Exam 5 Antiarrhythmic Drugs Flashcards
Which drugs are Type I Na channel blockers?
Ia - Medium affinity, increases AP duration Procainamide Quinidine Disopyramide Ib - Low affinity, decreases AP duration Lidocaine Mexiletine Ic - High affinity, no effect on AP duration Flecainide Propafenone
Which drugs are Type II Beta-blockers?
Propranolol
Metorpolol
Esmolol
Which drugs are Type III Potassium channel blockers?
Amiodarone Dronedarone Sotalol Dofetilide Ibutilide
Which drugs are Type IV calcium channel blockers?
Verapamil
Diltiazem
What are other anti arrhythmic drugs?
Adenosine
Digitalis
Which drugs are used for ventricular arrhythmias?
Procainamide Ia Quinidine Ia Disopyramide Ia Lidocaine Ib Mexiletine Ib Flecanide Ic Propafenone (weak) Ic Metoprolol (ectopic pacemaker) II Propranolol (ectopic pacemaker) II Amiodarone III Sotalol III
Which drugs are used for atrial arrhythmias?
Procainamide Ia Flecanide Ic Propafenone Ic Beta Blockers II -metoprolol -propranolol -esmolol Sotalol III Amiodarone III Dronedarone III Dofetilide III Ibutilide III Calcium Channel Blockers IV - verapamil -diltiazem Digitalis Other Adenosine Other
Procainamide
Class: Na channel blockers - Type 1a medium affinity, increased AP duration
MOA: slows the upstroke of the action potential and slows conduction velocity, prolong the refractory period and prolong the QRS interval. also block potassium channels and causes a prolongation of the action potential and can result in QT interval prolongation, and induction of torsade de pointes arrhythmia and syncope.
Indications: short term antiarrhythmic therapy
SE: long term - lupus erythematosus like symptoms
Quinidine
Class: Na channel blockers - Type 1a medium affinity, increased AP duration
MOA: slows the upstroke of the action potential and slows conduction velocity, prolong the refractory period and prolong the QRS interval. also block potassium channels and causes a prolongation of the action potential and can result in QT interval prolongation, and induction of torsade de pointes arrhythmia and syncope.
Indications: Broad spectrum antiarrhythmic activity
SE: GI effects, significant vagolytic and anti- alpha adrenergic activities, significant prolongation of QT interval and torsade de pointes at therapeutic doses
*Rarely used
Disopyramide (Norpace)
Class: Na channel blockers - Type 1a medium affinity, increased AP duration
MOA: slows the upstroke of the action potential and slows conduction velocity, prolong the refractory period and prolong the QRS interval. also block potassium channels and causes a prolongation of the action potential and can result in QT interval prolongation, and induction of torsade de pointes arrhythmia and syncope.
Indications: Broad spectrum antiarrhythmic activity
SE: anticholinergic actions and most of its side effects are associated with this action. (urinary retention, dry mouth, blurred vision, constipation, and worsening of preexisting glaucoma)
*Rarely used
Lidocaine (Xylocaine)
Class:
MOA:
Indications:
SE:
Mexiletine (Mexitil)
Class:
MOA:
Indications:
SE:
Flecainide (Tambocor®)
Class:
MOA:
Indications:
SE:
Propafenone (Rythmol®)
Class:
MOA:
Indications:
SE:
Propranolol
Class: T2 B-adrenergic antagonists
MOA:
Indications:
SE:
Metoprolol (Lopressor)
Class: T2 B-adrenergic antagonists
MOA:
Indications:
SE:
Esmolol (Brevibloc)
Class: T2 B-adrenergic antagonists MOA: Indications: SE: *only IV, used in urgent situations
Dofetilide (Tikosyn)
Class: T3 K channel blockers MOA: prolongs AP Indications: maintain/restore normal sinus rhythm in afib pts SE: Torsades de pointes *Contra w/ hypokalemia
Ibutilide (Corvert)
Class: T3 K channel blockers MOA: prolongs AP, blocks K, activates Na Indications: convert atrial flutter/afib to normal sinus rhythm SE: QT prolongation, torsades de pointes *only IV
Sotalol (Betapace)
Class: T3 K channel blockers
MOA: prolongs AP, blocks K and B adrenergic antagonist
Indications: ventricular tachycardia, afib/flutter
SE: torsades de pointes, bradycardia
Amiodarone (Cordarone, Pacerone)
Class: Type 3 K channel blockers
MOA: prolongs AP, blocks K, Ca, Na channels
Indications: ventricular and supraventricular arrhythmias - afib
SE: pulm fibrosis, photedermatitis, gray-blue skin, corneal micro deposits, hypo/hyperthyroidism (dt ^plasma iodine), ^QT on ECG
Dronedarone(Multaq)
Class: Type 3 K channel blockers
MOA: prolongs AP duration, blocks K, Ca, Na channels
Indications: afib
*Black box for heart failure pts
Verapamil (Calan)
Class: Type 4 Ca channel blockers
MOA: blocks L-type calcium channels.
Indications: supraventricular tachycardia
SE: peripheral vasodilation
Diltiazem (Cardizem)
Class: Type 4 Ca channel blockers
MOA: blocks L-type calcium channels.
Indications: supraventricular tachycardia, rate control of afib
SE: peripheral vasodilation
Adenosine (Adenocard)
Class: Other
MOA: activates ACh sensitive K in atrium, SA, AV nodes
Indications: reentrant supraventricular arrhythmias
SE: flushing, chest pressure, dyspnea
*given IV bolus
Digitalis (Digoxin)
Class: other
MOA: vagotonic > inhib of Ca in AV node - activation of ACh sensitive K in atrium
Indications: reentry arrhythmias AV node, afib
SE: arrhythmias, nausea, disturbances in cognition, blurred/yellow vision.
