Therapeutics: Arrhythmia 1

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kyleannkelsey
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267586
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Therapeutics: Arrhythmia 1
Updated:
2014-03-23 14:21:05
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Therapeutics Arrhythmia
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Therapeutics: Arrhythmia 1
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Therapeutics: Arrhythmia 1
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  1. What drugs can cause a Prolonged PR interval (AV block)?
    • BB
    • CCB (Non-DHP Diltiazem and verapamil)
    • Antiarrhythmics = propafenone and flecanide
    • Class III antiarrhthmics
  2. Drugs/conditions that prolong QT:
    • Antiarrhythmics: 1A, 1C, III
    • TCAs
    • Quinolones
    • Phenothiazines
    • Hypocalcemia
    • Long QT syndrome
  3. What anti arrhythmics are most likely to prolong the QT interval and cause torsades?
    1A and III
  4. What anti arrhythmics are most likely to prolong the QT interval and monomorphic ventricular tachycardia?
    1C
  5. What can cause a flattened or inverted T wave?
    Hypocalcemia, Hypokalemia, Digoxin, ischemia
  6. What can cause peaked T wave?
    Hyperkalemia
  7. What is the EKG indication of Atrial fibrillation?
    Non-equidistant RR distance
  8. Vaughn Williams Class I drugs are what type of drugs?
    Na+ channel blockers
  9. What are the Class IA drugs?
    • disopyramide, quinidine, procainamide
    • (Double Quarter Pounder)
  10. What are the Class IB drugs?
    • lidocaine, mexiletine
    • (Lettuce Mayo)
  11. What are the Class IC drugs?
    • flecainide, propafenone
    • ( Fries Please)
  12. Vaughn Williams Class II are what type of drugs?
    b-blockers
  13. Vaughn Williams Class III are what type of drugs?
    K+ channel blockers
  14. What are the specific Vaughn Williams Class III drugs?
    Amiodarone, sotalol, dofetilide, ibutilide, dronedarone
  15. Vaughn Williams Class IV are what type of drugs?
    CCBs
  16. Vaughn Williams Class V are what type of drugs?
    Adenosine, digoxin
  17. Which Vaughn Williams Class can treat both Ventricular and atrial arrhythmias?
    • IA
    • Disopyramide, quinidine, procainamide
  18. Lidocaine is a first or second line therapy?
    2nd line, would use amiodarone first
  19. What Vaughn Williams Class would be used to only treat ventricular arrhythmias?
    Class IB
  20. What is Mexiletine used for?
    Refractory arrhythmia
  21. What are 1C antiarrhythmics Na used for?
    • Atrial arrhythmia
    • Afib
    • in patients W/O underlying heart disease
  22. What group of patients are flecanide and propafenone (1C) contraindicated in?
    Structural heart disease or HF
  23. What Vaughn Williams Class II drugs used for (BBs)?
    Rate control, usually in atrial fibrillation
  24. What Vaughn Williams Class III drugs, amiodarone and sotolol are used for what purposes?
    Atrial or ventricular arrhythmias
  25. Dofetilide, ibutilide, dronedarone ( Class III) are only indicated for what?
    • Afib
    • A flutter
  26. What are amiodarone and sotolol (III) used for?
    Ventricular and Atrial arrhythmia
  27. Why is amiodarone so versatile?
    BB, Ca channel blocker, Na channel blocker and K channel blocker
  28. Class II Dofetilide, ibutilide, dronedarone are indicated for what?
    A fib or A flutter
  29. Which of Amiodarone’s properties kicks in first?
    BB (slow HR and lower BP)
  30. Which of Amiodarone’s properties kicks in after the BB property?
    • K channel blocker
    • (rhythm conversion)
  31. What are the routes of admin for Amiodarone?
    Oral and IV
  32. What patients should you use sotolol in caution with?
    Asthma, COPD and renal insufficiency (strict dosing)
  33. What properties other than K channel blocker does Sotolol have?
    BB
  34. What is Dofetilide (Tikosyn) used for?
    A fib or A flutter
  35. What is route of admin for Dofetilide (Tikosyn)?
    Oral
  36. Ibutelide is what admin route?
    IV only
  37. What is Ibutelide used for?
    IV only so we only use it to: convert patients back to normal sinus rhythm when they are in the hospital
  38. What is the route of admin for Dronedarone (newest antiarrhythmic) (Multaq)?
    Oral only
  39. What is the use for Dronedarone (newest antiarrhythmic) (Multaq)?
    Maintains sinus rhythm
  40. Class 4 agents (CCB, non-hydropyridine – verapimil and ditilazem) are used for what?
    Mostly for rate control
  41. What action does Adenosine have (Class V)?
    “S” = slows down the heart, blocks conduction across AV node
  42. What is the route of admin for Adenosine?
    Available in IV only
  43. What is adenosine used for?
    Acute situation then a patient presents w/ tachycardia
  44. Digoxin has what MOA?
    Blocks conduction across the AV node = used for rate control
  45. What routes of admin is Digoxin available in?
    IV and oral
  46. Which class of antiarrhythmics prolongs the QT interval but has a low incidence of torsades?
    1C
  47. What is the MOA of Class 1A antiarrhythmics?
    • Na channel blockers
    • Decrease conduction velocity
    • Prolong repolarization
    • Treat both ventricular and atrial arrhythmia
  48. Class 1C do not impact ___________ but do decrease __________.
    • Repolarization
    • Conduction velocity
  49. Class 1C do not impact repolarization but do _________ conduction velocity.
    Decrease
  50. How do BBs treat atrial arrhythmias?
    Slow ventricular response
  51. What is the main MOA of Class III drugs?
    • K channel blockers
    • Prolong repolarization
  52. What is the MOA of Class IV, Verapmil and Diltiazem in arrhythmias?
    • Block L-type channels in the SA and AV node
    • Used for rate control only
  53. How is Lidocaine excreted/metabolized?
    98% hepatic, 2% hepatic
  54. How is Mexilatine excreted/metabolized?
    80% CYP, 20% renal
  55. How is Quinidine (1A) cleared?
    60-80% CYP 3A4 and 2D6; 15-40% renal
  56. How is Procainamide (1A) cleared?
    50% renal; 50% n-acetyl-transferase
  57. How is Disopyramide (1A) cleared?
    55% renal; 45% hepatic
  58. How is Flecainide (1C) cleared?
    60% CYP 2D6; 40% renal
  59. How is Propafenone (1C) cleared?
    95% CYP 2D6
  60. What is the clearance for amiodarone (III)?
    100% hepatic CYP 3A4 and 2C9

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