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MS 2 - Unit 4 > Pharmacology - Antiarrhythmics > Flashcards

Pharmacology - Antiarrhythmics Flashcards

1
Q

P wave corresponds to:

A

Atrial activation

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2
Q

Q wave corresponds to:

A

His, BB, and septum activation

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3
Q

R wave corresponds to:

A

LV activation

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4
Q

S wave corresponds to:

A

late RV activation

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5
Q

T wave corresponds to:

A

ventricular repolarization (direction is opposite of activation

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6
Q

On EKG, Atrial Phase 0 corresponds to:

A

P wave

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7
Q

On EKG, Ventricular Phase 0 corresponds to:

A

QRS complex

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8
Q

On EKG, Ventricular Phase 2 corresponds to:

A

ST segment

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9
Q

On EKG, ventricular phase 3 corresponds to:

A

T wave

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10
Q

On EKG, the duration of the ventricular action potential corresponds to:

A

QT interval (start of QRS to end of T)

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11
Q

AVN conduction is measure on EKG by:

A

PR interval (start of P to start of QRS)

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12
Q

When are U waves (Purkinje repolarization) seen on EKG?

A

Prolonged QT interval;

Hypokalemia

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13
Q

What is the effect of hypercalcemia on the QT interval?

A

Increases it

Hypocalcemia decreases it

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14
Q

Wenckebach phenomenon is what kind of arrhythmia?

A

2nd degree AV block - not every P wave is followed by QRS complex
PR interval gets progressively longer until a beat is dropped
aka Mobitz Type I AVN Block

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15
Q

What is one notable cause of 1st degree AVN block?

A

Lyme disease

Prolonged PR interval, but 1:1 P:QRS complex

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16
Q

What is the recommended treatment for 2nd and 3rd degree AVN block?

A

Ventricular pacemaker installation

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17
Q

2/3 of all SVTs are what kind?

A

AV node re-entry tachycardia
dual AVN conduction pathways

Next most common is bypass tract re-entry - AVN and bypass tract reentry (1/5)

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18
Q

T/F: Adenosine will stop any kind of AVN reentry tachycardia.

A

Fuck yea it will (so will vagal tone - carotid massage)

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19
Q

What pharmacotherapy is indicated for treatment of WPW syndrome?

A 
Amiodarone (class III anti-arrhythmic - K channel blocker)
Procainamide (class IA anti-arrhythmic)

NO AVN blockers - CONTRAINDICATED so NO amlodipine, nifedipine, verapimil, diltiazem)

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20
Q

What is Torsades de Pointes syndrome (TdP)?

A

A kind of Polymorphic ventricular tachycardia;
associated with long QT interval;
can be genetic

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21
Q

Class IA, IB, IC anti-arrhythmic drugs all have actions where?

A

Direct membrane action - Na channel blockade

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22
Q 
Antiarrhythmics that:
Are involved in Na channel blockade;
Depress Phase 0;
Slow conduction;
Prolong repolarization
belong to what class?
A

Class IA
ie Quinidine
Procainamide
Disopyramide

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23
Q 
Antiarrhythmics that:
Are involved in Na channel blockade;
Depress Phase 0 ONLY in abnormal (ie ischemic tissue);
Shortern repolarization
belong to what class?
A

Class IB
ie Lidocaine
Mexiletine (oral lidocaine)

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24
Q 
Antiarrhythmics that:
Are involved in Na channel blockade;
Markedly depress Phase 0;
Markedly slow conduction;
Have a slight effect on repolarization
belong to what class?
A 
Class IC
ie
Flecainide;
Propafenone;
Moricizine
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25
Q

Antiarrhythmics that:
Are sympatholytic drugs
belong to what class?

A

Class II
Nonselective:
–ie Propranolol
–Carvedilol

Selective

  • -Metoprolol
  • -Acebutolol

Esmolol (IV only - fast acting)

26
Q

Antiarrhythmics that:
Are drugs that ONLY prolong repolarization
belong to what class?

A

Class III
Sotalol (K channel blocker)
Ibutilide
Dofetilide

Mixed:

  • -Amiodarone
  • -Dronedarone
27
Q

Antiarrhythmics that:
Are calcium channel blockers
belong to what class?

A 
Class IV
Dihydropyridines:
--Nifedipine
--Amlodipine
--Felodipine
--Isradipine

Verapimil (phenylakamine)
Diltiazem (benzothiazepine)

28
Q

When are Quinidine, Procainamide and Disopyramide (Class IA antiarrhythmics) indicated?

A 
Secondary drug of choice for tx of:
chronic Afib;
PSVTs;
sustained VT/VF (procainamide)
acute Afib/flutter (IV procainamide)

Lidocaine (Class IB) is ALSO secondary choice, but NOT for atrial arrhythmias

Class IC are ALSO secondary mgmt for chronic AF or SVT patients w/o structural HD

29
Q

SLE-like syndrome
TdP
QT Prolongation
Heart block

are toxicities of what drugs?

