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Pharm I Fall 2016 NUNM Jensen > Arrhythmia > Flashcards

Arrhythmia Flashcards

1
Q

How do anti-arrhythmic drugs generally work?

A

By affecting either specialized ion channels or sympathetic tone

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2
Q

What are the three main I-a class drugs? (Double Quarter Pounder)

A

Disopyramide
Quinidine
Procainamide

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3
Q

What is the MOA of class I-a drugs?

A

Moderate block of both open Na+ and K+ channels

  • slow phase 0 depolarization
  • prolong action potential and slow conduction
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4
Q

What conditions do class I-a drugs treat?

A

Ventricular tachyarrhythmias
Paroxysmal recurrent afib
Wolff-Parkinson-White syn. (procainamide)

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5
Q

What are the three I-b drugs? (Lettuce Pickles Mayo)

A

Lidocaine
Phenytoin
Mexiletine

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6
Q

What is the MOA for class I-b drugs?

A

Mild blocking or inactivating Na+ channels

  • shorten phase 3 repolarization
  • decrease the duration of the action potential
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7
Q

What conditions do class I-b drugs treat?

A

Ventricular tachycardias

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8
Q

What are the two I-c drugs? (Fries Please)

A

Flecainide

Propafenone

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9
Q

What is the MOA for class I-c drugs?

A

Block open Na+ channels

-markedly slow phase 0 depolarization

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10
Q

What conditions do class I-c drugs treat?

A

Paroxysmal atrial fibrilation

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11
Q

What is the class II drug?

A

Propranolol

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12
Q

What is the MOA of Propranolol (II)?

A

Block catecholamines at the AV node

  • decrease slope of phase 4 depolarization
  • prolong repolarization in AV node > block reentry
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13
Q

What conditions does Propranolol (II) treat?

A

Tachyarrhythmia

Supraventricular

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14
Q

What are the five class III drugs?

A 
Amiodarone
Sotalol
Ibutilide
Dofetilide
Dronedarone
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15
Q

What is the MOA of Class III drugs?

A 
Blocking IKr (rapid K+ delayed reaction, outflow)
-prolong phase 3 repolarization without altering phase 0
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16
Q

What conditions do class III drugs treat?

A

Wolff-Parkingons-White syn. (sotalol)
Ventricular arrhythmias
Atrial tachyarrhythmias

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17
Q

What makes Amiodarone different from other Class III drugs?

A

It blocks like other classes
Has a two month half-life
Treats atrial flutter, afib, vtach, vflutter, SVT

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18
Q

What are the class IV drugs?

A

Non-dihydropyridine CCBs
Verapamil
Diltiazem

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19
Q

What is the MOA of class IV drugs?

A 
Block L-type Ca++ channels, decrease AV node conduction and increase refractory period
-similar to class II but does not block the adrenergic system
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20
Q

What conditions do the class IV drugs treat?

A

Prevent recurrence of paroxysmal supraventricular tachycardias
Control ventricular rate in afib

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21
Q

What treatments control rate?

A

Class II, IV, digoxin

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22
Q

What treatments control rhythm?

A

Class I-a, I-c, III

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23
Q

What are two nonpharmacologic treatments for rate and rhythm control?

A

Ablation and pacing

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24
Q

What are the drug interactions or contraindications for Quinidine?

A

Warfarin and digoxin

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25
Q

What are the drug interactions or contraindications for Disopyramide?

26
Q

What are the drug interactions or contraindications for Mexiletine?

A

3rd degree AV block

27
Q

What are the drug interactions or contraindications for Propafenone?

A

Heart failure, liver disease, valvular disease, CAD, Vtach
May increase digoxin concentrations
May decrease warfarin metabolism, BB properties

28
Q

What are the drug interactions or contraindications for Flecainide?

A

Increase digoxin

Increased by haloperidol, cimetidine, fluoxetine

29
Q

What are the drug interactions or contraindications for beta blockers?

A

Severe sinus bradycardia or heart block

30
Q

What are the drug interactions or contraindications for Class III drugs?

A

Iodine hypersensitivity, hyperthyroidism, 3rd degree AV heart block
Warfarin, reduce 25-50%, recheck INR. Digoxin, reduce 50%. Statin (max 20mg).

