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LECOM pharmacology notecards > Chapter 23- Pharm Of Cardiac Rhythm > Flashcards

Chapter 23- Pharm Of Cardiac Rhythm Flashcards

1
Q

What is the general goal of class 1 anti-arrhythmias

A

Sodium channel blockers

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2
Q

What is the goal of class 2 anti-arrhythmias

A

Beta adrenergic receptor antagonists

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3
Q

What is the goal of class 3 anti-arrhythmics

A

K+ channel blockers

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4
Q

What is the goal of class 4 anti-arrhythmics

A

Calcium Channel blockers

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5
Q

How is quinine administered

A

Orally

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6
Q

What are the class 1A antiarrhythmics

A

Quididine, procainamide, disopyramide

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7
Q

What are some side effects of quinidine

A

SLE, headache, lightheadedness, diarrhea, cinchonism

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8
Q

What are some contraindications for quinidine

A

Myasthenia gravis, conduction defects, history of tornadoes de pointed or prolonged QT interval

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9
Q

What drug toxicity can quinidine induce

A

Digoxin toxicity

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10
Q

What is a major contraindication of procainamide use

A

SLE

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11
Q

What pretreatment should be considered when using procainamide

A

Cardiac glycoside

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12
Q

What is the drug of choice for life-threatening ventricular arrhythmias

A

Disopyramide

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13
Q

What drug impairs the antiarrhythmic activity of disopyramide

A

Rifampin

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14
Q

Who is disopyramide often prescribed to

A

Patients that cannot tolerate quinidine or procainamide

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15
Q

What anti-arrhythmic is best for post-MI

A

class 1B

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16
Q

What are the class 1B anti-arrhythmics

A

Lidocaine/mexiletine, phenytoin

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17
Q

What class 1B anti-arrhythmic can be used for status epilepticus

A

Lidocaine/mexiletine

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18
Q

What is the first sign of lidocaine toxicity in severely ill patients

A

Seizures

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19
Q

What can intramuscular injection of lidocaine cause large increases in the level of

A

Creatine kinase

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20
Q

What are some contraindications of phenytoin

A

Hydantoin hypersensitivity, SA node block, stokes-Adams syndrome

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21
Q

What are the class 1C anti-arrhythmics

A

Encainide, flecainide, miricizine, propafenone

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22
Q

What are some clinical uses for class 1C

A

Sustained ventricular tachycardia, paraoxysmal supraventricular tachycardia

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23
Q

What anti-arrhythmics are associated with excessive mortality and non-fatal cardiac arrest

A

Class 1C

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24
Q

What levels must be monitored with class 1C

A

Levels in patients with significant hepatic impairment

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25
Q

What class of antiarrhythmics are only approved for life-threatening situations

A

Class 1C

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26
Q

What are the class 3 anti-arrhythmics

A

Ibutilide, dofetilide, sotalol, bretylium, amiodarone, dronedarone

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27
Q

What is the clinical application of ibutilide

A

Conversation of atrial fibrillation or atrial flutter to normal sinus rhythm

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28
Q

What does the block of K+ channels caused by class 3 result in

A

Longer action potential plateau and prolonged repolarization

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29
Q

What are contraindications of ibutilide

A

History of polymorphic ventricular tachycardia (tostadas de pointes), pre-existing long QT syndrome

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30
Q

What must be monitored when ibutilide is administered

A

QT interval

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31
Q

How is dofetilide administered

A

Orally

32
Q

What is a unique contraindication of dofetilide

A

Patients with creatinine clearance less than 20mL/min

33
Q

Who is dofetilide use reserved to patients with

A

With highly symptomatic atrial fibrillation and/or atrial flutter

34
Q

What is dofetilide excreted by

A

Kidney

35
Q

What class 3 antiarrhythmic is also a class 1

A

Sotalol

36
Q

Who sotalol most frequently used in

A

Patients that cannot tolerate amiodarone

37
Q

Who must satalol be used with caution in

A

Patients with impaired renal function or DM

38
Q

What antiarrhythmic is contraindicated in patients with asthma

A

Sotalol

39
Q

What is a contraindication for bretylium use

A

Digitalis-induced arrhythmias

40
Q

What class 3 can be used in patients with depressed ejection function

A

Dofetilide

41
Q

What anti-arrhythmic can act as all classes

A

Amiodarone

42
Q

What antiarrhythmic can cause HF, severe pulmonary toxicity, thyroid dysfunction, corneal microdeposits, blue-gray skin pigmentation and photosensitivity

