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38 Cards in this Set

  • Front
  • Back
When do you treat cardiac arrythmias
Round the clock
What do you use to treat atrial arrhytmias?
Verapimil or Dilitiazem (Ca+ channel blockers- Class IV) or digoxin
Class I drugs
Lidocaine, Mexiletine, Procainamide, Quinidine
Class I drugs mechanism
Na channel blockers, reduce upstroke of action potential, increase time of phase 0
Nipedipine is a calcium channel blocker that is not considered a useful Class IV agent because:
Peripheral vasodilation leads to increased sympathetic discharge
What is the re-entry phenomenon?
Normally, impulses from pacemaker cells travel down the ventricular musculature. If one of the pathways is blocked, a process called reetnry occurs: re-excitation of ventricular muscle causing premature contraction or sustained ventricular arrythmia.
What is the most common arrythmia?
RE-ENTRY arrythmia, sustained ventricular contraction
The most important causes for the generation of arrythmias are:
1. impaired impulsse generation (anomalous automaticity) and 2. A problem with impusle propagation or conduction
Proven advantages of antiarrythmic drugs
1. Adenosine or verapamil for SVT
2.Lidocaine for termination of VT
Which two antiarrythmics are actually proven to be proarrythmic when used long term, though they can prevent ventricular ectopic beats? What is the outcome for this?
Ecainamide and Flecainamide (Class IC). Myocardial ischemia.
Class IA drugs
Quinidine, Procainamide, Dysopyramide
What are the major side effects of Quinidine (Class IA)
Cinchochism (blurred vision, tinnitus, headache, disorientation, psychosis), and lupus like syndrome
What is the major adverse effect of procainamide?
Lupus like syndrome
All Class IA drugs can precipitate arrythmias called
torsades des pointes (long QT interval VT)
Lidocaine (Class IB) mechanism
Shortens phase III repolarization and decreases the duration of the action potential
Uses of lidocaine (class IB)
Lidocaine suppresses arrythmias caused by abnormal automaticity, stops ventricular reenty, and can control secondary arrhytmias caused by drugs like dogixin
Short acting class II drug that is an extrememly short acting B1 selective blocker
Esmolol
Use of esmolol
IV infusion for acute control of HTN or supraventricular arrythmias in a perioperative, postoperative emergency setting
What are the Class III drugs?
Amiodaropne, Ibutilide, Dofetilide, Breatylium, Sotalol
They are potassium channel blockers
True or false, Class III agents are considered interchangeable
FALSE
Rapid conversion of Afib or Aflutter to normal sinus rhythm
Ibutilide (class III)
non pharmacologic rapid conversion of afib or aflutter to normal
AED electrical cardioversion
mechanism of ibutilide
promotes influx of NA thru slow inward NA channels, slowing repolarization and prolonging AP
when do you use sotalol
only in life threatening atrial or ventricular arrythmias
true or false: betapace (sotalol) can be substituted for betapace AF
FALSE
Hypo or hyperthyroidism, pulmonary fibrosis, blue discoloration of skin due to iodine accumulation, photosensitivity
amiodarone adverse effects
what are the uses of amiodarone?
antianginal and antiarrythmic
Amiodarone has drug action in which class of drugs?
I,II,III,IV
Which is more effective in controlling ventricular rate in patients with Afib: Digoxin or Verapamil?
Verapamil
Drugs effective in arrhythmias that transverse the AV node
Verapamil and diltiazem
labeled for chronic stable angina
Bepridil
For acute SVT, life threatening hypotension, Wolff Parkinson White syndrome, and paroxysmal reentrant SVTs
adenosine
this drug is a diagnostic aid
adenosine
not effective in managing aflutter, afib or atrial ectopy
adenosine
mechanism of adenosine
stimulates adenosine sensitive K channgels in SA and AV node, causing outward flow of K from myocyte, inducing sinus bradycardia
difference betweel calcium channel blockers and adenosine
adenosine does not affect the upstroje of action potential of sinus node cells
can cause ectopic ventricular beats and toxing levels that can result in Vtach and Vfib
digoxin
antidote to digoxin
lidocaine