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97 Cards in this Set
- Front
- Back
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What is the dominant electrophysiologic effect of class I antiarrhythmic drugs?
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sodium channel block
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What is the dominant electrophysiologic effect of class II antiarrhythmic drugs?
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Beta blockers-->sympatholytic
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What is the dominant electrophysiologic effect of class III antiarrhythmic drugs?
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prolong the action potential
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What is the dominant electrophysiologic effect of class IV antiarrhythmic drugs?
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L-type calcium channel blockers
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What are the class Ia antiarrhythmic drugs?
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Procainamide
Quinidine Disopyramide |
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What are the two effects of class Ia antiarrhythmic drugs?
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Sodium channel block
Slow repolarization |
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What are the side effects of procainamide?
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hypotension
SLE-like syndrome proarrhythmia |
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What is special about procainamide?
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Active metabolite is class III antiarrhythmic (prolong AP)
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What are the indications for procainimide?
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V-tach
Afib (conversion NOT rate control) Paroxysmal SVT |
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What are the indications for quinidine?
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Afib (conversion NOT rate control)
Paroxysmal SVT |
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What are the side effects of quinidine?
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Hypotension
Accelerated AV conduction (anti-cholinergic) Proarrhythmia |
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What makes disopyramide different from the other drugs in its class?
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Negative inotrope
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What are the indications for disopyramide?
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Afib (conversion NOT rate control)
Paroxysmal SVT |
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What are the side effects of disopyramide?
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Anticholinergic syndrome
Negative inotropy |
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What is the mechanism of action of class Ib antiarrhythmics?
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Sodium channel block
Fast offset kinetics (at fast HR)-->can accelerate repolarization |
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What are the class Ib antiarrhythmics?
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Lidocaine
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What are the uses of lidocaine?
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Treatment & suppression of vtach
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What are the side effects of lidocaine?
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CNS (paresthesias, confusion)
Dependent on unbound plasma concentration |
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What are the class Ic antiarrhythmics?
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Propafenone
Flecainide |
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What are the effects of class Ic antiarrhythmics?
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sodium channel block + slow offset kinetics
No change in repolarization (phase 3) |
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What is an additional effect of propafenone?
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Non-selective beta-adrenergic antagonist (beta blocker)
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What are the uses of propafenone?
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Vtach
Supraventricular arrhythmias w/o LVEF<40% |
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What are the side effects of propafenone?
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CNS (dizziness, taste changes)
Beta-blockade (negative inotrope, SA/AV node) |
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What is the most potent Na channel blocker w/slow offset kinetics?
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Flecainide
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What are the uses of flecainide?
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Vtach
Supraventricular arrhythmias w/o LVEF<40% |
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What are the side effects of flecainide?
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dizziness
proarrhythmia |
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What beta blocker antiarrhythmic is only available via IV?
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Esmolol
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What beta blockers have been labeled for antiarrhythmic use?
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Propranolol
Metoprolol Acebutolol Esmolol |
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How do the beta blockers work to suppress arrhythmias?
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Reduce sympathetic modulation of AV node-->modulate calcium current by reducing phosphoyrlation of L-type Ca channel
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What are the uses of beta blockers as antiarrhythmics?
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Supraventricular arrhythmias
Catecholamine-dependent ventricular arrhythmias |
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What are the side effects of beta blockers?
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Fatigue
Bronchospasm Bradycardia AV block Rebound w/aburpt discontinuation |
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What is the general effect of class III antiarrhythmics?
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Prolong QT interval-->prolong AP duration
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What are the class III antiarrhythmics?
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Ibutilide
Dofetilide Sotalol Amiodarone Dronedarone |
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Which class III antiarrhythmics are administered PO?
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Dofetilide
Sotalol Amiodarone |
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Which class III antiarrhythmics are administered IV?
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Ibutillide
Amiodarone |
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How does ibutilide work?
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prolongs repolarization by blocking outward K+ current during phase 3 & blocks activation of slow inward Na+ current during phases 1&2
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What are the uses of ibutilide?
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acute afib & atrial flutter
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How does dofetilide work?
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Prolong repolarization by blocking K+ current during phase 3
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What is dofetilide used for?
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Conversion & maintenance of normal sinus rhythm in patients w/afib or flutter
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How does sotalol work?
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Prolongs repolarization by blocking outward K+ channels during phase 3
Beta blocker |
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What class III antiarrhythmics are also beta blockers?
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Sotalol
Amiodarone Dronedarone |
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What is sotalol used to treat?
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Life-threatening ventricular arrhythmias
Maintenance of normal sinus rhythm in patients w/symptomatic afib or aflutter |
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What is a side effect of sotalol?
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Can lead to torsades de pointes, particularly in patients w/decreased renal function
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How does amiodarone work?
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Na channel blocker
Beta blocker Prolong repolarization by blocking K+ current during phase 3 Calcium channel blocker |
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What is the half-life of amiodarone?
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56 days
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What are the side effects of amiodarone?
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bradycardia, AV blocks, pulmonary fibrosis, thyroid dysfunction, liver damage, skin discoloration, neuro
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What is amiodarone used for?
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Vtach
Conversion of afib or aflutter AVNRT, AVRT |
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How does dronedarone work?
