Antiarrythmics Flashcards
ARRHYTHMIA An abnormal heartbeat – -Too fast (\_\_\_\_\_) -Too slowly (\_\_\_\_\_) -Irregularly (\_\_\_\_\_/\_\_\_\_\_) -\_\_\_\_\_ (Skipped or too early- premature contraction)
- _____ not working properly
- Abnormal _____ and contraction
Tachycardia Bradycardia Flutter/Fibrillation Ectopic Electrical signals coordination
SYMPTOMS
- No associated symptoms
- _____ in the chest
- _____ pain
- _____
- _____ or dizziness
- Sweating
- _____ (syncope) or near fainting
- Cardiac arrest
Fluttering chest SOB Lightheadedness Fainting
CAUSES & RISK FACTORS
- _____ Disorders (_____/_____)
drugs: _____
Thyroid
hyper/hypo
antiarrythmics
DIAGNOSIS
-PHYSICAL EXAM – _____ and _____ (Fast or slow heart rate, irregular rhythm, extra sounds, long pauses, or abnormal heart sounds)
DEFINITIVE TEST –
- ____
- Blood and Urine Tests
- _____ Monitor - a wearable device that records the heart for 1-2 days
- Echocardiogram
- Chest X-ray
- _____ Testing (or EP studies)
- _____ (CABG) and PCI
- Exercise Stress Testing- a contraindication
Pulse Auscultation Electrocardiogram (ECG/EKG) Holter Electrophysiologic Cardiac Catheterization
WHAT IS cardiac ARRHYTHMIAS?
- Disturbance of _____, _____ or _____
- Incidental (premature atrial beats), life threatening (ventricular fibrillation) or lethal
- Classification –
- _____ beats
- Slowing of heart (_____)
- Speeding (_____)
- _____
rhythm rate conduction Ectopic sinus bradycardia sinus tachycardia Arresting
Reentry – a Mechanism Underlying a Majority of Clinically Significant Arrhythmias
-Reentrant excitation can occur under conditions of _____ conduction &/or in regions having a dispersion of _____ (an increased heterogeneity of refractory periods in tissue, where _____ values differ greatly in neighboring areas
slow
refractoriness
ERP
WOLF-PARKINSON-WHITE SYNDROME
- An anatomical accessory _____ pathway for a _____
- Symptoms - _____, dizziness, _____, and angina.
- _____ and _____ (SVTs) may be leading to ventricular fibrillation and death
AV reentrant tachycardia fatigue syncope Paroxysmal atrial fibrillation flutter
LIDOCAINE
- Drug of 2nd choice (vs Amiodarone) to terminate _____ and prevent _____ after _____
- Cardiac arrest –100 mg bolus every 5-10 mins
- Used only in ______ setting
- Ineffective against _____
- _____ (Extensive first pass metabolism)
V tach V fib DC cardioversion hospital atrial arrhythmias IV
BETA BLOCKERS
- Reduce the automaticity of _____ (by blocking the effect of _____ stimulation)
- Direct _____ effects
- Decrease conduction velocity at _____ node
- Decrease _____action potentials by increasing action potential duration and effective _____ period
- Augment _______ due to increased _____ time
- Uses-
- _____ induced arrhythmias,
- Decreases incidence of _____(PSVT) + Prophylaxis
- First line drugs for ____ along with _____
pacemaker catecholamine membrane AV non-pacemaker refractory coronary perfusion diastolic Exercise AVN reentry A fib CCBs
K CHANNEL BLOCKERS
- _____ is highly bound to body tissues (very long t1/2)
- Very _____ soluble
- Cardiac concentration is _____ times that of plasma
- Effective against both _____ and _____ (blocks Na, K, Ca channels & alpha + beta receptors)
- May increase levels of _____, _____, Procainamide due to inhibition of CYP 450 enzymes
- _____ – 2nd choice for recurrence of Afib
Amiodarone lipid 50 Atrial Ventricular arrhythmias Warfarin digitalis Sotalol
CA CHANNEL BLOCKERS
- Channels – _____ and _____
- Verapamil & Diltiazem block ____ lasting type (Non-dihydropyridines)
- Slow down _____ conduction and increase _____
- Negative _____ and negative _____
- Uses:
- _____ (2nd choice) and control _____ rate in A fib & A flutter
- _____ Prophylaxis
- Prevent acute _____ secondary to _____
- _____ (____pine): Smooth muscles of blood vessels
- Side effect – Severe _____ due to inhibition of colonic motor activity
do not use these for ____
L type T type long AVN AVN ERP chronotropic inotropic PSVT ventricular
MI coronary artery spasm Dihydropyridines constipation CHF
ADENOSINE
- ___, Half life- _____
- Similar effect to _____
- When it is administered intravenously, adenosine causes transient_____ in the AV node via the _____ receptor, inhibiting _____, decreasing _____ and so causing cell _____ by increasing K+ efflux (increases AVN ERP)
- USE – Acute drug induced conversion of _____ node re-entry to sinus rhythm and to treat _____
- Increase in _____ tone decreases SA and AV nodal activity.