31
Q

What are the indications for Quinidine?

A

AF, Aflutter, paroxysmal supraventricular tachycardia, ventricular arrhythmias

32
Q

What are the indications for Disopyramide?

A

Only paroxysmal supraventricular tachycardia

33
Q

What are the indications for Mexiletine?

A

Ventricular arrhythmias

34
Q

What are the indications for Propafenone?

A

AF and atrial flutter, paroxysmal supraventricular tachycardia, ventricular arrythmias

35
Q

What are the indications for beta-blockers?

A

AF, atrial flutter, paroxysmal supraventricular tachycardia, ventricular arrhythmias

36
Q

What are the indications for Amiodarone?

A

Supraventricular and ventricular arrhythmias

37
Q

What are the indications for Dronedarone?

A

Paroxysmal or persistent atrial fibrillation and atrial flutter

38
Q

What are the indications for Sotalol?

A

Ventricular arrhythmias; maintenance of AF and atrial flutter

39
Q

What class has the highest risk of causing a proarrhythmia? Which drugs have a dose-related effect?

A 
Class I
Sotalol, class I-c and NAPA
40
Q

What is a side effect that must be considered with all antiarrhythmics and how do you monitor it?

A

QT prolongation

EKG

41
Q

What type of side effects should be monitored for all class I-a drugs?

A

Anticholinergic effects

42
Q

What are the potential side effects of Quinidine?

A

Negative inotropic, vagolytic, syncope, torsades

Cinchonism, GI, thrombocytopenia, DILE

43
Q

What are the potential side effects of Procainamide?

A

Weak ganglionic blocking, NAPA metabolite

DILE

44
Q

What are the potential side effects of class I-b drugs in general?

A

Neurologic (depression, convulsions)

45
Q

What are the potential side effects of Lidocaine?

A

CNS excitation or depression, N/V, tremor, vertigo, metalic taste, numb lips, visual and hearing disturbances
High concentrations > convulsions, resp. distress, seizures

46
Q

What are the potential side effects of Propafenone?

A

Proarrhythmia in pts w/ ischemic heart disease, beta-blocking
Metallic taste, dizziness

47
Q

What are the potential side effects of Propranolol?

A

Bradycardia, hypotension, left ventricular failure, AVN block, bronchospasm

48
Q

What are the potential side effects of Amiodarone?

A

Corneal microdeposits, peripheral neuropathy, pulmonary fibrosis, disturbed thyroid function, photosensitivity, heart failure, torsades

49
Q

What are the potential side effects of Sotalol?

A

Non-selective beta blockade, torsades

50
Q

What are the potential side effects of Verapamil and Diltiazem?

A

Negative inotropic, AVN block, sinus arrest

Peripheral vasodilation, constipation, dizziness, flushing, h/a, hypotension, gums can overgrow the teeth

51
Q

What is the MOA of adenosine?

A

Acts on adenosine receptors to decrease adenylyl cyclase to decrease cAMP
-increase K+ efflux > cell hyperpolarization (transient heart block of AVN)

52
Q

What conditions does Adenosine treat?

A

AV reentrant tachycardia

AV nodal reentrant tachycardia

53
Q

What are the potential side effects of adenosine?

A

Transient hypotension and chest pain

54
Q

What is the MOA of Atropine?

A

Competitive inhibitor of muscarinic acetylcholine receptors

55
Q

What is the indication for Atropine?

A

Bradycardia

56
Q

What are the potential side effects of Atropine?

A

Blurry vision, dry mouth, tachycardia (dry as a bone, red as a beet, hot as a hare, blind as a bat, mad as a hatter)

57
Q

What is the antidote to Atropine?

A

Physostigmine

58
Q

What is the MOA of Digoxin?

A

Inhibit the Na+/K+ ATPase in the myocardium

  • decrease membrane Na+ gradient
  • decrease Na+-Ca++ exchange
  • increase intracellular Ca++
59
Q

What conditions does Digoxin treat?

A

Afib, atrial flutter w/ RVR, heart failure

60
Q

What are the potential side effects of Digoxin?

A

Bradycardia, partial or complete heart block, GI, drowsiness and fatigue, visual disturbances

Pharm I Fall 2016 NUNM Jensen (11 decks)

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