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Pharmacology > Cardio: Anti-Arrythmics > Flashcards

Cardio: Anti-Arrythmics Flashcards

1
Q

What parts of the heart has fast APs?

A

Cardiomyocytes and Purkinje fibers

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2
Q

What parts of the heart has slow APs?

A

SA and AV nodes

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3
Q

What are the class 1a anti-arrhythmics?

A

Quinidine
Procainamide
Disopyramide

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4
Q

MOA of class 1a anti-arrhythmics?

A

Block sodium channels, and have some K+ channel affect as well.
-will prolong QT and QRS due to this

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5
Q

what effect do the class 1a anti-arrhythmics have on the heart AP?

A

Reduce slope of phase 0=Prolong QRS complex

Prolong AP duration=prolong QT interval

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6
Q

Indication for procainamide?

A

Effective in sustained V-tach and arrythmias after MI

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7
Q

Adverse effects of procainamide?

A

QT prolongation=Torsades!

Drug induced lupus

  • arthralgias, pleuritis, hepatitis, fever
  • anti-histone Ab
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8
Q

is quinidine used much clinically?

A

Nope.

Not sure why we even learn it then??

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9
Q

Adverse effects of quinidine?

A

QT Prolongation=torsades due to K+

Cinchonism
-hearing loss, tinnitus, confusion, delirium

thrombocytopenia

GI Upset

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10
Q

Indication for Disopyramide?

A

Recurrent ventricular arrhythmias

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11
Q

Adverse effects of Disopyramide

A

QT Prolongation=Torsades

Negative inotrope=heart failure

Atropine like symptoms
-blind as a bat, mad as a hatter, dry as a bone

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12
Q

What are the class 1B anti-arrhythmics?

A

Mexitile (oral) and Lidocaine (IV)

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13
Q

What effect do class 1B anti-arrhythmics have on AP?

A

Shorten AP

DO NOT PROLONG QT like 1A

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14
Q

Clinical use of lidocaine?

A

Termination of V-tach after MI

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15
Q

Adverse effects of lidocaine?

A

Least toxic of all class 1

hypotension

Neurological side effects
-paresthesias, tremor, slurred speech

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16
Q

Clinical use of Mexiletine

A

Ventricular arrythmias after MI

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17
Q

Adverse effects of Mexiletine

A

Neurological side effects

-paresthesias, tremor, slurred speech

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18
Q

Do class 1C drugs prolong the QT interval?

A

Nope, just the QRS complex as they are pure Na+ blockers

-no K+ activity

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19
Q

what are the Class 1c anti-arrhythmic drugs?

A

Flecainide and propanefone

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20
Q

Would you use class 1c anti-arrhythmic drugs post MI?

A

Nope, they are only for healthy hearts

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21
Q

Clinical use of flecainide and Propafenone?

A

Both: SVTs

Only flecainide: refractory ventricular arrythmias that are life threatening

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22
Q

Class II anti-arrhythmic drug MOA?

A

B-blockers

  • reduce cAMP to reduce contractility
  • block the funny current to prevent calcium from entering
  • -reduces HR
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23
Q

Class II anti-arrhythmic effects on AP?

A

Slow HR via SA node, so they prolong the RR interval

Reduce AV Conductance, so prolong PR interval

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24
Q

Clinical use for Propranolol

A

Arrhythmias associated w stress and thyroid storm

A fib and A Flutter, PSVTs, and post-MI arrhythmias

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25
Q

Which of the B-blockers is short acting?

A

Esmolol

-great for IV ifusion for rapid onset and termination

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26
Q

Clinical use for esmolol?

A

SVTs, thyrotoxicosis, post-MI arrhythmias

Used as adjunct w general anesthesias to control arrhythmias peri-operatively

27
Q

Adverse effects of B-blockers?

A

Block B2, so:

  • reduced CO, reduced glucose metabolism
  • increased LDL, low HDL
  • sedation
  • withdrawl sydrome
28
Q

Contraindications of B-blockers?

A

Asthma, PVD, Raynauds, T1DM, bradycardia

29
Q

MOA of class 3 anti-arrhythmic drugs?

A

Block K+ channel

30
Q

What are the class 3 anti-arrhythmic drugs?

