Nicole - Anti-Arrhythmetics

Question 1

What are the anti-arrhythmetic Class 1 drugs?

Answer 1

Class 1: Sodium channel blockade

1a: prolong APD, intermediate dissociation kinetics
- Procainamide, Quinidine
1b: shorten APD ion selective tissues, rapid dissociation kinetics
- Lidocaine
1c: minimal APD impact, slow dissociation kinetics
- Flecainide

Question 2

What are the class 2 anti-arrhythmics?

Answer 2

Class 2: sympatholytic action (B blockers)

Propranolol

Question 3

What are the class 3 anti-arrhthmics?

Answer 3

Class 3: Prolongation of APD

Amiodarone

Question 4

What are the class 4 anti-arrhythmics?

Answer 4

Class 4: Blockade of cardiac calcium current

Varapamil
Diltiazem

Question 5

What is the MOA of Procainamide?

Answer 5

• Decreases myocardial excitability and conduction velocity.
• may depress myocardial contractility by increasing electrical stimulation threshold of ventricle

Question 6

Procainamide has the potential to cause what significant side effect?

Answer 6

SLE

Monitor ANA tigors

Question 7

The indications for Procainamide?

Answer 7

Life threatening ventricular arrhythmias

Question 8

Lidocaine is in what class of anti-arrhytmics?

Answer 8

• Class 1b

Question 9

Indications for Lidocaine?

Answer 9

Suppression of existing ventricular arrhythmias

Question 10

MOA of Lidocaine

Answer 10

• blocks both the initiation and conduction of nerve impulses by decreasing the neuronal membranes permeability to sodium ions
• suppresses automaticity of conduction tissue
• increases electrical stimulation threshold of ventricle and spontaneous depolarization of ventricles during diastole

Question 11

Don’t use Lidocaine in what instances?

Answer 11

Severe SA/AV and inter ventricular heart block

- corn allergy

Question 12

Flecainide is indicated for what?

Answer 12

Ventricular arrhythmias (prevention)
paroxsysmal afib/flutter
PSVT

Question 13

What does flecainide do?

Answer 13

• slows conduction in cardiac tissue by altering transport of ions across cell membranes
• Causes slight prolongation of refractory periods
• increases electrical stimulation threshold of ventricle

Question 14

What do you need to make sure you monitor in flecainide?

Answer 14

Renal/liver impariment

Dose adjust for eGFR

Question 15

The beta blocker propranolol is in what classes of drugs

Answer 15

Non-selective beta blocker

Class 2 anti-arrhythmic

Question 16

The indications for propranolol include what?

Answer 16

• angina
• HTN
• tachyarrhythmias
  essential tremor
  migraine px
  anxiety

Question 17

You need to be be careful using propranolol in what patients?

Answer 17

DM

Asthma

Question 18

Why do you need to use caution in prescribing propranolol (and other b blockers) to Diabetics?

Answer 18

Because it can obscure early indications of hypoglycemia

Question 19

What can you use metoprolol for when it comes to arrhythmias?

Answer 19

a-fib

Question 20

What drug class is Metoprolol in?

Answer 20

• B1 selective Beta blocker

- Class 2 anti-arrhythmics

Question 21

What is a benefit of using b blockers in heart failure

Answer 21

they decrease mortality

decrease mortality post-MI

Question 22

In metoprolol vs atenolol, what do you have to remember when it comes to patients with CKD?

Answer 22

That you have to adjust the dose for Atenolol. Metoprolol is better for patients with CKD

Question 23

Atenolol indications include what?

Answer 23

• angina
• HTN
• stable, post MI
• Supraventicular tachyarrythmias (dig toxicity)

Question 24

Amiodarone is in what drug class?

Answer 24

Class 3 - prolongation of action potential duration

Question 25

The indictations of amiodarone include what?

Answer 25

- life threatening recurrent VF | - Unresponsive or unstable VT refractory to other anti-arrhythmics

Question 26

MOA of amiodarone

Answer 26

inhibits adrenergic stimulation affecting Na, K and Ca channels - prolongs action potential and refractory period in cardiac tissues - decrease AV conduction and sinus node function

Question 27

Calcium channel blockers (Varapamil) MOA is what?

Answer 27

Dilate coronary arteries | decrease myocardial oxygen demands

Question 28

Don't use verapamil with what drugs?

Answer 28

B blockers

Question 29

Why don't you use Verapamil in patients with CHF?

Answer 29

B/C of their action of decreasing myocardial contractility

Question 30

Adenosine is indicated for what?

Answer 30

PSVT | Pharm stress testing

Question 31

MOA of Adenosine in PSVT

Answer 31

slows conduction time through the av node, interrupting the reentry of pathways through he av node, restoring normal sinus rhythm

Question 32

the MOA of adenosine in stress testing is what?

Answer 32

causes coronary vasodilation and increases blood flow in normal coronary arteries with little to no increase in stenotic coronary arteries

Question 33

Do you use Adenosine for the treatment of fib, a flutter or Vtach?

Answer 33

Nope

Question 34

How do you administer adenosine?

Answer 34

IV

Question 35

What is the drug class of Digoxin?

Answer 35

Cardiac glycoside

Question 36

Explain the indications for digoxin?

Answer 36

Mild to moderate HF | Afib rate control

Question 37

MOA of Digoxin?

Answer 37

inhibits Na/K ATPase pump in myocardial cells, promoting influx Ca++ leading to increased contractility - also direct suppressor of AV noted which decreases ventricular rate

Question 38

what are the drug interactions with digoxin?

Answer 38

amiodarone verapamil multiple others

Question 39

MgSO4 is indicated for what?

Answer 39

Digitalis induced arrhythmias with low serum mag | low mg induced arrhythmias (VF, VT)

Question 40

What is a common S/E of MgSO4?

Answer 40

flushing