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57 Cards in this Set
- Front
- Back
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Mechanism of action of Quinidine.
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Class IA antiarrhythmic drug:
- Na+ blocker: decrease phase 0, conduction velocity - K+ blocker: increase ERP - antimuscarinic: increase SA, AV node conduction - alpha blocker: hypotension and reflex tachycardia - antimalarial - antipyretic - oxytocic: stimulate childbirth |
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Side effects of quinidine.
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- increase SA, AV node conduction: antimuscarinic effect
- prolongs QT interval -> Torsade de pointes - cinchonism: headache, dizziness, tinnitus - increase digoxin toxicity |
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These are side effects of which drug?
- headache - dizziness - tinnitus |
Quinidine: cinchonism
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Quinidine can be used to treat ____.
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Afib and atrial flutter
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Mechanism of procainamide.
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Class IA antiarrhythmic
- similar to quinidine - less antimuscarinic: more SA/AV nodal depression - ganglionic blocker - less QT prolongation |
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Side effects of procainamide.
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- cardiac depression -> congestive heart failure
- hypotension - drug induced SLE: arthralgia, arthritis, pleurisy, pericarditis |
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These are side effects of which drug?
- congestive heart failure - hypotension - SLE |
procainamide (Class IA antiarrhythmic)
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Mechanism of disopyramide.
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Class IA antiarrhythmic
- similar to quinidine - more antimuscarinic |
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Side effects of disopyramide.
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atropine like (antimuscarinic)
- urinary retention - dry mouth - blurred vision - constipation |
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List the three Class IA antiarrhythmic drugs.
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- quinidine: prototype
- procainamide: most commonly used - disopyramide |
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List some Class IB antiarrhythmic drugs.
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- lidocaine/tocainide and mexiletine (oral)
- phenytoin |
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Side effects of lidocaine.
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- CNS: eg seizure
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WHo are more at risk of developing lidocaine toxicity (CNS)?
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- people with liver dysfunction
- people with congetive heart failure - older people |
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Side effects of phenytoin.
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- CNS: cerebellar problem
- hypotension/cardiac arrest if give too fast |
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Name a drug that treats venticular arrhythmias caused by digoxin.
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phenytoin
magnesium |
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Mechanism of class IB antiarrhythmic drugs.
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- Na+ blocker
- K+ blocker in ischemic myocardium - shortens QT interval |
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List some ClassIC antiarrhythmic drugs.
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- flecainide
- propafenone |
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Mechanism of flecainide.
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ClassIC antiarrhythmic
- Na+ blocker - increase QRS interval, but not QT interval |
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Side effects of flecainide.
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- proarrhythmia
- heart failure - AV block |
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These are side effects of which drug?
- proarrhythmia - heart failure - AV block |
ClassIC antiarrhythmic
- especially flecainide |
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Mechanism of propafenone.
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ClassIC antiarrhythmic
- Na+ blocker - increase QRS interval, but not QT interval - weak beta-blocker - weak Ca2+ blocker |
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What are ClassIC antiarrhythmic used for?
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Atrial and ventricular arrhythmias.
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Mechanism of Class II antiarrhythmics.
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beta blockers
- decrease Ca influx in phase 0 (nodal cells) - decrease Na influx in phase 4 (nodal cells) - prolong ERP |
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Name two selective beta1 blockers.
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- esmolol
- metoprolol |
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Side effects of beta blockers.
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- bradycardia
- AV block - hypotension - bronchospasm - heart failure |
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Uses of beta blocker in arrhythmias.
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- atrial dysrrhythmia: SVT
- prevent ventricular dysrrhythmia - catecholamine induced acute MI |
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Mechanism of Class III antiarrhythmics.
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- K+ blocker
- increase ERP in phase 2 and 3 |
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Which drug may cause HTN first then postural hypotension and is taken off market?
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Bretylium (Class III)
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Mechanism of amiodarone.
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Class III antiarrhythmics
- K+ blocker - Na+ blocker - weak Ca2+ blocker - weak beta blocker |
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Side effects of amiodarone.
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- low proarrhythmia
- lots of other side effects: gray skin, photosensitivity, pulmonary fibrosis, increased liver enzymes. |
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Which antiarrhythmic drug has the longest T1/2?
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amiodarone: 53 days.
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What is the drug of choice for acute ventricular dysarrhythmia?
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amiodarone
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Mechanims of sotalol.
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Class III antiarrhythmics
- K+ blocker - beta blocker |
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Side effects of sotalol.
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- proarrhythmia: torsade de pointes
- beta blocker side effects: hypotension, bronchospasm, etc. |
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Name some Class III antiarrhythmics.
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- bretylium
- amiodarone - sotalol - ibutilide |
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Mechanism of ibutilide.
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Class III antiarrhythmics
- K+ blocker |
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Side effect of ibutilide.
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torsade de pointes
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What is ibutilide used for?
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atrial flutter/fibrillation
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Mechanism of Class IV antiarrhythmics.
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Ca2+ blockers
- decrease slope of phase 0 in SA and AV node - increase ERP (phase 2) - depress myocardium - peripheral vasodilation - coronary artery dilation |
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List drugs in Class IV antiarrhythmics.
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- verapamil
- diltiazem |
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Class IV antiarrhythmics are used in ____.
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atrial dysarrhythmias
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Mechanism of adenosine.
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- inhibit AV and SA node
- decrease Ca2+ influx - increase K+ conductance - increase AV nodal ERP lead to transient PR prolongation |
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Side effects of adenosine.
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3rd degree AV block
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What is the drug of choice for SVT?
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adenosine
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Which antiarrhythmic has the shortest T1/2?
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adensoine: <10s
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Mechanism of dogxin.
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- Na+/K+ ATPase blocker
- +inotropic - -chronotropic Lead to: - decreased SA firng - slow AV conduction - increase vagal response - increase AV nodal ERP |
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Side effects of digoxin.
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- GI
- cardiac - CNS: confusion, visual impairment |
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Digoxin is useful in treating ___.
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- atrial flutter/fib
- SVT - CHF by increase contractility |
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Side effects of magnesium.
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- decrease neuromuscular conduction
- hypotension |
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Magnesium is useful in treating ____.
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- torsade de pointes
- digoxin toxicity |
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What is the treatment for SVT when patient is clinically unstable (hypotension)?
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synchronized electrical cadioversion
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What is the treatment for SVT when patient is clinically stable?
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adenosine
also can use - calcium blockers verapamil - beta-blockers - class IA drugs procainamide - digoxin |
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What is the treatment for atrial flutter/fibrillation when patient is clinically unstable (ventricular rate >150)?
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synchronized electrical cadioversion
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What is the treatment for atrial flutter/fibrillation when patient is clinically stable?
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- ca blocker diltiazem
- digoxin - amiodarone |
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What is the treatment for VT when patient is clinically unstable (hypotension) and pulse present?
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synchronized electrical cadioversion
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What is the treatment for VT when patient is clinically stable (pulse present)?
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- amiodarone
- lidocaine - procainamide |
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What is the treatment for VT when patient is pulseless?
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electrical defibrillation
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