Cardiovascular 2 Anti-arrhythmics Flashcards
Drug class for Procainamide
class 1A Na channel
MoA for Procainamide
Decreases myocardial excitability and conduction velocity and may depress myocardial contractility, by increasing the electrical stimulation threshold of ventricle, His-Purkinje system and through direct cardiac effects (UtD)
Indications for Procainamide
life threatening ventricular arrhythmias
SE/ADRs for Procainamide
hypotension, N/V/D, SLE sxs, agranulocytosis (w/ prolonged use), QTc prolongation
Contra-indications for Procainamide
complete heart block, 2nd deg AV block, SLE, tornadoes de pointes
Dx-Dx interactions for Procainamide
other anti-arrhythmics
Monitoring for Procainamide
ECG, BP, eGFR, BUN, CBC, ANA titers, liver function, procainamide/NAPA conc (in liver disease)
PG category for Procainamide
PG C
Drug class for Lidocaine
class 1B Na channel
MoA for Lidocaine
blocks both the initiation and conduction of nerve impulses by decreasing the neuronal membrane’s permeability to sodium ions,suppresses automaticity of conduction tissue, by increasing electrical stimulation threshold of ventricle, His-Purkinje system, and spontaneous depolarization of the ventricles during diastole (UtD)
Indications for Lidocaine
suppression of existing ventricular arrhythmias
SE/ADRs for Lidocaine
arrhythmias, CV collapse, increase defib threshold, edema, heart block, hypotension, agitation, anxiety, metallic, taste, bronchospasm
Contra-indications for Lidocaine
severe SA, AV interventricular heart block w/out pacemaker, corn allergy
Dx-Dx interaction for Lidocaine
multiple (prolonged use)
Monitoring for Lidocaine
liver function, serum concentration, ECG, BP
PG category for Lidocaine
PG B
Drug class for Flecainide
class 1C Na channel
MoA for Flecainide
slows conduction in cardiac tissue by altering transport of ions across cell membranes; causes slight prolongation of refractory periods; increases electrical stimulation threshold of ventricle, His-Purkinje system
Indications for Flecainide
ventricular arrhythmias (prevention); PSVT (prevention); paroxysmal A fib/flutter
SE/ADRs for Flecainide
dizziness, blurred vision, dyspnea, palpitations, HA, pro-arrhythmic potential
Contra-indications for Flecainide
pre-existing 2 or 3 deg heart block, RBBB w/out pacemaker, cardiogenic shock
Dx-Dx interactions for Flecainide
multiple
Monitoring for Flecainide
ECG, BP, HR, periodic trough serum levels w/ renal or liver impairment
PG category for Flecainide
PG C
Flecainide should not be used for what chronic arrhythmia?
A fibrillation
Drug class for Amiodarone
Class 3 Repolarization delay
MoA for Amiodarone
inhibits adrenergic stimulation (alpha/beta) affecting Na, K, Ca channels; prolongs action potential & refractory period in cardiac tissues; decrease AV conduction & sinus node function
Indications for Amiodarone
life-threatening recurrent VF, unresponsive or unstable VT refractory to other anti-arrhythmic; off label- AF, PSVT, adjunct to ICD to suppress ventricular tacky in otherwise optimally tx patients w/ HF
SE/ADRs for Amiodarone
pulm toxicity, exacerbation of arrhythmias, optic neuritis, photosensitivity
Contra-indications for Amiodarone
hypersensitivity to iodine, cardiogenic shock, severe sinus node dysfunction, 2nd or 3rd deg HB or severe bradycardia without pacemakers
Dx-Dx interactions for Amiodarone
multiple, avoid grapefruit juice
Monitoring for Amiodarone
BP, HR, EKG, PE for lethargy, edema, wt loss, pulm toxicity, LFT, electrolytes, thyroid function, eye exams w/ long term use
PG category for Amiodarone
PG D
Drug class for Adenosine
other
MoA for Adenosine
- PSVT: slows conduction time through AV node, interrupting the re-entry pathways & restoring normal sinus rhythm
- Stress test: causes coronary vasodilation & increases blood flow in normal coronary arteries w/ little or no increase in stenotic coronary arteries
Indications for Adenosine
PSVT, pharmacologic stress testing
SE/ADRs for Adenosine
new arrhythmias, chest pain, HA, flushing, dyspnea, bronchospasm
Contra-indications for Adenosine
2nd or 3rd deg AV block, sick sinus syndrome, symptomatic brady (except ones w/ pacemaker), known bronchoconstrictive or bronchospastic lung disease, asthma
Dx-Dx interactions for Adenosine
agents that have vascular impact (nicotine, caffeine); dipyridamole, carbamazepine, digoxin
Monitoring for Adenosine
EKG, HR, BP
PG category for Adenosine
PG C
Drug class for Digoxin
other: cardiac glycoside
MoA for Digoxin
inhibits Na/K ATPase pump in myocardial cells promoting influx Ca leadings to increased contractility; also direct suppressor of AV node which decreases ventricular rate
Indications for Digoxin
mild to moderate HF; A fib rate control
SE/ADRs for Digoxin
incomplete heart block may proceed to complete block, digoxin toxicity, SSS
Contra-indications for Digoxin
V fib, co-existing thyroid disorders, recent MI
Dx-Dx interactions for Digoxin
Amiodarone, verapamil; multiple others
Monitoring for Digoxin
HR & rhythm, serum dig level, serum K+, eGFR, electrolytes, serum Ca, Mg, K, mental state (confusion, depression)
PG category for Digoxin
PG D
Drug class for MgSO4
other
MoA for MgSO4
unknown
Indications for MgSO4
digitalis induced arrhythmias w/ low serum Mg; low Mg induced arrhythmias (VF, VT); off label-torsades (severe exacerbation asthma in kids)
SE/ADRs for MgSO4
flushing, hypotension, hypermagnesemia
Contra-indications for MgSO4
heart block
Dx-Dx interactions for MgSO4
multiple
Monitoring for MgSO4
EKG, vital signs, serum Mg, K, Ca; eGFR, SaO2
PG category for MgSO4
avoid