Rhythm is gonna get you

Question 1

Quinidine

Answer 1

Class IA

Toxicity: Cinchonism (HA, tinnitus)

Question 2

Procainamide

Answer 2

Class IA

Toxicity: Reversible SLE-like syndrome

Question 3

Disopyramide

Answer 3

Class IA

Question 4

Lidocaine

Answer 4

Class IB

Question 5

Mexiletine

Answer 5

Class IB

Question 6

Tocainide

Answer 6

Class IB

Question 7

Flecainide

Answer 7

Class IC

Question 8

Propafenone

Answer 8

Class IC

Question 9

Class IA MOA

Answer 9

Na+ channel blocker

Increases AP duration, increases effective refractory period, & increases QT interval

Affect both atrial & ventricular arrhythmias, especially reentrant & ectopic supraventricular & ventricular tachycardia

Toxicity: Thrombocytopenia; torsades de pointes

Double Quarter Pounder

Question 10

Class IB MOA

Answer 10

Na+ channel blocker

Decreases AP duration

Preferentially affect ischemic or depolarized Purkinje & ventricular tissue. Useful in acute ventricular arrhythmias (esp post-MI) & digitalis-induced arrhythmias

Toxicity: Local anesthetic; CNS stimulation/ depression, cardiovascular depression

Lettuce, Tomato, Mayo

Question 11

Class IC MOA

Answer 11

Na+ channel blocker

No effect on AP duration

Useful in VTachs that progress to VF & in intractable SVT. Usually only used as last resort in refractory tachyarrhythmias. For pts w/o structural abnormalities

Toxicity: proarrhythmic, especially post-MI. Significantly prolongs refractory period in AV node

More Fries Please

Question 12

Which class is affected by hyperkalemia?

Answer 12

Hyperkalemia causes increased toxicity for all class I drugs

Question 13

Propanolol

Answer 13

Non-selective beta blocker

Question 14

Esmolol

Answer 14

Selective beta blocker

Question 15

Metoprolol

Answer 15

Selective beta blocker

SE: Dyslipidemia

Question 16

Atenolol

Answer 16

Selective beta blocker

Question 17

Timolol

Answer 17

Non-selective beta blocker

Question 18

Carvedilol

Answer 18

Beta blocker

Question 19

Acebutolol

Answer 19

Selective beta blocker

Question 20

Class II MOA

Answer 20

Beta blockers

Decreases cAMP, decreases Ca2+ currents

Suppresses abnormal pacemakers by decreasing slope of phase 4. AV node particularly sensitive. Prolongs PR interval

Used for VTach, SVT, slowing ventricular rate during atrial fibrillation & atrial fibrillation

Toxicity: impotence, asthma exacerbation, cardiovascular effects (bradycardia, AV block, CHF), CNS effects (sedation, sleep alteration). May mask signs of hypoglycemia

Treat OD w/ glucagon

Question 21

Ibutilide

Answer 21

K+ channel blocker

Toxicity: Torsades

Question 22

Sotalol

Answer 22

K+ channel blocker

Toxicity: torsades de pointes, excessive beta block

Question 23

Bretylium

Answer 23

K+ channel blocker

Toxicity: New arrhythmias, hypotension

Question 24

Amiodarone

Answer 24

K+ channel blocker 
BUT has class I, II, III, & IV effects b/c it alters lipid membrane

Toxicities: Pulmonary fibrosis, hepatotoxicity, hypothyroidism/hyperthyroidism, corneal deposits, skin deposits (blue/gray) resulting in photodermatitis, neurologic effects, constipation, cardiovascular effects (bradycardia, heart block, CHF)

Question 25

Dofetilide

Answer 25

K+ channel blocker

Question 26

Class III MOA

Answer 26

K+ channel blocker Increases AP duration, increases effective refractory period. Used when other antiarrhythmics fail. Prolongs QT interval

Question 27

Verapamil

Answer 27

Class IV | Cardioselective Ca2+ channel blocker

Question 28

Diltiazem

Answer 28

Class IV

Question 29

Nifedipine

Answer 29

Class IV | Selective for peripheral vasculature

Question 30

Class IV

Answer 30

Ca2+ channel blockers Decreases conduction velocity, increases effective refractory period, prolongs PR interval Used to prevent nodal arrhythmias (Ie SVT) Toxicity: Constipation, flushing, edema, CV effects (CHF, AV block, sinus node depression)

Question 31

Adenosine

Answer 31

Increases K+ efflux out of cells --> hyperpolarizing the cell Drug of choice in diagnosing/abolishing SVT Very short acting (~15 sec) Toxicities: flushing, hypotension, chest pain Effects blocked by theophylline

Question 32

Mg2+

Answer 32

Effective in torsades de pointes & digoxin toxicity