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D1 Spring > Pharmacology - Anti-Arrhythmic Drugs > Flashcards

Pharmacology - Anti-Arrhythmic Drugs Flashcards

1
Q

Resting HR is ___________ correlated to life expectancy

A

inversely

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2
Q

Why is having a fast heartbeat bad?

A
  1. Heart works harder (higher O2 demand)
  2. Diastole gets shorter (less O2 supply)
  3. Risk of ischemia (higher O2 demand + less O2 supply)
  4. Prone to arrhythmias
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3
Q

Irregular heartbeat

A

Arrhythmia

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4
Q

Your heart beats too fast, too slow, or with an irregular pattern

A

Arrhythmia

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5
Q

> 100 bpm (too fast)

A

Tachycardia

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6
Q

<60 bpm (too slow)

A

Bradycardia

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7
Q

Which is the more frequent issue: tachycardia or bradycardia

A

Tachycardia

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8
Q

What three things can cause arrhythmia?

A

Ischemia
Muscle death
Heart failure

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9
Q

Which drugs are specific to arrhymthia?

A

Na+ blockers
K+ blockers

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10
Q

Difference in electrical potential between inferior and exterior of a cell

A

Membrane potential

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11
Q

Which part of the cell is more negative?

A

Inside

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12
Q

Rapid rise and fall of membrane potential upon stimulus; occurs in excitable cells like neurons and muscle cells

A

Action potential

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13
Q

Resting membrane potential

A

-90 mV

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14
Q

Negative membrane potential starts becoming more positive

A

Depolarization

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15
Q

Positive membrane potential starts becoming more negative again

A

Repolarization

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16
Q

Which lead in EKG is most commonly used?

A

Lead II

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17
Q

What is “P” on an EKG?

A

Atrial depolarization

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18
Q

What is “R” on an EKG?

A

Ventricular depolarization

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19
Q

What is “T” on an EKG?

A

Ventricular repolarization

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20
Q

Where is atrial repolarization on an EKG?

A

Hidden between “P” and “R” in the PR segment

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21
Q

Explain the electrochemical gradient

A

Outside membrane: positive, more Na+, less K+, more Ca2+

Inside membrane: negative, less Na+, more K+, less Ca2+

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22
Q

Voltage gated channels are also called what?

A

Ion channels

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23
Q

What are voltage gated channels NOT activated by?

A

Ligands

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24
Q

What are voltage gated channels activated by?

