Therapeutics II - Antiarrhythmics

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  1. quinidine
    CARDIOQUIN
  2. procainamide
    PRONESTYL
  3. disopyramide
    NORPACE
  4. lidocaine
    XYLOCAINE
  5. mexilitine
    MEXITIL
  6. Flecainide
    TAMBOCOR
  7. propafenone
    RYTHMOL
  8. bisoprolol
    ZEBETA
  9. atenolol
    TENORMIN
  10. metoprolol succinate
    TOPROL XL
  11. metoprolol tartrate
    LOPRESSOR
  12. esmolol
    BREVIBLOC
  13. propranolol
    INDERAL
  14. timolol
    BETIMOL
  15. carvedilol
    COREG
  16. amiodarone
    CORDARONE, PACERONE
  17. dofetilide
    TIKOSYN
  18. dronedarone
    MULTAQ
  19. sotalol
    BETAPACE
  20. verapamil
    CALAN, VERELAN
  21. diltiazem
    CARDIZEM
  22. adenosine
    ADENOCARD, ADENOSCAN
  23. digoxin
    DIGOX, LANOXIN
  24. warfarin
    COUMADIN
  25. What is a refractory period?
    a period immediately following stimulation during which a nerve or muscle is unresponsive to further stimulation.
  26. What is conduction velocity?
    the speed with which an electrical impulse can be transmitted through excitable tissue, as in the movement of an action potential through His-Purkinje fibers of the heart
  27. What is automaticity?
    the cardiac cell's ability to spontaneously generate an electrical impulse (depolarize)
  28. Which drugs are Class IA antiarrhythmics?
    • quinidine (CARDIOQUIN)
    • procainamide (PRONESTYL)
    • disopyramide (NORPACE)
  29. What drugs are in class IB antiarrhythmics?
    • lidocaine (XYLOCAINE)
    • mexilitine (MEXITIL)
  30. What drugs are in class IC antiarrhythmics?
    • flecainide (Tambocor)
    • propafenone (Rhythmol)
  31. What drugs are class II antiarrhythmics?
    • beta blockers:
    • -bisoprolol (Zebeta)
    • -atenolol (Tenormin)
    • -metoprolol tartrate (Lopressor)
    • -metoprolol succinate (Toprol XL)
    • -carvedilol (Coreg)
    • -propranolol (Inderal)
    • -timolol (Betimol)
  32. What drugs are class III antiarrhythmics?
    • amiodarone (Pacerone, Cordarone)
    • dofetilide (Tikosyn)
    • dronedarone (Multaq)
    • sotalol (Betapace)
  33. What drugs are class IV antiarrhythmics?
    • verapamil (Calan, Verelan)
    • diltiazem (Cardizem)
  34. Which class of antiarrhythmics drugs block sodium AND potassium ion channels?
    • Class IA
    • disopyramide (Norpace)
    • procainamide (Pronestyl)
    • quinidine (Cardioquin)
  35. Which class of antiarrhythmics block Na channels ONLY?
    • class IB
    • -lidocaine (Xylocaine)
    • -mexilitine (Mexitil)
    • class IC
    • -flecainide (Tambocor)
    • -propafenone (Rhythmol)
  36. Which class of antiarrhythmic drugs block potassium channels?
    • Class III
    • amiodarone (Cordarone, Pacerone)
    • dofetilide (Tikosyn)
    • dronedarone (Multaq)
    • sotalol (Betapace)
  37. What class of antiarrhythmics effect the SA/AV?
    • Class II
    • -beta blockers
    • Class IV
    • -verapamil (Calan, Verelan)
    • -diltiazem (Cardizem)
  38. Which class of antiarrhythmics will have the greatest increase in the refractory period of myocytes?
    • Class III antiarrhythmics
    • -amiodarone (Pacerone, Cordarone)
    • -dofetilide (Tikosyn)
    • -dronedarone (Multaq)
    • -sotalol (Betapace)
  39. Which class of antiarrhythmics has zero effect on the refractory period?
    • Class IC
    • -flecainide (Tambocor)
    • -propafenone (Rhythmol)
  40. Which class of antiarrhythmics have the greatest decrease in conduction velocity?
    • Class IC
    • -flecainide (Tambocor)
    • -propafenone (Rhythmol)
  41. Which class of antiarrhythmics increase the QRS and QT on an ECG?
    • Class IA
    • -disopyramide (Norpace)
    • -procainamide (Pronestyl)
    • -quinidine (Cardioquin)
  42. Which class of antiarrhythmics decrease the QT interval, only?
    • Class IB
    • -lidocaine (Xylocaine)
    • -mexilitine (Mexitil)
  43. Which class of antiarrhythmics increase the QRS interval, only?
    • Class IC
    • -flecainide (Tambocor)
    • -propafenone (Rhythmol)
  44. Class of antiarrhythmics used to slow depolarization and repolarization thereby increasing the refractory period; widens QRS complex, preventing re-entrant or triggered automaticity. Good for supra ventricular (atrial) and ventricular arrhythmias.
    • Class IA
    • -disopyramide (Norpace)
    • -procainamide (Protensyl)
    • -quinidine (Cardioquin)

