Pharm of Antidysarythmias Flashcards by Scott Meteer

What does the Vaughn williams classification tell you?

What part of the Cardiac cycle a drug works on
IA
IB
IC
II
III
IV

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What are class 1A drugs that are used often?
Not very often?

Amiodarone Procainamide

Quinidine

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What happens during each phase of the cardiac cycle?

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Why is quiniine not used much anymore

Vagolytic action (slows heart)
Adverse effects
Increased mortality in A fib

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Where is Quinidine metabolized? AA?

Prolongs QT interval
Metabolized in the liver (toxicity)
Makes people VERY NAUSEOUS
G6PD incompatible (will cause hemolysis)
CINCHONISM

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What was Quinidine used for?

Prevention of SVT, VT, an VF

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What was Procainamide used for?

Reduces automaticity
Prolongs refractory period
Little effect on AV node

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What is the active metabolite from procainamide?

NAPA (more depending on how fast they metabolize it)

Not usually an issue unless they have renal insufficiency

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AA of Procainamide>

QT prolongation

N/V

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What is Disopyrimide?

Prolongs duration of Action Potential

SEVERE anticholinergic effects

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What is Disopyrimide used for?

VT, VF, SVT (more effective in atrial arrythmias

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What is Lidocaine used for?

preventive for VT or VF(ONLY USED FOR VENTRICULAR ARRHYTHMIAS!)
continuing arrhytmias that aren’t well controlled
IV only

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What are rhe AA of Lidocaine?

CNS: Dizziness, paresthesia, confusion, come, lethargy, tremor, and seizures.
Toxicity more common than eficacy
Hypersensitivity

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What is Flecainide?

Class 1C (sodium channel blocker)
Increases QRS (godd if Pt only has A-fib)
Cannot be used if Pt has any ishcemic heart disease
Decrease dose in renal failure

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What are rhe AA of Flecanide?

Very little. AV block, New or worsening CHF

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What is Propafenone?

IC antiarrythmic

Non-selective beta-blocking

What are the metabolic considerations of Propafenone?

Low bioavailability(high first pass effect)

What are the Drug Reactions of Propafenone?

Need to reduce dose if Pt is on Digoxin or Warfarin

Why are Class 1 drugs used less often overall?

Increases Mortality

What is the actionof Beta blockers?

Prolongs action potential and slows HR

What is Sotolol?

Beta blocker AND Class 3 antiarrythmic

PROFOUND INCREASE IN»> QT interval

What are the AA of Sotolol?

Torsades VERY Likely with this drug
Severe prolongation of QT interval
Lots of B Blocker SA

What is AMIODARONE used for?

DELAYS REPOLARIZATION BY PROLONGING APD AND ERP

1st line agent for ACLS VT/VF** Look at the end

What are rhe pharmacokinetics of Amiodarone?

Poor Bioavailability and needs a high dose&raquo_space; Side effects

Long half life

What are the SA of Amiodarone?

Few Cardiac SA(safe for heart failure Pts) PULMONARY FIBROSIS(10% will die from it) most feared -total dose exposure increases the risk THYROID(44% of the drug is iodine) -Hypo and Hyperthyroidism (hypo more common can be replaced arteficially) OCULAR: Corneal Deposits in almost all Pts, halos, photophobia CNS: Intention tremor after mon/yr on the drug, ataxia, DERM: Photosensitivity, BLUE/GREEN skin (SMURF in sun exposed skin) Hepatic: Elevations in Transaminases, Bili Interactions: Assume it will interact with EVERY other drug -back off Digoxin and Warfarin

Monitoring for Amiodarone?

Waht is the difference between Amiodarone and Dronaderone?

Take off the Iodine and replace it with a methyl Less Side effects but less effective in heart failure NOT to be used in heart failure

what is Dofetilide used for?

ONLY used in A-fib VERY HIGH risk of Torsades! QT prolongtion Renal Excretion Interacts with lots of OTC meds: Verapamil, Etc

What is the treatment approach for Ventricular Arrythmis?

Implantable Devices are more effective with less side effects for ongoing Arrhthmias Used Prophylacticly too Will put them on an antiarrhthmics to decrease the number of shocks per day and improve Quality of life

What is the Tx of Afib?

Shock, then use drugs to KEEP them in normal sinus rhythm. CHF: Amiodarone, D.. Rate control drugs: BB, Diltiazem, Digoxin also used ****

What is the limitation of using devices these days?

Much more expensive to implant. 40-50k