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CVS Pharma papre 1 > Arrythmia > Flashcards

Arrythmia Flashcards

1
Q

بسم الله الرحمن الرحيم وبه نستعين

arrhthmia more common in?

A

MI
, anesthesia
& with drugs e.g. Digoxin

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2
Q

Treatment includes:

A

❶ Cardioversion. ❷ Pacing ❸ Drug

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3
Q

Disturbances in normal automaticity:

A
  • ↑ Sympathetic (thyrotoxicosis) → ↑ Ca++ influx → ↑ slop of phase 4 → Sinus tachycardia (Treated by Beta blockers)
  • ↑Vagal tone (Digoxin toxicity & Carotid sinus syndrome) → ↑ K+ outflux → ↓ slope of phase 4 → Sinus bradycardia (Treated by Atropine)
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4
Q

Abnormal automaticity (ectopic focus):

A

Ischemia →
abnormal depolarization →
↑ slope of phase 4 →
initiates abnormal automaticity in( non) automatic tissues

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5
Q

❶ Heart block

A
  • 1st degree: All impulses reach
  • 2nd degree: some impulses reach
  • 3rd degree: Complete AV Block
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6
Q

Re-entry arrhythmia: Occurs when continues circulation of an impulse occur → re-enter the point of origin →

A

re excite the same part of the heart more than once (circus movement):
A. Ventricular tachycardia, ventricular fibrillation جدا خطر & QT syndrome

B. Atrial flutter (Single focus/ regular) & Atrial fibrillation (multiple/ irregular) خطوره أقل

C. PSVT (paroxysmal Supraventricular tachycardia)
• AV nodal re-entrant tachycardia (AVNRT)
• Atrioventricular re- entrant tachycardia (AVRT) e.g. WPW syndrome: Pre-excitation Syndrome is a heart condition in which part of the cardiac ventricles are activated too early due to presence of accessory bundle (e.g Bundle of Kent)

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7
Q

Classification according to mechanism of action (Vaughn William classification)

A

Class I: Na+ channel blockers
Ia: Procainamide Ib: Lidocaine, Phenytoin Ic: Propafenone

Class II: beta blockers: Propranolol, Esmolol, Atenolol

Class III: K+channel blockers: Amiodarone

Class IV: CCBs: Verapamil

Miscellaneous: Adenosine, Digoxin

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8
Q

Class I:

Ia: Procainamide Ib: Lidocaine, Phenytoin Ic: Propafenone

A

Na+ channel blockers

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9
Q

Class II: ?: Propranolol, Esmolol, Atenolol

A

beta blockers

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10
Q

Class III:?: Amiodarone

A

K+channel blockers

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11
Q

Class IV:?: Verapamil

A

CCBs

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12
Q

All can be given orally except

A

Lidocaine
Esmolol
Adenosine

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13
Q

Na+channel blocker(fast fiber)

A

A.↓Vmax & conduction velocity

B.↓Automaticity (↓ slope phase 4)

C. ↑ ERP

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14
Q

Rate of dissociation from Na+

channels

A

Ia: Procainamide moderate
Ib lidocaine : rapid
Ic Propafenone : slow dissociation most

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15
Q

Procainamide and K channels?

A

BLOCK BOTH?

Increasing APD and ERP

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16
Q

Ib lidocaine ?>

A

Open K channels

Decrasing APD and ERP

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17
Q

Propafenone ? Ic K channels

A

No effect on K channels
No effect on APD
Increasing ERP ?

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18
Q

Effect on AVN

A

pROCAIMIDE INCREASING APD AND ERP
LIDOCAINE NO EFFECT
Propfaenone : BB EFFET INCREASING ERP

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19
Q

Procainamid on ecg?

A

prolong pr and qt intervals and QRS

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20
Q

Lidocaine and ecg?

A

No effect on PR interval nor AVN ?

Shorten the QT interval due to opening of the K channels

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21
Q

propfanone and ecg?

A

Prlolng pr interval due to BB effect

Prlong qrs and qt interval due to Na channel blcking and slow dissociation

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22
Q

Procainamide autoniomic effect? A

A

ANTIM MUSCARIN
GANGLIONO BLOCKADE
ALPHA BLOCKADE

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23
Q

pROPAFENONT AUTOMNOMIC EFFECT?

A

BB

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24
Q

Theraputic users of procaimaide?

A

BS

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25
Q

Lidocaine?

A

NS/V

Digtalis induced arrhytmia

after Myocardial infarction

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26
Q

Adverse effects of the Procaiameide? s

A

TSC2

Cardiac toxixity HMQ
Myocardial depression
prlong qt interval torsade de pointes
Hypotension block sympathatic ganglia

Cinnchonism
Thromboemolism
Systemic lupus

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27
Q

Lidocaine?

A

Least Cardiotoxic
CNS Perioral parathesia
dizzness
convulsions

AF AND Af due to low ERP
PSVT NO effect on AVN

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28
Q

Propafenone therpautic uses?

