Arrhythmia Flashcards by Matthew Hicks

How do anti-arrhythmic drugs generally work?

By affecting either specialized ion channels or sympathetic tone

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

Disopyramide
Quinidine
Procainamide

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What is the MOA of class I-a drugs?

Moderate block of both open Na+ and K+ channels

slow phase 0 depolarization
prolong action potential and slow conduction

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What conditions do class I-a drugs treat?

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

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

Lidocaine
Phenytoin
Mexiletine

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What is the MOA for class I-b drugs?

Mild blocking or inactivating Na+ channels

shorten phase 3 repolarization
decrease the duration of the action potential

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What conditions do class I-b drugs treat?

Ventricular tachycardias

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

Flecainide

Propafenone

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What is the MOA for class I-c drugs?

Block open Na+ channels

-markedly slow phase 0 depolarization

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What conditions do class I-c drugs treat?

Paroxysmal atrial fibrilation

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What is the class II drug?

Propranolol

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What is the MOA of Propranolol (II)?

Block catecholamines at the AV node

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

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What conditions does Propranolol (II) treat?

Tachyarrhythmia

Supraventricular

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What are the five class III drugs?

Amiodarone
Sotalol
Ibutilide
Dofetilide
Dronedarone

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What is the MOA of Class III drugs?

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

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What conditions do class III drugs treat?

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

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What makes Amiodarone different from other Class III drugs?

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

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What are the class IV drugs?

Non-dihydropyridine CCBs
Verapamil
Diltiazem

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What is the MOA of class IV drugs?

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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What conditions do the class IV drugs treat?

Prevent recurrence of paroxysmal supraventricular tachycardias
Control ventricular rate in afib

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What treatments control rate?

Class II, IV, digoxin

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What treatments control rhythm?

Class I-a, I-c, III

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What are two nonpharmacologic treatments for rate and rhythm control?

Ablation and pacing

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What are the drug interactions or contraindications for Quinidine?

Warfarin and digoxin

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What are the drug interactions or contraindications for Disopyramide?

Glaucoma

What are the drug interactions or contraindications for Mexiletine?

3rd degree AV block

What are the drug interactions or contraindications for Propafenone?

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

What are the drug interactions or contraindications for Flecainide?

Increase digoxin | Increased by haloperidol, cimetidine, fluoxetine

What are the drug interactions or contraindications for beta blockers?

Severe sinus bradycardia or heart block

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

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

What are the indications for Quinidine?

AF, Aflutter, paroxysmal supraventricular tachycardia, ventricular arrhythmias

What are the indications for Disopyramide?

Only paroxysmal supraventricular tachycardia

What are the indications for Mexiletine?

Ventricular arrhythmias

What are the indications for Propafenone?

AF and atrial flutter, paroxysmal supraventricular tachycardia, ventricular arrythmias

What are the indications for beta-blockers?

AF, atrial flutter, paroxysmal supraventricular tachycardia, ventricular arrhythmias

What are the indications for Amiodarone?

Supraventricular and ventricular arrhythmias

What are the indications for Dronedarone?

Paroxysmal or persistent atrial fibrillation and atrial flutter

What are the indications for Sotalol?

Ventricular arrhythmias; maintenance of AF and atrial flutter

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

``` Class I Sotalol, class I-c and NAPA ```

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

QT prolongation | EKG

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

Anticholinergic effects

What are the potential side effects of Quinidine?

Negative inotropic, vagolytic, syncope, torsades | Cinchonism, GI, thrombocytopenia, DILE

What are the potential side effects of Procainamide?

Weak ganglionic blocking, NAPA metabolite | DILE

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

Neurologic (depression, convulsions)

What are the potential side effects of Lidocaine?

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

What are the potential side effects of Propafenone?

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

What are the potential side effects of Propranolol?

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

What are the potential side effects of Amiodarone?

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

What are the potential side effects of Sotalol?

Non-selective beta blockade, torsades

What are the potential side effects of Verapamil and Diltiazem?

Negative inotropic, AVN block, sinus arrest | Peripheral vasodilation, constipation, dizziness, flushing, h/a, hypotension, gums can overgrow the teeth

What is the MOA of adenosine?

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

What conditions does Adenosine treat?

AV reentrant tachycardia | AV nodal reentrant tachycardia

What are the potential side effects of adenosine?

Transient hypotension and chest pain

What is the MOA of Atropine?

Competitive inhibitor of muscarinic acetylcholine receptors

What is the indication for Atropine?

Bradycardia

What are the potential side effects of Atropine?

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)

What is the antidote to Atropine?

Physostigmine

What is the MOA of Digoxin?

Inhibit the Na+/K+ ATPase in the myocardium - decrease membrane Na+ gradient - decrease Na+-Ca++ exchange - increase intracellular Ca++

What conditions does Digoxin treat?

Afib, atrial flutter w/ RVR, heart failure

What are the potential side effects of Digoxin?

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

Arrhythmia Flashcards

(60 cards)