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Board Review > AntiarrhythmicsFC > Flashcards

AntiarrhythmicsFC Flashcards

1
Q

The most common causes of an arrhythmia are…..

A

coronary heart disease, heart valve disorders, heart failure, and damage from heart attack

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2
Q

QT prolongation is a marker for ventricular tachyarrhythmias, including torsades.

A

good to know

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3
Q

what are 2 factors to consider when looking at drugs that can prolong the QT interval?

A

dose and duration

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4
Q

what are some agents that have additive QT prolongation?

A

Class 1a and Class III antiarrhythmics (amiodarone, disopyramide, dronaderone, pocainamide, quinidine, sotalol)
abx - FQNs, macrolides,
azole antifungals
anticancer agents
protease inhibitors
SSRIs / SNRIs
antiemetics - ondansetron, droperidol
antipyschotics

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5
Q

Rate control vs rhythm control?

A

studies show that ventricular RATE control is as effective as rhytum control with cardioversion and antiarrhytimic drugs

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6
Q

What drugs are used for rate control in pts with afib?

A

BB, non DHP CCBs (V&D) and digoxin

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7
Q

What are the Class 1 antiarrhythmics?

A

1a - Double Quarter Pounder = Disopyramide, Quinidine, Procainamide
2a - Mayo Lettuce - Mexiletine, Lidocaine
3a - Fries Please - Flecainide , Popafenone

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8
Q

what are the Class II antiarrhythmics?

A

BB - esmolol, propranolol

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9
Q

What are the class III antiarrhythmics?

A

amiodarone, Dofetilide, dronaderone, Ibutilide, sotalol

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10
Q

What are the class IV antiarrhythmics?

A

Verapamil, Diltiazem

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11
Q

What is the MOA of the Class IAs?

A

block Na channels, decrease conduction velocity, increase refractory period, decrease automaticity

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12
Q

What dietary considerations should be made when taking quinidine?

A

Avoid changes in Na intake. decreased Na intake can increase quinidine serum conc.
-take with food or milk to dec GI upset

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13
Q

What is the BBW with quinidine?

A

may increase mortality in treatment of Afib/A.flutter

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14
Q

What is the major side effects of quinidine?

A

diarrhea, cramping, cincohnism (tinnitus, eye issues etc), N, V

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15
Q

What 2 Class 1A’s must be taken on an empty stomach?

A

procaiamide and disopyramide

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16
Q

what are the BBW’s on procainamide?

A

fatal blood dyscrasias,
positive ANA test leading to drug induced lupus like syndrome

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17
Q

what is the name of the active metabolite of procainamide ?

A

METABOLIZED by acetylation to N-acetylprocainamide (NAPA), which makes it active!! KNOW

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18
Q

SE procainamide

A

hypotension, n, V, D, Lupus like syndrome, qt prolongation, and agranulocytosis

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19
Q

What major side effects of disopyramide?

A

anticholinergic effects (can’t see ,spit, pee, poop)

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20
Q

Quinidine is a major substrate of what CYP?

A

3A4

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21
Q

What is the MOA of class IB antiarrythmics?

A

block Na channels, decrease refractory period, decrease automaticity

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22
Q

what is the use of class 1 b antiarrythmics

A

only used for ventricular arrhythmiaxs

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23
Q

Lidocaine is a substrate of what 2 CYP ?

A

3A4 and 2D6

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24
Q

What is the MOA of Class IC antiarrythmics?

A

block Na channels, significantly decrease conduction velocity, decrease automaticity
Not used much

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25
Q

What are the Class II antiarrythmics?

A

esmolol (Brevibloc) / propranolol (Inderal)

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26
Q

What is the MOA of the Class III antiarrythmics?

A

blocks mainly K channels, no change on conduction velocity, significant increase in refractory period

27
Q

what are the class 2 antiarrhytmics?

A

esmolol and propranolol

28
Q

what is the difference between esomolon and propranolol?

A

esmolol is beta 1 selective (just affects the heart) and propranolol is beta non selective

29
Q

what is the use of class 2 antiarrhythmics?

