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Antirrhythmatics Drugs Flashcards

1
Q

Class IA drugs function?

A

Prolong the refractory period
Slows the conduction
Or slows the phase 0 depolarisation of the ventricle

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2
Q

What are the names of class IA anti arrhythmics?

A

Quinidine
Disopyramide
Procainamide

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3
Q

Class IA drugs are used to suppress ________________

A

Ventricular arrhythmias

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4
Q

Quinidine is used for ventricular and supraventricular arrhythmia especially caused by ________

A

Ectopia

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5
Q

What are the uses of quinidine

A

Ventricular and supraventricular arrhythmia

Maintain sinus rhythm after conversion of atrial flutter or fibrillation by drugs

Quinine isomer so antimalarial antipyeritic and oxytoxic effect

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6
Q

What are adverse effects of quinidine

A 
Skeletal muscle weakness (especially in myasthenia gravis)
Hypotension and shock
Cinchonism
Thrombocytopenia
Quinidine syncope
GI distress
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7
Q

What is quinidine syncope

A

Dizziness and fainting due to ventricular tachycardia. Associated with a prolonged QT interval

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8
Q

Quinidine increases the plasma levels of ___________ and risk of _________ toxicity

A

Digoxin

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9
Q

Quinidine causes _________ toxicity

A

Digoxin

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10
Q

Digoxin toxicity is due to __________ class IA anti arrhythmic

A

Quinidine

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11
Q

The t1/2 of quinidine is decreased by?

A

Phenytoin and phenobarbital

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12
Q

The cardiotoxic effects of quinidine are exacerbated by ______________

A

Hyperkalemia

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13
Q

Lupus like syndrome is a consequence of _____________

A

Procainamide

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14
Q

Procainamide pros?

A

Safer to use as IV

Few GI adverse effects

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15
Q

Procainamide cons?

A

Lupus like syndrome
Dose reduction in renal failure
Severe of irreversible heart failure

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16
Q

Onset of Lupus like syndrome is early in ________ acetylators (slow/fast)

A

Slow

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17
Q

Procainamide is acetylated to__________ that also has anti arrhythmic properties

A

NAPA(n-acetyl provainamide)

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18
Q

Half life of procainamide?

A

3-4 hours

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19
Q

Disopyramide has the _________ (shortest/longest) half life of its class

A

Longest

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20
Q

Disopyramide is used for the treatment of ventricular arrhythmias generally for ____________

A

Cases refractory or intolerant to quinidine or procainamide

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21
Q

Adverse effects of disopyramide

A 
Dry mouth
Blurred vision
Constipation
Urinary retention
Acute angle closure glaucoma
Worsen heart block and adversely affect sinus node function
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22
Q

_________is the second line choice for the treatment pf ventricular arrhythmias

A

Lidocaine

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23
Q

First line choice for treating ventricular arrhythmias?