A

BS

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29
Q

Propafenone adverse effects ?

A

BAC :

Bronchospasm
blurred vision
AVN block
constipation

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30
Q

Block Na channels → ? & block K channels → ?

A

↑ERP without ↑ APD

↑ ERP & APD

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31
Q

Ia ; procainamide effects?

A

Electrophysiolpgy:
Block Na channels:
with moderate rate of dissociation → moderate ↓ in Vmax & conduction velocity
Block K channels:
↑ repolarization time (class III activity)

Autonomic effect:
antimuscarinin:
Atropine like action) → ↑ conduction in AVN (↓ APD): Disopyramide> Quinidine > Procainamide
Block ganglion sympahtthic: (↓ BP): Procainamide
Block alpha receptors: ( ↓ BP): Quinidine

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32
Q 
Clinical implication of antimuscarinic effect of class Ia: 
• Paradoxical ↑ AVN conduction → ventricular tachycardia in patients with Atrial 
fibrillation (AF)

ايه الحل؟

A 
فيونكه!
adenosine
bb
ccb:verapamil
digoxin
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33
Q

blockers & verapamil should be avoided if the AF is associated

A

with heart failure?

34
Q

cardiac effect: OF Ia

• Negative inotropic (may aggravate Heart failure): Especially

A

with Disopyramide

Prolonged Q-T interval: Quinidine&raquo_space; Procainamide

35
Q

Therapeutic uses: (procainamide replaces quinidine for fear of: excess atropine like action & torsade de pointes)

A

Broad spectrum: Ventricular & supraventricular arrhythmia including WPW syndrome

36
Q

Procaiamnide and Torsade de pointes (polymorphic ventricular tachycardia)

A

Block K+

channels → ↑ APD → prolong QT interval>syncope

37
Q

Procaiamide Cardiac toxicity

?

A

Cardiac toxicity
Hypotension due ganglion blockade and myocardial depression
Block K channels casuing Torsade de pointes arrhtymai
reduce AVN conduction but in AF increases due to atropine like action

Git nasuse vomitai NVDA

38
Q

pROCAIAMADE AND thromboembolism ?

A

in Chronic AF > Thrombosis
In retrunung to normal rhtym > emobli
Add Heparin

39
Q

Special adverse effects of Ia ?

A

Procaiamed systemic lupus symptoms in slow acetylators
in Qunidine : Cinnchonism and Thrombocytopenia
Disopyramide: Herat failure urine retenriton Glucoma

40
Q

Procaianmide afvers effecsts?

A

Cardiac toxicity
Git
Thromboembolism
specials

41
Q

Lidocaine is ?

A

Local anathetic and antiarrhtymic more in inactivated Na channels of ischemic depolarized tissues

42
Q

Lidocaine theraputic uses?

A

NS/V Ventruclar tachy cardia on catdica surgery or ischmic infarction
digitalis induced arrhtmia

43
Q

lidocaine is ineffective in ?

A

Atrila fluute or filbrillation due to its decrasing of ERP

ALSO PSVT NO RELATION TO AVN

44
Q

DOsage of lidoacine ?

A

Not oral due to FPM ?

IV Bolus followed by maintaince IV infusion due to its short T1/2

45
Q

Lidocaine adverse effects?

A

CNS: Perioral anaethsis: dizziness: convulsions

Less cardiotoxic as it can cause cardiac arrest or impaied conduction

46
Q

Class Ic: Propafenone (see summary)
• No effect on APD ?
? → ↑ERP

A

Has no effect on K+channels).

Beta blocking effect

47
Q

First choice in AF /

A

Propafenone

48
Q

Proafenone

Theraputic uses ?

A

Therapeutic uses: BS: Supraventricular (1

st choice in AF & Af فيه منه فيونكه & (ventricular arrhythmi

49
Q

Propafenone

adverse effects ?

A

Cardiac heart block heart failure arrhtmyiaa
beta blocking effect ? Constipation and Bronchospasm
dizzness and blurring and taste disturbacnse

50
Q

Class 3 bb and calss 4 ccb adenosine are common in /

A

Decreasing SAN rate And AVN Conduction
decrsaing slope 4 decrsaing automaticity

calss 3BS  in san avn and ventricles decreaing sumpathatic flow in slow fibers BS
class 4NS in san avn omly  decrasing ca entery to slow fibers NS 
adenosine NS: avn san only: act on A1 receptora opening K channels casuing Hyperplarriztaion preventing ca entery: + vasodilation of coronary and peripheral
51
Q

Common idications of both adenosine and BB and ccb ?

A

Both Termination of PSVT
BB IV ESMOLOL
Adenosis IV bolus ultrashort t1?2
CCB : termination and prophylaxis of PSVT orally and IV

52
Q

Indications of BB /

A

Arrhthmia due to ?
Sypmathtic flow
Myocardial infarction

termination of PSVT IV Esmolol

53
Q

Adverse effects of BB?