    MOA: block Na+ and K+ channels
  45. Class IA anti arrhythmic to avoid in patients with impaired ejection fraction (EF) due to its negative inotropic effects; also most potent anticholinergic side effects.
    disopyramide (Norpace)
  46. antiaarhythmic avoided due to its 30% incidence of diarrhea.
    • Class IA
    • -quinidine (Cardioquin)
  47. This anti arrhythmic is only available in IV (15-18 mg/kgg over 60 minutes). Its active metabolites primarily block K+ channels. ADR's include bradycardia and hypotension but its most notable side effect is WORSENING if heart failure.
    • Class IA
    • -procainamide (Pronestyl)
  48. This class of antiarrhythmics is the MOST effective for ventricular arrhythmias; not effective in atrial tissue. More effective at faster heart rates (Fast ON-OFF); and blocks Na+ channels in the inactive state (after completion of phase 0).
    • Class IB
    • -lidocaine (Xylocaine)
    • -mexilitine (Mexitil)
  49. This anti arrhythmic is available as IV ONLY (1-1.5 mg/kg push, then 1-4 mg/min; 1-2 mg/min in liver dysfunction). Its active metabolites are RENALLY eliminated and needs to be monitored for nephrotoxicity. Therapeutic range is 1.5-5 umol/L
    • Class IB
    • -lidocaine (Xylocaine)
  50. This anti arrhythmic is useful as a longterm agent if lidocaine(Xylocaine) is effective. Its therapeutic range is 0.5-2 mcg/ml
    • Class IB
    • -mexilitine (Mexitil)
  51. This class of anti arrhythmics is effective for supra ventricular tachycardia (Atrial) and ventricular arrhythmias. They are significant for slowing depolarization (conduction velocity) but little effect on refractory period. They also have a slow ON-OFF, prolonged effect; blocking Na+ channels.
    • Class IC
    • -flecainide (Tambocor)
    • -propafenone (Rhythmol)
  52. This anti arrhythmic is dosed at 50-200 mg q12h. It requires renal dosing but is also eliminated hepatically (CYP2D6, 1A2). Should be avoided in impaired EF due to being a negative inotrope. Other ADR's include headache, blurred vision, confusion, VT and TdP.
    • Class IC
    • -flecainide (Tambocor)
  53. This anti arrhythmic is known as the "pill in the pocket", prescribed for one dose for patients with paroxysmal symptoms. Should avoid in impaired EF; is a negative ionotrope. ADR's include dizziness, confusion, taste disturbance, VT and TdP.
    • Class IC
    • -propafenone (Rhythmol)
  54. This class of antiarrhythmics have been shown to decrease sudden cardiac death after an MI and decrease development of A.Fib after MI. They slow ventricular responses to A.Fib/Flutter. Contraindicated in severe bradycardia, sick sinus syndrome, and AV nodal blockade. ADR's include fatigue, exercise intolerance, lethargy, depression, impotence, Raynauds. May cause rebound ischemia if removed abruptly. Taper over 1-3 weeks.
    • Class II
    • Beta Blockers
    • -metoprolol tartrate (Lopressor)
    • -metoprolol succinate (Torpol XL)
    • -bisoprolol (Zebeta)
    • -atenolol (Tenormin)
    • -esmolol (Brevibloc)
    • -carvedilol (Coreg)
    • -propranolol (Inderal)
    • -timolol (Betimol)
  55. What class II antiarrhythmics are best in management for patients with low EF?
    • -metoprolol succinate (Toprol XL)
    • -carvedilol (Coreg)
    • -bisoprolol (Zebeta)
  56. This class of antiarrhythmics has the HIGHEST risk of prolonging QTc. Also carries the HIGHEST risk for tornadoes de pointes. They slow depolarization and prolong the refractory period by blocking K+ channels.
    • Class III
    • -amiodarone (Cordarone, Pacerone)
    • -dofetilide (Tikosyn)
    • -dronedarone (Multaq)
    • -sotalol (Betapace)
  57. Which anti arrhythmic has activity to ALL 4 AAD classes w/ Na, K, beta-blocker and CCB activity? What is its dosing for A.Fib and V.Tach? What is its half-life and mean half-life? What is important about its volume if distribution? What are its main DDI's?
    • Class III
    • -amiodarone (Cordarone, Pacerone)
    • -A.Fib Bolus dose IV = 150mg
    • -V.Tach Bolus dose IV = 300 mg
    • ----then 1mg/min for 6hours followed by 0.5 mg/min
    • -Large volume of distribution = 66L/kg
    • -half life = 15-100 days; mean = 55 days
    • -DDI's digoxin and warfarin
  58. What parameters are important for amiodarone toxicity?
    • -Head (eyes): corneal deposits
    • -Shoulders (thyroid): hyper/hypo TFT q6mo.
    • -Lungs (fibrosis):PFT q12mo.
    • -Liver (hepatitis): LFT's q6mo.
  59. What makes amiodarone different from dornedarone?
    • -additional methylsplfonyl group
    • -less lipophilic, so small vol. of distribution
    • -Iodine moet removed, so less side effects
  60. This class III anti arrhythmic should NOT be used in patients with permanent A.Fib or congestive heart failure per black box warning; increases mortality. Has an onset of action of 5-7 days.
    -dronedarone (Multaq)
  61. This class III antiarrythmic requires renal dose adjustment and should have an EKG (ECG) order upon administration. It is dosed at 500 mcg q12h and prolongs QT. What medications block its secretion? What medications alter its metabolism?
    • -dofetilide (Tikosyn)
    • -HCTZ, Trimethoprim, Cimetidine, Metformin, Prochlorperazine, Megesterol
    • -Ketaconazole and Verapamil

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Author:
mbailey585
ID:
325502
Filename:
Therapeutics II - Antiarrhythmics
Updated:
2016-11-10 15:55:39
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antiarrhythmics
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Therapeutics II - Antiarrhythmics
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