Antiarrythmics

Question 1

Reserved for use in patients with no significant organic/structural heart disease (e.g. no evidence of coronary artery disease such as angina pectoris or previous MI) (yet are arrhythmic

Answer 1

quinidine- class 1A

Question 2

Sustained Ventricular Arrhythmias, has unforuntate pro-arrythmia side effects,
mixed Na channel blocker & K channel blocker, decreased ectopic pacemaker activity

Answer 2

quinidine 1A

Question 3

restore sinus rhythm in patients who are not adequately controlled by drugs that reduce the ventricular response, or to reduce the frequency of relapse into atrial fib/flutter

Answer 3

quinidine, class 1a

Question 4

anticholinergic side effects that can decrease the AV node’s Effective Refractory Period, which can result in a rapid acceleration of ventricular rate (which is potentially dangerous in patients with coronary artery disease)

Answer 4

quinidine, class 1a

Question 5

diarrhea, cinchonism

Answer 5

quinidine, class 1a

Question 6

increased by coadministration of amiodarone or cimetidine

Answer 6

quinidine 1a

Question 7

commonly develop a positive anti-nuclear antibody (ANA) titer

Answer 7

procainamide, class 1a

Question 8

Weak ganglionic blocker (use cautiously in patients with atrial tachyarrhythmias)

Answer 8

procainamide class 1a

Question 9

Negative inotropic effects (use cautiously in CHF)

Answer 9

procainamide class 1a

Question 10

Effective against most atrial & ventricular arrhythmias

Life-threatening ventricular arrhythmias, such as sustained ventricular tachycardia.

Answer 10

procainamide class 1a

Question 11

slurred speech
numbness (around the lips)
blurred vision
twitching, convulsions 
parasthesias

Answer 11

lidocaine

Question 12

ventricular cardiac arrhythmias (esp. post-MI

Answer 12

lidocaine

Question 13

weak β-blocking activity

Answer 13

propafenone

Question 14

Treatment of paroxysmal atrial fibrillation/flutter & PSVT in patients WITHOUT structural heart disease.

Answer 14

propafenone

Question 15

has pro-arrhythmic potential, but can be used with caution to treat ventricular arrhythmias (such as sustained VT) that are judged to be life-threatening.

Answer 15

propafenone

Question 16

cardiac arrhythmias (atrial tachyarrhythmias induced by catecholamines, digitalis, thyrotoxicosis, or associated with Wolff-Parkinson-White syndrome; for the control of ventricular rate in patients with atrial flutter or fibrillation when digoxin is ineffective or contraindicated, ventricular arrhythmias caused by catecholamines or digoxin).

Answer 16

propanolol

Question 17

prevention of sudden death and reinfarction after an MI.

Answer 17

propanolol

Question 18

cutely blocks IKr, but IKs also becomes reduced with chronic therapy

Answer 18

amiodarone

Question 19

arrythmias associated with stress

Answer 19

propanolol

Question 20

rentrant arrythymias that involve AV node

Answer 20

propanolol

Question 21

decreases mortality in patients suffering acute MI

Answer 21

propanolol

Question 22

avoid in patients with pre-existing ventriculat tachyarrythmias

Answer 22

flecainide

Question 23

avoid in patients with previous MI

Answer 23

flecainide

Question 24

avoid in patient with ventricular ectopic rhythms

Answer 24

flecainide

Question 25

do not combine with CYP2d6 and CYP3A4 inhibitors

Answer 25

propafenone

Question 26

increases RR interval

Answer 26

class 2 drugs

Question 27

increases PR interval and decreases Ca overload

Answer 27

class 2 drugs

Question 28

does not prolong AP duration, QT interval on ECG, but does prolong QRS interval duration

Answer 28

class 1c drugs

Question 29

blocks inactivated Na channels blocks potassium channels, does NOT block QT duration on ECG

Answer 29

class Ib drugs

Question 30

prolongs QRS and QT intervals on the ECG

Answer 30

class 1A drugs

Question 31

agranulocytosis, pleuritis, arthritis, hepatitis, pulmonary dx

Answer 31

procainamide

Question 32

thrombocytopenia, cinchonism, n/v

Answer 32

quinidine

Question 33

may cause HypoT--> tachycardia

Answer 33

quinidine

Question 34

recurrent ventricular arrhythmias

Answer 34

disopyramide

Question 35

QT prolongation, induction of torsade de pointes arrhythmia + syncope, negative inotropic effect. atropine-like symptoms, urinary retention, dry mouth, blurred vision, constipation, exacerbation of glaucoma

