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Pharmacology III > Block II: Antiarrythmics > Flashcards

Block II: Antiarrythmics Flashcards

1
Q

What constitutes a prolonged QTC interval and may bar you from initiating an antiarrythmic?

A

M > 450

F > 470

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2
Q

What drugs belong to class Ia?

A
  1. quinidine
  2. procanimide
  3. disopryramide

Double
Quarter
Pounder

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3
Q

Where do class Ia drugs exert their effects primarily?

A

Supraventricular/ventricular arrythmias

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4
Q

What ion channel do class Ia drugs affect?

A

Na+

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5
Q

What drugs are class Ib

A
  1. lidocaine

2. mexiletine

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6
Q

where do class Ib drugs exert their effect?

A

ventricular arrythmias

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7
Q

what ion channel do class Ib drugs alter?

A

Na +

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8
Q

Where to BB exert their effects?

A

supraventricular, ventricular

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9
Q

what ion channel to BB block

A

Ca+

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10
Q

What are class Ic drugs?

A
  1. flecaninide

2. propfanone

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11
Q

where do class Ic drugs exert their effects?

A

supraventricular, ventricular

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12
Q

what ion channel do class Ic drugs exert their effects on?

A

Na+

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13
Q

Where do non-DHP CCBs exert their effects?

A

termination SVT, slow rapid Afib or Aflutter

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14
Q

what drugs belong to class III

A
  1. amiodarone
  2. Dofetilide
  3. dronedarone
  4. sotalol
  5. ibutilide
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15
Q

What drugs belong to class II

A

BB

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16
Q

where do class III drugs exert their effects?

A

any tachycardia

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17
Q

what ion to class III drugs work on?

A

K+

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18
Q

what are class IV drugs?

A

Non-DHP CCB

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19
Q

Quinidine belongs to what class?

A

Ia (supravent/ventricular Na+ block)

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20
Q

Procanimide belongs to what class?

A

Ia (supravent/ventricular Na+ block)

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21
Q

Disopyramide belongs to what class?

A

Ia (supravent/ventricular Na+ block)

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22
Q

Lidocaine belongs to what class?

A

Ib ventricular, Na+ block

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23
Q

Mexiletine belongs to what class?

A

Ib ventricular, Na+ block

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24
Q

Flecanide belongs to what class?

A

Ic supravent, vent Na+ block

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25
Q

Propafenone belongs to what class?

A

Ic supravent, vent Na+ block

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26
Q

How can you remember class one drugs?

A 
Ia:
Double- Disopyramide
Quarter-Quinidine
Pounder- Procanimide
Ib:
Lettuce-Lidocaine
Mayo-Mexiletine
Ic: 
Flecainidie- fries
Please- Propafenone
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27
Q

What class does Amiodarone belong to?

A

III, tachyarrythmias K+

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28
Q

What class does dofetilide belong to?

A

III, tachyarythmias, K+

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29
Q

What class does Dronedarone belong to?

A

III, tachyarythmias, K+

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30
Q

What class does sotalol belong to?

A

III, tachyarythmias, K+

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31
Q

What class does Ibutalide belong to?

A

III, tachyarythmias, K+

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32
Q

What class does verapamil belong to?

A

IV, termination SVT and slowing rapid Afib/flutter

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33
Q

What class does diltiazem belong to?

A

IV, termination SVT and slowing rapid Afib/flutter

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34
Q

What is the MOA class Ia

A

Prolong phase 0, rapid depolarization phase, and widen QRS
Moderate Na+ channel blocker may increase ERP (refractory period)- prolongs action potential
-risk for secondary arrythmia (dose dependent)

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35
Q

Disopyramide is a strong []

A

anticolingergic

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36
Q

Quinidine is a []

A

anticholinergic

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37
Q

Procanamide may cause []

A

lupus like syndrome

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38
Q

MOA class Ib drugs

A

shorten refractory period, shorten AP, and shorten QTc

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39
Q

Class Ib drugs are only used for

A

ventricular arrythmias

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40
Q

What is mexilteines dosage limitation

A

severe nausea

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41
Q

MOA class Ic drugs

A

NO change refractory period, QTc, no risk secondary arrythmias

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42
Q

what is the mc use Ic drugs

A

atrial arrythmias or life threatening ventricular

43
Q

What is the MOA class II drugs

A

BB

Block adrenergic stimulation (decrease HR, CO, Force contraction)

44
Q

What is the use Class II drugs

A

BB

  1. terminate re-entrant arrythmia at AV node
  2. control ventriculat rate in afib/flutter
  3. exercise tachycardia
45
Q

What BB are used to treat arrythmias?

A
  1. metoprolol
  2. propanolol
  3. esmolol
46
Q

What is the MOA class III drugs

A 
K+ channel blocker 
prolong repolarzation (phase 3) AP
-halt exit K+, prolong repolarization, refractoriness, an QT interval
47
Q

How are class III drugs used

A

to control tachyarrythmias

48
Q

SE class III drugs

A

may be pro arrythmic

49
Q

what is the MC antiarrythmic?

