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PH 113 - Pharmacology 1 > MIDTERM 03 - Antiarrhythmic Drugs > Flashcards

MIDTERM 03 - Antiarrhythmic Drugs Flashcards

1
Q

System composed of autorhythmic fibers; acts as a pacemaker that sets the rhythm of electrical excitation

A

Cardiac conduction system

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2
Q

Node located in the right atrial wall; a natural pacemaker that is faster than the pace of other autorhythmic fibers

A

Sinoatrial (SA) node

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3
Q

If the sinoatrial node (100x/min) fails, the __________ node takes over (40-60x/min)

A

Atrioventricular (AV) node

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4
Q

If the atrioventricular (AV) node fails, other __________ fibers take over (20-35x/min)

A

Autorhythmic

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5
Q

A recording of electrical signals on the skin generated by cardiac action potentials

A

Electrocardiogram (ECG)

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6
Q

An instrument used to record ECG

A

Electrocardiograph

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7
Q

Signifies atrial depolarization before atrial contraction (Parts of normal electrocardiogram)

A

P wave

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8
Q

Phase 0 (rapid upstroke) (Parts of normal electrocardiogram)

A

P wave and QRS complex

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9
Q

Signifies ventricular depolarization before ventricular contraction (Parts of normal electrocardiogram)

A

QRS complex

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10
Q

Signifies ventricular repolarization before ventricular relaxation (Parts of normal electrocardiogram)

A

T wave

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11
Q

Phases 1-2 (initial repolarization and plateau) (Parts of normal electrocardiogram)

A

T wave

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12
Q

Refers to the conduction time from the beginning of atrial excitation to the beginning of ventricular excitation; may be prolonged in coronary heart disease or RF

A

PQ interval

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13
Q

Refers to the time when the ventricular contractile fibers are depolarized during the plateau phase of the action potential; may be elevated in acute MI and depressed in myocardial ischemia

A

ST interval

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14
Q

Refers to the time from beginning of ventricular depolarization to the end of ventricular repolarization; may be prolonged in heart injury

A

QT interval

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15
Q

Refers to the continuous ambulatory electrocardiography

A

Holter monitoring

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16
Q

A battery-operated monitor that records an ECG continuously for 24 hours

A

Holter monitor

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17
Q

Refers to the loss of cardiac rhythm, especially the irregularity of heartbeat

A

Arrhythmia

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18
Q

Increased firing of tissues with spontaneous pacemaker activity (Abnormalities in impulse formation)

A

Enhanced automaticity

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19
Q

Normal cardiac action potential followed by an abnormal afterdepolarization (Abnormalities in impulse formation)

A

Afterdepolarizations and triggered automaticity

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20
Q

Decrease in conduction (Abnormalities in impulse formation)

A

Block

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21
Q

Impulse reenters and excites areas of the heart more than once (Abnormalities in impulse formation)

A

Reentry

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22
Q

Includes atrial fibrillation (AF), atrial flutter, and paroxysmal supraventricular tachycardia (PSVT) (Types of arrhythmia)

A

Supraventricular tachyarrhythmias

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23
Q

Includes premature ventricular contractions (PVCs), ventricular tachycardia (VT), and ventricular fibrillation (VF) (Types of arrhythmia)

A

Ventricular arrhythmias

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24
Q

Includes sinus bradyarrhythmias and AV block (Types of arrhythmia)

A

Bradyarrhythmias

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25
Q

Due to reentry; extremely rapid (400-600 atrial beats/min); no P wave (Types of supraventricular tachyarrhythmias)

A

Atrial fibrillation (AF/Afib)

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26
Q

Due to reentry; rapid (270-330 atrial beats/min); 2-3 P waves in sawtooth pattern followed by QRS-T (Types of supraventricular tachyarrhythmias)

A

Atrial flutter

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27
Q

Due to reentry; is rapid and regular; P wave merged with T wave (Types of supraventricular tachyarrhythmias)

A

Paroxysmal supraventricular tachycardia (PSVT)

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28
Q

Has an unknown mechanism; has single ventricular beats that fall earlier than the next anticipated supraventricular beat (Types of ventricular arrhythmias)

A

Premature ventricular contractions (PVCs)

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29
Q

Due to reentry, afterdepolarization, and triggered automaticity; is rapid and regular; three or more repetitive PVCs occurring at a rate greater than 100 beats min (Types of ventricular arrhythmias)

