Pharmacology Anti-Arrhythmic 1

Question 1

DAD stands for

Answer 1

delayed afterdepolarization

Question 2

EAD stands for

Answer 2

early after-depolarization

Question 3

ERP stands for

Answer 3

effective refractory period

Question 4

define arrhythmia

Answer 4

abnormal heart rhythm/rate affects cardiac output

Question 5

_________ increases risk for stroke and heart failure

Answer 5

arrhythmia

Question 6

What are the different causes of arrhythmia?

Answer 6

genetic - wolff parkinson white syndrome
drug induced - digitalis
anesthetized patients
heart dysfunction/ acute mi

Question 7

What are some nonpharmacologic therapies?

Answer 7

pacemakers
cardioversion
catheter ablation
surgery

Question 8

What is bradycardia?

Answer 8

slow heart beat

Question 9

less than 60 bpm is

Answer 9

bradycardia

Question 9

more than 100 bpm is

Answer 9

tachycardia

Question 10

what is normal sinus rhythm?

Answer 10

between 60 to 100 bpm

Question 10

tachycardia is

Answer 10

rapid heart beat

Question 11

an abnormality in impulse initiation and/or impulse propagation

Answer 11

arrhythmia

Question 12

what are the three types of atrial arrhythmias?

Answer 12

premature atrial contractions
paroxysmal atrial tachycardia
atrial fibrillation

Question 13

a premature atrial contraction triggerering a flurry of atrial activity, with ventricles still able to keep pace and the heart rate jumping to 180 bpm is known as

Answer 13

paroxysmal atrial tachycardia

Question 14

impulses moving over the arial surface at rates of perhaps 500 beats per minute with quivers instead of an organized contraction is known as

Answer 14

atrial fibrillation

Question 15

what are the types of ventricular arrhythmia

Answer 15

premature ventricular contractions
ventricular tachycardia
ventricular fibrillation

Question 16

what type of atrial arrhythmias occur in often healthy individuals

Answer 16

PACs

Question 17

what is known as a surprise atrial contraction

Answer 17

PACs

Question 18

what increases incidences of PACs

Answer 18

stress, caffeine, and various drugs

Question 19

what type of ventricular arrhythmia occurs when a purkinje cell or ventricular myocardial cell depolarizes to threshold and triggers a premature contractions

Answer 19

PVCs

Question 20

which cell is responsible for PVCs

Answer 20

ectopic pacemaker

Question 21

what arrhythmia is defined as four or more PVCswithout intervening normal beats

Answer 21

ventricular tachycardia

Question 22

what arrhythmia is responsible for cardiac arrest

Answer 22

ventricular fibrillation

Question 23

T or F VF is rapidly fatal, because the ventricles quiver and stop pumping blood

Answer 23

T

Question 24

torsades de pointes is a type of

Answer 24

V tach

Question 25

what does torsades de pointes mean

Answer 25

polymorphic ventricular tachycardia

Question 26

what are the ion movements of the NA K ATPase pum

Answer 26

1 ATP pumps out 3 Na+= and 2 K+

Question 27

What is the ion movement of the Na+ Ca++ exchanger

Answer 27

3 Na + in, 1 Ca++ out

Question 28

electrical activity of the heart is maintained by

Answer 28

pumps ion channels autonomic nervous system

Question 29

what is the mechanism of arrhythmias

Answer 29

distrubance of impulse formation

Question 30

which class of anti arrhythmic drugs decrease phase 4 slope?

Answer 30

class 2

Question 31

what class of antiarrthymic drugs increase threshold?

Answer 31

class 1 and class 4

Question 32

what class of antiarrthymic drugs increase the maximum diastolic potential

Answer 32

adenosine and acetylcholine

Question 33

what class of antiarrhythmic drugs increase action potential duration?

Answer 33

class 3

Question 34

what are two ways to increase refractoriness?

Answer 34

in early after depolarization and delayed afterdepolarization

Question 35

what are some examples of class III drugs?