A

Changes in membrane potential

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25
T/F voltage gated ion channels are transmembrane
True
26
What are the 2 types of action potentials?
1. Nodal 2. Non-nodal
27
What is nodal action potential made by?
Pacemaker cells SA/AV nodes
28
What is non-nodal action potential made by?
Myocytes
29
What 3 things regulate HR?
1. Automaticity 2. Refractoriness 3. Conduction velocity
30
Spontaneous impulse generation
Automaticity
31
What controls automaticity?
SA node AV node
32
Increased automaticity causes what?
Increased rate of impulse generation Increased HR
33
What 2 things can change automaticity?
1. Rate of leakiness 2. Magnitude of threshold potential (under neurohormonal control)
34
Which action potential has a leaky Na+ current?
Pacemaker action potential
35
T/F the ventricular action potential has a leaky Na+ current
FALSE
36
How long is the effective refractory period in non-nodal/ventricular action potential?
~0.2 seconds
37
Period during which no AP can be fired again
Effective refractory period (ERP)
38
Speed of impulse conduction (travel) in cardiac fibers?
Conduction velocity
39
Influenced by rate (slope) of depolarization and resting membrane potential
Conduction velocity
40
What causes cardiac arrhythmias?
Abnormal impulse generation and conduction
41
What are impulse generation and conduction determined by? (3)
1. Automaticity 2. Refractoriness 3. Conduction speed
42
What are the etiologies of cardiac arrhythmias? (5)
1. Ischemia/hypoxemia 2. Fibrosis/scar tissue 3. Electrolyte imbalance (Na+, K+, Ca2+) 4. Drug toxicities 5. Congenital defects
43
What are the 2 types of cardiac arrhythmias?
1. Supraventricular tachycardia (SVT) 2. Ventricular tachycardia (V-tach)
44
What are the 4 types of supraventricular tachycardia (SVT)?
1. Atrial fibrillation (A-fib) 2. Atrial flutter 3. Multifocal atrial tachycardia (MAT) 4. Atrioventricular reentrant tachycardia (AVRT)
45
What are the 4 types of ventricular tachycardia (V-tach)?
1. Focal V-tach 2. Reentrant V-tach 3. Torsades de pointes 4. Ventricular fibrillation (V-fib, deadly)
46
T/F atrial fibrillation (A-fib) has multiple foci of automaticity (not just SA node and AV node)
True
47
In atrial fibrillation (A-fib), you have no prominent _____ waves due to absence of synchronous ____________ depolarization
P; atrial
48
In atrial fibrillation (A-fib), you have irregular _________ depolarization
ventricular
49
What is atrial fibrillation (A-fib) also called?
"Irregularly irregular" rhythm
50
What are the 2 pathways of conduction in the heart?
1. AV conduction (normal) 2. Accessory (abnormal)
51
Which pathway of conduction is present in people with atrioventricular reentrant tachycardia (AVRT)?
Accessory (abnormal)
52
T/F the accessory (abnormal) node can fire in 2 directions: up and down
True
53
What happens in someone who has Wolff-Parkinson-White syndrome? (3)
1. SA node fires to accessory pathway 2. No pause 3. Causes premature ventricular depolarization
54
Wolff-Parkinson-White syndrome falls under what kind of SVT?
Atrioventricular reentrant tachycardia (AVRT)
55
Wolff-Parkinson-White syndrome has a short _______ interval
PR
56
What kind of wave is seen in Wolff-Parkinson-White syndrome?
Delta wave (caused by short PR interval)
57
What can atrioventricular reentrant tachycardia (AVRT) be caused by?
Unidirectional block (due to scar tissue)
58
What are the 4 causes of conduction blocks?
1. Ischemia 2. Fibrosis 3. Inflammation 4. Drugs
59
What are the 4 non-pharmacologic interventions?
1. Electrical cardioversion 2. Automatic implantable cardioversion/defib device 3. Ablation therapy 4. Pacemaker
60
What are the 4 anti-arrhythmic drugs in order?
"Some block potassium channels" Na+ blockers B blockers K+ blockers CCBs
61
Majority of arrhythmias are associated with __________
tachycardia
62
What is the mechanism of anti-arrhythmic drugs?
Decrease automaticity, conduction velocity, HR Increase refractoriness
63
What are the classes of anti-arrhythmic drugs?
Class I - Na+ blockers Class II - B blockers Class III - K+ blockers Class IV - CCBs Misc. - Adenosine
64
Which drugs are used to treat supraventricular tachycardias (SVTs) such as atrial fibrillation and Wolff-Parkinson-White syndrome?
Na+ blockers K+ blockers CCBs
65
What drug is used to treat supraventricular tachycardias (SVTs) such as atrial fibrillation and Wolff-Parkinson-White syndrome, as well as ventricular tachycardias (V-tachs)?
B blockers
66
What is the problem with K+ blockers?
Longer QT interval
67
What is a longer QT interval diagnosed as?
Torsade de pointes Ventricular fibrillation (V-tach conditions)
68
T/F anti-arrhythmic drugs can cause arrhythmias
True, they are arrhythmogenic
69
Which drug is a class III drug?
Amiodarone
70
What does Amiodarone block?
Na+ channel K+ channel Ca2+ channel B receptor
71
What does Amiodarone resemble?
Thyroid hormone
72
Amiodarone is ________ (more/less) arrhythmogenic
less
73
What are 2 adverse effects of long term use of Amiodarone?
Pulmonary fibrosis Pneumonitis
74
Which drug is a miscellaneous drug?
Adenosine
75
What does Adenosine cause?
Hyperpolarization
76
Margin of safety of anti-arrhythmic drugs is ___________
narrow
77
Drugs that slow AV conduction like B blockers and Amiodarone can cause what 2 things?
Bradycardia Heart block
78
Drugs with negative ionotropic effects (decreased contractility) like B blockers can precipitate what?
Heart failure

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