Ipapburke Pharm Test 2- Antiarrhythmic Agents

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A DISTURBANCE OF RATE OR RHYTHM THAT LEADS TO ABNORMAL CONTRACTION, OR IN WORST CASE, CARDIAC STANDSTILL

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CARDIAC ARRHYTHMIAS

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WHAT IS THE PURPOSE OF MEDICATIONS USED TO TREAT ARRHYTHMIAS?

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TO RESTORE CARDIAC RHYTHMS

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ALL MEDICATIONS THAT ARE USED TO TREAT ARRHYTHMIAS MAY ALSO PRECIPITATE LETHAL ARRHYTHMIAS. TRUE OR FALSE

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TRUE

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PHASE 0 OF AP

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RAPID DEPOLARIZATION DUE TO INFLUX OF SODIUM IONS

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RAPID DEPOLARIZATION DUE TO INFLUX OF SODIUM IONS

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PHASE 0 OF AP

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PHASE 1 OF AP

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EARLY RAPID REPOLARIZATION DUE TO POTASSIUM MOVING OUTOF CELL

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EARLY RAPID REPOLARIZATION DUETO POTASSIUM MOVING OUT OF THE CELL

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PHASE 1 OF AP

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PHASE 2 OF AP

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PLATEAU PHASE MAINLY DUE TO THE INWARD MOVEMENT OF CALCIUM IONS

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PLATEAU PHASE MAINLY DUE TO THE INWARD MOVEMENT OF CALCIUM IONS

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PHASE 2 OF AP

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REPOLARIZATION- POTASSIUM IONS ARE MOVED OUT OF CELL

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PHASE 3 OF AP

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PHASE 3 OF AP

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REPOLARIZATION- POTASSIUM IONS ARE MOVED OUT OF CELL

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PHASE 4 OF AP

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POTASSIUM FLOWS OUT AND SODIUM SEEPS INTO THE CELL

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POTASSIUM FLOWS OUT AND SODIUM SEEPS INTO THE CELL

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PHASE 4 OF AP

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ARRHYTHMIAS ARISE FROM WHAT (2)?

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ABNORMAL AUTOMATICITY (IMPULSE FORMATION) OR ABNORMAL IMPULSE CONDUCTION

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MOST COMMON SYSTEM OF ANTIARRHYTHMIC CLASSIFICATION

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VAUGH-WILLIAMS CLASSIFICATION SYSTEM

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CLASS I AGENTS- HOW DO THEY WORK?

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WORK BY BLOCKING THE VOLTAGE SENSITIVE SODIUM CHANNELS

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CLASS IA ANTI-A INCLUDE

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QUINIDINE, PROCAINAMIDE, DISOPYRAMIDE

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ACTION OF QUINIDINE (QUINAGLUTE)

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INHIBIT ECTOPIC ARRHYTHMIAS AND VENTRICULAR ARRHYTHMIAS CAUSED BY INCREASED AUTOMATICITY AND PREVENTS REENTRY ARRHYTHMIAS

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INDICATIONS FOR QUINIDINE

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ATRIAL, AV JUNCTIONAL AND VENTRICULAR TACHYCARDIAS

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ADVERSE EFFECTS OF QUINIDINE

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HIGH DOSES CAN CAUSE ARRHYTHMIAS AND V FIB- FATAL; CINCHONISM- BLURRED VISION, TINNITUS, HEADACHE, DISORIENTATION, PSYCHOSIS

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DRUG INTERACTIONS WITH QUINIDINE

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INCREASES DIGOXIN CONCENTRATION AND INCREASES THE ANTICOAGULATION EFFECT OF COUMADIN

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WHAT IS THE INDICATION FOR PROCAINIMIDE?

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USED TO TREAT SUSTAINED VENTRICULAR TACHYCARDIA IF LIDOCAINE FAILS

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ADVERSE EFFECT OF PROCAINIMIDE?