A 
HF HB Bradycardia
bronchospasm
Constipation
Glucose intolerance
hyperlipidemia
54
Q

ccb indication ?

A

فيونكة
PSVT termination and prohylaxix
Atrial flutter and fibrillation by blockng avn

55
Q

Adverse effects of CCB?

A

Brady cardia heart block heart failure

Paradoxical increase in Ventricular rate in AF with WPW Due to block AVN with intact bundle of Kent\

56
Q

Bronchospasm occure in ?

A

BB

Adenosine

57
Q

Adenosine adverse effects ?

A

1-Bronchosapsm asthma A1

2-Flushing headche fasle chest pain A2

3-Sinus bradycardia or AV Block Heart Block

58
Q

Drugs has BS and affect WPW/

A

Amoidaroen class III

59
Q

pHARMACODYNAMIC ACTIONS OF Amiodarone/ ?

A

K channels block increasing APD AND ERP block reentry in af AF PSVT and WPW
Na channels block decresing Vman and conduction velocity and slope 4 and automtaticty
Ca channels blocker Decreasing SAN rate and AVN conduction and slope 4 automaticity + vasodilation of coronary and peripherals

60
Q

Why Amoidarone is taken as A loading dose followed with Maintance one?

A

Due to its long t1/2 30 -120 days

cumulative effect appear afet 1-3 weeks

61
Q

Drug contraindicated in digoxin toxity ?

A

AMoidarone

62
Q

AMOidarone and Digosxin ?

A

Displace digoxin from paslams protein causing digoxin toxcitiy

63
Q

Amoidarone and warfarin ?

A

Enzyme inhibitor increasing Warfarin

64
Q

Pharmacokinetics of AMoidarone ?

A

longest t1/2
Digoxin toxcitiy
warfarin toxicity

65
Q

Dronedarone

A

related to amiodarone no iodine

with riske of qt syndrome trorsade de pointes

66
Q

Precautions of amoidarone ?

A

Thyoid function test 6 months
Liver functions test 6 months
Chest X-ray 3 months

67
Q

Adverse effects of amiodarnoe?

A 
Thyroid dysfuntions
pulmonary infiltate of fibrosier
increasing liver serum proteins
Cardiac bradycardia
Hypotension CCB
Photoseneitvity
Corneal Microdeposits
Perpheral nerropahty and myopathy
68
Q

Corneal Microdeposits

in ?

A

Amiodarone

69
Q

Soltalol ‘ ?

A

Torsade de ponte
non selectiv BB + Class III activity
control ventricular and supreaventricular AF Af

70
Q

Treatment of torasde de pointe

A

Magnusum sulphate

71
Q

Magnisum sulphate used as?

A 
physilogical ca comptetice anatgonist 
Decreasing SAN rate and Myocardial Conduction
used in : 
Digitalis induced arrhtymia as bb 
Torsade de pintes

if oral : osomtic laxative

72
Q

Broad spectrum ( include WPW syndrome):

A

Class I a,c III

73
Q

Ventricular arrhythmia:

A

Class Ib: Lidocaine, Phenytoin & Mexiletine

74
Q

Supraventricular arrhythmia: فيونكات

A

Class IV (verapamil), Adenosine & Digoxin

75
Q

Vernacular & supraventricular due to
sympathetic overactivity or
myocardial Infarction:

A

β blockers

76
Q

Broad spectrum

including WPWS

A

Ia: procainamide ADD DIGOXIN
Ic: Propafenone
III: Amiodarone

77
Q

PSVT
Af
AF

A

Adenosine # BA termination IV bolus
Verapamil # HF termination Prophylaxis
Digoxin termination Prophylaxis

78
Q

Ventricular tachycardia

A 
DC shock: In unstable patients
Stable patients: IV
• Lidocaine: of choice
• Amiodarone: of choice
• Procainamide & sotalol
79
Q

PSVT

A

• Verapamil
• Adenosine
• Procainamide & β
blockers (2nd choice)

80
Q

Treatment of AF

A 
Conversion ( to restore sinus rhytm)
A. Electrical cardioversion
B. Pharmacological conversion (drugs)
 Ia: procainamide
Ic: Propafenone 1
st choice 
III: Amiodarone
Add anticoagulant to avoid thromboembolism

All used as maintenance therapy after
restoration of sinus rhythm

81
Q

Treatment of AF
A. If conversion failed
B. If there is a thrombus

A 
Rate control (block AVN)
a) Digoxin
b) β blockers
c) Verapamil
d) Propafenone
Add anticoagulant to avoid thromboembolism
82
Q

الحمدللـــــــــــــــــــــــــــــــــــ رب العالمين ــــــــــــــــــــــــــــــــه

A

CVS Pharma papre 1 (4 decks)

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