A

Amiodarone

43
Q

What side effect is most common at high doses of amiodarone

A

Pulmonary toxicity

44
Q

What antiarrhythmic can cause gasping syndrome in neonates

A

Amiodarone

45
Q

What drug can cause amiodarone increased elimination when co-administered

A

Cholestyramine

46
Q

Why is dronedarone less lipophilic than amiodarone

A

Lacks iodine moieties

47
Q

What anti-arrhythmic is contraindicated in pregnancy

A

Dronedarone

48
Q

Who should dronedarone be used with caution in

A

Patients with systolic heart failure

49
Q

What anti-arrhythmic increases creatinine without affecting glomerular filtration rate

A

Dronedarone

50
Q

What are common side effects of adenosine use

A

Facial flushing, bronchoconstriction in patients with asthma, headache, hypotension

51
Q

What anti-arrhythmic opens G protein coupled K+ channels and suppresses Ca++ dependent action potential, thereby inhibiting SA nodal, atrial and AV nodal conduction

A

Adenosine

52
Q

What may occur at onset of adenosine infusion

A

Transient arrhythmia

53
Q

What anti-arrhythmic is notably less effective when used with caffeine

A

Adenosine

54
Q

What is the clinical use of ranolazine

A

Chronic angina pectoris

55
Q

What antiarrhythmic improves exercise capacity and reduces anginal events; inhibits fatty acid beta oxidation

A

Ranolazine

56
Q

What are some common side effects of ranolazine

A

Constipation, dizziness, headache

57
Q

On what phase(s) of the cardiac AP do amiodarone and sotalol wrk

A

Phase 0 and 3

58
Q

On what phase(s) of the cardiac AP do lidocaine, flecainide, and quinidine work

A

Phase 0

59
Q

On what phase(s) of the cardiac AP do beta blockers work

A

Phase 2 and 4

60
Q

What is responsible for depolarization of SA and AV nodal fibers

A

Calcium ion (inward)

61
Q

What ion current is responsible for the repolarization of SA and AV nodal fibers

A

Potassium ion (outward)

62
Q

Where is the SA node located

A

Right atrium

63
Q

What class of antiarrhythmic agents has membrane stabilizing effects

A

Beta-blockers

64
Q

What is the general mechanism of class 1

A

Sodium channel blockers

65
Q

What is the general mechanism of class 2

A

Beta blockers

66
Q

What is the general mechanism of class 3

A

Potassium channel blockers

67
Q

What is the mechanism of class 4

A

Calcium channel blockers

68
Q

Magnesium is used to treat what specific type of arrhythmia

A

Torsades de pointes

69
Q

What 2 drugs can antagonize the effects of adenosine

A

Theophylline and caffeine

70
Q

What is the only subgroup of class1 that increase Ap duration and ERP

A

Class 1A

71
Q

Drugs that affect AV conduction velocity are referred to as what types of agents

A

Dromotropes

72
Q

What class 1a antiarrhythmic can cause peripheral vasoconstriction

A

Disopyramide

73
Q

What class 1B antiarrhythmic can cause pulmonary fibrosis

A

Tocainide

74
Q

Verapamil should not be given in what types of arrhythmias

A

Wolff-Parkinson’s-white (WPW) syndrome; ventricular tachycardia

75
Q

Digoxin-induced arrhythmias are treated by what drugs

A

Lidocaine; phenytoin

LECOM pharmacology notecards (22 decks)

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