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PRODUCES A REVERSIBLE LUPUS ERYTHEMATOUS LIKE SYNDROME (JOINT PAIN OR INFLAMMATION) IN 30% OF PATIENTS WHO USE IT LONG TERM

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MOST COMMON CLASS IB AGENT AND IT'S USE

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LIDOCAINE; DECREASED THE DURATION OF THE ACTION POTENTIAL BY SHORTENING PHASE 3 REPLOARIZATION; WAS USED TO TREAT V FIB/ PULSELESS V TACH BUT HAS BEEN REPLACE BY AMIODARONE

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ACTION OF CLASS IC DRUGS

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MARKEDLY DEPRESS THE RATE OF RISE OF THE MEMBRANE ACTION POTENTIAL WHICH SLOWS CONDUCTION WITH LITTLE EFFECT ON DURATION

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INDICATION FOR FLECAINADE (TAMBOCOR)- CLASS IC

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PREVENTION OF ATRIAL FIB AND FLUTTER AND LIFE THREATENING V TACH

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INDICATION FOR PROPAFENONE (RYTHMOL)- A CLASS IC AGENT WITH BETA BLOCKING PROPERTIES

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INDICATED FOR LIFE THREATENING VENTRICULAR ARRHYTHMIAS SUCH AS V TACH

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ACTION OF CLASS II- BETA BLOCKERS

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DIMINISH PHASE 4 DEPOLARIZATION- DEPRESS AUTOMATICITY, PROLONG AV CONDUCTION, DECREASE HR, AND DECREASE CONTRACTILITY

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INDICATIONS FOR CLASS II BETA BLOCKERS

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TACHYARRHYTHMIAS, ATRIAL FLUTTER, AND ATRIAL FIB CAUSED BY INCREASED SYMPATHETIC ACTIVITY

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DRUG OF CHOICE FOR A FIB AND A FLUTTER

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BETA BLOCKERS

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IN ADDITION TO A BETA BLOCKERS, ATRIAL FIB PATIENTS SHOULD ALSO BE STARTED ON WHAT DRUG?

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ANTICOAGULANT TO PREVENT CLOT FORMATION (COUMADIN)

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WHY ARE POST MI PATIENTS STARTED ON A BETA BLOCKER UNLESS CONTRAINDICATED?

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TO SUPPRESS PREMATURE VENTRICULAR CONTRACTIONS

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WHAT DRUG SHOULD BE USED TO ACUTELY CONTROL VENTRICULAR RESPONSE IN HF INSTEAD OF BETA BLOCKERS>

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DILTIAZEM

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THIS BETA BLOCKER HAS BEEN PROVEN TO REDUCE THE INCIDENCE OF SUDDEN ARRHYTHMIC DEATH AFTER MI

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PROPRANOLOL (INDERAL) - NONSELECTIVE IV AND ORAL FORMS

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USE OF ESMOLOL (BREVIBLOC)

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B1 SELECTIVE AGENT WITH A VERY SHORT HALF LIFE; USED INTRAOPERATIVE AND IN OTHER ACUTE ARRHYTHMIAS REQUIRING A BETA BLOCKER

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B1 SELECTIVE BLOCKERS

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METOPROLOL (LOPRESSOR) AND ATENOLOL (TENORMIN)

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CLASS III DRUGS DO WHAT?

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BLOCK K CHANNELS; PROLONG DURATION OF AP WITHOUT ALTERING PHASE 0 DEPOLARIZATION

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BRETYLIUM, AMIODARONE, SOTALOL, IBUTILIDE, DEOFETILIDE- WHAT CLASS OF ANTI-ARRHYTHMICS?

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CLASS III

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MAIN ACTION OF AMIODARONE?

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PROLONGATION OF THE ACTION POTENTIAL AND REFRACTORY PERIOD. HAS BOTH ANTIANGINAL AND ANTIARRHYTHMIC ACTIVITY

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CONSIDERED ANTI-ARRHYTHMIC OF CHOICE IN SVT/V FIB AND IN PATIENTS WITH HF

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AMIODARONE (CORDARONE)

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SIDE EFFECTS OF AMIODARONE

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PULMONARY FIBROSIS, LIVER TOXICITY, HYPO/HYPERTHYROIDISM; BLU GRAYSKIN DISCOLORATION AFTER SUN EXPOSURE

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ACTION OF SOTALOL (BETAPACE AND BETAPACE AF)

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CLASS III ANTIARRHYTHMIC WITH POTENT NON SELECTIVE BETA BLOCKER ACTIVITY

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INDICATIONS FOR SOTALOL

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V TACH AND SUPRAVENTRICULAR ARRHYTHMIAS

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ADVERSE EFFECTS OF SOTALOL

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SAME AS BETA BLOCKERS- CAUSE FATIGUE, BRADYCARDIA, HYPOTENSION; WILL PRODUCE TORSADE DE POINTS IN SOME BECAUSE OF PROLONGED QT INTERVAL (MUST DO BASELINE QT INTERVAL BEFORE STARTING)

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THIS DRUG IS A CLASS III AGENT GIVEN VIA IV THAT IS USED TO TERMINATE ATRIAL FIBRILLATION/FLUTTER BY BLOCKING K CHANNELS AND ENHANCING THE SLOW NA CHANNELS

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IBUTILIDE (CORVERT)

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WHAT ARE CLASS IV CCB'S?