- DC cardioversion can be used if the patient is _____ unstable, and requires immediate treatment
IV few seconds ACH transient heart block Adenosine A1 adenylyl cyclase cAMP hyperpolarization AV PSVT vagal hemodynamically
LIDOCAINE TOXICITY
- _____
- _____ taste
- _____ speech
- _____ and _____ disturbance
- _____ (numb lips)
- Tremors
- _____ and coma (CNS excitation and /or depression)
- Impaired _____ function- higher incidence
- _____, _____ and _____
Tinnitus metallic slurred Visual hearing Paresthesias seizures liver Metronidazole clarithromycin tetracyclines
AMIODARONE
- _____ microdeposits
- Peripheral _____
- Disturbance in _____ function (hypo/hyper)
- _____ (blue-gray discoloration – Blue man syndrome)
- _____
- Pulmonary fibrosis (_______) - anti cancer drug
- Drug-induced photosensitivity –
- _____ (Doxycycline)
- NSAIDs (Naproxen)
- _____ (Voriconazole)
Corneal neuropathy thyroid parasthesias bleomycin Photosensitivity Torsades de pointe Tetracyclines NSAIDs antifungals
calcium channel blockers
- _____ hypertrophy/hyperplasia
- _______
- Peripheral _____
- _____
- phenytoin and cyclosporine
Gingival
constipation
vasodilation
syncope
TORSADES DE POINTEs
-A lethal _____
-Rapid, irregular _____/ Polymorphic VT, an illusion of a _____ around the ECG isoelectric baseline.
Factors –
- Prolonged _____ syndrome
- _____ loss (Diarrhea, Hypokalemia, Hypomagnesemia, Hypocalcemia, Chr alcoholics)
- _____ disease (CHF, LVH)
- medications
(_____, _____, _____, _____, Phenothiazines and anti-arrhythmics
VT QRS complexes twisting QT Electrolyte Heart medications Macrolides methadone lithium TCAs
LONG QT SYNDROME
-Congenital – Genetic defect in _____ channels involved during _____ + Facial _____
Acquired –
-_____
-During____
-Heart ds (HOCM, Acute MI, Acute myocarditis)
-_____
-History of _______ is the most typical clinical presentation in patients with long QT syndrome
K+ repolarization dysmorhia DRUGS sleep Hypothermia
Drugs causing lqts
- Meds causing _____
- Local _____ and ______
- Sedative hypnotic – ________ (knock-out drug)
- _____
- _____
- Inhalational anesthetics, such as Halothane, Enflurane, and Sevoflurane
- N2O (_____)- no effect on QT
- Propofol – both ↑ or ↓ QT
Torsades anesthetics epinephrine chloral hydrate Fluoroquinolones antifungals Nitrous oxide
___________> 100 beats/min
Physiological response to exercise, anxiety, stress or emotions
Meds- Atropine, Epinephrine, Nicotine, Caffeine
Pathological – Fever, Hypoxia, Infection, Anemia, Hyperthyroidism
________ > 150-200 beats/min
COPD, Acute MI, Pneumonia
__________ 220 – 360 beats/min, Regular
IHD, Mitral stenosis
___________ 400 – 650 beats/min + no p wave tracing, Irregular
Thrombus
_____________100/min + 3 or more ectopic ventricular beats per min
sinus tachycardia atrial tachycardia atrial flutter atrial fibrillation ventricular tachycardia
entry of sodium ions, Na+ channels open, depolarization
phase 0
short peak the sodium channels start to close, decrease in movement of sodium ions towards inside of the cell
phase 1
plateau phase, contraction is occuring
phase 2
repolarization phase, K+ is moving out (efflux)
phase 3
resting potential
phase 4
