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DT III Exam 1 > Drugs to Treat Dysrhythmias > Flashcards

Drugs to Treat Dysrhythmias Flashcards

1
Q

Effects of Proarrhythmic drugs (4)

A

Increased automaticity
Conduction block or slowing
Decreased/ increased ERPs
Heterogeneity of ERP

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2
Q

Effects of antiarrhythmic drugs (5)

A

Decreased automaticity
Restore conduction (depressed conduction/ reverse reentry)
Decreased conduction
Decreased/ increased ERPs (reverse/ block reentry)
Homogeneity of ERPs

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3
Q

Class I antiarrhythmic drug

A

Na channel block

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4
Q

Class II antiarrhythmic drug

A

Beta-receptor block

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5
Q

Class III antiarrhythmic

A

Prolong APD

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6
Q

Class IV antiarrhythmic

A

Ca channel block

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7
Q

Class IA

A

Moderate dissociation rate

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8
Q

Class IB

A

Rapid dissociation

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9
Q

Class IC

A

Slow dissociation

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10
Q

State dependent ion channel block

A 
Class I antiarrhythmic drug
Binding to open/ inactivated channel
Association during systole
Dissociation during diastole
Block related to depolarization (HR, ischemia, APD)
Block related to dissociation rate
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11
Q

Class IA drugs (3)

A

Procainamide

Quinidine, Disopyramide

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12
Q

Procainamide

A

Class IA drug

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13
Q

Class IA: function

A

Direct effect: decrease automaticiy and conduction velocity, increase APD and ERP
Anticholinergic effects

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14
Q

Class IA: effects on AV node

A

Direct effect= decrease AV conduction
Anticholinergic= increase AV conduction
Net= variable AV conduction

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15
Q

Class IA: contra

A

Prolonged QT syndrome causes Torsades de pointes

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16
Q

Class IA: indication

A

Life-threatening ventricular arrythmia

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17
Q

Procainamide: kinetics

A

Well absorbed orally (or IV)

RE and HM

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18
Q

Procainamide active metabolite

A

NAPA

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19
Q

Procainamide: ADR

A

+ANA (Lupus-like syndrome)
Agranulocytosis/ Leuopenia
Proarrhythmic effects
Conduction block, decreased myocardial contractility, hypotension, GI

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20
Q

Procainamide: contra

A

Prolonged QT
Hypokalemia
SLE

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21
Q

Class IB

A

Lidocaine

Mexiletine

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22
Q

Lidocaine

A

Class IB drug

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23
Q

Mexiletine

A

Class IB drug

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24
Q

Class IB: general characteristics

A

Minimal effects on normal myocardium

Class IA action in diseased myocardium

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25
Q

Lidocaine: indication

A

Life threatening V arrhythmias

Digoxin-induced arrhythmias

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26
Q

Lidocaine: pharmacokinetics

A

HM (first pass elimination)
Decrease dose in liver disease and CHF
IV only

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27
Q

Lidocaine: ADR

A

CNS (disorientation to seizures)
Hypotension
Decrease cardiac contractile

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28
Q

Lidocaine: Contra

A

Hypersensitivity to Amides
Severse hepatic dysfunction
History of lidocaie-induced seizures

29
Q

Mexiletine: ADR

A

GI
Tremors
CNS
Thrombocytopenia *

30
Q

Class IC

A

Flecainide

Propafenone

31
Q

Clas IC: general

A

Markedly slow conduction
ADP, ERP +/-
Decrease automaticity

32
Q

Flecainide: indication

A

Life threatening V. arrhythmias in absence of organic heart disease
Disabling supraventricular arrhythmias in absence of organic heart disease

33
Q

Flecainide: ADR

A 
Increase Post MI mortality
Conduction block
CHF (by decreased contractility)
Proarrhythmic
AV block
34
Q

Propafenone: general

A

Similar to Flecainide
Weak Beta blockade (class II)
Proarrhythmic
Negative inotropic effect *

