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Pharmacology > Antidysrhythmic Drugs > Flashcards

Antidysrhythmic Drugs Flashcards

0
Q

Quinidine: What kind of alkaloid is Quinidine?

A

Cinchona alkaloids

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1
Q

Sodium Channel Blockers

A

Quinidine
Lidocaine
Flecainide

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2
Q

Quinidine: Effects on the heart

A

Na channel block
Slows conduction in atria, ventricles and His-Purkinje fibers
Delays repolarization at these sites [K block]
Blocks vagal input to the heart

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3
Q

Quinidine: Vagal block effects

A

Blocks muscarinic receptors
Parasympathetic blocking action
Decrease AV refractory period-> increased conduction velocity AV node
Rapid atrial rate can drive ventricles at excessive rate [paradoxical ventricular tacycardia]
Prevention: Digoxin

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4
Q

Quinidine: Effects on the ECG

A

Widens the QRS complex [ slowing depolarization of ventricles]
Prolongs the QT interval [ delay ventricular repolarization]

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5
Q

Quinidine: Therapeutic use

A

Used against supraventricular and ventricular dysrhythmias

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6
Q

Quinidine: Adverse effects

A

Diarrhea
Cinchonism [ tinnitus, headache, visual disturbance]
Anticholinergic efects
Cardiotoxicity
- “paradoxical ventricular tachycardia”
- Sinus arrest
- DC and notify prescriber if QRS widening is greater than 50%

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7
Q

Quinidine: Drug interactions

A

Digoxin
- Levels increase 2x by quinidine
Anticholinergics
- Increase effect [ tachycardia, dry mouth]

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8
Q

Quinidine: C/I

A

Risk of embolism following conversion of atrial fibrillation to sinus rhythm
Should not be used in presence of any degree of block except those associated with atrial arrhythmias
When AV block from digitalis intoxication

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9
Q

Quinidine: Affiliation with Digitalis

A

Digitalis is administered before quinidine in presence of atrial flutter of fibrillation

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10
Q

Procainimide: Relation

A

Similar to quinidine

Weakly anticholinergic

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11
Q

Procainamide: Adverse effects

A

Symptoms of systemic lupus erythematosus

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12
Q

Disopyramide: Relation

A

Similar to quinidine
Even greater anticholinergic
Prominent side effects causing limited use

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13
Q

Lidocaine: Mechanism

A

Blocks cardiac sodium channels
- Slows conduction in the atria, ventricles, and His-purkinje system
- Less effect on normal than in ischemic/ dysrhythmic tissue
- Less cardiotoxic than other
Reduces automaticity in the ventricles
Accelerates repolarization

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14
Q

Lidocaine: Adverse effects

A 
Hypotension in large doses
CNS effects
   - Drowsiness
   - Confusion
   - Paresthesias
   - Respiratory arrest
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15
Q

Lidocaine: Use

A

Emergency treatment of arrhythmias

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16
Q

Lidocaine: Oral analog

A

Mexiletine

17
Q

Beta blocking agents

A

Propranolol
Acebutolol
Esmolol
Sotalol

18
Q

Propranolol: Effects on the heart and ECG

A

Decreased automaticity of the SA node
Decreased velocity of conduction through the AV node
Decreased myocardial contractility
Decreases HR

19
Q

Propranolol: Therapeutic Use

A

Dysrhythmias caused by excessive sympathetic stimulation
Supraventricular tachydysrhythmias
- Suppression of excessive discharge
- Slowing of ventricular rate

20
Q

Propranolol: Adverse effects

A 
Heart block 
Heart failure
AV block
Sinus arrest 
Hypotension
Bronchospasm
21
Q

Potassium Channel blockers

A

Bretylium

Amiodarone

22
Q

Bretylium: Mechanism

A

Delays repolarization of fast potentials through block of calcium channel

23
Q

Bretylium: Effects on ECG

A

QT interval prolonged

24
Q

Bretylium: Adverse effect

A

Profound persistent hypotension

Guanethidine like effect on catechoamines

25
Q

Bretylium: Use

A

Ventricular fibrillation

Ventricular tachycardia

26
Q

Amiodarone: Use

A

Broad spectrum
For life-threatening ventricular dysrhythmias
Recurrent ventricular fibrillation
Recurrent hemodynamically unstable ventricular tachycardia

27
Q

Amiodarone: Effect on the heart and ECG

A 
Reduced automaticity in the SA node
Reduced contractility
Reduced conduction velocity
QRS widening
Prolongation of the PR And QT intervals (effective refractory period)
Decreases pace maker activity
28
Q

Amiodarone: Adverse effects

A 
Pulmonary toxicity (pneumonitis)
Cardiotoxicity
   - Cardiotoxicity
Toxicity in pregnancy and breast feeding
Corneal microdeposits
Optic neuropathy
29
Q

Amiodarone: Drug interactions

A 
Quinidine
Digoxin
Procainamide
Diltiazem
Phenytoin
Warfarin
30
Q

Sotalol

A 
Combined class II and class III properties
Beta blocker that also delays repolarization
Torsades de pointes in around 5%
31
Q

Dofetilide

A 
Oral class III antidysrhythmic 
Predisposes patient to torsades de pointes
32
Q

CCB: Drugs

A

Verapamil

Diltiazem

33
Q

Verapamil and diltiazem: Mechanism

A

Reduce SA nodal automaticity
Delay AV nodal conduction
Reduce myocardial contractility

34
Q

Verapamil and diltiazem: Therapeutic

A

Slow ventricular rate (atrial fibrillation or atrial flutter)
Terminate SVT caused by an AV nodal reentrant circuit

35
Q

Verapamil and diltiazem: Adverse effects

A 
Bradycardia
Hypotension
AV block 
Heart failure
Peripheral edema
Constipation
Can elevate digoxin levels
Increased risk when combined with a beta blocker
36
Q

Adenosine: Effect on the heart and ECG

A

Decreases automaticity in the SA node
Slows conduction through the AV node
Prolongation of PR interval

37
Q

Adenosine: Therapeutic use

A

Termination of paroxysmal SVT

38
Q

Adenosine: Adverse effects

A 
Sinus bradycardia
Dyspnea
Hypotension
Facial flushing
Chest discomfort
39
Q

Adenosine: Drug interactions

A

Methylxanthines

Dipyridamole

40
Q

Digoxin: Mechanism

A

Suppresses dysrhythmias by decreasing conduction through AV node and automaticity in the SA node
QT interval may be shortened

41
Q

Digoxin: Adverse effect

A

Cardiotoxicity

Pharmacology (13 decks)

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