A

Amiodarone

Electrical defibrillation

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24
Q

____________ is ineffective in the prevention of arrhythmia subsequent to MI

A

Lidocaine

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25
Dose of lidocaine has to be adjusted in _________ and _________
CHF | Hepatic disease
26
Adverse effects of lidocaine?
Neurological symptoms like seizures | Low toxic effect on heart and autonomic nervous system
27
____________ used for the long term tx of ventricular arrhythmia associated with previous MI (class IB)
Mexiletine
28
Flecainide is used for?
Maintenance of sinus rhythm in pts w/ paroxysmal atrial fibrillation or atrial flutter Ventricular tachyarrhythmias
29
What does class IC drugs do?
Maximally slows the rate of phase 0 depolarization of ventricles Slows His-perkunjie conduction Causes QRS widening Shorten the action potential of perkunjie fibers
30
Class IC drugs use is limited due to _________
proarrhythmias
31
Use flecainide w/ caution in patients w/ ________, __________ and ____________
CHF Post MI Sinus node dysfunction (SND)
32
Propafenone is a class _____ drug
Class IC
33
Propafenone is used for?
Supraventricular arrhythmias | Ventricular arrhythmias
34
Adverse effects of propafenone?
CHF Bradycardia New arrhythmias
35
What are the names of class II antiarrhythmic drugs?
Propranolol Esmolol Acebutalol
36
WHat are the functions of class II drugs?
Decrease automaticity Slows HR and contractility Prolongs the AV nodal conduction Inhibit phase 4 depolarization
37
What are class II drugs?
Beta antagonist
38
Group the class II drugs acc to selective and non selective B antagonist?
B1 selective - Esmolol and Acebutalol | B nonselective - Propranolol
39
Class II drugs are used for the treatment of ventricular tachyarrhythmias due to ___________
increased sympathetic activity
40
What is propranolol used for?
Atrial fibrillation/flutter Reflex tachycardia due to vasodilating agents Digitalis toxicity Recurrent MI
41
What are the adverse effects of propranolol?
``` Bronchospasm (don't give in asthma) Arteriolar vasoconstriction Myocardial depression Bradycardia Heart block ```
42
__________ and __________ are given for the adverse effects of propranolol? (bradycardia)
Atropine and Isoproterenol
43
What are the names of class III drugs?
``` Amiodarone Dronedarone Sotalol Ibutilide Dufetilide ```
44
Amiodarone → uses?
Ventricular arrhythmias in preference to lidocaine Conversion of Atrial fibrillation Suppression of arrhythmias in pts w/ implanted defibrillators Antianginal and vasodilatory effects
45
_________ is the first line agent for patients refractory to CPR
Amiodarone
46
Dronedarone is used for the treatment of _____________
permanent atrial fibrillation/flutter (that cannot be converted to normal sinus rhythm)
47
Amiodarone has a ________ half life
long (14-100 days) | so effects take a long time to set in and stays for long period
48
Amiodarone has long half life so it can be used for patients who have _________
long working hours
49
What r the adverse effects of amiodarone?
``` Gray man syndrome Pulmonary fibrosis Interstitial pneumonitis GI related effects Photosensitivity Corneal microdeposits Thyroid disorders ```
50
Amidarone is structurally related to ________-
thyroxine
51
Defutilide and Ibutilide are used for ___________
maintanence of sinus rhythm after conversion of atrial fibrillation/flutter
52
___________ does not affect the conduction velocity (Class III)
Defutilide
53
What is the function of class III drug?
Prolongs the action potential duration and effective refractory period
54
__________ also has B-adrenoceptor antagonist activity (class III)
sotalol
55
Adverse effects of Sotalol?
Proarrhythmias Dyspnea Dizziness
56
What are the name sof class IV drugs?
Verapamil | Diltiazem
57
Class IV drugs block ______________-
L type Ca channels
58
Class IV drugs functions?
Prolong nodal conduction and effective refractory period
59
Effect of Class IV drugs is mainly on the ________
node
60
Dose reduction is required in ________ and __________ in verapamil
hepatic disease | elderly
61
What is verapamil used for?
Reentrant supraventricular tachycardia | Reduce ventricular rate in atrial flutter/fibrillation
62
Verapamil has _______ inotropic effect
negative
63
Verapamil can lead to ________ if given in large doses or in patients w/ partial blockage
AV block
64
Verapamil adverse effects
``` Sinus bradycardia Sinus arrest Peripheral vasodilation Transient asystole Arrhythmias ```
65
Arrhythmias due to verapamil can get exacerbated due to ____________
B adrenoceptor antagonists
66
Arrhythmias due to verapamil and B antagonists can be reversed by?
Atropine B agonists Calcium
67
Verapamil should not be used in patients w/ abnormal conduction circuits like in ____________-
Wolff-Parkinson white syndrome
68
What is the advantage of diltiazem over verapamil?
Diltiazem has less inotropic effect
69
Uses of diltiazem
Supraventricular arrhythmias because of inhibitory effects on conduction through AV node
70
How does adenosine works?
Acts thru purinergic receptors Increase K+ influx and decrease Ca++ influx leading to hyperpolarization and decreases calcium dependent part of action potential
71
Adenosine is the DRUG OF CHOICE for the tx of __________________ including those associated w/ Wolff parkinson white syndrome
Paroxysmal supraventricular arrhythmias
72
Digoxin controls the __________ response in atrial flutter/fibrillation
ventricular response
73
__________ is used for the treatment of bradycardia that accompany MI
Atropine
74
Isoproterenol is used to _____________ and ____________ in patients w/ AV block
maintain heart rate | cardiac output
75
Adverse effects of Isoproterenol?
``` Tachycardia Anginal effects Headache Dizziness Flushing Tremors ```

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