35
Q

Class II: MoA

A 
Inhibit sympathetic input
Decrease automaticity
Decrease conduction velocity
Increase Refractoriness
Prominent effects on SA/ AV nodes
Decrease contractility
36
Q

Class II: indication

A 
Supraventricular arrhythmia
A flutter and fib
Symptomatic PVC
Post MI
CHF
37
Q

Class II: ADR

A 
Bronchoconstriction
CHF
AV block
Cold extremities
Increase insulin induced hypoglycemia
Block Increase in HR (hypoglycemia)
38
Q

Class II (3)

A

Propranolol (nonspecific Beta blocker)
Metoprolol (cardioselective beta-blocker)
Esmolol (cardioselective, short, control V rate in A fib/ flutter, control sinus tachycardia)

39
Q

Class III: general

A

Homogeneous prolongation of APD (proarrhythmic)

40
Q

Class III: indication

A

Refractory, life-threatening ventricular arrhythmia

41
Q

Class III drugs

A

Amilodarone
Dronedarone
Ibutilide/ Dofetilide

42
Q

Amiodarone:general

A

Highly efficacious
DOC acute suppression of V arrhythmia
refractory life threatening V tach
Sustained V tach

43
Q

Amiodarone: kinetics

A

Highly lipophilic

Very long half life (month)

44
Q

Amiodarone

A

Class III

45
Q

Amilodarone: ADR

A 
Pulmonary fibrosis
Hyper/hypothyroidism
Hepatotoxicity
AV block, Bradycardia
Proarrhythmic
Corneal microdeposite, photosensitivity, blue/gray nose/ cheeks
46
Q

Dronedarone

A

Class III

47
Q

Dronedarone: indication

A

Prevent A flutter/ fib

48
Q

Dronedarone: kinetics

A

24 hr half life

49
Q

Dronedarone: ADR

A

Increase mortality in CHF
Liver injury/ failure
(Monitor liver function 6 mos)

50
Q

Ibutilide/ Dofetilide

A

Class III

51
Q

Ibutilide/ Dofetilide: inidication

A

Prolong ADP/ERP

Terminate A flutter/ fib

52
Q

Ibutilide/ Dofetilide: ADR

A

Proarrhythmic (Torsades de pointes)

53
Q

Sotolol

A

Class III + nonselective Beta blockade

54
Q

Sotolol: indication

A

Life-threatening ventricular arrhythmia

Prevent recurrence of symptomatic A flutter/ fib

55
Q

Sotolol: ADR

A

Prolongs QT (Torsades de pointes)

56
Q

Verapamil

A

Class IV

57
Q

Class IV

A

Verapamil

58
Q

Verapamil: MoA

A

In SA/ AV nodes
Decrease firing rate of SA node (decrease HR)
Decreased conduction velocity in AV node
Increase APD and ERP (increase AV refractoriness)
In Atrial/ ventricular muscle
Decrease contractility

Vasodilation + decrease CO= Decrease BP

59
Q

Class IV: indication

A

Supraventriular arrhythmias
PSVT with AV notal reentry
A flutter/ fib

60
Q

Verapamil: ADR

A

Hypotension
CHF
AV block
Constipation

61
Q

Verapamil: drug interaction

A

Concurrent Beta blocker
Digoxin
Antiarrythmic drugs
HM interaction (Cimetidine)

62
Q

Adenosine

A

Decrease AV doncution
short acting
Rapid uptake/ adenosine deaminase
Rapid bolus dosing

63
Q

Adenosine: indication

A

Acute termination of PSVT

64
Q

Adenosine: ADR

A

Asthma and COPD

65
Q

Vagomimetics

A

Decrease AV conduction

66
Q

Terminate PSVT

A

Valsalva

Carotid sinus massage

67
Q

Drug that controls V rate in A/ fib and flutter

A

Digoxin

68
Q

Drugs that increase conduction, AS node rate

Treat bradyarrhythmias

A

Atropine

Isoproterenol

69
Q

Know the graphs for Class I-IV

A

Refer to the lecture ppt 1/14/2016

DT III Exam 1 (5 decks)

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