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CCB'S THAT DECREASE THE RATE OF PHASE 4 DEPOLARIZATION AND SLOW CONDUCTION IN CA DEPENDENT CURRENTS (AV NODE)

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TWO CLASS IV CCB'S

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VERAPAMIL AND DILTIAZEM

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INDICATION FOR CLASS IV CCB'S

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MORE EFFECTIVE AGAINST ATRIAL THAN VENTRICULAR ARRHYTHMIAS; MORE EFFECTIVE AGAINST SUPRAVENTRICULAR TACHYCARDIA

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WHY DO YOU AVOID CLASS IV CCB'S IN PATIENTS WITH DEPRESSED CARDIAC FUNCTION?

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THESE DRUGS HAVE NEGATIVE INOTROPIC PROPERTIES

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WHAT IS THE USE FOR DIGOXIN?

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USED TO CONTROL VENTRICULAR RESPONSE RATE IN ATRIAL FIBRILLATION

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WHAT IS THE ACTION OF DIGOXIN?

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ENHANCES VAGAL TONE AND CAUSES DIRECT AV BLOCK SLOWING RATE AND CONDUCTION

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DIGOXIN WILL INTERACT WITH THESE DRUGS TO INCREASE DIGOXIN CONCENTRATION

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VERAPAMIL, QUINIDINE, PROPAFENINE, FLECAINIDE, AND AMIODARONE

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MOA OF ADENOSINE (ADENOCARD)

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DECREASES CONDUCTION VELOCITY, PROLONGS THE REFRACTORY PERIOD, AND PRODUCES AUTOMATICITY IN THE AV NODE

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WHAT IS THE DOC FOR ACUTE SUPRAVENTRICULAR TACHYCARDIA?

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ADENOSINE (ADENOCARD)

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DRUG INTERACTION OF ADENOSINE

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PATIENTS TAKING THEOPHYLLINE MAY NOT RESPOND BECAUSE THEOPHYLLINE IS AN ADENOSINE RECEPTOR BLOCKER

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THIS DRUG IS USED TO TREAT BRADYCARDIA---BLOCKS EFFECT OF VAGUS NERVE IN THE HEART AND WILL INCREASE SINUS RATE AND AV CONDUCTION

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ATROPINE

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DRUG OF CHOICE FOR TREATMENT OF TORSADES AND HYPOMAGNESEMIC STATES

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MAGNESIUM SULFATE

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GOAL OF TREATMENT OF ATRIAL FIBRILLATION

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RELIEVE SYMPTOMS; SLOW VENTRICULAR RATE; RESTORE NORMAL SINUS RHYTHM AND PREVENT RECURRENCE; REDUCE THE RISK OF STROKE

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WHAT TWO DRUGS ARE USED TO REDUCE THE RISK OF STROKE IN A FIB PATIENTS?

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ASPIRIN AND WARFARIN OR COUMADIN

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IN PATIENTS WITH SYSTOLIC HEART FAILURE, WHAT ANTI-ARRHYTHMIC IS USED?

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DIGOXIN

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RHYTHM DRUGS HAVE LESS RISKS THAN RATE DRUGS. T OR F

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FALSE ---RHYTHM DRUGS HAVE MORE RISKS THAN RATE DRUGS.

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BEFORE CONVERTING A PATIENT WITH A FIB, WHAT MUST BE ENSURED?

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ABSENCE OF ATRIAL THROMBI MUST BE ENSURED (TEE OR 3 PLUS WEEKS OF ANTICOAGULATION)

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CLASS I AGENTS ARE CONTRAINDICATED IN PATIENTS WITH A FIB AND THIS CONDITION

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HEART FAILURE

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THE BEST TOLERATED CLASS I AGENT FOR CONVERTING A FIB

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PROPAFENONE

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WHAT ARE THE PRO'S TO USING CLASS III AMIODARONE FOR CONVERSION OF A FIB?

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ORAL INITIATION CAN BE INITIATED AS AN OUTPATIENT AND IT IS EFFECTIVE IN HF

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WHAT ARE THE CONS TO USING CLASS III AMIODARONE FOR CONVERSION OF A FIB?