Answer 35

amiodarone dofetilide sotalol

Question 36

what are some examples of class II drugs

Answer 36

beta blockers like propranolol, atenolol, metoprolol

Question 37

what are some examples of class IV drugs

Answer 37

non DHP calcium channel blockers like verapamil and diltiazem

Question 38

what is the mechanism of action of class I drugs?

Answer 38

sodium channel blockade

Question 39

which class of drugs reduces phase 0 slope and peak of AP

Answer 39

class I

Question 40

which subclass of class I drugs are moderate

Answer 40

A

Question 41

which subclass of Class I drugs are strong

Answer 41

C

Question 42

which subclass of class I drugs are weak

Answer 42

B

Question 43

which class of drugs has a moderate reduction in phase 0 slope with an increased APD

Answer 43

IA

Question 44

which class of drugs reduced APD

Answer 44

IB

Question 45

which class of drugs has no effect on APD

Answer 45

IC

Question 46

what is the mechanism of action of Class II drugs

Answer 46

beta blockade, blocks sympathetic activity, reducing rate and conduction

Question 47

what is the mechanism of action of Class III drugs

Answer 47

potassium channel blockade

Question 48

what class of drugs has delay repolarization in phase 3 thereby increasing APD and ERP

Answer 48

class III

Question 49

what is the mechanism of action of class IV drugs

Answer 49

calcium channel blockade

Question 50

which class of drugs blocks L type calcium channels and is most effective at the SA and AV nodes, reducing rate and conduction

Answer 50

class IV

Question 51

what are the Class IA drugs?

Answer 51

procainamide quinidine disopyramide

Question 52

what are the Class IB drugs

Answer 52

lidocaine mexiletine

Question 53

what are the class IC drugs

Answer 53

flecainide propafenone

Question 54

which class I subclass dissociates with the channel with rapid kinetics?

Answer 54

IB

Question 55

which class I subclass dissociates with the channel with intermediate kinetics?

Answer 55

Class IA

Question 56

which class I subclass dissociates with the channel with slow kinetics?

Answer 56

class IC

Question 57

procainamide is effective against

Answer 57

most atrial and ventricular arrhythmias WPW syndrome

Question 58

what are the cardiac effects of procainamide?

Answer 58

slows the upstroke of the AP slows conduction prolongs the QRS duration of ECG prolongs the APD - class 3 has direct depressant actions on SA and AV nodes all 1a show reverse use dependence

Question 59

what are the extracardiac effects of procainamide?

Answer 59

has ganglion blocking properties and causes hypotension

Question 60

what are the dosage forms of procainamide?

Answer 60

oral iv - slow infusion im

Question 61

how is procainamide metabolized?

Answer 61

hepatic NAPA - n acetyl procainamide

Question 62

NAPA has class _ effects causing

Answer 62

3 torsades de pointes

Question 63

how is procainamide excreted?

Answer 63

renally

Question 64

T or F procainamide does not need dose adjustment for patients in renal or heart failure

Answer 64

F , needed because eliminated renally

Question 65

who is contraindicated for procainamide

Answer 65

hypersensitivity CHF renal failure shock patients

Question 66

are there DDI concerns with procainamide?

Answer 66

YES potentiate cardiac effects of beta blockers hypotensive effect of thiazides anticholinergic effects neuromuscular blocking effects

Question 67

what are the toxicities of procainamide

Answer 67

cardiotoxicity immunity issues blood dyscrasia pulmonary toxicity

Question 68

what are the cardiotoxicity effects of procainamide?

Answer 68

excessive action potential prolongation QT interval prolongation induction of torsades de pointes arrhythmia syncope

Question 69

1/3 of patients who take procainamide experience immune toxicities, what is that?

Answer 69

lupus erythematosus, arthralgia and arthritis

Question 70

what kind of toxicities, blood dyscrasias, does procainamide have?

Answer 70

agranulocytosis bone marrow depression neutropenia hypoplastic anemia thrombocytopenia