A

Ventricular tachycardia (VT/VTach)

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30
Q

Due to reentry; immeasurable rate and irregular rhythm; the most serious of all arrhythmias (Types of ventricular arrhythmias)

A

Ventricular fibrillation (VF/Vfib)

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31
Q

Due to depressed automaticity; slow (<60 beats/min) and regular (Types of bradyarrhythmias)

A

Sinus bradyarrhythmias

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32
Q

__________ usually does not require treatment (Types of sinus bradyarrhythmias)

A

Physiologic bradycardia

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33
Q

__________ (e.g. sick sinus syndrome) is treated with a pacemaker (Types of sinus bradyarrhythmias)

A

SA node dysfunction

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34
Q

Due to block; normal SA activation and atrial systole but delayed or absent ventricular activation; has 3 degrees (Types of bradyarrhythmias)

A

AV block

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35
Q

Prolonged PR interval (Degrees of AV block)

A

1st degree

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36
Q

Prolonged PR interval with missing QRS complexes (Degrees of AV block)

A

2nd degree

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37
Q

Atrial and ventricular activation are independent (Degrees of AV block)

A

3rd degree

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38
Q

Inhibits Na+ channel; decreases excitability and conduction velocity (Classes of antiarrhythmics)

A

Class I antiarrhythmics

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39
Q

Slows phase 0 depolarization in ventricular muscle fibers (Types of Class I antiarrhythmics)

A

Class IA antiarrhythmics

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40
Q

Procainamide, quinidine, and disopyramide are all examples of Class __________ antiarrhythmics

A

IA

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41
Q

Derivative of procaine; used as an acute treatment of AFib, VFib, and VTach in MI (Examples of Class IA antiarrhythmics)

A

Procainamide (PO, IV, IM)

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42
Q

Rarely used; used for maintenance of sinus rhythm in patients with atrial flutter and prevention of recurrence of VTach or VFib (Examples of Class IA antiarrhythmics)

A

Quinidine (PO)

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43
Q

Has modest antimuscarinic and alpha antagonist effect (Examples of Class IA antiarrhythmics)

A

Quinidine (PO)

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44
Q

Used for maintenance of sinus rhythm in patients with atrial flutter and prevention of recurrence of VTach or VFib (Examples of Class IA antiarrhythmics)

A

Disopyramide (PO)

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45
Q

Blocks open Na+ blocker and K+ channels; sometimes used in hypertrophic cardiomyopathy (Examples of Class IA antiarrhythmics)

A

Disopyramide (PO)

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46
Q

Most common ADR of quinidine (PO)

A

Diarrhea

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47
Q

ADR of quinidine characterized by headache, dizziness, and tinnitus

A

Cinchonism

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48
Q

Shortens phase 3 repolarization in ventricular muscle fibers (Types of Class I antiarrhythmics)

A

Class IB antiarrhythmics

49
Q

Lidocaine and mexiletine are all examples of Class __________ antiarrhyhmics

50
Q

DOC for termination of VT (Examples of Class IB antiarrhythmics)

A

Lidocaine (IV)

51
Q

DOC for prevention of VF after cardioversion in the setting of acute ischemia (Examples of Class IB antiarrhythmics)

A

Lidocaine (IV)

52
Q

One of the least cardiotoxic (Examples of Class IB antiarrhythmics)

A

Lidocaine (IV)

53
Q

Seizures due to lidocaine must be treated with __________

54
Q

Oral congener of lidocaine; used for ventricular arrythmias (Examples of Class IB antiarrhythmics)

A

Mexiletine (PO)

55
Q

Oral congener of lidocaine that has reduced 1st pass effect (Examples of Class IB antiarrhythmics)

A

Mexiletine (PO)

56
Q

Slows phase 0 depolarization in ventricular muscle fibers (Types of Class I antiarrhythmics)

A

Class IC antiarrhythmics

57
Q

Moricizine, flecainide, and propafenon are all examples of Class __________ antiarrhythmics

58
Q

A phenothiazine derivative; used as chronic treatment of ventricular arrhythmias (Examples of Class IC antiarrhythmics)

A

Moricizine (PO)

59
Q

Used for maintenance of sinus rhythm in AFib; used as chronic treatment of PSVT (Examples of Class IC antiarrhyhmics)

