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45 Cards in this Set

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What conditions make TdP more likely?
hypokalemia
hypomagnesemia
bradycardia
How do class I anti-arrhythmic drugs work? Class II? III? IV?
I: modulate or block Na+ channels
II: inhibit sympathetic activity
III: Block K+ channels
IV: CCBs
Other
Name the Class Ia antiarrythmics.
Quinidine
procainamide
disopyramide
Name the only Class Ib antiarrythmic.
Lidocaine
not used much anymore
Name the class Ic antiarrythmics.
Flecainide
Propafenone
Which drugs are class II antiarrythmics?
Beta blockers
Name the class III antiarrythmics.
sotolol
dofetilide
amiodarone
Which class III antiarrythmic is also a beta blocker?
sotolol
Which drug is a cardiac glycoside?
digoxin
What are the cytochrome interactions of quinidine? Which antiarrythmic class is it?
Class Ia
3A4 substrate
3A4 inhibitor
2D6 inhibitor
p-glycoprotein
What are the 2D6 substrates?
beta blockers (not atenolol)
TCAs
flecainide
mexiletine
propafenone
SSRIs
Opiods
Which three antiarrythmic drugs increase dig levels? how? and what classes are they?
Ia - quinidine
IV - verapamil
III - amiodarone

*blocks P-glycoprotein
What drugs besides verapamil and quinidine can increase dig levels?
cyclosporin
erythromycin
amiodarone
ketoconazole
Which antibiotics are QT prolongators?
quinolones
erythromycin
clarithromycin
What drugs are associated with Cinchonism? What is cinchonism?
Quinidine

Urinary retention, vascular flushing, blurred vision/mydriasis, delirium, psychosis, anhidrosis, hot skin.
Which antiarrythmic is associated with a lupus-like syndrome?
procainamide
What drugs are associated with a lupus-like rxn?
procainamide
hydralazine
penicillamine
diltiazem

minocycline
infliximab
methyldopa
quinidine
rifampin
nitrofurantoin
sulfonamides
HCTZ
Which antiarrythmic is associated with potential bone marrow suppression?
procainamide
What are the cytochrome interactions of procainamide?
2D6 substrate
NAT substrate (along with hydralazine and INH)
Which Class Ia antiarrythmic is a 3A4 substrate and a negative inotrope?
Disopyramide
Disopyramide may be problematic in which patients due to neg inotropic effects? What other anti-arrythmic drugs are negative inotropes?
CHF

flecainide and sotalol
Anticholinergic SE are a problem with which class Ia antiarrythmic? Which patients should you use caution when prescribing this drug?
Disopyramide

Careful in glaucoma and BPH
WHat class of anti-arryhthmic is associated with CNS toxicity (tremor and seizures)
Class Ib (lidocaine)
What are the cytochrome interactions of Class Ib antiarrythmic?
2D6 substrate
3A4 substrate
Which drug has class and II and III antiarryhthmic activity?
sotalol
Avoid this antiarrythmic in patients taking BBs or CCBs.
Sotalol
This antiarrythmic may mask hypoglycemia.
Sotalol
What are the three class III antiarrythmics?
Sotalol
Dofetilide
Amiodarone
Where is much of amiodarone stored in the body?
fat, muscle, liver, lungs, and skin (highly lipid soluble)
Must get amiodarone out of system for weeks before starting which drug?
dig
What eye problems can amiodarone cause?
optic neuritis
floaters in anterior chamber (corneal deposits)
What tests should be ordered when amiodarone is started?
LFTS
TSH
Creat and lytes (BMP)
CXR
Optho eval
PFTs
ECG
What are the CYP interactions of amiodarone?
2C9 inhibitor (inc warfarin level)
2D6 inhibitor (inc BB)

3A4 substrate and inhibitor

P glycoprotein substrate (doubles dig levels)
What ABX should be avoided if patient is on amiodarone?
Macrolides (3A4)
ketolides
Fluroquinolones (QT prolongator)

(antiarrythmic + abx --> torsades)
This drug can cause lungs to scar themselves (subacute cough and progressive dyspnea - infiltrates - ARDS possible)
amiodarone

D/C and give steroids
What disease processes can look like amiodarone pulmonary scarring? What other drugs can cause this?
Sarcoid (order ACE)
Churg Strauss (order ANCA)
Wegener (order sed rate)
RA
Polymyalgia rheumatica

Drugs: bleomycin, nitrofurantoin, MTX
What are the cardiac side effects of amiodarone besides QT prolongation?
bradycardia and AV nodal block
Which class of antiarrythmics can cause gingival hyperplasia (and constipation)?
Class IV (verapamil)
How are cardiac glycosides metabolized/excreted?
minimally metabolized but renally excreted (watch the creat!)

*p glycoprotein
Gynecomastia is side effect of which anti-arrythmic?
Digoxin
How does dig work?
inhibits Na/K ATPase --> inc cardiac output and alteration of electrical function of the heart
What drugs interfere with dig by altering the potassium level?
diuretics
oral steroids
What drug is a recombinant human brain natriuretic peptide? What does it do?
Nesiritide

--> venous AND arterial dilation
WHen might nesiritide be used?
decompensated CHF w/dyspnea at rest
what is the most serious ADR of nesiritide?
hypotension (but also increases the creat)