Medications in cardiology

Question 1

Contraindications for bisoprolol

Answer 1

Acute HF
History of severe bronchoconstriction

Question 2

Contraindications for Metoprolol

Answer 2

Asthma

Question 3

Give 3 selective beta blockers
What class of antiarrhythmetics are they in?
Give 2 Non-selective

Answer 3

Selective: Bisoprolol, Atenolol, Metoprolol
Non-selective: Propranolol, Carvedilol

Class 2 Antiarrhytmetics

Question 4

Give an example of a thiazide-like diuretic

Answer 4

Indipamide

Question 5

Anti-arrhythmic medications are classified according to the Vaughan-William’s classification. List all the classes of this system

Answer 5

Class I - Sodium channel blockers
Ia - Moderate blockade
Ib - Mild blockade/Fast dissociation
Ic - Strong blockage/slow dissociation

Class II - Beta Blockers

Class III - K+ channel blockers

Class IV - CCB

Class V - Others

Question 6

For each of the subclasses of class 1 antiarrhymic medications,

State which also has a K+ channel blockade
State their effect on QRS and QT intervals
Give 2 examples

Answer 6

Ia has K+ channel blockade too

Class I - Sodium channel blockers
Ia - Moderate blockade => prolongs QRS and QT
e.g. Quinidine, Procainamide

Ib - Mild blockade/Fast dissociation => Shorter QRS and QT
e.g. Lidocaine, Phenytoin

Ic - Strong blockage/slow dissociation => Very prolonged QRS and QT
e.g. Flecainide, Propafenone

Question 7

What class of anti-arrhythmics does Digoxin fall into?

What is its mechanism of action?

Answer 7

Na/K ATP-ase pump inhibition => Increased cardiac inotropy
Vagal stimulation => increased PNS

Question 8

Give 4 examples for Classes II, III and IV of anti-arrhythmic drugs

Answer 8

Class II - Beta Blockers
Bisoprolol, Atenolol, Metoprolol

Class III - K+ channel blockers
Sotalol, Amiodarone, Ibutilide, Vernakalant

Class IV - CCB (Non-dihydro only)
Verapamil, Diltiazem

Question 9

Give 2 examples for Class IV anti-arrhythmic drugs

Answer 9

Class IV - CCB (Non-dihydro only)
Verapamil, Diltiazem

Question 10

What classes of anti-arrhythmic drugs may prolong the QT interval and lead to long QT syndrome?
Give some drug examples

Answer 10

Class Ia and III
(Quinidine, procainamide/ amiodarone, sotalol, ibutilide)

Also Verapamil (class IV) in patients with A.fib or WPW (AVRT)

Question 11

What medications may cause Long QT sydrome?

Answer 11

Class Ia and III antiarrhythmics (Quinidine, procainamide/ amiodarone, sotalol, ibutilide)

Antibiotics: Macrolides (azithromycin, clarithromycin, erythromycin)
Fluoroquinolones (ciprofloxacin, levofloxacin)

Antifungals (azoles)

Antidepressants: both typical and atypical

Antipsychotics: TCAs, SSRIs

Antiemetics: ondansetron (5HT-3 receptor antagonist)

Methadone (opioid)