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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
Lidocaine?
NS/V Digtalis induced arrhytmia after Myocardial infarction
26
Adverse effects of the Procaiameide? s
TSC2 Cardiac toxixity HMQ Myocardial depression prlong qt interval torsade de pointes Hypotension block sympathatic ganglia Cinnchonism Thromboemolism Systemic lupus
27
Lidocaine?
Least Cardiotoxic CNS Perioral parathesia dizzness convulsions AF AND Af due to low ERP PSVT NO effect on AVN
28
Propafenone therpautic uses?
BS
29
Propafenone adverse effects ?
BAC : Bronchospasm blurred vision AVN block constipation
30
Block Na channels → ? & block K channels → ?
↑ERP without ↑ APD | ↑ ERP & APD
31
Ia ; procainamide effects?
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
32
``` Clinical implication of antimuscarinic effect of class Ia: • Paradoxical ↑ AVN conduction → ventricular tachycardia in patients with Atrial fibrillation (AF) ``` ايه الحل؟
``` فيونكه! adenosine bb ccb:verapamil digoxin ```
33
blockers & verapamil should be avoided if the AF is associated
with heart failure?
34
cardiac effect: OF Ia • Negative inotropic (may aggravate Heart failure): Especially
with Disopyramide Prolonged Q-T interval: Quinidine >> Procainamide
35
Therapeutic uses: (procainamide replaces quinidine for fear of: excess atropine like action & torsade de pointes)
Broad spectrum: Ventricular & supraventricular arrhythmia including WPW syndrome
36
Procaiamnide and Torsade de pointes (polymorphic ventricular tachycardia)
Block K+ channels → ↑ APD → prolong QT interval>syncope
37
Procaiamide Cardiac toxicity | ?
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
pROCAIAMADE AND thromboembolism ?
in Chronic AF > Thrombosis In retrunung to normal rhtym > emobli Add Heparin
39
Special adverse effects of Ia ?
Procaiamed systemic lupus symptoms in slow acetylators in Qunidine : Cinnchonism and Thrombocytopenia Disopyramide: Herat failure urine retenriton Glucoma
40
Procaianmide afvers effecsts?
Cardiac toxicity Git Thromboembolism specials
41
Lidocaine is ?
Local anathetic and antiarrhtymic more in inactivated Na channels of ischemic depolarized tissues
42
Lidocaine theraputic uses?
NS/V Ventruclar tachy cardia on catdica surgery or ischmic infarction digitalis induced arrhtmia
43
lidocaine is ineffective in ?
Atrila fluute or filbrillation due to its decrasing of ERP | ALSO PSVT NO RELATION TO AVN
44
DOsage of lidoacine ?
Not oral due to FPM ? | IV Bolus followed by maintaince IV infusion due to its short T1/2
45
Lidocaine adverse effects?
CNS: Perioral anaethsis: dizziness: convulsions | Less cardiotoxic as it can cause cardiac arrest or impaied conduction
46
Class Ic: Propafenone (see summary) • No effect on APD ? ? → ↑ERP
Has no effect on K+channels). Beta blocking effect
47
First choice in AF /
Propafenone
48
Proafenone | Theraputic uses ?
Therapeutic uses: BS: Supraventricular (1 | st choice in AF & Af فيه منه فيونكه & (ventricular arrhythmi
49
Propafenone | adverse effects ?
Cardiac heart block heart failure arrhtmyiaa beta blocking effect ? Constipation and Bronchospasm dizzness and blurring and taste disturbacnse
50
Class 3 bb and calss 4 ccb adenosine are common in /
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
Common idications of both adenosine and BB and ccb ?
Both Termination of PSVT BB IV ESMOLOL Adenosis IV bolus ultrashort t1?2 CCB : termination and prophylaxis of PSVT orally and IV
52
Indications of BB /
Arrhthmia due to ? Sypmathtic flow Myocardial infarction termination of PSVT IV Esmolol
53
Adverse effects of BB?
``` HF HB Bradycardia bronchospasm Constipation Glucose intolerance hyperlipidemia ```
54
ccb indication ?
فيونكة PSVT termination and prohylaxix Atrial flutter and fibrillation by blockng avn
55
Adverse effects of CCB?
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
Bronchospasm occure in ?
BB | Adenosine
57
Adenosine adverse effects ?
1-Bronchosapsm asthma A1 2-Flushing headche fasle chest pain A2 3-Sinus bradycardia or AV Block Heart Block
58
Drugs has BS and affect WPW/
Amoidaroen class III
59
pHARMACODYNAMIC ACTIONS OF Amiodarone/ ?
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
Why Amoidarone is taken as A loading dose followed with Maintance one?
Due to its long t1/2 30 -120 days | cumulative effect appear afet 1-3 weeks
61
Drug contraindicated in digoxin toxity ?
AMoidarone
62
AMOidarone and Digosxin ?
Displace digoxin from paslams protein causing digoxin toxcitiy
63
Amoidarone and warfarin ?
Enzyme inhibitor increasing Warfarin
64
Pharmacokinetics of AMoidarone ?
longest t1/2 Digoxin toxcitiy warfarin toxicity
65
Dronedarone
related to amiodarone no iodine | with riske of qt syndrome trorsade de pointes
66
Precautions of amoidarone ?
Thyoid function test 6 months Liver functions test 6 months Chest X-ray 3 months
67
Adverse effects of amiodarnoe?
``` Thyroid dysfuntions pulmonary infiltate of fibrosier increasing liver serum proteins Cardiac bradycardia Hypotension CCB Photoseneitvity Corneal Microdeposits Perpheral nerropahty and myopathy ```
68
Corneal Microdeposits | in ?
Amiodarone
69
Soltalol ' ?
Torsade de ponte non selectiv BB + Class III activity control ventricular and supreaventricular AF Af
70
Treatment of torasde de pointe
Magnusum sulphate
71
Magnisum sulphate used as?
``` 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
Broad spectrum ( include WPW syndrome):
Class I a,c III
73
Ventricular arrhythmia:
Class Ib: Lidocaine, Phenytoin & Mexiletine
74
Supraventricular arrhythmia: فيونكات
Class IV (verapamil), Adenosine & Digoxin
75
Vernacular & supraventricular due to sympathetic overactivity or myocardial Infarction:
β blockers
76
Broad spectrum | including WPWS
Ia: procainamide ADD DIGOXIN Ic: Propafenone III: Amiodarone
77
PSVT Af AF
Adenosine # BA termination IV bolus Verapamil # HF termination Prophylaxis Digoxin termination Prophylaxis
78
Ventricular tachycardia
``` DC shock: In unstable patients Stable patients: IV • Lidocaine: of choice • Amiodarone: of choice • Procainamide & sotalol ```
79
PSVT
• Verapamil • Adenosine • Procainamide & β blockers (2nd choice)
80
Treatment of AF
``` 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
Treatment of AF A. If conversion failed B. If there is a thrombus
``` Rate control (block AVN) a) Digoxin b) β blockers c) Verapamil d) Propafenone Add anticoagulant to avoid thromboembolism ```
82
الحمدللـــــــــــــــــــــــــــــــــــ رب العالمين ــــــــــــــــــــــــــــــــه

CVS Pharma papre 1 (4 decks)

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