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Exam 3- Antiarrhythmics Flashcards

1
Q

Quinidine

A

Class 1a

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2
Q

Lidocaine (xylocaine)

A

Class 1b

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3
Q

Propafenone (rythmol)

A

Class 1c

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4
Q

Beta-adrenergic antagonists

A

Class 2

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5
Q

Dronedarone (multaq)

A

Class 3

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6
Q

Verapamil (calan, isoptin)

A

Class 4

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7
Q

Procainamide

A

Class 1a

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8
Q

Mexiletine (mexitil)

A

Class 1b

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9
Q

Flecainide (tambocor)

A

Class 1c

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10
Q

Amiodarone (cardarone)

A

Class 3

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11
Q

Diltiazem (cardizem)

A

Class 4

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12
Q

Disopyramide (norpace)

A

Class 1a

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13
Q

Sotalol (betapace)

A

Class 3

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14
Q

Ibutilide (corvert)

A

Class 3

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15
Q

Dofetilide (tikosyn)

A

Class 3

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16
Q

Adenosine (adenocard)

A

Misc.

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17
Q

What does class 1 mostly block?

A

Phase 0 (Na)

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18
Q

What does 1a block?

A

Na and K

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19
Q

Dissociation rate for 1a?

A

Intermediate

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20
Q

Overall results of 1a?

A

Increase QRS and QT

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21
Q

What does 1b block?

A

Na

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22
Q

Dissociation rate for 1b?

A

Rapid (<1sec)

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23
Q

Overall result of 1b?

A

Decrease QT

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24
Q

What does 1c block?

A

Na

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25
Q

Dissociation rate for 1c?

A

Slow (>10sec)

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26
Q

Overall result of 1c?

A

Increase QRS

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27
Q

Indication for class 1b?

A

Ventricular tachycardia and ventricular fibrillation

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28
Q

Should you use 1b for atrial arrhythmias?

A

NO because not useful for anything above ventricles

29
Q

Overall result from 1c?

A

Slow phase 0 (depolarization)

30
Q

Dissociation rate for 1c?

31
Q

2 Indications for class 1c?

A

Atrial fibrillation in patients without CAD or HF

SVTs

32
Q

MOA of class 2?

A

Reduce intracellular cAMP:

  • reduction of the funny current
  • slows and limits Ca++ influx
33
Q

Overall what does class 2 do?

A

Increase PR interval
Decrease slope of phase 4 depolarization
Prolong depolarization at AV node

34
Q

What do beta blockers end in?

A

“olol”

35
Q

Indications for class 2?

A

Treat/prevent Supra-ventricular and ventricular arrhythmias

36
Q

7 adverse effects of beta blockers?

A
  1. Fatigue
  2. Bronchospasm
  3. Hypotension
  4. Impotence
  5. Depression
  6. Aggravation of HF
  7. Masking of symptoms of hypoglycemia in DM
37
Q

MOA of class 3?

A

Block K+ delayed rectifier current

38
Q

Overall effect of class 3?

A

Prolong redepolarization period (QT interval)

39
Q

Major side effects to class 3?

A

Torsade de pointes

Bradycardia

40
Q

Why is amiodarone considered a big gun?

A
  1. Na channel blocker (class 1)
  2. Beta and alpha 1 blocker (class 2)
  3. K channel blocker (class 3)
  4. L type Ca channel blocker (class 4)
41
Q

When does amiodarone work best?

A

High heart rate

42
Q

3 unusual pharmacokinetics with amiodarone:

A
  1. Delayed onset
  2. Loading dose required
  3. T1/2 of ~2months
43
Q

Where is amiodarone metabolized?

44
Q

What 3 other drugs have interactions with amiodarone?

A

Digoxin
Warfarin
Statins

45
Q

4 contraindications for amiodarone:

A
  1. Known hypersensitivity (plus iodine)
  2. Cardiogenic shock
  3. Sinus bradycardia
  4. 2nd or 3rd degree AV block
46
Q

What is the only thing that amiodarone does not affect?

47
Q

MOA of class 3:

A

Non-dihydropyridine Ca++ channel blockers

48
Q

Overall what does class 4 do?

A

Inhibition of l-type Ca channels that increase PR interval and ERP

  • slow rise of AP
  • prolonged repolarization at AV node
49
Q

Indications for class 4:

A

Supraventricular tachyarrhythmias

  • atrial flutter/fibrillation
  • SVTs
50
Q

4 adverse effects of class 4:

A

Hypotension
Bradycardia
AV block
Negative inotropy

51
Q

What does digoxin do to central and peripheral vagal tone?

A

Enhance them

52
Q

MOA of digoxin:

A

Inhibits Na/K-ATPase pump

  • increase Ca
  • increase contractility and proarrhythmic potential
53
Q

Indications for digoxin:

A

Atrial flutter/fibrillation - control of ventricular rate

54
Q

6 toxicity of digoxin:

A
  1. GI upset
  2. Altered color perception (halo vision)
  3. Malaise
  4. Bradycardia
  5. AV block
  6. Ventricular tachycardia/fibrillation
55
Q

What does adenosine do?

A

Activates ACh-sensitive K current in atria and sinus and AV bodes
-hyperpolarization and suppression of Ca-dependent APs

56
Q

What is the goal for adenosine?

A

Produce a complete AV block for a couple of seconds

57
Q

What does adenosine terminate?

A

PSVTs (reentry involving AVN)

58
Q

MOA of class 1a:

A

Inhibit Na
Inhibit K
-intermediate

59
Q

MOA of 1b:

A

Inhibit Na

-fast

60
Q

MOA of 1c:

A

Inhibit Na

-slow

61
Q

MOA of class 2:

A

Beta adrenergic receptor competitive antagonist

62
Q

MOA of class 3:

A

Multichannel blocker

Inhibit K

63
Q

MOA of class 4:

A

Inhibit Ca L-type

64
Q

Limitations for class 1a:

A

Risk of torsades de pointes, associated with possible increased mortality

65
Q

Limitations for class 1b:

A

No efficacy in atrial arrhythmias

66
Q

Limitations for class 1c:

A

Contraindicated in CAD and HF

67
Q

Limitations for class 2:

A

Hypotension and bradycardia

68
Q

Limitations for class 3:

A

Extra-cardiac side effects:

Risk of torsades de pointes, dependent on renal clearance

69
Q

Limitations for class 4:

A

Hypotension and bradycardia

Pharmacology (14 decks)

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