Arrhythmia drugs

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Author:
xinchen3
ID:
196402
Filename:
Arrhythmia drugs
Updated:
2013-01-29 21:55:44
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Arrhythmia drugs
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Arrhythmia drugs
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  1. Treatment for bradycardia?
    • Atropine
    • Isoproterenol (beta agonist)
  2. Class I anti-arrhythmic drug - MoA
    • Na channel blockers
    • prolong effective refractory period
    • greatest effect on fast heart rate
  3. Class II anti-arrhythmic drug - MoA
    • Beta-blockers
    • decrease AV conductance 
    • prolong phase 4 depolarization
  4. Class III anti-arrhythmic drug - MoA
    • K channel blockers
    • prolong QT interval (can lead to torsade de points)
  5. Class IV anti-arrhythmic drug - MoA
    • Calcium Channel Blockers
    • block AV conduction
  6. Class Ia - MoA
    • block OPEN Na & K channels
    • prolong QRS & QT
    • prolong AP duration
  7. Class Ib - MoA
    • block INACTIVATED Na channels
    • little effect on QRS
    • shortens AP duration
  8. Class Ic - MoA
    • block OPEN Na channels
    • prolong QRS
    • No Change on AP duration
  9. What does blocking of Na channel does on the EKG?
    prolong QRS interval
  10. What does blocking of K channel does on the EKG?
    prolong QT interval
  11. What can prolong QT interval do?
    cause Torsades de Pointes
  12. Quinidine - MoA
    • Class Ia anti-arrhythmic
    • alpha-blocking action
    • anti-muscarinic (leads to decrease AV node refractory period => ventricular tachycardia)
    • give AV blocker when using this drug
  13. Quinidine - Use
    • Supraventricular tachycardia
    • ventricular tachycardia (w/ AV blocker)
  14. Quinidine - Adverse Effects
    • GI irritant
    • Cinchonism (ringing in ear)
    • CYP450-2D6 inhibitor => increase warfarin
    • increase digoxin conc.
    • torsades de pointes
  15. Procainamide - MoA
    • Class Ia
    • converts to NAPA => prolong AP, does not block Na channels
  16. Procainamide - Use
    Ventricular tachycardia
  17. Procainamide - Adverse Effect
    • SLE like symptoms
    • NAPA => torsade de pointes in renal failure
  18. Lidocaine - MoA
    • Class Ib
    • IV only
  19. Lidocaine - Use
    • Ventricular arrhythmia
    • Digoxin induced arrhythmia
  20. Lidocaine - Adverse Effect
    • Neurologic toxicity
    • (drowsy, confuse, nystagmus)
  21. Flecainide - MoA
    Class Ic
  22. Flecainide - use
    • Life threatening V. fib
    • Refractory or symptomatic Supraventricular arrhythmia
    • severe arrhythmias 
  23. Flecainide - Adverse Effect
    • negative inotropic effect
    • pro-arrhythmogenic (esp. in MI)
  24. Class II - Beta Blockers - MoA
    • prolong AV conduction
    • diminish phase 4 depolarization
  25. Class II - Use
    • prevent re-infarction & sudden death after MI or CHF
    • control ventricular rate
  26. Amiodarone - MoA
    • Class III - K blocker
    • block K & INACTIVATED Na channel
    • inhibits Ca channels
    • contains Iodine (thyroid)
  27. Amiodarone - Use
    Ventricular & Atrial Arrhythmia
  28. Amiodarone - Adverse effects
    • Pulmonary fibrosis (irreversible)
    • skin pigmentation
    • hypothyroid (iodine)
    • inhibits CYP450 => inc. digoxin
    • hepatotoxicity, corneal opacity
  29. Sotalol
    • Class III
    • arrhythmias
  30. Dofetilide
    • Class III
    • Atrial fib & flutter
  31. Ibutilide
    • Class III
    • Atrial fib & flutter
  32. Verapamil
    Dilitiazem
    • class IV - CCB
    • Use: PSVT treatment, controls ventricular rate & A. fib
    • AE: decrease contractility of heart
  33. Adenosine - MoA
    • Activate K channels in AV node
    • short acting (~10s), AV blocking drug that resets the heart rhythm
  34. Adenosine - Use
    drug of choice for PSVT
  35. Adenosine - Adverse Effect
    Bronchospasm (but short acting)

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