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47 Cards in this Set
- Front
- Back
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Class Ia
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Na Channel Block/Slow repol.
Procainamide Quinidine Disopyramide |
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Class Ib
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Na Channel Block/Fast offset kinetics (can speed repol)
Lidocaine Mexiletine |
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Class Ic
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Na Channel Block/Slow offset kinetics (no change in repol)
Propafenone Flecainide |
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Class II
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Sympatholytic (Beta-blockers)
Propranolol Metoprolol Acebutolol Esmolol |
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Class III
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Prolong Action Potentials:
True III: Ibutilide, Dofetilide II-III: Sotalol I, II, III, IV: Amiodarone, Dronedarone |
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Class IV
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Calcium-Channel Blockers (L-type)
Verapamil Diltiazem |
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Vaughan-williams misc. drugs
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Digoxin
Adenosine |
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Class I effects
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All block Na Channels
All reduce rate of AP phase 0 (atrial, ventricular, His-Purkinje)SLOWED CONDUCTION through all tissues Effects may be increased in ischemic tissue |
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Class Ia:
Indications |
V-tach (P)
AFib/AFL (Conversion ONLY, not rate control!) Paroxysmal supraventricular tachycardia |
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Procainamide:
Side Effects |
Hypotension
Lupus-like syndrome Proarrhythmia |
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Quinidine:
Side Effects |
Hypotension
Accelerated AV conduction Proarrhythmia |
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Disopyramide:
Side Effects |
Strong Anticholinergic
Negative Inotrope |
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Lidocaine:
Indications, PK |
Treat/suppress v-tach (esp during ischemia)
Potency increases as HR increases |
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Lidocaine:
Adverse Effects |
CNS: Numbness, confusion, seizure, coma, death (depend on Fup, binds both albumin & AAG)
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Mexiletine:
Indications, PK |
Preventions of life-threatening ventricular arrhythmias
Potentcy increases as HR increases 2D6 substrate |
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Mexiletine:
Side Effects |
SNS: Numbness, tremor, loss of coordination
GI effects |
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Propafenone:
Indications/Effect |
Prevent & suppress v-tach
Supraventricular arrhythmias IN ABSENCE OF IHD, LVEF<40% Affects myocardium & conducation in His-Purkinje |
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Propafenone:
PK |
Saturable first-pass
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Propafenone:
Side Effects |
SA/AV Node block, negative inotrope, dizziness, dysgeusia
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Fleicainide:
Indications |
*Most potent of all class 1*
Prevent/suppress v-tach Supraventricular arr. |
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Fleicainide:
Side Effects |
Dizziness
Proarrhythmias |
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Class Ic WARNING!
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AVOID in IHD! Very slow-offset of channel block, "Incessant v-tach"
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Class II:
Indications |
Supraventricular arr (reduce AV conduction)
Catecholamine-dependent ventricular arr. (Decr. SNS effect) Reduce post-MI reinfarction & sudden death (modulate Ca, reduce DADs, decr. If) |
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Class II:
Side Effects |
Fatigue
Bradycardia AV Blocks Bronchospasm NOTE: Rebound with abrupt discontinuation |
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Class III:
Mechanism |
All act to prolong AP duration (atrial & ventricular) and prolong refractoriness:
All block outward K+ current during phase III Ibutilide also activates slow inward Na+ current during phases I-II |
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Class III:
EKG changes |
Prolong QT interval
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Ibutilide:
Indication/Monitoring |
Acute conversion of AF/AFL
Monitor for return to baseline QTc |
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Dofetilide:
Indication/Monitoring |
Conversion and maintenance of AF/AFL
FDA mandates in-hosp initiation, 3 month f/u's: ECG, K/Mg, renal function, and registration to prescribe or dispense |
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Sotalol:
Indications |
Life-threatening ventricular-arr.
NSR maintenance in symptomatic AF/AFL NOT USED for LVEF<40% |
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Sotalol: PK
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renal elimination
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Sotalol:
Side-effects |
Beta-blockade related: bradycardia, AV block, bronchospasm
Excessive QT prolongation: Torsades de Pointes |
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Amiodarone:
Indication |
*Most effective antiarrhythmic*
Treat (IV)/Suppress (oral) life-threatening ventricular arr. (independent of LVEF) Off-label: Convert/suppress AF/AFL |
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Amiodarone:
PK |
hepatic clearance
t1/2 = 56 DAYS Inhibits 2C9, 2D6, 3A4 |
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Amiodarone:
Side Effects |
Cardiac: bradycardia, AV block
Other: pulmonary fibrosis, hyper-or-hypo-thyroid, abnormal LFT, hepatitis, skin discoloration, corneal microdeposits & optic neuritis CNS: tremor, abnormal gait, neuropathy |
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Amiodarone:
Initiation standards |
LFT, lung function, thyroid, chest xray, chem7, ECG, opth exam
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Dronedarone:
Indications |
Persistent AF/AFL and assoc risk factors (age, DM, HTN, stroke, LVEF<40, enlarged left atrium) who are in sinus rhythm or will be cardioverted
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Dronedarone:
Side Effects |
Cardiac: Incr. mortality for NYHC clas IV, or for II-III w/ recent decomp., also bradycardia
Non-cardiac: GI, hepatotoxicity, rash, photosensitivity, incr SCr WITHOUT decr. renal function |
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Class IV:
Indications |
AF/AFL
Termination of AV node reentrant tachycardia |
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Class IV:
Mechanism |
Block L-type Ca-channel, so decrease inotropy
Slows AV node conduction |
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Class IV:
Comparison |
Verapamil more potent negative inotrope, so, must consider ventricular function
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Class IV:
Contraindications |
Sick sinus syndrome
2nd or 3rd degree AV block Hypotension Cardiogenic shock or uncomp HF |
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Digoxin:
Effects |
Parasympathetic (vagal) effects, reduced sympathetic outflow.
NET RESULT: Inhibition of AV & SA nodes - slowed conduction - increased refractory period |
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Digoxin:
Side Effects |
Proarrhythmias: Intracellular CA overload plus increased extracellular K+ leads to DADs.
Hypokalemia Bradycardia AV Blocks |
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Adenosine:
Effects |
Acute slowing of AV node conduction (v. brief) by G-protein augmentation of hyperpolarizing K+ current in AV node
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Adenosine:
Indications |
Termination of paroxysmal superventricular tachycardia
(this drug will block & stop reentry that includes the AV node) |
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Adenosine:
Side Effects |
Dyspnea (up to 30 min!)
Flushing/ha (transient) Asystole/chest pain (transient) |
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Adenosine:
PK |
Nucleoside, t1/2 = 10-30 SECONDS (given as IV bolus)
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