A

amiodarone

50
Q

MOA amiodarone

A

Class III: K+ blocker, some Na+ activity, alpha block, and beta block activity

51
Q

What is the use amiodarone

A

prevent recurrent ventricular arrythmias, sinus rhythm w/ paradoxical afib,

52
Q

SE amiodarone

A

EXTENSIVE, may cause neuropathies

53
Q

What is the MOA Sotalol

A

Class III

NOS BB Ca2+ channel effective

54
Q

Pearl on Sotalol

A

check baseline EKG!! to eval. QTc
and titrate accordingly
don’t use if over 500

55
Q

Use Ibutalide

A

class III
IV only
Afib/flutter

56
Q

pearl ibutalide

A

SULFONAMIDE

*sulfa allergy

57
Q

Use dofetilade

A 
class III
Afib/flutter
58
Q

Pearl dofetalide

A

renal dose adjustment

Monitor EKG x3 days post intiation and 12 hrs post dose increase

59
Q

use non-DHP CCB

A

Class IV
affect slow response myocardial tissue by blocking long Ca++ channels
Supraventricular tachycardia
RATE control afib/flutter

work in SA and AV node

60
Q

Who should avoid diltiazem/verapamil

A

HF or decreased ventricular function

61
Q

If a pt. has sinus bradycardia with symptoms of hemodynamic compromise, what is the tx of choise

A

Atropine

62
Q

If a pt. has sinus bradycardia with symptoms of hemodynamic compromise and a likelihood or coronary ischemia, what is the treatment of choice?

A

Isoproterenol, dopamine, epi, dobutamine

63
Q

What if a pt is hemodynamically compromised and is refractory to medical therapy

A

temporary pacing until pacemaker can be set

64
Q

How are you treating a 1st degree AV block?

A

No tx

  • eval meds, dc causative agents
  • check lytes
65
Q

How are you treating 2nd degree AV block

A

Pacemaker

66
Q

How are you treating a 3rd degree Av Block

A

Pacemaker

67
Q

Pts. showing symptoms of bradycardia and hemodynamic compromise must receive

A

atropine

68
Q

How are you treating a pt. with hemodynamic compromise and suffering acute MI

A

Aminophylline

69
Q

How are you treating Asystole

A

Epi

70
Q

what should you run through in a PEA pt?

A

H’s and T’s

H: hypovolemia, H+ acidosis, Hypo/Hyper kalemia, Hypoxia, hypoglycemia, hypothermia

T: thrombosis, trauma, tension/pneumothorax, tamponade, toxines

71
Q

How are you treating a PEA pt?

A

Epi (asystole)

72
Q

Are PEAs shockable?

A

NO, shocking gets you in rythm, if no beat no rythm to fix

73
Q

How are you treating a hemodynamically stable Vtach pt

A

IV procainamide, amiodarone, or sotalol

74
Q

How are you treating a hemodynamically unstable Vtach pt?

A

Defibrillation

75
Q

How are you treating a polymorphic Vtach pt. due to MI

A

BB

unless torsades!!!!

76
Q

How are you treating a torsades pt?

A

Mg IV

D/c offending agent

77
Q

How are you treating your Vfib patient?

A

SHOCK

78
Q

How are you treating your SVT pt who is hemodynamically stable?

A
  1. vagal maneuvers, cold water, carotid massage

2. adenosine, BB, non-DHP CCB if all else fails

79
Q

How are you treating your SVT patient who is hemodynamically unstable?

A

shock (DCC) direct cardio version

80
Q

MOA Adenosine

A

slow conduction through AV node, interrupt re-entrant pathway, flatline x10 s

81
Q

SE adenosine

A

flushing, HA, SOA

82
Q

How are you treating acute Afib?

A

Rate control

BB, non-DHP CCB, digoxin

83
Q

How are you treating Afib pts. long term?

A
  1. Rate control (easier, less SE)
    vs.
  2. Rythym (if sympomatic)
  3. stroke prevention
84
Q

How are you treating Afib rate control and why?

A

if asypmtomatice, easier with less SE

  1. BB
  2. Non-DHP CCB
  3. Digoxin (can only be adjunct, only works when pt. at rest)
85
Q

What is the rate goal Afib?

A

< 110 BPM if stable LV function

<80 BPM at rest

86
Q

How are you treating afib ryhtm control and why?

A

If symptomatic, get rythm

  1. cardioversion, will need anticoag. post shock x 4 weeks.
    will need antiarrythmic after schock too.
  2. Dofetalide, Flecanide, Ibulilide, propafenone, amiodarone
87
Q

If afib > [] hrs (or UK time), what is needed prior to shock?

A

48 hours, warfarin or DOAC x 3 weeks prior, 4 weeks after shock

*heparin if hemodynamically unstable

88
Q

What is 1st line rythm maintenance in an Afib pt. with no structural heart defects?

A
  1. flecainide
  2. propafenone
  3. stoalol
89
Q

What is 1st line rythm maintenance Afib with CAD

A
  1. dofetalide

2. sotalol

90
Q

What is 1st line rythm maintenance in afib with HF

A
  1. amiodarone

2. dofetilide

91
Q

What is second line Afib rythm maintenance

A
  1. amiodarone
  2. dofetalide
  3. catheter ablation
92
Q

What is second line afib rythm maintenance if CAD

A
  1. amiodarone

2. cath ablation

93
Q

what is second line afib rythm mainteneance if HF

A

amiodarone

94
Q

what drug is category X

A

dronedarone

95
Q

What drug is category D

A

amiodarone

96
Q

[] anticoag is used if mechanical valves

A

warfarin

97
Q

What CHADs is women req. anticoag

A

3

98
Q

what CHADs in men req. anticoag

A

2

99
Q

Dabigitran is a [] drug

A

factor IIa DOAC

100
Q

Rivaroxaban is a [] drug

A

Factor Xa DOAC

101
Q

How would you treat symptomatic PVCs

A

BB

102
Q

Afib patients must be [] to be considered rate controlled

A

asymptomatic

103
Q

What can cause pharmacologic cardioversion?

A

Dofetilide, flecainide, ibutilide, propafenone, amiodarone

Pharmacology III (6 decks)

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