Heart Meds

Question 1

Class 1 Anti-arrhythmic

__ blockers?

Answer 1

Fast Na+ Channel blockers

Question 2

Class 2 Anti-arrhythmic

__ blockers?

Answer 2

B adrenergic antagonists

Question 3

Class 3 Anti-arrhythmic

__ blockers?

Answer 3

Inhibitors of repolarization

Question 4

Class 4 Anti-arrhythmic Agents

__ blockers?

Answer 4

Ca+ Channel blockers

Question 5

Class 2 MOA

Answer 5

Depress pacemaker activity
< threshold
= < SA Node discharge

=
< automaticity, suppress ventricular arrhythmias

Question 6

Class 2 Effects on Heart

Answer 6

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Question 7

Class 2 Agents

Answer 7

Propanolol
Metoprolol
Esmolol
Labetolol

Question 8

Propranolol

kinetics

Answer 8

Dose: 1 mg/min IV
Onset: 2-5 min
Peak E 10-15 min
DOA: 3-4 hr
Metab: Liver
PB: highly 90%

Question 9

Propranolol

SE

Answer 9

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Raynauds

Interfere w/ glucose metab

Question 10

Propranolol

CI/ Caution with-

Answer 10

Reactive AW disease
Hypovolemia
CHF
AV Block

Question 11

Metoprolol

Kinetics

Answer 11

DOSE:  5mg IV over 5 min
   Max= 15mg over 20min
ONSET: 2.5 min
1/2 Life: 3-4 hrs
METAB: liver

Question 12

Esmolol

Kinetics

Answer 12

DOSE: 
   0.5 mg/kg IV over 1 min
\+
    50-100 mcg/kg/min
DOA: <15min

Effects HR w/out < BP
(in small doses)
METAB: hydrolyzed by plasma esterases

Question 13

Class 3 MOA?

Answer 13

Prolong cardiac depolarization
> AP duration
Lengthen repolarization

Question 14

Class 3 USES?

Answer 14

Tx SVT & vent arrhythmias
Prophylaxis in card surgery (afib)
Pt who survive sudden cardiac death & can’t get ICD
Control rhythm in Afib

Question 15

Class 3 Agents

Answer 15

Amiodarone
Dronedarone
Sotalol

Question 16

Amiodarone

USES:

Answer 16

Class 1 ,2, 3, 4 properties
Prophylaxis/acute tx of; 
    -SVT
   - refractory VT/VF
  - AF

1st line for VT/VF if defib not work

Question 17

Amiodarone

kinetics

Answer 17

DOSE:
bolus 150-300 mg IV over 2 min (max 5mg/kg)
then 1 mg/hr for 6 hr
then .5 mg/hr x 18hr

E1/2 = 29 days
Metab: Liver 
   active metab
Excretion: 
  Biliary/intestine
96% PB
Large Vd

Question 18

Amiodarone

SE

Answer 18

Pulm toxicity/ edema
ARDS
Photosensitive rash
Grey/Blue skin discolor
Thyroid prob
corneal deposit
CNS/GI disturbance
torsades de P
Heart block
HoTN
Nightmares
Abnormal LFTs
inhibit P450

Question 19

Class 4 MOA

Answer 19

block slow Ca channel = < conduction through AV node = shorten phase 2 of AP in V myocytes
< contractility

Question 20

Class 4 Uses

Answer 20

Tx of SVT & V rate control in Afib/Aflutter
Prevent SVT re-occur

Not used in Vent arrhythmias

Question 21

Class 4 Agents

Answer 21

Verapamil*

Diltiazem

Question 22

Verapamil

Kinetics

Answer 22

DOSE: 2.5-10 mg IV over 1-3 min
    (max 20mg)
Infusion:  5 ug/kg/min
T1/2 =6-8hr
Metab: liver
   active metabolite
Excrete: urine / bile
PB: highly

Question 23

Verapamil

SE

Answer 23

Myocard depression
HoTN
Constipation
Bradycardia
Nausea
Prolong NMB

Question 24

Don’t use IV verapamil with __ ?

Answer 24

B Blocker

= heart block

Question 25

Verapamil Caution w/ :

Answer 25

``` +Inhalational Agents = myocard depression vasodilation Potentiate NMB > risk of LA toxicity +Dantrolene = >K Digoxin: < clearance of ```

Question 26

Diltiazem kinetics

Answer 26

``` Class 4, Ca Ch blocker DOSE: 5-20mg IV over 2 min 10 mg/hr T1/2: 4-6 hr METAB: liver PB: highly ```

Question 27

Diltiazem SE

Answer 27

Myocard depression HoTN Constipation

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Question 28

Class 5/ Other Agents? 4

Answer 28

Adenosine Digoxin Phenytoin Atropine