response cells (no impact in fast response cells)

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6
Q

specific side effects, diltiazem (less so in other Ca blockers )

A

interact with digitalis to slow AV conduction > heart block (and verapamil)

compete for digitalis renal excretion (and verapamil)

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7
Q

indications sotalol

A

VF VT

supravent tachycardia

a fib

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8
Q

impact, flecainide

threshold

vmax

A

increase threshold

decrease Vmax

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8
Q

main physiological effect of fleccainide

A

strongest change in depol (slight in duration)

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8
Q

side effects amiodarone

A

triggered arrhythmias (torases de pointes rare)

altered thyroid fxn (inhibts T4>T3) > hypothyroidism

pulmonary fibrosis (reversible)

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9
Q

impact, Na channel blockers (Class I)

membrane responsiveness

threshold

Vmax

Refractory

A

reduce mem responsiveness

increase threshold

decrease Vmax

increase refractory

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10
Q

indirect effects QUinidine, class Ia na blockers

A

block K channels early after depol (EAD)

Vagolytic effect - enahnce communication across AV > Vtach

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11
Q

phase 3 =

A

rapid repolarization

(L type close while K still open)

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12
Q

indications flecainide

A

approved in life-threatenign when supraventricular and ventricular arrhythmias are resistant to other drugs

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13
Q

action of class II drugs

Propanolol, esmolol

A

beta adrenergic blockers

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13
Q

class III K channel blockers

A

amiodarone

sotalol

dofetilide

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14
Q

class IV Ca channel blockers

A

verapamil

diltiazem

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15
Q

since beta blockers do not _____, they are safe for pt with Long Qt

A

prolong repolarizaation

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16
Q

indications Adenosine

A

supraventricular tachycardia (slows AV conduction and heart rate)

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18
Q

1-4-dihydropyridines are not used as antiarrhythmics because,

they are used, however, to relieve

A

primarily target vascular cells (vs cardiac)

used to relieve angia pectoris to relieve chest spasms

19
Q

Class IV Ca blockers (Diltiazem and Verapamil) act primary on ___ cells
which are dependent on ___ for AP depol

A

act primarily on slow response cells (AV and SA nodes) which are dependent on Ca influx for AP

20
Q

action 1C Na blockers

flecainide

A

Marked 0 depression

slow conduction (4+)

little impact on repol

21
Q

triggered automaticity after repolarization excerbated by

A

fast rates

high intracellular Ca

23
Q

class IA Na Channel blockers

A

quinidine

procainamide

disopyramide

24
Q

action 1b Na blockers

(lidocaine)

A

minimal phase 0 depression

slow conduction (0- 1+)

shorten repol

26
Q

indications lidocain

A

Vtach

Digitalis - induced arrhthmias

Safe for pts with long QT syndrome

27
Q

indications Ca blockers

A

Atrial tachycardia

paroxysmal supraventricular tachycardia

28
Q

mechanism DIoxin

A

enhances vagal parasympathetic activity > slow conduction at AV node

29
Q

mechanism Adenosine

A

rapidly activates K channels to slow phase 4 depol at AV node

blocks cAMP enhance Ca channel activity at AV node

30
Q

nifedipine specific side effects (weaker in other Ca blockers)

A

peripheral edema

31
Q

side effects felcainide

A

pro-arrhtyhmic (CAST trial)

32
Q

all actions of amiodarone (class III)

A

**K blocker **

Modest Na, Ca blocker

modest B adenoreceptor blocker

33
Q

ach impact on depolarization

A

significantly depresses depol in slow response cells (no effect inf ast)

34
Q

indications, Beta blockers

A

arrhythmias

VF vT with high catecholamine

(SA and AV node highly innervated)

35
Q

action calsss III drugs

amiodarone, sotalol, dofetilide

A

K channel blockers

36
Q

triggered automaticity, intterupted repolarization exacerbated by

A

long QT syndrome

38
Q

phase 1

A

inactivation of fast Na chennels (or closure of L-type Ca)

39
Q

Torsade de Pointes in pt on sotalol

A

U wave likely due to long repol of purkinje fibers

post ectopic pause + long QT

40
Q

phase 4 =

A

resting membrane potential

(mostly K)

41
Q

4 ways antiarrhythmic drugs reduced spontaneous discharge

A

1 decrease phase 4 slope (slow rate)

  1. increase max diastolic potential (more negative, further from threshold)
  2. Increase threshold
  3. increase AP duration > increase refractory period
42
Q

phase 0

A

rapid depol of AP phase (Na in fast cells, Ca L-type in slow cells)

43
Q

impact, lidocaine

threshold

AP

refractory rate

A

increase threshold

decrease AP duration

decrease refractory

44
Q

Class II beta adrenergic blockers

A

propanolol, esmolol

45
Q

class IB Na channel blockers

46
Q

verapamil side effects (less so in other Ca blockers )

A

constipation

interaction with digitalis to slow conduction velocity in AV > hear block (and verapamil)

increase plasma digitalis levels by competing for renal excertion (and verapamil)

48
Q

short, long acting B blockers

A

propanolol - long, oral

esmolol - short, IV

49
Q

indications Digoxin

A

Afib and supravent tachycardia

(to control ventricular response rate)

50
Q

major side effects Ca blockers

A

Negative chronotropic effect - decreases automaticity of SA (brady)

Negative ionotropic (decrease Ca influx)

hypotension (decrease Ca into smooth muscle)

51
Q

indication amiodarone (class III)

A

VF VT

prevention of reccurent paroxysmal a fib or flutter

52
Q

most common target of Class III (amiodarone, sotalol)

A

IKr channel (increases Refractory peirod) (possible arrhytmias)

53
Q

indications quinidine

A

atrial flutter

A fib

prevent VF VT

54
Q

action of beta blockers in presence of catecholamines

A

slow rate of diastolic (phase 4) depolarization)

55
Q

major side effects QUinidine

A

Severe GI

Vagolytic

inhibits p450s

Proarrhythmic,

reduced renal clearance of digitalis

metabolized by liver (renal failre pt OK)

Cardiovascular (39 decks)

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