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(J2) CPR II Test 1 (Cardiovascular) > Pharm: Antiarrhythmics > Flashcards

Pharm: Antiarrhythmics Flashcards

1
Q

What are the classes/MOA of antiarrhythmic drugs?

A

Type 1 - sodium channel blockers

Type 2 - Beta blocker

Type 3 - potassium channel blockers

Type 4 - cardioactive calcium channel blockers

Misc - atropine

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2
Q

What antiarrhythmics don’t target ion channels?

A
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3
Q

What are the different subclasses of class 1 anti-arrhythmics?

What differentiates them (effect and EKG)?

A

all slow conduction velocity making them useful in tachyarrhythmias

Class 1A:

  • blocks Na channels and K channels
  • prolongs QRS/reduces slope of phase 0 (moderate)
  • prolongs QT interval/delays phase 3 (via K channel) -> Torsades risk

Class 1B:

  • blocks Na channels only (weak)
  • prolongs QRS/reduces slope of phase 0 (least)
  • decreases QT/interval/earlier phase 3

-favors depolarized/damaged tissue -> minimal effect on healthy tissue

Class 1C:

  • blocks Na channels
  • prolongs QRS/reduces slope of phase 0 (most)
  • does not effect QT interval
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4
Q

What drugs are class 1A antiarrhythmics?

A
  • quinidine
  • disopyramide
  • procainamide
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5
Q

What types of arrhythmias are Class 1A antiarrhythmics used to treat?

A

both supraventricular and ventricular tachyarrhythmias

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6
Q

What adverse effects occur with quinidine?

A

Cinhonism:

  • tinnitus
  • vision changes
  • confusion
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7
Q

What adverse effects occur with procainamide?

A

-drug-induced SLE

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8
Q

What adverse effects occur with disopyramide?

A

Exacerbates heart failure due to negative inotropic effect

strong anticholinergic activity:

  • tachycardia
  • dry mouth
  • warm
  • vision changes
  • confusion
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9
Q

What adverse effect common to all class 1A antiarrhythmics leads to them not being commonly used?

A

QT prolongation with risk of Torsade de pointes

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10
Q

What drugs are class 1B antiarrhythmics?

A
  • lidocaine
  • mexiletine
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11
Q

What types of arrhythmias are Class 1B antiarrhythmics used to treat?

A

-ventricular arrhythmias in the setting of MI (preferential binding to Na channels in damaged tissue)

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12
Q

What adverse effects occur with lidocaine?

A

neurologic effects; it also works on nerves:

  • dizziness
  • nausea
  • seizures
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13
Q

What adverse effects occur with mexiletine?

A

neurologic effects; it also works on nerves:

  • dizziness
  • nausea
  • seizures
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14
Q

What drugs are class 1C antiarrhythmics?

A
  • flecanide
  • propafenone
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15
Q

What types of arrhythmias are Class 1C antiarrhythmics used to treat?

A

mostly supraventricular tachyarrhythmis, some ventricular arrhythmias

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16
Q

What is a common contraindication of class 1C antiarrhythmics?

A

structurally abnormal hearts (especially h/x of MI)

does not prolong effective refractory period of venticular tissue; this plus slowing of tachyarrhythmia results in possible ventricular re-entry arrhythmias

17
Q

What difference in activity is there between flecanide and propafenone?

A

propafenone has mild β-blocking activity

otherwise the two are roughly identical

18
Q

How does β-blocker activity cause an antiarrhythmic effect?

A

β-agonists increase expression of cAMP which causes increased expresion of If (funny channels) and L-/T-type Ca channels

β-blockers inhibit this:

  • decreased If and T-type Ca channel negative chronotorpic effect by decreasing slope of phase 4
  • decreased L-type Ca channels prolongs depolarization -> increased threshold potential/decreased slope of phase 0
  • these combine to decrease HR and conduction velocity in the SA and AV, especially in the AV node
19
Q

What ekg and action potential changes are seen in with β-blockers?

A
  • prolonged PR interval/decreased slope of phase 0
  • increased R-R interval/decreased slope of phase 4 (decrease HR)
20
Q

What β-blockers are used as anti-arrhythmics?

A
  • propanolol
  • esmolol
21
Q

What types of arrhythmias are Class 2 antiarrhythmics used to treat?

A

primarily supraventricular tachyarrhythmias, due to prolongation of AV condution and negative chronotropic effect

  • a-fib/flutter
  • SVT
  • hyperthyroid related arrhythmias
22
Q

What are common contraindications of class 2 antiarrhythmics?

A
  • prolonged PR intervals/bradyarrhythmias
  • decreased cardiac output (ie. HF)
  • asthma (β2 bronchodilating inhibition)
  • PVD/Raynaud’s (β2 vasodilating inhibition)
23
Q

What are common adverse effects of class 2 antiarrhythmics?

A
  • reduced cardiac output
  • AV block
  • hypoglycemia
  • asthma/COPD exacerbation
  • dyslipidemia
24
Q

What is special about esmolol use as an antiarrhythmic?

A

cardioselective, given IV and has a short half-life -> fast on, fast off

  • used in termination of SVT
  • used perioperatively to prevent anesthesia related arrhythmias

(J2) CPR II Test 1 (Cardiovascular) (18 decks)

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