A

the use is for ventricular arrhythimias

30
Q

What are they?

A

amiodarone (cordorone)
Dronaderone (Multaq)
sotalol (Betapace)
ibutilide (Corvert)
dofetilide (Tikosyn)

31
Q

pacerone

A

amiodarone

32
Q

nexterone

A

amiodarone

33
Q

cordorone

A

amiodarone

34
Q

multaq

A

dronaderone

35
Q

betapace

A

sotalol

36
Q

corvert

A

ibutilide

37
Q

tikosyn

A

dofetilide

38
Q

Which class III has a REMS?

A

Tikosyn (dofetilide)- initial dose HAS to be given in a hospital and adjusted based on QT and renal function

39
Q

What is unique about administration of IV amiodarone?

A

infusions lasting longer than 2 hours must be administered in non-PVC container

40
Q

What are the 4 BBWs for amiodarone? KNOW

A
  1. pts should be hospitilized when therapy is initiated
  2. lung damage may occur w/out symptoms
  3. liver toxicity
  4. exacerbation of arrhythmias - more difficult to reverse
41
Q

what are some side effects of amiodarone? (theres a lot)

A

hypotension (IV), bradycardia, increase LFTs, corneal microdeposits, optic neuritis, pulmonary fibrosis, photosensitivity, blue skin, insomnia

42
Q

what is important about the dosing /dosage forms of sotalol?

A

Betapace should not be substituted for Betapace AF

43
Q

What is the BBW for sotalol (Betapace)

A

initiation and dosage increase should be done in a hospital

44
Q

What is the BBW for dofetilide?

A

Tikosyn must be initiated or reinitiated in a setting with continuous ECG monitoring for 3 days or 12 hours after cardioversion

45
Q

What medications must have a dose reduction of 30-50% while taking amiodarone?

A

digoxin, warfarin, quinidine, procainamide
also, lower doses of Ator, Lova, Simvastatin

46
Q

DDIs for amiodarone?

A

Amiodarone is an inhibitor of CYP 2C9, 2D6, 3A4 and p-glycoprotein

47
Q

When might CCB’s be preferred over BB’s in pts with arrythmias?

A

if the pt has asthma or COPD

48
Q

What is the therapeutic lab value for digoxin in afib?

A

0.8-2.0

49
Q

What is the dose adjustment from oral to IV digoxin?

A

decrease dose by 20-25% when going from oral to IV

50
Q

what are signs of digoxin toxicity?

A

N/V, loss of appetite, bradycardia
blurred or yellow vision, confusion

51
Q

digoxin can accumulate with _____

A

renal insufficiency

52
Q

What electrolyte imbalances can increase chance of digoxin toxicity?

A

hypokalemia, Hypercalcemia

53
Q

Multaq - generic name and class, indication

A

dronedarone - Class III
only indicated for maintenance of sinus rhythm. CI IN persistant afib

54
Q

What is the normal lab value for K?

A

3.5-5 meq/L

55
Q

Which of the following is not a side effect of amiodarone? skin discoloration, corneal deposits, lung damage, taste perversion, hypothyroidism

A

taste perversion

56
Q

greatest risk of qt prolongation

A

class 1a and class III

57
Q

how is the classification determined for van gough class 1

A

a= INTERMEDIATE
b- SHORT
C. long
NOTICE NOT in right order.

58
Q

dronadarone bbw

A
  1. class IV heart failure
  2. pts w/ permenant AFIB.
59
Q

Adenosine

A

works by ACTIVATING A1 receptors- causes a transiet BLOCK in the AV node.

60
Q

adenosine ADR

A

ADR: headache, flushing, chest pain

61
Q

half life of amiodarone is abt

A

60 days

62
Q

Digoxin- MOA

A

helps to control RATE. digoxin works on AV node conduction. DEcreases resting RATE.

63
Q

amiodarone good for

A

pts w/ structural heart dz, decompensated heart failure. BUT 1c- is BAD CI in these cases and 1a- is meah

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