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NUMEROUS DRUG TO DRUG INTERACTION; EXTENSIVE MONITORING FOR NON CARDIAC SE'S

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THIS CLASS III DRUG FOR CONVERTING AF IB MUST BE INITIATED IN THE HOSPITAL AND IS SAFE IN PATIENTS WITH HF

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DOFETILIDE

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WHAT IS THE NORMAL CAUSE FOR PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA?

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USUALLY DUE TO AV NODAL REENTRY; MAY FOLLOW AN MI

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DRUG OF CHOICE FOR PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA?

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ADENOSINE

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SECOND CHOICE FOR TREATMENT OF PSVT FOLLOWING ADENOSINE?

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VERAPAMIL AND DILTIAZEM (NON-DHP CCB'S)

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FOR UNSTABLE SUSTAINED V TACH, WHAT IS THE TREATMENT?

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SYNCHRONOUS CARDIOVERSION

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ACLS ALGORITHM FOR SUSTAINED V TACH

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AMIODARONE, LIDOCAINE, MAGNESIUM, PROCAINIMIDE (IN THAT ORDER)

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A RAPID UNDULATION VT THAT CAN DEGENERATE INTO VF; USUALLY CAUSED BY PROLONGATION OF THE Q-T INTERVAL

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TORSADES DE POINTES

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THE RISK LEVEL OF MOST QT PROLONGING DRUGS INCREASES WITH _______.

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DOSE

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TREATMENT OF TORSADES?

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MAGNESIUM- SECOND CHOICE IS CLASS IB AGENTS- LIDOCAINE, TOCAINIDE, OR MEXILETINE2

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CLASS I ANTI-A WITH INTERMEDIATE POTENCY BLOCKADE; SLOWS CONDUCTION BY SLOWING PHASE 0 DEPOLARIZATION

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CLASS 1A

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LEAST POTENT OF CLASS 1 ANTI-A; SHORTENS PHASE 3 REPOLARIZATION

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CLASS 1B

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MOST POTENT BLOCKADE AMONG CLASS 1 ANTI-A DRUGS; MARKEDLY SLOWS PHASE 0 DEPOLARIATION

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CLASS 1C

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CLASS I AGENTS ALL BLOCK WHAT CHANNELS

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SODIUM CHANNELS

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"PDQ"- THREE CLASS 1A DRUGS THAT HAVE MODERATE BLOCKADE EFFECT ON SODIUM CHANNELS

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PROCAINAMIDE, DISOPYRAMIDE, QUINIDINE

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HIGH DOSES OF THIS CLASS 1A DRUG CAUSE ARRHYTHMIAS AND V FIB WHICH CAN BE FATAL

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QUINIDINE

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CORRELATE CINCHONISM WITH THIS DRUG

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QUINIDINE (CLASS 1A)

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QT PROLONGATION IS POSSIBLE WITH ALL AGENTS IN THIS CLASS OF ANTI-ARR. DRUGS

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CLASS 1A

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THIS DRUG INCREASES CONCENTRATION OF DIGOXIN AND INCREASES THE ANTICOAG EFFECT OF COUMADIN USED FOR A FIB

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QUINIDINE (CLASS 1A)

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CLASS 1A DRUGS WORK ON WHAT PART OF THE HEART

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ATRIA AND VENTRICLE

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CLASS 1B DRUGS WORK ON WHAT PART OF THE HEART

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VENTRICLE

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CLASS 1C DRUGS WORK ON WHAT PART OF THE HEART

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ATRIA

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MOST COMMON ROUTE FOR PROCANIMINE

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ORAL; IV ROUTE IS NOT USUALLY USED BECAUSE LEADS TO HYPOTENSION IF GIVEN QUICKLY

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PROCAINIMIDE IS USED TO TREAT WHAT ARRHYTHMIA

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VENTRICULAR TACHYCARDIA WHEN LIDOCAINE FAILS

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CORRELATE THIS CLASS 1A DRUG WITH REVERSIBLE LUPUS ERYTHEMATOUS LIKE SYNDROME

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PROCAINIMIDE

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CLASS 1B AGENTS ARE NOT USED FOR SVT'S BECAUSE?

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THEY DO NOT AFFECT THE SINUS NODE; THEREFORE ARE USED FOR V TACH

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HOW DOES LIDOCAINE DECREASE THE DURATION OF THE ACTION POTENTIAL?

