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0
Q

What phase of the action potential does class Ia effect?

A

Prevents sodium influx in phase 0, and block potassium currents to lengthen the action potential.

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1
Q

What are the Class Ia drugs?

A

Quinidine - Cadioquin
Procainamide - Pronestyl
Disopyramide - Norpace

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2
Q

How does Class Ia drugs work?

A

Blocks Na channels and slows conduction velocity, decreasing the speed of depolarization.

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3
Q

Which class I slows the rate of the action potential rise and prolong ventricular effective refractory period?

A

IA

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4
Q

What is the pharmacokinetic characteristic of Quinidine?

A

Rapid oral absorption

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5
Q

What is the mechanism of Quinidine anti arrhythmic activity?

A

Active sodium channel blockade
Depression of conduction velocity
Reduced excitability

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6
Q

Is Quinidine effective in suppressing SVT/WPW?

A

True

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7
Q

What is the principal ion for the SA and AV node?

A

Calcium

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8
Q

What Drugs are Class Ib?

A

Lidocaine
Tocainide
Mexiletine
Phenytoin - Dilantin

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9
Q

What is a short acting B-adrenergic receptor agonist?

A

Esmolol (Brevilock)

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10
Q

What drug can delay after depolarizations?

A

digoxin toxicity

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11
Q

What receptors does Isoproterenol stimulate?

A

Beta 1&2.

Increase HR, enhanced conduction time through AV node. Causes arterial vasodilitation

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12
Q

What are Ic Drugs?

A

Flecainide

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13
Q

What effects can Quinidine have

A

Prolong QRS
Increase pacing and defib thresholds
Improve AVN conduction

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14
Q

What actions does Procainamide have?

A

Prolong P-R, QRS, QT interval
Increase pacing threshold
Choice for AFIB conducting down BT

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15
Q

What are Disopyramide actions

A

Prolong the QRS and QT interval

Negative Inotrope

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16
Q

What needs to be monitored when giving a Class 1a?

A

Watch QT interval want it to be <500ms

May cause EADs

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17
Q

What is the first line drug in the treatment of VT?

A

Lidocaine

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18
Q

What is the action of Mexiletine

A

Shortens action potential duration
Increases the ERP of the HIS outline system
Treat VT

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19
Q

What are the primary actions of Phenytoin?

A

Shortens QT
Used in children for LQTS when BB fail
DOC in dig toxicity by maintaining AV node conduction and inhibiting DADs

20
Q

What are the primary actions of Tocainide

A

PO form of lidocaine
Shortens action potential
Deceased ERP of HiS purkinje system

21
Q

What are the 1C drugs?

A

Moricizine - Ethmozine
FlecInide - Tambocor
Propafenone - Rhythmol

22
Q

How do class Ic drugs work?

A

Block sodium fast current

Depresses depolarization without changing action potential duration.

23
Q

What does 1c drugs treat?

A

SVT
Widens the QRS with inhibition of HIS
Depress upstroke of phase 0

24
What does flecainide treat?
VT and SVT including WPW, AFIB, and AFlutter Not for pts with structural heart disease. Increase pacing thresholds and DFT Decreases conduction velocity therefore prolongs P-R and QRS
25
What does Moricizine treat?
-Increase a regrade and retrograde refractory in re entrant limbs of WPW -Slows retrograde conduction AVNRT -Exercise stress when initiated Tx Not for patients with structural heart disease?
26
What doe Propafenone treat?
``` Used for VT, SVT, AF, AFL, WPW Prolongs P-R and QRS with no effect on QT Slows AV conduction Mild BB and CAB effects Increase pacing thresholds ```
27
Considerations for Ic drugs
Arrhythmia a may be provoked with increase heart rate Exercise stress test Not for pts with underlying heart dx
28
What are Class II drugs?
Beta Blockers Block effects of catacholamines Decrease SA and AV conduction Increase refractory of AVN
29
What are the Class II drugs?
propranolol - Inderal Sotalol - Betapace Cartelol Carvedolol
30
What are the class III drugs?
``` Amiodarone Sotalol Bretylium Ibutilide Dofetilide - Tikosyn ```
31
How do Class III drugs work?
``` Prolongs action potential Blocks potassium currents Prolongs refractory pd Prolongs QT interval Little effect on conduction velocity ```
32
How does Amiodarone work
- Increases ERP of tissue - Prolongs AP duration - Slows conduction through AVN b/c beta receptor inhibition - calcium agonist - increase pacing thresholds and DFT - Tx VT and VF and maintaining SR
33
How does Sotalol work?
Used to treat VT, VF, AFIB, AFL Prolongs refractory pd in atrial, AVN, BT and ventricle Increase pacing thresholds
34
How does Ibutilide work?
QT and QTc prolongation Prolongs repolarization Pharmacological cardio version Can cause torsades
35
How does Tikosyn work?
Delays repolarization by blocking inward k rectifiers Prolongs QT and QTc without effecting Ca currents Decrease DFT Mild negative ionotrope Hospital loading for 72hrs to monitor QT
36
What are Class IV drugs?
Calcium channel blockers Vasodilator and decrease PVR Negative Inotrope Slows SA and AVN conduction
37
What are the class IV drugs?
``` Nifedipine Verapamil Diltiazem Amyloid pine Bepridil ```
38
How does verapamil work?
``` Used for SVT NOT WPW or LGL Increases AVN ERP and AV block Increase pacing threshold Tx for exercise induced VT/RVOT Tx HF post MI Relaxes arteries throughout system ```
39
What are Afterdepolarizations?
Early occur in phase 2 or 3 Late occur in phase 4 If early enough can initiate an action potential
40
What is EAD
Early afterdwpolarizatjon Proposed mechanism for Torsades Hypomagnesemia, hypokalemia
41
What increases EADs?
``` Increase sympathetic tone Hypoxia Hypokalemia Bradycardia Sotalol, quinidine n-acetylprocainamide ```
42
What causes DADs?
``` Dig toxicity Tachycardia Hypokalemia Hypercalcemia Catacholamines ```
43
What drugs increase DFTs?
``` Ecainide Flecainide Lidocaine Amiodarone Propafenone Mexiletine Moricizine ```
44
WhT drugs decrease DFTs?
Ami Sotalol Procainamide
45
What effect does diltiazem have on the AVN?
Slows conduction by blocking Ca channels
46
Cardiac cells resting transmembrane potential is?
-90mV
47
Which areas of the heart exhibit the type of action potential known as the "slow response" type?
SA and AVN
48
A 33yo woman with paroxysmal AFIB has an evaluation that reveals normal physician exam, normal ECG and echo. The most reasonable anti arrhythmic agent to start her on as an outpatient?
Flecainide

Drugs (5 decks)

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