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Cardio > Cardiac Arrhythmia Pharm > Flashcards

Cardiac Arrhythmia Pharm Flashcards

1
Q

Class 1A drugs and their MOA

A

Na channel blockers (also block K channels)

*Quinidine, Procainamide, Disopyramide

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2
Q

Class 1B drugs and their MOA

A

Na channel blockers (do not block K channels)

*Lidocaine, Mexiletine

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3
Q

Class 1C drugs and their MOA

A 
Na channel blockers (also block some K channels)
*block Na channels stronger than other class 1

*Flecanide, Propafenone

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4
Q

Class 2 drugs and their MOA

A

Beta blockers

*Esmolol, Propanolol

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5
Q

Class 3 drugs and their MOA

A

K channel blockers

*Amiodarone, Sotalol, Dofetilide, Ibutilide

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6
Q

Class 4 drugs and their MOA

A

Cardioactive (non-dihydropyradine; L-type) Ca channel blockers

*Verapamil, Diltiazem

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7
Q

Where in the heart are fast action potentials?

A

Artial/ventricular cardiomyocytes, purkinje fibers

*targets of class 1 and 3 drugs

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8
Q

Where in the heart are slow action potentials?

A

SA node and AV node

  • targets of class 2 and 4 drugs
  • ventricular rate control
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9
Q

Fast action potential phases in the heart (atria and ventricles)

A 
0- Na influx
1- Na close, K efflux
2- plateau, K efflux and Ca influx
3- Ca close, K efflux
4- Na/K and Na/Ca ATPases restore RMP
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10
Q

Slow action potential phases in the heart (SA and AV nodes)

A

4- funny channels (If) and T-type Ca channels slowly depolarize
0- Rapid Ca influx through L-type Ca channels
3- Ca channels close, rapid K influx, repolarization

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11
Q

Class 1A drugs indication

*Quinidine, Procainamide, Disopyramide

A

Disopyramide most commonly used, treats ventricular arrhythmias

*all class 1A prolong QT interval and AP

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12
Q

Class 1B drugs indication

*Lidocaine and Mexiletine

A
  • Lidocaine (VTach in acute MI)
  • Mexiletine (ventricular arrhythmias, chronic pain)

*all class 1B do NOT prolong AP or QT interval

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13
Q

Class 1C drugs indication

Flecainide, Propafenone

A
  • Flecanide (supraventricular arrhythmias, ventricular arrhythmias refractory to other treatment)
  • Propafenone (supraventricular arrhythmias)
  • all class 1C do not prolong AP or QT interval
  • prolong QRS interval
  • contraindicated in pt with any structural heart disease
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14
Q

Class 2 drugs indication

Propanolol, Esmolol

A
  • Propanolol (Afib, Aflutter, supraventricular arrhythmias)

- Esmolol (short acting, supraventricular arrhythmias)

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15
Q

Class 3 drugs indication

Amiodarone, Sotalol, Dofetilide, Ibutilide

A

Amiodarone (Afib and Vtach)
Sotalol (Afib and Vtach)
Dofetilide (Afib, maintain sinus in pt after cardioversion)
Ibutilide (Afib)

*all class 3 drugs block K channels, prolong QT, prolong refractory period, prolong AP

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16
Q

Amiodarone adverse effects

A

Has qualities of Class 1, 2, 3, 4 drugs

  • AV block and bradycardia
  • Torsades de pointes due to QT prolongation
  • Pulm fibrosis
  • Hepatitis
  • Photodermatitis
  • Corneal deposits
  • Hypo or hyperthyroidism
17
Q

Class 4 drugs indication

Verapamil, Diltiazem

A

Verapamil, Diltiazem (superventricular tachys, afib, aflutter)

*block L-type Ca channels in SA/AV nodes, slowing phase 0

18
Q

Adenosine indication and MOA

A

Clinical use: conversion to sinus rhythm in PSVT

  • MOA: activates A1 adenosine receptor (Gi), enhances K current and inhibits Ca current and funny current
  • Hyperpolarizes pacemaker cells, slowing conduction
19
Q

Class 1A and 3 drugs are proarrhythmic, causing…

A

excesive slowing of repolarization and torsades du pointes

*class 1A causes slowed repolarization and conduction

20
Q

Class 1A and 1C drugs are proarrhythmic, causing…

A

excesive slowing of conduction and persistent ventricular tachycardias

*class 1A causes slowed repolarization and conduction

21
Q

Drugs to treat atrial fibrillation

No HF and LVEF >40%

A

Class 1C or Class 3 drugs

*first try direct current cardioversion (DCC)

22
Q

Drugs to treat atrial fibrillation

No HF and LVEF <40%

A

Class 3 drugs

*first try direct current cardioversion (DCC)

23
Q

Drugs to treat atrial fibrillation in patient with structural heart disease or former ischemic disease

A

Class 3 drugs

*Class 1C contraindicated in this situation

24
Q

Goal of pharmacologic treatment in patient with atrial fibrillation

A

restoration of sinus rhythm

25
Q

Drugs to treat paroxsymal supreventricular tachycardia (PSVT)

Most common type is atrioventricular nodal reentrant tachycardia (AVNRT)

A

Class 2 and 4 drugs

26
Q

Reversal of torsades de pointes

A

If hemodynamically unstable:

  • Correct electrolyte abnormalities
  • Magnesium sulfate
  • Transvenous temporary pacemaker or isoproterenol

Cardio (18 decks)

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