Answer 35

disopyramide

Question 36

preferentially binds to depolarized cells and no effect on conduction in normal tissue

Answer 36

class 1B drugs

Question 37

class 1 drug that may shorten AP

Answer 37

class 1B

Question 38

VERY efficiency in arrythmias associated with acute MI

Answer 38

lidocaine

Question 39

extensive 1st pass metaboilsm, used only by the intravenous route

Answer 39

lidocaine

Question 40

least toxic of all class 1 drugs

Answer 40

lidocaine

Question 41

neurological effects: parasthesias, tremor, slurred speech, convulsion

Answer 41

lidocaine

Question 42

used for ventricular arrhythmias and to reduce pain in diabetes associated neuropathy

Answer 42

mexiletine

Question 43

orally active drug in class 1

Answer 43

mexiletine

Question 44

1. metallic taste, constipation, exacerbation of ventricular arrythmias

Answer 44

propafone

Question 45

MOA: decreases HR by ↓ RR interval @ the SAN, decreases ventricular contractions by ↓ AV conductance and increasing the PR interval, and decreases Ca overload in the ventricular myocardium, which prevents delayed after depolarizations

Answer 45

class 2 drugs

Question 46

half life is 10 minutes because it's hydrolyzed in the blood so quickly. how is it administered?

Answer 46

esmolol: administered via continuous IV infusion

Question 47

used to tx arrhythmias associated with thyrotoxicosis

Answer 47

esmolol

Question 48

used to tx arrhythmias in acute MI and mycocardial ischemia

Answer 48

esmolol

Question 49

MOA: blocks K channels

Answer 49

class 3 drugs

Question 50

prolongs AP duration and QT interval on ECG

Answer 50

class 3 drugs

Question 51

action potential depolarization is rate dependent, and has the most marked effect at slow rates

Answer 51

class 3 drugs

Question 52

prolongs refractory period

Answer 52

class 3 drugs

Question 53

prolongs QT interval and ADP uniformly over a wide range of heart rates

Answer 53

amiodarone

Question 54

a class 3 drug that blocks inactivated Na channels

Answer 54

amiodarone

Question 55

possesses adrenolytic activity

Answer 55

amiodarone

Question 56

has calcium channel blocking activities

Answer 56

amiodarone

Question 57

class 3 drug that induces peripheral vasodilation

Answer 57

amiodarone

Question 58

two clinical uses for amiodarone

Answer 58

tx of ventricular arrhythmias and atrial fib (although the FDA does not approve of the latter)

Question 59

class 3 drug metabolized by CYP3A4

Answer 59

amiodarone

Question 60

two drugs that alter amiodarone's metabolism

Answer 60

cimetidine (CYP3A4 inhibitor) and rifampin (CYP3A4 inducer)

Question 61

amiodarone metabolism produces what

Answer 61

active metabolite, whose half life is weeks to months

Question 62

up to how long can you still find amiodarone in the body?

Answer 62

up to a year

Question 63

ADE of amiodarone

Answer 63

av block brady fatal pulmonary fibrosis hepatitis photodermatitis blue-grey skin (deposits on skin) discoloration in sun exposed areas drug-deposits in cornea optical neuritis blocks peripheral conversion of thyroxine to triiodothryonine- may cause hypo or hyperthyroidism note: amiodarone DOES have an iodine moiety (inorganic)

Question 64

amiodarone derivative

Answer 64

dronedarone but without iodine moiety

Question 65

MOA dronedarone

Answer 65

1. blocks multiple potassium channels 2. blocks L type Ca current --> decreased nodal conduction-->bradycardia 3. prolongs AV refractory period--> increases PR interval

Question 66

in terms of adrenergics, how does dronedarone differ from amiodarone?

Answer 66

dronedarone has strong anti-adrenergic effects

Question 67

T/F: dronedarone is weaker than amiodarone in maintaining sinus rhythm in AFIB/flutter patients

Answer 67

T

Question 68

what are the advantages of dronedarone's toxicology profile?

Answer 68

shorter half life, no iodine moiety, less drug interactions

Question 69

AE of dronedarone

Answer 69

abdominal pain, n/v, diarrhea

Question 70

black box warning for dronedarone

Answer 70

increases risk of mortality in patients with decompensated HF and those with HF requiring hospitalization

Question 71

dofetilide

Answer 71

blocks rapid