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DECREASES THE DURATION OF THE ACTION POTENTIAL BY SHORTENING PHASE 3 REPOLARIZATION (CLASS 1B)

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SPECIFIC CLASS 1B AGENT

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LIDOCAINE

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SIDE EFFECT OF LIDOCAINE IN HIGHER DOSES

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CONVULSIONS (IT HAS CNS SIDE EFFECTS BECAUSE IT IS LIPOPHILIC)

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THIS CLASS OF DRUGS MARKEDLY SLOW DEPOLARIZATION, BUT HAS LITTLE EFFECT ON DURATION

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CLASS 1C

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FLECAINIDE IS USED FOR ARRHYTHMIAS OF WHAT TYPE?

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ABOVE THE VENTRICLE (A FIB AND A FLUTTER)

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PROPAFENONE IS A CLASS 1C DRUG USED TO TREAT WHAT?

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LIFE THREATENING V TACH

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WHAT EFFECT DO PROPAFENONE AND FLECAINIDE HAVE ON MEMBRANE ACTION POTENTIAL?

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SLOW CONDUCTION DURING DEPOLARIZATION MARKEDLY, BUT HAVE LITTLE EFFECT ON ACTION POTENTIAL DURATION

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BETA BLOCKERS ARE THE DRUG OF CHOICE IN WHAT CONDITIONS

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A FIB AND A FLUTTER (PAIRED WITH COUMADIN TO PREVENT CLOT FORMATION)

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WHAT DRUGS ARE POST MI PATIENTS PLACED ON (UNLESS CONTRAINDICATED) TO PREVENT PVC'S?

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BETA BLOCKERS

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A BETA 1 BLOCKER WITH ISA USED FOR ARRYHTHMIAS MAY CAUSE WHAT?

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BRADYCARDIA

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FOUR BETA BLOCKERS (CLASS II) USED AS ANTIARRHYTHMICS

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PROPANOLOL, METOPROPOL, ATENOLOL, AND ESMOLOL

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B1 SELECTIVE AGENTS USED AS CLASS II DRUGS IN ARRHYTHMIAS?

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METOPROPOL AND ATENOLOL

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THIS CLASS OF ANTI-ARR. DRUGS BLOCKS POTASSIUM CHANNELS

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CLASS III

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THE ANTI-ARR OF CHOICE IN PATIENTS WITH PVT/V FIB AND IN PATIENTS WITH HF (CLASS III)

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AMIODARONE

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BECAUSE THE HALF LIFE OF AMIODARONE IS VERY LONG AND IT TAKES UP TO 6 WEEKS TO GET A CLINICAL EFFECT, WHAT DO WE DO?

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LOADING DOSES

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AMIODORONE CAN BE USED IN WHAT TYPE OF ARRHYTHMIAS?

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WIDESPREAD UTILITY IN SVT'S AND VENTRICULAR ARRHYTHMIAS

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YOU MUST DECREASE THE LEVELS OF WHAT TWO DRUGS IN PATIENTS TAKING AMIODORONE (CLASS III ANTI-ARR DRUG)

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COUMADIN AND DIGOXIN

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SOTALOL IS WHAT CLASS OF DRUG?

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CLASS III ANTI-ARR

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THIS IS A CLASS III ANTI-ARR WITH POTENT NON SELECTIVE BB PROPERTIES

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SOTALOL

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WHAT IS THE DIFFERENCE BETWEEN BETASPACE AND BETASPACE AF?

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BOTH ARE CLASS III ANTI-ARR WITH BETA BLOCKER PROPERTIES (SOTALOL)- FIRST BETASPACE APPROVED FOR VENTRICULAR ARR. AND THEN AF WAS APROVED FOR A FIB AND FLUTTER; SAME DRUG WITH 2 DIFFERENT NAMES

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USE THIS CLASS III DRUG FOR MEDICAL CARDIOVERSION IN EARLY ONSET OF A FIB/ FLUTTER

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IBUTILIDE (CORVERT)

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WHAT CHANNELS DOES IBUTILIDE BLOCK?

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BLOCKS K CHANNELS BECAUSE IT IS A CLASS III ANTI-ARR

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CCB'S (CLASS IV) WORK ON WHAT TYPE OF ARRHYTHMIAS (ATRIAL OR VENTRICULAR)?