A

amiodarone, sotalol, ibutilide/Dofetilide

31
Q

Effects of class 3 anti-arrhythmic drugs on AP?

A

Prolong AP, QT interval, and ERP

32
Q

Clinical use of Amiodarone?

A

Recurrent V-tach and a-fib

33
Q

Adverse effects of Amiodarone?

A

AV block and bradycardia

Fatal pulmonary fibrosis**

Photodermatitis and deposits in corneas

Blocks thyroid=hyper/hypothyroidism
-iodine

34
Q

Which of the class 3 drugs has B Blockers activity as well?

35
Q

Clinical use of Sotalol

A

Life threatening Ventricular arrhythmias

Maintenance of sinus rhythm in patients w a fib

36
Q

Side effects of sotalol

A

Depressed cardiac function

QT torsades

37
Q

Clinical use of ibutilide/dofetilide?

A

Restore sinus rhythm in a fib and maintain sinus rhythm after cardioversion in those w a fib

38
Q

Adverse effects of ibutilide/dofetilide?

A

QT prolongation and increase risk for ventricular arrhythmias

39
Q

What are the class 4 anti-arrhythmics?

A

Verapamil, Dilitiazem

40
Q

MOA of class 4 anti-arrhythmics?

A

block L-type calcium channels

-slow SA node depolarization

41
Q

What effect do class 4 anti-arrhythmics have on AP?

A

Prolong ERP and PR interval

42
Q

Clinical use of Verapamil, Dilitiazem?

A

Termination of PVST and ventricular rate control in a fib and flutter

43
Q

Adverse effects of Verapamil, Dilitiazem?

A

Negative inotropy, AV block, SA arrest, bradycardia

Constipation and gingival hyperplasia (verapamil only)

44
Q

MOA of adenosine?

A

Activates A1 receptor on Gi-coupled GPCR
-enhances K+ efflux and inhibits Ca2+ influx

Causes marked hyperpolarization, slowing AP

45
Q

Effect of adenosine on AP?

A

Prolongs QT interval and ERP

46
Q

Indication of adenosine?

A

PVST conversion to sinus rhythm

47
Q

Adverse effects of Adenosine?

A

SOB, bronchospasm, chest burning, flushing, AV block

48
Q

What is a proarrhythmia? What can cause it?

A

A proarrythmia is a drug induced new arrhythmia or worsening of an existing arrhythmia
-Flexainide can cause this

49
Q

What are the non-pharm options to treating arrhythmias?

A

Catheter ablation
Implantable defibrillator
Artificial pacemaker
Direct current cardioversion

50
Q

Which drug classes cause torsades?

A

Class 1A and Class 3

-slide 44

51
Q

Which drug classes can cause excessive slowing of the heart and lead to persistent V-tach

A

Class 1A and 1C

-slide 44

52
Q

Drugs to control rhythm in A-fib?

A

Class 1C drugs: reduce retrograde conductance Flecainide and propanefone

Class 3 drugs: terminate reentry by prolonging refractory period
-amiodarone, sotalol, ibutilide/Dofetilide

53
Q

If a patient has a-fib with HF, what drug classes can you use?

A

Class 3 only

-1C contra in unhealthy hearts!

54
Q

If a person has A-fib w/o HF, what drug classes can you use?

A

Class 1C or 3

55
Q

Pharmological Rate control in A-fib if person has HF?

56
Q

Pharmological Rate control in A-fib if person w/o HF?

A

CBB or B-blocker

57
Q

Will you need to do anti-thrombotic therapy in someone with A-fib?

A

Yes, most of the time it is needed!

58
Q

PSVT non-pharm treatment?

A

Vagal maneuvers

59
Q

What is the preferred treatment in PSVT?

A

Vagal maneuvers->Adenosine is first

60
Q

To prevent PVST episodes, what is first line?

A

Verapamil and Diltiazem

61
Q

What drugs can cause torsades?

A

1a and 3, as well as hydroxychloroquine and azithromycin

-stop them, and torsades will stop

62
Q

If pt is hemodynamically unstable with torsades, how would you treat?

A

Direct current cardioversion

63
Q

If pt is hemodynamically stable with torsades, how would you treat?

A

correct electrolyte imbalance, MgSO4, may need pacemaker

Pharmacology (50 decks)

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