A

Flecainide (PO)

60
Q

Has some structural similarities to propranolol; used for maintenance of sinus rhythm of AFib and for supraventricular tachyarrhythmias (Examples of Class IC antiarrhythmics)

A

Propafenone (PO)

61
Q

Has beta blocking activity (Configurations of propafenone)

A

S-(+)-propafenone

62
Q

RyR2 Ca2+ channels-blocking activity (Configurations of propafenone)

A

R-(-)-propafenone

63
Q

Blocks β-receptors; inhibits phase 4 depolarization in SA and AV nodes; used as acute and chronic treatment of VT without structural heart disease (Classes of antiarrhythmics)

A

Class II antiarrhythmics

64
Q

Acebutolol, esmolol, and propranolol are all Class __________ antiarrhythmics

65
Q

DOC for chronic treatment to prevent arrhythmias in congenital LQTS and CPVT (Class II antiarrhythmics) (NPM)

A

Nadolol (preferred), Propranolol, Metoprolol

66
Q

Has an ultrashort half-life of 9 minutes; used as an acute treatment to control rate in AF (Class II antiarrhythmics)

A

Esmolol (IV)

67
Q

Inhibits K+ channels; prolongs phase 3 repolarization in ventricular muscle fibers (Classes of antiarrhythmics)

A

Class III antiarrhythmics

68
Q

Amiodarone, ibutilide, dofetilide, and sotalol are all examples of Class __________ antiarrhythmics

69
Q

A structural analog of thyroid hormone; used for maintenance of sinus rhythm in AFib and treatment of VFib and VTach in MI (Examples of Class III antiarrhythmics)

A

Amiodarone (PO, IV)

70
Q

Has a broad spectrum; having class I-IV activity (Examples of Class III antiarrhythmics)

A

Amiodarone (PO, IV)

71
Q

DOC for acute treatment of VT or VF causing cardiac arrest (Examples of Class III antiarrhythmics)

A

Amiodarone (PO, IV)

72
Q

Pulmonary fibrosis due to amiodarone (PO) should be treated with __________

A

Glucocorticoids

73
Q

A noniodinated structural analog of amiodarone used as chronic treatment in restoring sinus rhythm in AF and atrial flutter (Examples of Class III antiarrhythmics)

A

Dronedarone (PO)

74
Q

Has class I-IV activity; is both a substrate and inhibitor of CY3A4 (Examples of Class III antiarrhythmics)

A

Dronedarone (PO)

75
Q

Dronedarone (PO) has a __________; meaning it is not to be used in acute decompensated or advanced HF

A

Black box warning

76
Q

Blocks rapid delayed rectifier K+ channel; has no extracardiac effects (Examples of Class III antiarrhythmics)

A

Dofetilide (PO)

77
Q

Used for the acute conversion of atrial flutter and AFib to normal sinus rhythm (Examples of Class III antiarrhythmics)

A

Ibutilide (IV)

78
Q

Adverse drug reaction (ADR) of ibutilide (IV), dofetilide (PO), and sotalol (PO)

A

Torsades de pointes

79
Q

Used for the maintenance of normal sinus rhythm in patients with AFib (Examples of Class III antiarrhythmics)

A

Dofetilide (PO)

80
Q

Non-selectively blocks beta receptors (class II) and prolongs AP duration (class III) activity (Examples of Class III antiarrhythmics)

A

Sotalol (PO)

81
Q

Has beta blocking activity (Configurations of sotalol)

82
Q

Has AP-prolonging activity (Configurations of sotalol)

A

D- & L-sotalol

83
Q

Used for chronic treatment to prevent AF, VT, and VF; decreases threshold for cardiac defibrillation (Examples of Class III antiarrhythmics)

A

Sotalol (PO)

84
Q

A quaternary ammonium compound used as treatment and prevention of VF (Examples of Class III antiarrhythmics)

85
Q

Blocks Ca2+ channel; inhibits action potential in SA and AV nodes (Classes of antiarrhythmics)

A

Class IV antiarrhythmics

86
Q

Verapamil and diltiazem are all examples of Class __________ antiarrhythmics

87
Q

Blocks activated and inactivated L-type Ca2+ channels; suppresses EADs and DADs (Examples of Class IV antiarrhythmics)

