Calcium Channel Blockers and Anti-Arrhythmics

Question 1

Verapamil
1.) Drug class?

2. ) Purpose?
3. ) Hallmark side effect?
4. ) DDI?
5. ) C/I?

Answer 1

Verapamil

1.) Non DHP- calcium channel blocker

2. )
   - -angina→ effect supply and demand

• Non DHPSblock Ca Channels in slow-response tissues (SA/AV node)to slow AV nodal conduction velocity→ Can be uses as ananti-arrhythmic (CLASS IV)
  3. ) Constipation
  4. )Don’t used with beta-1 blocker
  5. ) Don’t use with patients who have CHF

Question 2

Diltiazem
1.) Drug class?

2. ) Purpose?
3. ) Hallmark side effect?
4. ) DDI?
5. ) C/I?

Answer 2

1.) Non DHP- calcium channel blocker

2. )
   - angina→ effect supply and demand
   - Non DHPSblock Ca Channels in slow-response tissues (SA/AV node)to slow AV nodal conduction velocity→ Can be uses as ananti-arrhythmic (CLASS IV)
3. ) Constipation
4. )Don’t use with beta-1 blocker
5. ) Don’t use with patients who have CHF

Question 3

DHP’s
1.) Drug class?

2. )Purpose?
3. )Hallmark side effect?
4. ) Agents available?
5. ) prescribe this drug with?

Answer 3

1.) DHP-calcium channel blocker

2. )
   - To reduce BP in hypertension via peripheral dilation
3. )Peripheral edema
4. ) drugs that end in dipine
5. ) Beta-1 antagonist

Question 4

Procainamide
1.)Drug class ?

2. ) Purpose?
3. ) ADR?

Answer 4

1. )Class 1A-sodium channel blockers-Anti-Arrhythmic Drugs (AAD)
2. )Moderate Na+ channel blockade
3. ) Lupus-Like syndrome

Question 5

Quinidine
1.)Drug class ?

2. ) Purpose?
3. ) ADR?

Answer 5

1. )Class 1A- sodium channel blockers-Anti-Arrhythmic Drugs (AAD)
2. )Moderate Na+ channel blockade
3. )GI disturbances

Question 6

Disopyramide
1.)Drug class ?

2. ) Purpose?
3. ) ADR?

Answer 6

1. )Class 1A- sodium channel blockers-Anti-Arrhythmic Drugs (AAD)
2. )Moderate Na+ channel blockade
3. )Anti-muscarinic

Question 7

Lidocaine
1.) Drug class?

2. ) Purpose?
3. ) ADR?

Answer 7

1. )Class 1B sodium channel blockers- Anti-Arrhythmic Drugs (AAD)
2. )Weak Na+ blockade strength- for ventricular arrhythmias
3. )CNS toxicity paresthesia (pins and needles)

Question 8

Mexiletine
1.) Drug class?

2. ) Purpose?
3. ) ADR?

Answer 8

1. )Class 1B sodium channel blockers- Anti-Arrhythmic Drugs (AAD)
2. )Weak Na+ blockade strength- for ventricular arrhythmias
3. )CNS toxicity- tremor

Question 9

Flecainide
1.) Drug class?

2. ) Purpose?
3. ) ADR?

Answer 9

1. ) Class 1C -sodium channel blockers
2. ) High sodium channel blockade
3. )Metallic taste

Question 10

Propafenone
1.) Drug class?

2. ) Purpose?
3. ) ADR?

Answer 10

1. ) Class 1C- sodium channel
2. ) High sodium channel blockade
3. )Taste disturbances

Question 11

What sodium channel blocker drug has mild beta blocking properties?

Answer 11

Propafenone

Question 12

What class of drugs should not be used in patients with structural heart disease?

Answer 12

Class 1C

Question 13

What class of drugs have poor affinity for atrial tissues?

Answer 13

Class 1B

Question 14

What class of drugs can precipitate new arrhythmias especially Torsades de Pointes?

Answer 14

Class 1A and Class 3

Question 15

What is the MOA and indication for Class 2, anti-arrhythmic drugs?

Answer 15

o Block Beta-1 receptor in the SA/AV node
o Used for rate control
o Used for prophylaxis against sudden death and V-Fib

Question 16

What Class 2 beta blocker agents do we have available?

Answer 16

Agents:
• Metoprolol
• Propanolol→ thyrotoxicosis induced arrhythmia
• Esmolol→ acute arrhythmias

Question 17

Ibutilide

1. ) Drug class ?
2. ) Indication?
3. ) MOA?

Answer 17

1. ) Class 3: Potassium channel blocker
2. ) acute a-fib
3. ) blocks K+ , Na+ and beta receptors

Question 18

Sotalol

1. ) Drug class ?
2. ) Indication?
3. ) MOA?

Answer 18

1. )Class 3: Potassium channel blocker
2. ) treat afib and vfib (least amount of DDI’s good for patients on a lot of medications)
3. ) blocks K and beta receptors

Question 19

Amiodarone

1. ) Drug class ?
2. ) MOA?
3. ) ADR?
4. ) DDI’S?

Answer 19

1. )Class 3: Potassium channel blocker
2. ) Has class 1, 2, & 4 anti-arrhythmic properties (broad spectrum → very widely used)
3. ) Pulmonary fibrosis ( very serious but takes years to manifest)
4. ) LOTS OF DDI’s

Question 20

Dofetilide

1. ) Drug Class
2. ) MOA?
3. ) ADR

Answer 20

1. ) Class 3: potassium channel blocker
2. ) blocks K+ only
3. ) most ↑ risk of torsades

Question 21

Dronedarone

1. ) Drug class?
2. ) C/I?

Answer 21

1. ) weaker amiodarone basically

2. ) Pt’s with HF → INCREASED mortality rate

Question 22

What are our class 4 anti-arrthythmic drugs?

Answer 22

verapamil

diltiazem

Question 23

Digoxin

1. ) MOA?
2. )DDI’s?
3. ) Caution w/?

Answer 23

1. ) increases force of contraction (positive inotrope)
2. )Quinidine, verapamil, amiodarone
3. )
   - Digoxin with ACEIs/ARBs and Potassium Sparing Diuretics cause decrease efficacy in Digoxin→ hyperkalemia

-Digoxin with Loop and Thiazide Diuretics → Cause toxicity risk→ xanothphobia→ blurred, yellow halos

Question 24

Adenosine
1.) MOA?

2. ) Indication?
3. ) ADR?

Answer 24

1. ) slows AV nodal conduction
2. ) SVT
3. ) vasodilation→ flushing