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Na channel blocker
Beta blocker Prolong repolarization by blocking K+ current during phase 3 Calcium channel blocker |
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What is the difference between amiodarone & dronedarone?
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Dronedarone doesn't have nearly as much iodine
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What is the half-life of dronedarone?
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13-19 hours
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What are the uses for dronedarone?
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recent afib or aflutter
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What is the basic mechanism of class IV antiarrhythmics?
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non-dihydropyridine L-type calcium channel blockers of
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What are the class IV antiarrhythmics?
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diltiazem
verapamil |
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What are the contraindications for verapamil?
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sick sinus syndrome
2nd or 3rd degree AV block hypotension cardiogenic shock of uncompensated HF |
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What are the contraindications for diltiazem?
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sick sinus syndrome
2nd or 3rd degree AV block hypotension cardiogenic shock of uncompensated HF |
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What is verapamil used for?
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AVNRT
slow ventricular rate in afib or flutter multifocal atrial tachycardia RARELY ventricular tachycardia |
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What is diltiazem used for?
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sick sinus syndrome
2nd or 3rd degree AV block hypotension cardiogenic shock of uncompensated HF |
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What class of antiarrhythmics only increases the PR interval?
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II and IV
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What classes of antiarrhythmics can prolong the QT interval?
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Ia and III
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What classes of drugs can prolong the QRS?
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Ia
Ic III |
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What drugs do you NOT use if LVEF<40%?
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Ia
Ic sotalol |
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What drugs are safe to use if LVEF>40%?
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digoxin
dofetilide amiodarone |
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How does digoxin work as an antiarrhythmic?
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vagal effects on SA & AV nodes-->slow ventricular response to atrial tachyarrhythmias
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What are the side effects of digoxin?
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Bradycardia, AV blocks
Proarrhythmia secondary to increased intracellular Ca & increased extracellular K-->increased automaticity & afterdepolarizations |
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What are the uses of digoxin as an antiarrhythmic?
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AVNRT
slow ventricular rate in a fib, flutter |
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What are the uses of adenosine?
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convert AVNRT
temporarily slow ventricular rate in a fib, flutter to dx atrial rhythm |
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How does adenosine work?
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G-protein stimulated augmentation of hyperpolarizing K current in AV node-->slows AV node conduction
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What are the side effects of adenosine?
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dyspnea
flushing/headache transient asystole, chest pain |
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How does digoxin work as an inotropic agent?
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inhibits Na-K ATPase-->increase intracellular Ca by inhibiting Na-Ca exchanger due to increase intracellular Na
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What are the side effects of digoxin?
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Slow HR
CNS issues (tinting of vision, nausea) Increased effects in hypokalemia |
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How does dobutamine work?
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Activates beta-1, beta-2, and alpha-1 receptors-->increase contractility by increasing cAMP
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How does dopamine work?
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Low dose: vasodilation (via dopamine receptors)
Int. dose: acts on beta-1 receptors High dose: act on dopamine, beta-1, and alpha-1 receptors-->vasoconstriction |
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What are the phosphodiesterase inhibitors used in HF treatment?
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Inamrinone
Milrinone |
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How do the phosphodiesterase inhibitors act as inotropic agents?
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inhibition of phosphodiesterase 3 in the heart-->increae cAMP-->increased contractility
Also causes peripheral vasodilation |
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What are the side effects of inamrinone?
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Increase aflutter
thrombocytopenia |
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What are the side effects of milrinone?
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arrhythmias
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What are the beta-1 only blockers?
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metoprolol
bisoprolol |
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What are the beta1, beta2 and alpha1 blockers?
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carvedilol
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How do the beta blockers work to treat HF?
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Decrease work of heart-->decrease oxygen demand-->slow spiral of damage
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What are side effect of beta blockers?
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asthma
increased bradycardia |
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What older vasodilators are used to treat HF?
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isosorbide dinitrate and hydralazine
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How does isosorbide dinitrate act as a vasodilator?
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increases NO-->increases cGMP-->vasodilation
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What are the inhibitors of angiotensin II synthesis?
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ACE inhibitors--> "-prils"
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How do the ACEi's work?
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inhibit ACE which converts angiotensin I-->angiotensin II
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What are the side effects of the ACEi's?
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Angioedema
Chronic dry cough Fetal damage |
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What are the inhibitors of angiotensin II binding to its receptor?
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"-artans"
losartan, valsartan, candesartan Competitive inhibitors of angiotensin binding |
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What are the side effects of the -artans?
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fetal damage
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What are the inhibitors of aldosterone B?
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spironolactone
eplerenone |
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How does spironolactone work?
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bind to & blocks the aldosterone receptor
mineralocorticoid aldosterone usually causes Na reabsorption & heart remodeling |
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What are the side effects of the aldosterone blockers?
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decreased libido
gynecomastia hyperkalemia |
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How does nesiritide work?
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natriuretic factor that increases Na+ loss & activates guanylate cyclase to increase cGMP
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What is a side effect of nesiritide?
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renal failure
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What is bosentan?
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endothelin blocker
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How does bosentan work?
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blcoks endothelin
Endothelin causes vasoconstriction By blocking endothelin-->decrease pulmonary resistance |
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What particularly is bosentan used?
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PH
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What is a side effect of bosentan?
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hepatotoxicity
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What is a renin inhibitor?
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Aliskiren
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