A

Verapamil (PO, IV)

88
Q

Used as a 2nd line drug as acute treatment to terminate SVT; has dose-related cardiotoxicity (Examples of Class IV antiarrhythmics)

A

Verapamil (PO, IV)

89
Q

Used for PSVT; has less cardiac ADRs than verapamil (Examples of Class IV antiarrhythmics)

A

Diltiazem (IV)

90
Q

A nucleoside; DOC for acute treatment of PSVT (Other antiarrhythmic drugs)

A

Adenosine (IV)

91
Q

The therapeutic goal of adenosine (IV)

A

Transient asystole (<5 sec)

92
Q

Has muscarinic (vagotonic) activity; causes atrial tachycardia with AV block (Other antiarrhythmic drugs)

93
Q

Used for the acute treatment of torsades de pointes and digitalis-included arrhythmia (Other antiarrhythmic drugs)

A

Magnesium sulfate (IV)

94
Q

A surgically implanted device that sends out small electrical currents to stimulate the heart to contract; it restores and maintains normal heart rhythm

A

Artificial pacemakers

95
Q

From closed to open state (Ionic basis of membrane potential)

A

Activation

96
Q

Closed but cannot be reavtivated (Ionic basis of membrane potential)

A

Inactivation

97
Q

Reversal of activation (Ionic basis of membrane potential)

A

Deactivation

98
Q

Atrial myocytes (Fast or slow-response cell)

A

Fast-response cell

99
Q

Ventricular myocytes (Fast or slow-response cell)

A

Fast-response cell

100
Q

Purkinje fibers (Fast or slow-response cell)

A

Fast-response cell

101
Q

SA node (Fast or slow-response cell)

A

Slow-response cell

102
Q

AV node (Fast or slow-response cell)

A

Slow-response cell

103
Q

Depolarization; rapid increase in Na+ current (Ina); increase in inward rectifier K+ current (Ik1) (Phases in fast-response cells)

A

Phase 0 (Rapid upstroke)

104
Q

Rapid decrease in inward Na+ current (Ina); increase in transient outward K+ current (Ito) (Phases in fast-response cells)

A

Phase 1 (Initial repolarization)

105
Q

Increase in Ca2+ current; slow activation of L-type Ca2+ channels (Ica,L) (Phases in fast-response cells)

A

Phase 2 (Plateau)

106
Q

Decrease in Ca2+ current; increase in K+ current (Phases in fast-response cells)

A

Phase 3 (Final repolarization)

107
Q

-90 mV; stable; background K+ conductance (Phases in fast-response cells)

A

Phase 4 (Resting membrane potential)

108
Q

Period from the beginning of action potential (phase 0) to midway of repolarization (phase 3)

A

Effective refractory period

109
Q

Period from the end of effective refractory period and complete repolarization

A

Relative refractory period

110
Q

Depolarization; increase in Ca2+ current (Phases in slow-response cells)

A

Phase 0 (Upstroke)

111
Q

Decrease in Ca2+ current; activation of delayed rectifier K+ current (Ik) (Phases in slow-response cells)

A

Phase 3 (Final repolarization)

112
Q

Less negative and less stable; depolarization; increase in Ca2+ current (Phases in slow-response cells)

A

Phase 4 (Diastole/Maximum diastolic potential)

113
Q

Enhances pacemaker/funny current (Sympathetic or parasympathetic)

A

Sympathetic

114
Q

Enhances Ca2+ channel activity (Sympathetic or parasympathetic)

A

Sympathetic

115
Q

Enhances ACh-sensitive K+ current (Sympathetic or parasympathetic)

A

Parasympathetic

116
Q

Refers to the refractory period extension beyond phase 3; due to L-type Ca2+ channel inactivation

A

Postrepolarization refractoriness

117
Q

Selectively blocks open “funny” current (If) in SA node (Other antiarrhythmic drugs)

A

Ivabradine

118
Q

Blocks early Ina, late InaL, and delayed rectifier K+ current (Ikr) channels; currently undergoing clinical trials (Other antiarrhythmic drugs)

A

Ranolazine

119
Q

Blocks early Ina, late InaL, and ACh-sensitive K+ (Ikach) channels; used for rapid termination of AF (Other antiarrhythmic drugs)

A

Vernakalant (IV)

PH 113 - Pharmacology 1 (20 decks)

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