Arrythmia Drugs DSA - Konorev

Question 1

class 1A drugs

Answer 1

quinidine
procainamide
disopyramide

Question 2

class 1B drugs

Answer 2

lidocaine

mexiletine

Question 3

class 1C drugs

Answer 3

flecainide

propafenone

Question 4

General overview class 1A drugs

MOA and main effect
channels targeted
action potential
ECG effects

Answer 4

block sodium channels, slow impulse conduction, reduce automatism of ectopic pacemakers

preferentially bind to open (activated) sodium channels
-ectopic pacemaker cells with faster rhythms preferentially targeted

• block potassium channels
• prolong action potential duration
• prolong QRS and QT intervals of ECG

Question 5

procainamide used to treat

Answer 5

sustained ventricular tachycardias, may be used in arrhythmias associated with MI

Question 6

procainamide moa

Answer 6

directly depress SA and AV node activity
antimuscarinic activity

• ganglionblocking properties, reduces peripheral vascular resisatnce, m
  
  • may cause hypotension

Question 7

adverse effects of procainamide

Answer 7

QT prolongation
induction of torsade de pointes arrhythmias and syncope
excessive inhibtion of conduction

Lupus sydrome with arthritis, pleuritis, pulmonary disease, hepatitis, and fever

nausea, diarrhea
agranulocytosis

Question 8

quinidine use

Answer 8

restore rhythm in atrial flutter/fibrillation pts with normal hearts

-sustained ventricular arrhythmia

Question 9

quinidine and AV conductance

Answer 9

affords antimuscarinic effect on the heart which may enhance AV conductance

Question 10

quinidine AE

Answer 10

may cause hypotension–>tachycardia

QT interval prolongation
induction of torsade de pointes and syncope
excessive slowing conduction throughout heart

diarrhea, nausea, vomiting
headache, dizziness, tinittus
thrombocytopenia, hepatitis, fever

Question 11

disopyramide use

Answer 11

recurrent ventricular arrhythmias

potent antimuscarinic effect on heart

Question 12

disopyramide AE

Answer 12

QT interval prolongation
induction of torsade de pointes and syncope
may precipitate heart fialure bc of neg inotropic effect
excessive depression of cardiac conduction

atropine like symptoms- urinary retention, dry mouth, blured vision, constipation, exacerbation of glaucoma

Question 13

lidocaine blocks ___ sodium channels

Answer 13

inactivated

-selectively blocks conduction in depolarized tissue, making damaged tissue completely electirically silent

Question 14

lidocaine use

Answer 14

in mono and polymorphic ventricular tachy

-very efficient in arrhythmias assocaited with acute MI

Question 15

administration of lidocaine

Answer 15

IV bc of rapid first pass metabolism

Question 16

AE of lidocaine

Answer 16

least toxic of all class 1 drugs

hypotension in pts with heart failure

paresthesias, tremor, slurred speech, convulsions

Question 17

mexiletine clinical use

Answer 17

ventricular arrhytmias

releieve chronic pain, especially due to diabetic neuropathy and nerve injury

Question 18

mexiletine AEs

Answer 18

tremor
blurred vision
nausea
lethargy

Question 19

class 1B overview
blocks what channel and in what state
effect on what tissue
efect on AP
effect on potassium channel
effect on QT

Answer 19

block sodium channels
bind to inactivated sodium channels (preferentially bind to depolarized cells)
no effect on conduction in normal tissue
may shorten AP
do not block postassium channels, and do not prolong AP or QT duration on ECG

Question 20

Class 1C overview

blocks what, conduction effect
bind what channels
action on AP and QT
effect on QRS

Answer 20

block sodium channels, slow impulse conduction
bind open (activated) sodium channels
block certain potassium channels
do not prolong action potential duration and QT intervatl duration on ECG
prolong QRS interval duration

Question 21

flecainide blocks

Answer 21

sodium and potassium channels

Question 22

flecainide clinical use

Answer 22

in pt with normal hearts
treat supraventricualr arrhythmias including AF, paroxysmal SVT
life threatening ventricular arrhythmias like sustained ventricular tachy

Question 23

AE of flecainide

Answer 23

may cause severe exacerbation of ventricular arrhytmias when administered to pts with

-preexisting vent tachys
pts with previous MI
pts with ventricular ectopic rhythms

Question 24

propafenone posseses weak

Answer 24

weak B-blocking activity

Question 25

propafenone use

Answer 25

to prevent paroxysmal AF and SVT in pts without structural disease

sustained vent arrhytmias

Question 26

AE propafenone

Answer 26

exacerbation of ventricualr arrhythmias
metallic taste
constipation
don’t combine with CYP2D6 and CYP3A4 inhibtiors as risk of proarrhytmia may be incresaed

Question 27

class 2 drugs overview

Answer 27

decrease SA node
decrease AV node
decrease Ca2+ overload, prevent delayed afterdepolarization

Question 28

propranolol indicated for use in cardiac arrhythmias

Answer 28

arrhythmias associated with stress
re-entrant arrhythmias that involve AV node
A fib and a flutter
arrhthmias associated with MI (decrease mortalitly)

Question 29

Esmolol DOA

Answer 29

short acting selective beta-1 blocker

use as continuous IV

Question 30

esmolol clinical use

Answer 30

supraventricular arrhythmias
arrhytmias associated with thyrotoxicosis
myocardial ischemia or acute MI with arrhythmias
adjunct drug in gen anesthesia to control arrhythmias in perioperative period

Question 31

PR interval in WPW and lown-ganong-levine syndrome

Answer 31

It is shortened