trigger CV pharm Flashcards
slow rate of rise of AP and prolongs duration
Class 1a (Quinidine, procainamide, disopyramide)
shorted AP (minimal depression of phase 0 upstroke)
Class 1b - lidocaine, mexiletine
dissociates from channel with slow kinetics (no change in AP duration)
flexainide, propafenone
works as an anticholinergic on SA and AV nodes.
increases SA nodal discharge rate and AV nodal conduction
quinidine
proarrhythmic that can cause torsades via QT prolongation
quinidine, procainamide, disopyramide
similar to quinidine but lacks anticholinergic activity
procainamide
MC ADE is a clinical syndrome similar to SLE and MC use is WPW
procainamide
Potent anticholinergic and negative inotrope
disopyramide
CI in pts w HFrEF
CI in pts with HFrEF
Disopyramide
can precipitate CHF and has anticholinergic effects such as dry mouth, UR, constipation and blurred vision
Disopyramide
used for Ischemic tissue, primarily active fast sodium channels below the AV node
Lidocaine
used with ventricular dysrhythmias, especially those associated with MI
lidocaine
caution in hepatic impairement
lidocaine
dronedarone
often combined with classes Ia and III for refractory ventricular dysrhythmias
mexiletine
this is the oral lidocaine like drug
use of this medication is limited by its GI SEs
mexiletine
slows conduction velocity in the purkinje and AV node
flecainide
MC use is afib/aflutter
propafenone too but propafenone as has a nonselective BB effect
MC use is afib/aflutter
Flecainide
may cause rapid VT in someone w structural abnormalities
may cause rapid VT in someone w structural abnormalities
flecainide
this drug is not used alone
mexiletine
slows conduction velocity in the purkinje fibers and AV node + mild non-selective BB effect.
propafenone (similar to flecainide)
class 1c
lengthens PR and QRS which can lead to bradycardia or heart block. AVOID in structural heart disease
propafenone
SE of metallic taste
propafenone
Contraindicated in patients w structural heart disease
class 1c antiarrhythmics
(flecainide and propafenone)
Decrease automaticity, prolong AV conduction, prolong refractory period
beta blockers
mainly used to suppress ventricular dysrhythmias and SVTs
Beta blockers
Block potassium channels and prolong repolarization, widening QRS and prolonging QT.
class III antiarrhythmics
amiodarone, sotalol, dofetilide, dronedarone, ibutilide
has characteristics of all 4 antiarrhythmic classes and works on all cells but is primarily a K+ channel blocker
amiodarone (class III)
should be avoided in bradycardic patients but is also ok to use in LV dysfunction
amiodarone
pts on this medication should get an annual CXR. why?
amiodarone
it can build up and cause pulmonary toxicity
can induce hyper or hypothyroidism. must check TSH Q 6 months
amiodarone. this is because it MIMICS IODINE!!!!
blue/gray discoloration & photosensitivity
amiodarone (derm toxicity)
CYP3A4 inhibitor: can potentiate warfarin and digoxin (doubles digoxin levels)
amiodarone
Primarily a potassium channel blocker but also has non-selective BB properties (negative inotrope)
sotalol
Prolongs AP and QT interval. mainly atrial focused
dofetilide
MC ADE is torsades (must get EKG 2 hrs after every dose)
dofetilide
Similar to amiodarone with less efficacy but less SEs also
dronedarone
CI: Symptomatic CHF or recent decompensation, Permanent AF
dronedaron
IV only used soley for afib/aflutter cardioversion. AVOID in LV dysfunction and lyte abnormalities
ibutilide/corvert
a negative inotrope that decreases automaticity and AV conduction
Class IV antiarrhythmics (verapamil and diltiazem.)
Inhibition of Ca channels in AV node and activates K+ channels. slows ventricular rate in Afib/aflutter and terminates AVNRTs
digoxin
PR prolongation and ST segment depression
digoxin
toxicity w coadmin of ABX
oral digoxin
also has super poor bioavailability
used to convert SVT to sinus rhythm
adenosine
Activate potassium channel and hyperpolarizes membrane, decreasing SA node depolarization
adenosine
