Cardiac Drugs Flashcards

1
Q

Name a class II drug

A

Propranolol, atenolol; beta-blockers

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2
Q

What is a class IA drug?

A

Procainamide, quinidine, disopyramide

Decrease conduction and automaticity and increase threshold and refractory period.

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3
Q

Name the 4 mechanisms of generating arrhythmias

A

Automatic
Triggered
Conduction block
Re-entrant

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4
Q

What is the rationale and goal when prescribing anti-arrhythmic drugs?

A

Restore sinus rhythm and prevent further issues.

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5
Q

What are the effects of Class II cardiac drugs?

A

Decrease phase 4 depolarisation (catecholamine dependant)
Increase acute phase depolarisation and refractory period in AV node to slow AV conduction velocity.

Increase PR interval and decrease heart rate.

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6
Q

What conditions would Class II drugs be prescribed for?

A

Treating sinus and catecholamine tachycardia
Converting re-entrant arrhythmia at AV node
Slow AV conduction in AF or flutter- preventing ventricles from doing the same.

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7
Q

What are the side effects of Class II drugs?

A

Bronchospasm
Hypotension
Not used in partial AV block or acute HF

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8
Q

What is a class 1B agent?

A

Lidocaine, mexiletine
increased threshold and decrease phase 0 in fast beating /ischaemic tissue

Used for VT

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9
Q

What is a class 1C drug?

A

Flecainide and propafenone
Decrease phase 0 in normal tissue and automaticity
increase APD and refractory period in rapidly depolarising atrial tissue

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10
Q

What class is amiodarone and how does it work?

A

Class III
Increase refractory period, apd and threshold
Decrease phase 0 and conduction, decrease phase 4 and AV conduction speed.

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11
Q

What class is sotalol and how does it work?

A

Class III
Increases APD and refractory period in atrial and ventricular tissue
Slow phase 4 and AV conduction

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12
Q

Name a class IV agent and how they work?

A

Slow conduction through AV

Increase refractory period in AVN and slope of phase 4 SAN to slow HR

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13
Q

What is the effect of atropine?

A

Blocks vagal activity to speed AV conduction and increase HR.

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14
Q

What is the mechanism of action of digoxin?

A

Enhances vagal activity, slows AV conduction and HR.

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15
Q

What is the mechanism of action of ivabradine?

A

Blocks funny current expressed in the SAN - no effect on blood pressure.

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16
Q

What is the mechanism of action of vernakalant?

A

Blocks atrial specific potassium channels and therefore slows atrial conduction and increases in potently with higher heart rates.

17
Q

What is the mechanism of action of adenosine?

A

Binds A1 receptors and activates potassium currents in AV and SA node. Decreased APD and causes hyperpolarization - decreasing heart rate.
Decreases calcium currents and therefore increases refractory period in AVN.

18
Q

What are the side effects of a class 1a drug?

A
Hypotension 
Proarrhythmia 
GI upset 
Lupus like syndrome 
High dose induces Dizziness/confusion/ insomnia/seizure
19
Q

What are the side effects of a class 1b drug?

A

Abdominal upset

CNS effects like dizziness and drowsy

20
Q

What are the side effects of 1c agents?

A

Pro arrhythmias
CNS and gastro effects
Increased ventricular response to SVT

21
Q

What are the side effects of soltalol?

A

Proarrythmia
Fatigue
Insomnia

22
Q

What are the side effects of amiodarone?

A
Pulmonary fibrosis
Hepatic injury 
Increased LDL
Thyroid disease 
Photosensitivity 
Optic neuritis
23
Q

What side effects and cautions are there for class 4 drugs?

A

GI upset

Caution:
Partial AV block - with a beta blocker leads to asystole
Hypotension, decreased CO and sick sinus