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21 Cards in this Set
- Front
- Back
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Quinidine
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type Ia
MOA : Na+ channel blocker ; slows the upstroke of the action potential and conduction; prolongs the QRS duration of the ECG; intermediate kinetics; also block K+ channels to some extent Adverse Effects: cardiac = excessive QT prolongation and torsade de pointes; syncope; anticholinergic effects: extracardiac effects = GI (up to 50% of pts); CNS effects at toxic levels; idiosyncratic reactions |
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Procainamide
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type Ia
MOA: Na+ channel blocker; similar to quinidine in terms of electrophysiologic effects; PKs: hepatically metabolized with active metabolites (NAPA which has type III activity– eliminated via kidneys…watch renal failure) Adverse Effects: cardiac = hypotension (esp IV); arrhythmia; extracardiac = LUPUS LIKE SYNDROME (1/3 of pts on long-term therapy) – arthralgias and arthritis, maybe pleuritis, pericarditis, pulmonary dz; GI; agranulocytosis |
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Disopyramide (Norpace)
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type Ia
MOA: Na+ channel blocker; cardiac effects are similar to quinidine; marked cardiac antimuscarinic (anticholinergic: ) effects = many side effects; Adverse Effects: cardiac = arrhythmias; heart failure; extracardiac = anticholinergic (see above); GI |
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Lidocaine (Xylocaine)
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type Ib
MOA: Na+ channel blocker; Adverse Effects: cardiac = arrhythmias; hypotension; extracardiac = neurologic (dose-related)…paresthesias, tremor, N (chemoreceptor trigger zone), lightheadedness, convulsions, slurred speech, hearing problems |
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Mexiletine (Mexitil)
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type Ib
MOA: Na+ channel blocker Adverse Effects: frequent at therapeutic doses = neurologic…tremor, blurred vision, lethargy; GI |
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tocainide (Tonocard)
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type Ib
MOA: Na+ channel blocker Adverse Effects: frequent at therapeutic doses = neurologic…tremor, blurred vision, lethargy; GI |
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Flecainide (Tambocor)
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type Ic
MOA: blocks Na+ and K+ channels w/ slow unblocking kinetics CAST – flecainide used = 2x mortality rate in pts taking flecainide and encainide… |
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Propafenone (Rythmol)
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type Ic
MOA: weak beta blocker; similar to quinidine Adverse Effects: metallic taste, constipation, arrhythmia |
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Moricizine (Ethmozine)
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type Ic
MOA: potent Na+ channel blocker Adverse Effects: arrhythmias, dizziness, N |
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β- blockers
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β- blockers - type II
MOA: block cardiac beta receptors Adverse Effects: cardiac = CHF; extracardiac = watch asthma and COPD pts!!! ↓IOP; CNS…sedation, depression, sleep disturbances; impotence |
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acebutolol (Sectral)
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β- blockers - type II
MOA: block cardiac beta receptors Adverse Effects: cardiac = CHF; extracardiac = watch asthma and COPD pts!!! ↓IOP; CNS…sedation, depression, sleep disturbances; impotence |
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esmolol (Brevibloc)
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β- blockers - type II
MOA: block cardiac beta receptors Adverse Effects: cardiac = CHF; extracardiac = watch asthma and COPD pts!!! ↓IOP; CNS…sedation, depression, sleep disturbances; impotence β- blockers - type II |
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propranolol (Inderal)
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β- blockers - type II
MOA: block cardiac beta receptors Adverse Effects: cardiac = CHF; extracardiac = watch asthma and COPD pts!!! ↓IOP; CNS…sedation, depression, sleep disturbances; impotence |
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sotalol (Betapace)
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β- blockers - type II
MOA: block cardiac beta receptors Adverse Effects: cardiac = CHF; extracardiac = watch asthma and COPD pts!!! ↓IOP; CNS…sedation, depression, sleep disturbances; impotence |
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Amiodarone (Cordarone)
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type III; MAJOR AGENT USED!
MOA: K+ channel blocker = prolongation of action potential; also blocks Na+ channels; weak adrenergic and Ca2+ blocking channel capabilities; effective in atrial and ventricular arrhythmias PKs: poor GI absorption; IV available also (2-3 days to SS level) • t1/2 = 56 days…takes a few weeks (minimally) to reach some type of steady blood level • 96% protein bound • Hepatically metabolized with active metabolites • Requires blood level monitoring • Watch drug interactions due to CYP450 enzymes in liver Adverse Effects: cardiac = bradycardia, heart block; extracardiac = major limitation – but as long as the pt is appropriately monitored…LFTs, PFTs, TFTs, ocular exam • due to accumulation in many tissues (lung, liver, skin, tears) • pulmonary toxicity – dose related; see fibrosis (1% fatal) • abnormal LFTs and hepatitis • gray-blue skin discoloration in sun exposed areas and photosensitivity in general • corneal microdeposits – may see halos in peripheral vision…microdeposits seen in almost all pts • optic neuritis – rare = blindness • blocks conversion of T4 to T3= hypo or hyperthyroidism Widely use |
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Bretylium
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type III
MOA: K+ channel blocker = prolongation of action potential; also blocks Na+ channels; weak adrenergic and Ca2+ blocking channel capabilities; effective in atrial and ventricular arrhythmias Adverse Effects: arrhythmia; dissimilar to amiodarone in terms of the extracardiac effects |
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dofetilide (Tikosyn)
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type III
MOA: K+ channel blocker = prolongation of action potential; also blocks Na+ channels; weak adrenergic and Ca2+ blocking channel capabilities; effective in atrial and ventricular arrhythmias Adverse Effects: arrhythmia; dissimilar to amiodarone in terms of the extracardiac effects |
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ibutilide (Corvert)
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type III
MOA: K+ channel blocker = prolongation of action potential; also blocks Na+ channels; weak adrenergic and Ca2+ blocking channel capabilities; effective in atrial and ventricular arrhythmias Adverse Effects: arrhythmia; dissimilar to amiodarone in terms of the extracardiac effects |
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sotalol (Betapace)
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type III
MOA: K+ channel blocker = prolongation of action potential; also blocks Na+ channels; weak adrenergic and Ca2+ blocking channel capabilities; effective in atrial and ventricular arrhythmias Adverse Effects: arrhythmia; dissimilar to amiodarone in terms of the extracardiac effects |
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diltiazem (Cardizem)
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type IV
MOA: slowing of inward Ca2+ through L-channels Adverse Effects: cardiac = verapamil has dose-related cardiotoxic effects; both arrhythmia; extracardiac = verapamil causes constipation, diltiazem causes diarrhea; peripheral edema, nervousness |
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Verapamil (Calan
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type IV
MOA: slowing of inward Ca2+ through L-channels Adverse Effects: cardiac = verapamil has dose-related cardiotoxic effects; both arrhythmia; extracardiac = verapamil causes constipation, diltiazem causes diarrhea; peripheral edema, nervousness |
