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Cardio 1 > Pharm - Antiarrhythmic Drugs > Flashcards

Pharm - Antiarrhythmic Drugs Flashcards

1
Q

Most antiarrhythmic agents that target K channels target ___

A

IKR

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2
Q

Antiarrhythmic drugs can cause ___ but not treat them. These are best treated with ___

A

Bradyarrhythmias

Implantable devices

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3
Q

Vaughan Williams classification of Antiarrhythmic drugs

A

I: Na channel blockers (IA, IB, IC)
II: beta receptor blockers
III: K channel blockers
IV: Ca channel blockers

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4
Q

___ has the least effect on Phase 0.
___ has the most effect on Phase 0.
___ also increases the AP duration because ___

A
  1. IB
  2. IC
  3. IA, side effect: blocks IKR and IKS channels (IB, IC do not)
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5
Q

Avoid class ____ in patients with structural damage (e.g. Post-MI)

A

IC

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6
Q

Class IA examples:

A

Quinidine
Procainamide
Disopyramide

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7
Q

Class IB examples:

A

Lidocaine
Mexiletine
Phenytoin

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8
Q

Class IC examples:

A

Flecainide

Propafenone

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9
Q

Class ___ has the lowest affinity for Na channels

Class __ has the highest affinity for Na channels

A

IB

IC

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10
Q

Affinity and kinetics of Class I drugs

A

Affinity: IC>IA>IB
Kinetics: IB>IA>IC

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11
Q

All class I antiarrhythmic decrease the ___ and reduce the ___

A

Decrease the upstroke velocity (phase 0) and reduce the amplitude of the cardiac AP
*this may depress conduction velocity and slow impulse propagation

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12
Q

Class IA

A

Anti-muscarinic
May enhance conduction through the AV node
-also blocks IKR channels (class III effect)
-prolongs QT interval
-increases risk of torsades de pointes

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13
Q

Class IA agents list:

Detailed

A
  1. Quinidine (rarely used due to toxicity, blood cos CYP2D6, metabolized by CYP3A4)
  2. Procainamide (IV only; most used, half life is 3-4 hrs, adverse effect includes lupus like disorder)
  3. Disopyramide (avoid in heart failure, negative inotropic effect)
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14
Q

Uses of class IA drugs

A

Atrial and ventricular tachyarrythmias

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15
Q

Uses for class IB agents

A

Ventricular arrhythmias ONLY

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16
Q

Class IB agents list:

Detailed

A
  1. Lidocaine (very effective for post-MI ventricular arrhythmias, ineffective for most supraventricular arrythmias, neurological side effects, less cardiotoxic than IA or IC)
  2. Mexiletine (orally active form of lidocaine)
  3. Phenytoin (antiepileptic drug)
17
Q

Class IC drugs have no effect on ___ and are used for ___

A

AP repolarization

-supraventricular arrhythmias or life threatening ventricular arrhythmias in patients without heart disease

18
Q

Class IC agents list:

Detailed

A
  1. Flecainide (supraventricular arrhythmias, NOT for previous MI, metabolized by kidney and CYP2D6)
  2. Propafenone (supraventricular and ventricular tachycardias, NOT for previous MI, hepatic metabolism, also blocks cardiac beta adrenergic receptors as in class II)
19
Q

___ are shown to reduce mortality in HF patients

A

Beta Adrenergic receptor blockers

Class II

20
Q

Class II examples:

A
  1. Esmolol
  2. Metoprolol
  3. Atenolol
  4. Propranolol
21
Q

Uses for class II

A
  1. Sinus tach
  2. Supraventricular and ventricular tachyarrhythmias
  3. A fib
  4. Stable angina
  5. Hypertension
  6. HF
  7. Reduces mortality following acute MI and in HF
22
Q

Class II agents list:

Detailed

A
  1. Propranolol (nonselective, b1 and b2)
  2. Metoprolol (cardioselective, b1)
  3. Atenolol (same as metoprolol)
  4. Esmolol (same as metoprolol, IV only)
23
Q

Atenolol can only be used in patients without ___

A

Bronchospasms

24
Q

Class III drug list:

A
  1. Amiodarone
  2. Ibutilide
  3. Difetilide
  4. Sotalol
  5. Dronedarone
25
Q

___ is the most common class III drug. It also blocks what?

A

Amiodarone

-Na, Ca, and Beta receptors

26
Q

Dosing of amiodarone

A

Once daily due to long half life

27
Q

Uses of dronedarone
Half life?
Side effects?

A

A flutter/fib after conversion to sinus rhythm

  • half life is 13-19 hours
  • no iodine so no thyroid probs, but does have hepatic tox
28
Q

Sotalol is a class ___ drug but is also a ___

A

III

nonselective beta blocker

29
Q

Ibutilide is a class ___ drug that also does what?

A

III
Enhances a slow inward Na current
*IV only

30
Q

Class IV drugs

-2 subclasses

A

Dihydropyridines
-smooth muscle relaxation (antihypertensive and antianginal)
Non-dihydropyridines
-cardiac selective, slows HR and decreases contraction (antiarrhythmic and antianginal)

31
Q

Class IV non-dihydropyridines list

A

Diltiazem

Verapamil

32
Q

Other agents:

Adenosine

A

IV only

Acute termination of PSVT

33
Q

Other agents:

Digoxin

A

Cardiac glycoside
Inhibits Na/K ATPase pump
Slows HR and conduction velocity
Increases ERP in AV node (vagomimetic)

Cardio 1 (14 decks)

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