A

Class IA
ie Quinidine
Procainamide
Disopyramide

30
Q

What drug class is indicated for LAST resport in patients with refractory VT?

A

Class IC anti-arrhythmics:
Flecainide
Propafenone

CONTRAINDICATED in HF and post-MI (pro-arrhythmic) - cannot use in pts with structural HD

31
Q

Beta-blockers (Class II anti-arrhythmics) are contraindicated in what disease?

A

WPW syndrome

Ca blockers and Digoxin are ALSO contraindicated in WPW (anything that does AVN block)

32
Q

Amiodarone is the primary drug of choice for sustained VT/VF. Why?

A

Acts on fast-acting Na channels, Ca channels AND K channels AND is both and alpha and beta blocker
AND has a long half life (80 days)

MANY adverse side effects

DO NOT use for digitalis toxicity

33
Q

Acute SVT –> first line therapy is:

A

IV Adenosine
Verapimil
Diltiazem

34
Q

Acute SVT –> second line therapy is:

A

IV Esmolol
beta-blockers
digoxin

35
Q

Chronic SVT –> first line therapy is:

A 
Beta blockers
Verapimil
Diltiazem
Flecainide
Propafenone
Amiodarone
Sotalol
Digoxin

DC cardioverion
Atrial pacing effective but rarely required

36
Q

Chronic SVT –> second line therapy is:

A

Quinidine
Procainamide
Disopyramide
RF ablation may cure most patients

37
Q

Acute Afib/flutter –> first line therapy is:

A

Verapimil
Diltiazem
beta-blocker
Digoxin

DC cardioversion

38
Q

Acute Afib/flutter –> secondary line therapy is:

A

IV procainamide
Ibutilide
Dofetilide
single large dose of Propafenone or Flecainide

39
Q

PVCs or nonsustained VT –> therapy is:

A

If symptomatic or post-MI, use beta blockers

40
Q

Sustained VT –> use

A

First-line - amiodarone, intracardiac device, beta blockers often added

Second-line - procainamide, lidocaine

SAME for tx of Vfib

41
Q

Vfib first line therapy is:

A

Amiodarone, intracardiac device, beta blockers often added

Second-line - procainamide, lidocaine

42
Q

EADs happen in what phase of the cardiac cycle?

A

EAD - Early Afterdepolarization
Phase 3
EADs result from blockade of repolarizing K channels (eg) and/or increased INa late, ICa,L

43
Q

DADs happen in what phase of the cardiac cycle?

A

DAD - Delayed Afterdepolarization
Phase 4
DADs result from blockade of IK1, which maintains the resting potential
(can be the result of cardiac glycoside toxicity)

44
Q

Drug-induced TdP can cause what kind of arrhythmia?

A

EAD - Early Afterdepolarization
Phase 3
EADs result from blockade of repolarizing K channels (eg) and/or increased INa late, ICa,L

45
Q

Class III anti-arrhythmics, K channel blockers, are known carriers of the risk of developing TdP. These include Sotalol, Amiodarone, Ibutelide, Dronedarone and Dofetilide. What OTHER anti-arrhythmic class also carries the risk of TdP development?

A

Class IA
Because they are both fast Na channel blockers and K rectifier blockers

Procainamide - Quinidine - Disopyramide

46
Q

Double Quarter Pounder

A

Class IA anti-arrhythmics

Procainamide - Quinidine - Disopyramide

47
Q

“Lettuce, Tomato, Mayo, Pickles”

A

Class IB anti-arrhythmics

*Lidocaine, Tocainide, *Mexilitine, Phenytoin

48
Q

“More Fries Please”

A

Class IC anti-arrhythmics

Moricizine, *Flecainide, *Propafenone

49
Q

“A Big Dog Is Scary”

A

Class III anti-arrhythmics

(*Amiodarone, Bretylium, *Dofetilide, *Ibutilide, *Sotalol). + *Dronedarone

50
Q

Class: Dipyridamole

A

Antiplatelet agent
Anti-anginal
Pyrimido-pyrimidine

51
Q

Class: Aspirin

A

NSAID

Antiplatelet agent

52
Q

Class: Ticlopidine

A

Antiplatelet agent

Thienopyridine

53
Q

Class: Clopidogrel

A

Antiplatelet agent

Thienopyridine

54
Q

Class: Ticagrelor

A

Antiplatelet agent

Adenosine-like

55
Q

Class: Prasugrel

A

Thienopyradine

Antiplatelet agent

56
Q

Class: Cilostazol

A

Antiplatelet agent

Quinoline

57
Q

What APA is standard of care with a stent placement?

A

Clopidogrel

58
Q

What is a notable SE of Ticlopidine?

A

Neutropenia
TTP rare

not used anymore

59
Q

What APA carries the greatest bleeding risk?

A

Prasugrel

60
Q

What APA is contraindicated in HF?

A

Cilostazol

MS 2 - Unit 4 (16 decks)

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