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Cardiology Exam 1 > Pharmacology of Arrhythmias > Flashcards

Pharmacology of Arrhythmias Flashcards

1
Q

Vaughn Williams classification system is based on?

A

the channel that the drug blocks

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2
Q

Class Ia

  • what effect?
  • example drugs?
A

-Na channel blockers - dec conduction velocity and prolonging repolarization

  • quinidine
  • procainamide
  • disopyramide
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3
Q

Class Ib

  • what effect?
  • example drugs?
A

-Na channel blocker - shortened repolarization, slight dec in conduction velocity

  • Lidocaine
  • mexiletine
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4
Q

Class Ic

  • what effect?
  • example drugs?
A

-Marked Na channel blocking - dec conduction velocity, no effect on repolarization

  • Flecinide
  • propafenone
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5
Q

Class II

  • what effect?
  • example drugs?
A

-Beta blockers - lowered sinus rate

  • Metoprolol
  • atenolol
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6
Q

Class III

  • what effect?
  • example drugs?
A

-marked potassium channel blocker - marked prolongation of refractory period

  • sotolol
  • amiodarone
  • ibutilide
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7
Q

Class IV

  • what effect?
  • example drugs?
A

-calcium channel blocker - lowered sinus rate

  • verapamil
  • diltiazem
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8
Q

3 basic things that antiarrhythmics do to effect heart electrophysiology-wise:

A

1) prolong resting membrane potention
2) prolong refractory period
3) harder to reach action potential

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9
Q

Quinidine

  • class?
  • uses? How?
  • use today?
A
  • class 1a
  • atrial fib must give digoxin first
  • not used today- many side effects and causes heart failure
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10
Q

Quinidine use puts patient at risk for?

A

torsades - do an EKG to see how QRS loks

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11
Q

Quinidine - major adverse effect?

A

-GI upset

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12
Q

quinidine drug interactions:

A
  • digoxin
  • amiodarone
  • cimetidine
  • verapamil
  • phenytoin
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13
Q

Procainamide

  • class?
  • effect?
  • use today?
A
  • class 1a
  • prolongs refractory period (QT)
  • little effect on AV nodal conduction
  • second line in ACLS algorithm for VT/VF
  • not used today because neg hear effects.
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14
Q

Potential for drug induced lupus with?

A

procainamide

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15
Q

Disopyramide

  • class?
  • effect?
  • use today?
A
  • class 1a
  • prolongs the duration of the action potential
  • anti-cholinergic effects balance out depression of AV node conduction
  • not used much today
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16
Q

Disopyramide - side effects?

A
  • dry everything
  • sleepy
  • urinary incont

**(so many anticholinergic effects)

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17
Q

Disopyramide- dosing consideration with patient with certain diseases?

A

-must reduce dose in people with kidney disease* (renal failure)

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18
Q

Lidocaine

  • what class?
  • effect?
  • useful for?
  • use today?
A
  • class 1b
  • minimal QT or QRS
  • increased VT of VF threshold
  • effective for re-entral rhythms
  • used to be used in post MI patients for prophylaxis
  • no longer first line
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19
Q

Lidocaine administration?

A

*only IV and in hospirtal

no oral

20
Q

Lidocaine is what type of drug?

A

-useful for arrhythmias but it is a AMIDE TYPE LOCAL ANESTHETIC

21
Q

only has effect on ventricles?

A

lidocaine - no use for anythnig atria

22
Q

Lidocaine side effects to know about?

A

-MANY CNS effects- crossed BBB = dizzy, parasthesias, confusion, lethargy,…

23
Q

checking blood levels for this drug is actually useful?

A

-lidocaine - if patient has CNS effects –> check levels to see if you should lay off the dosing

24
Q

Flecainide

  • class?
  • effect?
  • use today?
A
  • class 1c
  • increases QRS
  • potentn Na channel blocker
  • used today in patients with atrial arrhythmias w/out ischemic heart disease
  • rarely used in ventricular arrhythmias
25
Q

Reduce dose of these drugs in patients with renal failure

A

Disopyramide
flecainide
sotolol
dofetilide

26
Q

benefit to Class 1c drugs/

A

-well-tolerated and without weird adverse effects

27
Q

main use for flecainide?

A

-supra ventricular tachycardias (A FIB) with normal cardiac function

28
Q

propafenone

  • class?
  • effects?
  • used for?
A
  • class 1c
  • slows atrial and ventricular conduction wihtout prolonging repolarization
  • non-selective beta block
  • less pro-arrhyhtmic that other 1c agents
  • used in patients without significant CHF (patients without structural heart disease) that have atrial arrhythmias or sustained VT/VF
29
Q

primarily used for a fib in US?

A

propafenone

30
Q

two drug interactions of propafenone?**

A

digoxin

warfarin

31
Q

Class 1 drugs are not use with what patients?

A

NOT with patients that have structural heart problems - aka CHF

32
Q

only class of drugs that reduces mortality in arrhyhtmia patients?

A

beta-blockers

33
Q

sotolol

  • class?
  • effect?
  • used for?
A
  • class III (potassium channel) but beta blocking agent too
  • minimal effect on PR intervals
  • dose dependent inc in QT interval
  • used for prevention of A fib and VT/VF
34
Q

sotolol adverse?

A

-Huge cause of torsades!!

35
Q

sotolol primary prevention in US?

A

-prevent recurrence of a fib

36
Q

*Amiodarone
-class?
effect?
-used for?

A
  • class 3 ( has effects in all 4 classes though)
  • delayed repolarizing by proonged APD and ERP
  • first line for ACLS VT/VF
37
Q

Main problem with amiodarone?

A

-long list of adverse effects - it pretty much hits every organ system!

38
Q
  • *amiodarone adverse effects?

- worst effects?

A

HEART:-low risk of torsades
-IN GENERAL PRETTY SAFE FOR THE HEART…

LUNGS: worst= pulmonary fibrosis or delayed hypersensitivity pneumonitis –> 10% die from this

THYROID - much of drug contains Iodine = hypo hyper thyoridism (hypo more common)

EYES: everyone on this drug long term gets corneal deposits (no effect on vision); halos; photophobia

NEURO: tremor common with long term, periph neuropathy

SKIN: photosensitivity; blue green discoloration (smurf drug)

LIVER: -asymptmatic elevations in bilirubin & transaminases; rare hepatitis

GI: N & V very common

39
Q

Amidarone drug interactions?

A

pretty much everything unless proven otherwise

40
Q

Amiodarone indications:

A

-prevent SVT (especially a fib), VT, and VF

41
Q

Dronaderone

  • what class?
  • interesting about drug?
  • used for?
  • side effects?
A
  • class III
  • basically amiodarone without the iodines (since iodine was causing so many of the side effects)
  • good for a fib

-FEWER ADVERSE EFFECTS BUT LESS EFFECTIVE THAN AMIODARONE

42
Q

Dofetilide

-used for?

A

a fib!

even good in patients with structural heart disease

43
Q

dofetilide - big problem?

A

huge incidence of torsades - more than sotolol!!

-cleared mostly by kidneys = not good if kidneys are bad

44
Q

patient gets frequent ventricular arrhythmias - give?

A

-implantable cardioverter defibrillator (ICD) - gives them a shock when its monitoring of the heart determines that something isnt right

45
Q

A fib and no heart disease give?

A
  • flecanide

- propafenone

46
Q

A fib with CAD but no CHF give?

A

sotolol

47
Q

A fib with CHF give?

A

amiodarone

dofetilide

Cardiology Exam 1 (24 decks)

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