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39 Cards in this Set
- Front
- Back
List the 4 classes of anti-arrhythmics drugs
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I - Na Channel Blockers
II - B- Receptor Blockers III - AP Duration Extenders IV - Ca Channel Blockers |
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What are the three class I-A anti-arrhythmics?
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Quinidine
Procainamide Disomyramide |
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What are the primary indications of Quinidine?
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A-fib, A-flutter
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What is the MOA of the class I-A anti-arrhythmic?
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Use dependent Na channel blocker, it slows phase 0 and depresses phase 4. Overall, it increases AP duration and refractory period length
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What are the adverse effects of Quinidine?
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Alpha block (vasodilation)
Muscarinic Block (tachycardia) Can elicit V-fib or EAD's |
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What is the primary indication for Procainamide?
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Used as a backup to lidocaine in treatment of ventricular arrhythmias
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Rank the class I-A drugs in order of muscarinic effect from weakest to strongest.
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Procainamide, Quinidine, Disopyramide
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What is the indication of Disopyramide?
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Treatment of ventricular arrhythmias (backup to the other I-A's)
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Procainamide can be considered a class III in some ways. Why?
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Its NAPA metabolite acts to slow AP duration much like class III drugs.
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What are the side effects of Procainamide?
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Lupus-like symptoms
EAD's |
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What are the side effects of Disopyramide?
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Negative ionotropic effects
Atropine-like effects (urinary retention, dry mouth, constipation) EAD |
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What class of anti-arrhythmic is Lidocaine?
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I-B
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What is the indication of Lidocaine?
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Ventricular arrhythmia after MI. Not good for atrial issues
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What is the MOA of Lidocaine. Be sure to describe it's state affinity.
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It blocks Na channels. Particularly, it blocks inactivated channels in a use-dependent manner.
By doing so, it can extend the refractory period. |
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What are the side effects of Lidocaine?
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Primarily neurological (parastesia, tremors, convulsions)
It is the least cardiotoxic anti-arrhythmic |
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Name the class I-C anti-arrhythmic.
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Flecainide
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What is the indication of Flecainide
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Ventricular arrhythmias (second line) PVT's SVT's
NOT post MI |
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What is the MOA of Flecainide? Be sure to describe it's state affinity.
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Blocking BOTH Na and K channels. It prefers resting states (even in tissue).
It prolongs the refractory period and slows conduction. |
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List three class I-B anti-arrhythmics.
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Lidocaine
Mexiletine Tocainide |
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List three class I-C anti-arrhythmics
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Flecainide
Propafenone Moricizine |
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List 4 class II anti-arrhythmics.
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Propanolol
Metoprolol Esmolol Atenolol |
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What are the indications of Propanolol?
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Exercise induced arrhythmias, Prolonged Q-T syndrome, post MI protection
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What are electrical effects of Propanolol on the heart?
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Extend phase 4 (automaticity)
Slow sinus rate Increase AV conduction Increase refractoryness |
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What are the side effects of Propanolol?
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Bradycardia
Bronchospasm Increased LDL/HDL |
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List 4 Class III Anti-Arrhythmics.
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Amiodarone
di-Sotalol Ibutilide Bretyllium |
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What are the indications of Amiodarone?
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Refractory SVT, v-Tach, A-fib, a tach
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What is the MOA of Amiodarone?
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Blocking Na channels, B-receptors, and weakly Ca channels.
It prolongs AP duration, refractoriness, and delays conduction |
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What are the side effects of Amiodarone.
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Pulmonary Fibrosis
Thyroid Dysfunction Weakness Photo sensitivity It and it's metabolites are highly lipophilic. Note: It's cousin Dronedarone is newer and has reduced side effects |
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What are the indications of di-Sotalol?
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SVT and Ventricular Arrythmias
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What is the MOA of di-Sotalol
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At low concentrations: B-Blocker
At high concentrations: B-Blocker and Anti-Arrhythmic. It slows depolarization, increases refractoriness, and increases AP duration. |
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What are the adverse effects of di-Sotalol?
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B-Blockade (Bradycardia, Bronchospasm, increased LDL)
EAD's (anything that prolongs AP's can cause EAD's) |
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List two class IV anti-arrhythmics used in treating arrhythmias.
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Diltiazem
Verapamil |
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What are the indications for Ca-channel Blockers in arrhythmias?
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Superventricular tachycardia, A-fib, A-flutter
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What are the side effects of Ca-channel blockers when used to treat arrhythmias?
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Negative ionotropic effects
Do not give with B-blockade (double whammy) |
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What is the treatment for DAD's caused by Digitalis toxicity?
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Magnesium
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What drug is used to cardiovert?
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Adenosine
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What is the MOA of Adenosine?
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Increases K conductance, inhibit Ca currents. Blocks AV node
Primarily atrial effects (doesn't work well for ventricular cardioversion) |
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What is the indication of Digitalis in treating arrhythmias?
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Atrial stuff (fib and flutter)
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What is the MOA of Digitalis
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Increases AV node refractoriness and AV node conduction (blocks Na/K transporter) This manages to slow transmission or SVT rates
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