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ATRIAL

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CLASS IV CCB USED AS ANTI-ARRHYTHMICS

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NON-DHP CCB- VERAPIIL AND DILTIAZEM (THEY BLOCK CA INFLUX AND HAVE A NEGATIVE INOTROPIC EFFECT)

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ADVERSE EFFECTS OF USING VERAPAMIL AND DILTIAZEM IN SVT'S?

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NEGATIVE IOTROPIC DRUG SO MAY CAUSE BRADYCARDIA IN PATIENTS WITH DEPRESSED CARDIAC FUNCTION; ALSO CAUSE HYPOTENSION WHEN GIVEN BY IV SO MAY HAVE TO GIVE CALCIUM FIRST TO HYPOTENSIVE SENSITIVE PATIENTS

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CCB'S USED FOR SVT'S

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VERAPAMIL AND DILTIAZEM

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THIS DRUG REPLACED CCB'S AS DOC FOR SUPRAVENTRICULAR TACHYCARDIA

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ADENOSINE

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ADENOSINE IS THE DRUG OF CHOICE FOR WHAT?

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SVT

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WHAT ANTI-ARR DRUGS WILL CAUSE AN INCREASE IN DIGOXIN CONCENTRATION?

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VERAPAMIL (CLASS IV CCB), QUINIDINE (CLASS 1A- MODERATE NA CHANNEL BLOCKER), PROPAFENONE (CLASS IC- MARKED NA CHANNEL BLOCKER), FLECAINIDE (CLASS 1C), AMIODARONE (CLASS III-BLOCK K CHANNELS)

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DRUG USED TO TREAT BRADYCARDIA BY BLOCKING EFFECT OF THE VAGUS NERVE (PARASYMPATHETIC N.S.) AND INCREASING SINUS RATE AND AV CONDUCTION

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ATROPINE

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DRUG OF CHOICE FOR TORSADES AND HYPOMAGNESEMIC STATE

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MAGNESIUM SULFATE

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DRUGS ARE GIVEN TO A FIB PATIENTS WITH WHAT GOAL?

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TO BRING THE HR RATE TO GOAL (60-80 AT REST AND 90-115 WITH EXERCISE) AND TO REDUCE THE RISK OF STROKE

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DRUGS GIVEN TO A FIB PATIENTS TO SLOW HR

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BETA BLOCKERS (DOC)- METOPROLOL, ESMOLOL, AND PROPANOLOL; CCB- VERAPAMIL AND DILTIAZEM; DIGOXIN- INOTROPIC USED WHEN PT HAS HF

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DRUGS GIVEN TO A FIB PATIENT TO PREVENT CLOTS

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COUMADIN; ASPIRIN

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CLASS I DRUGS HAVE A HIGH RISK OF WHAT?

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THEY ARE RHYTHM DRUGS SO THEY HAVE A HIGHER LIKELIHOOD TO CAUSE INDUCED ARRHYTHMIAS

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BEST TOLERATED CLASS I DRUG FOR CHEMICAL CARDIOVERSION

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PROPAFENONE

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FLECAINIDE IS A CLASS I DRUG USED FOR CHEMICAL CARDIOVERSION THAT IS CONTRAINDICATED IN WHAT PATIENTS/

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PATIENTS WITH HEART DISEASE

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THIS DRUG HAS THE GREATEST EFFICACY OF DRUGS IN CLASS I OR III FOR CHEMICAL CARDIOVERSION

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AMIODARONE (70%)- BE AWARE OFSIDE EFFECTS AND DRUG TO DRUG INTERACTIONS (INCREASES CONC. OF COUMADIN AND DIGOXIN)

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DRUG OF CHOICE FOR ACUTE CARDIOVERSION

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IBUTILIDE (CLASS III)

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CLASS I AND CLASS III DRUGS ARE RATE OR RHYTHM?

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RHYTHM

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CLASS II AND IV DRUGS ARE RATE OR RHYTHM?

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RATE

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RATE CONTROL CLASSES OF DRUGS?

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CLASS II AND IV

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DRUG OF CHOICE FOR SVT'S

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ADENOSINE; NEXT CHOICE- VERAPAMIL OR DILTIAZEM (CLASS IV CCB'S)

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ACLS ALGORITHM FOR SUSTAINED V TACH

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REMEMBER PALM- PROCAINIMIDE; AMIODORONE; LIDOCAINE; MAGNESIUM

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DECREASED ____________ AND _______________ LEAD TO PROLONGED QT INTERVAL AND ARRHYTHMIAS>

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MAGNESIUM AND POTASSIUM