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Cardiovascular > EXAM #1: ANTIARRHYTHMIC PHARMACOTHERAPY > Flashcards

EXAM #1: ANTIARRHYTHMIC PHARMACOTHERAPY Flashcards

1
Q

What are Class I antiarrhythmics?

A

Na+ Blockers

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2
Q

What are Class II antiarrhythmics?

A

Beta Blockers

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3
Q

What are Class III antiarrhythmics?

A

K+ Blockers

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4
Q

What are Class IV antiarrhythmics?

A

Ca++ Blockers

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5
Q

What are the class IA drugs?

A

Quinidine
Procainamide
Disopyramide

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6
Q

What are the class IB drugs?

A

Lidocaine

Mexiletine

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7
Q

What are the class IC drugs?

A

Flecainide

Propafenone

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8
Q

Generally, what do you need to remember about IB vs IC drugs antiarrhythmics?

A

B is Best post-MI, C is Contraindicated post-MI

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9
Q

Why have the class IA drugs most faded from clinical use?

A
  • Association with INCREASED MORTALITY in atrial arrhythmia
  • QT prolongation is arrhythmiogenic (Torsades)
  • Induces G6PD hemolytic anemia
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10
Q

How was Quinidine used in clinical practice?

A

Both atrial and ventricular arrhythmias, esp.

  • Re-entrant SVT
  • VT
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11
Q

What was the previous use of procainamide?

A

2nd line in ACLS algorithm (2014) for VT/VF

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12
Q

What toxicity is specifically associated with procainamide?

A

SLE-like syndrome

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13
Q

What metabolite is associated with procainamide toxicity?

A

NAPA–polymorphisms can lead to differential toxicity

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14
Q

What is the specific toxicity associated disopyramide?

A

Heart failure

*Also, anticholingeric effects i.e. dry mouth, urinary retention, constipation…etc.

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15
Q

What type of local anesthetic is lidocaine?

A

Amide

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16
Q

What is lidocaine specifically indicated for?

A

Ventricular arrhythmias especially post-MI

Note that it has been entirely replaced by Amiodarone in 2016 ACLS guidelines

17
Q

What toxicities are associated with Lidocaine?

A

CNS stimulation/depression

18
Q

Can you take lidocaine with a hx of allergy to procaine?

A

Yes, procaine is an ESTER

19
Q

What is Flecainide indicated for?

A

First line agent for atrial arrhythmias WITHOUT IHD

20
Q

When is Flecainide contraindicated?

A

Remember, Class IC is Contraindicated in patients with structural or IHD (esp. post MI)

21
Q

What are the clinical indications for Propafenone?

A

Class IC–same as Flecainide i.e. first line for a-fib

22
Q

What adverse effects are associated with Class IC drugs?

A

Proarrhythmic i.e. QT prolongation and Torsades

23
Q

What do you need to remember about Class I drugs and CHF?

A

Increased mortality of Class I (all) in CHF

24
Q

What positive effect is associated B-Blocker use in arrhythmias?

A

Decreased mortality in ventricular arrhythmias

25
Q

What receptors does Sotalol have an effect on?

A

K+ and Beta

26
Q

What is Sotalol commonly indicated for?

A

A-fib WITH IHD

27
Q

What are the major side effects associated with Sotalol?

A

1) Torsades (one of the most dangerous drugs associated with QT prolongation and drug induced Torsades)
2) Excessive Beta-blockade

So bad that you’re really supposed to start the drug in the hospital

28
Q

What is Amiodarone the first line agent for?

A

VT/VF

29
Q

Why is Amiodarone so important?

A

Class III but has effects in all classes; thus, it is efficacious in the treatment of almost any arrhythmia

30
Q

What are the major side effects associated with Amiodarone? What do you have to do when you prescribe this drug?

A

1) Pulmonary fibrosis (chronic use)
2) Hepatotoxicity
3) Hypothyroidism

Thus, check PFTs, LFTs, and TFTs

4) Corneal deposits (annual fundoscopic exam)
5) Blue/grey skin deposits and photosensitivity
6) Neurologic effects–fine intention tremor

31
Q

What is the half-life of Amiodarone?

A

2 months–related to its high Vd

32
Q

What drugs do you need especially conscious of when prescribing Amiodarone?

A

Warfarin and digoxin

33
Q

What is Dronaderone?

A

Amiodarone without iodine–much safer than amiodarone but not as effective

34
Q

When is Dronaderone contraindicated?

A

CHF–increased mortality

35
Q

What is Dofetilide indicated for?

A

A-fib (both acute and chronic)

36
Q

What toxicity is associated with Dofetilide?

A

Torsades de Points (worse than Sotalol)

This drug has the highest incidence of Torsades of ANY drug–requires 3 day admission for monitoring

37
Q

How are ventricular arrhythmias commonly treated?

A

ICD

38
Q

What is the general treatment approach for A-fib?

A

1) Shock

2) Drugs

39
Q

What is the difference between rhythm and rate control for a-fib?

A

Rhythm=

  • Flecainide or Propafeneone (NO IHD) vs.
  • Sotalol/ Amiodarone (IHD/CHF)

Rate= Beta-blockers, diltiazem, digoxin

Cardiovascular (38 decks)

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