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Pharmacology II > CV & Renal: Antiarrhythmics > Flashcards

CV & Renal: Antiarrhythmics Flashcards

1
Q

What is a serious risk of all anti-arrhythmic drugs?

A

can precipitate lethal arrhythmia

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2
Q

Which three populations should be especially worried for arrhythmia development?

A

80% of MI

50% anesthetized patients

25% digoxin patients

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3
Q

What four factors can lead to decreased conduction?

A

Increased Threshold Potential: > -40

Decreased Maximum Diastolic Potential (Hyperpolarization): < -65

Decreased Slope of Phase 4 (Slower funny current)

Increased AP duration

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4
Q

What is the major mechanism for arrhythmia?

A

unidirectional block and reentry

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5
Q

What are the two main goals for arrhythmia therapy?

A

↓ Pacemaker Activity

Modify conduction/AP to disable reentry

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6
Q

What are Class IA arrhythmics, and what type of channels do they work on?

A

Quinidine, procainamide

open, active sodium channels

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7
Q

Quinidine and procainamide can block what two channel types?

A

open, active sodium channels (decrease phase 0 slope)

potassium channels (prolong AP, ERP)

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8
Q

Blockage of potassium channels by quinidine or procainamide has what effect?

A

prolonged ADP and ERP

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9
Q

Blocking open and active sodium channels by quinidine and procainamide has what effect?

A

“State dependent” blockade

Normal cells: slowing max rise of action potential

Damaged cells: no depolarization

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10
Q

What are three major adverse effects of quinidine?

A

Torsades

Widened QRS/QT and quinidine syncope/death

Chinconism

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11
Q

Slow acetylators can have what adverse effect with procainamide?

A

SLE

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12
Q

Which Class IA drug is a HIP drug?

A

procainamide

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13
Q

This drug blocks inactivated sodium channels, therefore blocking window current leading to shortened APD (increased phase 0 slope)

A

Lidocaine

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14
Q

Lidocaine has preference for (healthy/damaged) tissue

A

damaged

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15
Q

lidocaine is only effective where?

A

purkinje/ventricles

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16
Q

What is the DOC for acute ventricular arrythmia?

A

lidocaine

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17
Q

What is quinidine and procainamide used for?

A

acute/chronic tx of SV and ventricular arrhythmia

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18
Q

Which drug is a class IC antiarrhythmic?

A

flecainide (tambocor)

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19
Q

This drug has strong blockage of all sodium channel states and is slow to dissociate from binding. (big decrease in phase 0 slope)

It has no effect on ERP

A

Flecainide (tambocor)

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20
Q

This drug is used in the following situations:

SV Arrhythmias

Life threatening ventricular arrhythmia

Drug of last resort

A

flecainide (tambocor)

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21
Q

This drug is strongly pro-arrhythmic

A

flecainide (tambocor)

22
Q

What three drugs are class II antiarrhythmics?

A

propranolol, metoprolol, esmolol

23
Q

Which class II beta blocker has the following characteristics?

Short t1/2
IV admin
2nd line for acute PSVTs

A

esmolol

24
Q

What two drugs are Class III antiarrhythmics?

A

amiodarone, sotalol

25
Q

This class III antiarrhythmic is the “jack of all antiarrhythmics”

A

amiodarone

26
Q

This drug has the following mechanisms:

Primary: block K+ Channels (Class III effect)

Others:
Block Na+ Channels (Class I)
Beta Blocker (Class II)
Some Ca2+ channel blocking (Class IV)
Alpha Blocker
A

Amiodarone

27
Q

Which drug is DOC for Ventricular Arrhythmia (used in ACLS protocols)

A

amiodarone

28
Q

A patient presents with yellowish cornea, bluish gray skin. what drug likely caused this?

A

amiodarone

29
Q

Why does amiodarone cause thyroid dysfunction?

A

it contains iodine

30
Q

What drug hast he following adverse effects?

↓ Sinus Rate, ↓ Conduction
↑ QT w/out Torsades
Pulmonary Fibrosis
Photodermatitis

A

amiodaraone

31
Q

describe the half-life and route of admin for amiodarone?

A

PO admin

half life: 13-103 days

32
Q

Amiodarone and sotalol are/aren’t able to treat both ventricular and SV arrhythmias

A

are

33
Q

This Class III drug has the following mechanism…

K+ Block → APD
Non-specific Beta Blocker

A

sotalol

34
Q

Does amiodarone cause torsades?

A

no

35
Q

Which Class III drug causes torsades?

A

sotalol

36
Q

These drugs only works in the atria, and therefore is useful in the below arrhythmias:

Reentrant SVT
PSVT
A. Fib/flutter

A

Verapamil, Diltiazem (Class IV)

37
Q

What are two adverse effects of Class IV drugs (verapamil, diltiazem)

A

negative inotropic

can’t be used with beta blockers

38
Q

Which drug has the following mechanism?

↑ K+ Conductance & ↓ cAMP-induced Ca2+ influx →

hyperpolarization →

heart reset

A

Adenosine

39
Q

this is the DOC for acute PSVT and WPW syndrome.

It is only useful for reentry arrhythmias

A

Adenosine

40
Q

What are the 5 adverse effects of Adenosine?

A 
Flushing
SOB
CP
Hypotension
HA
41
Q

this is the DOC for torsades

A

Magnesium

42
Q

Magnesium has what 4 indications?

A

DOC for Torsade

Antiarrhythmic effects in patients w/ normal Mg levels

Digitalis induced arrhythmia

Seizer mgmt

43
Q

What is the route of admin for magnesium?

A

IV

44
Q

This drug causes increased potassium permeability and therefore hyperpolarization

A

Potassium

45
Q

Potassium administration decreases what four things?

A

↓ APD, Conduction, Pacemaker Rate, Pacemaker Arrythmogenesis

46
Q

Preferred treatment order for acute PSVT…

A

Adenosine > Esmolol > IV CCBs

47
Q

Preferred treatment order for Chronic PSVT?

A

Beta Blockers > CCBs

48
Q

Which two drug classes can’t treat both SV and ventricular arrhythmia?

A

Class IV (SV only)

Class IB (ventricular only)

49
Q

Which antiarrhythmic prolongs QT without torsades?

A

amiodarone

50
Q

Arrhythmic prophylaxis can be achieved with what two drugs?

A

beta blockers

CCBs

Pharmacology II (23 decks)

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