Term
| Arrhythmia is a heart condition where there is a disturbance in either __ __ or __ of __ __. These result in __ timing or poor __ ____ __ such that there is alteration in normal cardiac pumping. |
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Definition
- pacemaker function
- conduction of electrical impulses
- altered timing
- poor electricle/contraction coupling |
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Term
| Antiarrhythmias are actually ___ with occasionally beneficial side effects. |
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Definition
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Term
| Vaughn-Williams classifications are classifications of drugs based on their ability to __ specific __ currents and __ __ receptors. |
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Definition
- block specific ion currents
- beta-adrenergic receptors |
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Term
| Classes of Anti-arrhythmics: |
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Definition
Some Block Potassium Channels.
Class I: Sodium channel blockers
Class II: Beta blockers
Class III: Potassium channel blockers
Class IV: Calcium channel blockers |
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Term
| Name drugs that are class I antiarrhythmics and explain what they block: |
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Definition
Class I's block sodium channels
- Quinidine
- Procainamide
- Lidocaine
- Propafenone |
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Term
| Name drugs that are class II anti-arrhytmic drugs and explain what they block: |
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Definition
Class IIs are beta blocker antiarrhythmics:
- Metoprolol
- Propanolol
- Sotalol |
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Term
| Name some class III antiarrhythmics and explain how they work: |
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Definition
Class IIIs block potassium channels:
- Amiodarone
- Sotalol |
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Term
| Name some class IV antiarrhythmics and what they block: |
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Definition
Class IVs block calcium channels:
- Diltiazem
- Verapamil |
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Term
| Other antiarrhythmics that don't fall into one of the four classes: |
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Definition
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Term
| Three subtypes of class 1 antiarrhythmics: |
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Definition
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Term
| Class IA antiarrhythmics, such as ___, depress the __ and prolong the __ __ of the atria, perkinje fibers, and ventricular tissues. These drugs are ___ (cholinergic blockers/antimuscarinic) and are ___ ___. |
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Definition
- Procainamide
- depress the conduction
- prolong the refractory period
- vagolytic
- negative ionotropes |
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Term
| Use Class IA __ channel blocking antiarrhythmics like ___ for ___ and __/__. |
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Definition
- sodium channel blockers
- Procainamide
- SVT/ ventricular tachycardias
- A-fib/flutters |
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Term
| Procainamide a Class ___ antiarrhythmic decreases metabolism of ___. |
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Definition
- Class IA
- decreases metabolism of amiodarone |
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Term
| Side effects of Procainamide/Class IA antiarrhythmics: |
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Definition
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Term
| Class IB drugs blunt the __ slightly because they are __ sodium channel blockers, but also have action at __ __, which is why these drugs shorten the __ __ __. |
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Definition
- blunt the upstroke
- weak sodium channel blockers
- potassium channels
- shorten the action potential duration |
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Term
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Definition
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Term
Although lidocaine had long been the first choice for treating ventricular arrhythmias, ECC/AHA 2000 guidelines for cardiopulmonary resuscitation recommend IV amiodarone before lidocaine for treatment of ventricular fibrillation or pulseless ventricular tachycardia.
Dose
1 mg/kg, then 20-50 g/kg/min (level: 2-5 g/ml)
Side effects
CNS toxicity w/ levels > 5 g/ml |
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Definition
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Term
| Mexiletine is just the oral form of ___, thus it is also a class ___ antiarrhythmic. |
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Definition
- oral form of Lidocaine
- class IB |
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Term
| Mexiletine, a second 1B antiarrhythmic has good use in ___ ___ ___ (on the long-term, not acute basis). Its main side affects are __ __ with a few patients developing some central nervous system complaints. |
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Definition
-post-operative ventricular tachycardia
- GI intolerance |
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Term
| Class IB antiarrhythmics are very __ and very __. They have little to no effect on normal tissue. These are good treatments for __, ___ ___ and __ __. |
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Definition
- very effective and very safe
- ischemic, automatic arrhythmias
- ventricular tachycardia |
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Term
| Class IC antiarrhythmics, such as __ and ___, depress __ __, __ __ in the AV node, AP, and ventricles. These drugs are __ ___. |
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Definition
- Flecainide and Propafenone
- depress abnormal automaticity
- slow conduction
- negative inotropes |
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Term
| Flecainide, a class ___ antiarrhythmic, should only be initiated in the __ under close monitoring. |
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Definition
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Term
| Propafenone contraindication: |
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Definition
| - patient with a history of heart attack (this drug will kill them) |
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Term
| The Class IC antiarrhythmics are rarely used in the acute setting. They have many affects on the conduction of the heart and propofenone is a relatively profound negative inotrope. These medications should be used under the guidance of a Cardiologist primarily for long-term treatment of dysrhythmias. |
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Definition
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Term
| Class IC indications for use: |
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Definition
| Indicated for the treatment of life-threatening ventricular tachycardia or ventricular fibrillation, or symptomatic PVCs |
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Term
| Class IC negative side effects: |
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Definition
- negative inotropes, so use in normal hearts only (NO POST OPS, NO CHF)
only use class IC with guidance of a cardiologist |
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Term
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Definition
Propranolol
Atenolol
Metoprolol
Nadolol
Esmolol
d,l-Sotalol |
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Term
| Sotalol is a class __ antiarrhythmic that is a __ ___ and also a __ ___ __. |
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Definition
- class II
- beta blocker
- potassium channel blocker |
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Term
| DON’T USE PROPANOL OR BETA BLOCKERS IN __, __, or ___. |
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Definition
| - COPD, asthma, or bradycardia |
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Term
| Class II antiarrhythmics: |
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Definition
Uses
SVT (reentry, ectopic)
Sinus tachycardia (thyrotoxicosis)
VT (exercise-induced)
causes both myocardial β–adrenergic blockade and membrane-stabilizing effects
Slows SA node and ectopic pacemaking
Can block arrhythmias induced by exercise or apprehension |
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Term
| side effects of propanolol and other beta blockers class II antiarrhythmics: |
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Definition
Propanolol crosses BBB so has CNS effects:
- depression
- decreased blood pressure b/c suppresses renin release and therefore RAS |
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Term
Beta-blockers are good for re-entry circuits and automatic dysrhythmias.
Their effect of decreasing contractility may be limiting. |
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Definition
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Term
| Class III antiarrhythmics are __ blockers. They prolong __ and __ __ __. Contractility is __ or __. |
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Definition
- potassium blocking
- prolong repolarization and action potential duration
- unchanged or increased |
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Term
| Class III antiarrhythmic agents: |
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Definition
- Amioderone
- Dronederone
- Dofetilide |
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Term
| Class III antiarrhythmics are used in patients with persisting __ to maintain __ __. |
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Definition
perisisting AF
maintain sinus rhythm |
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Term
| Class III agents include __ and __. |
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Definition
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Term
Class III:
i.v. amiodarone
VT
VF
Wide Complex Tachycardia
A-fib
Oral amiodarone – off label
Prophylaxis for A-fib and A-flutter. |
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Definition
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Term
| ___ is used in advanced cardiac life support (ACLS). |
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Definition
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Term
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Definition
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Term
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Definition
Prolongs myocardial cell-action potential
Prolongation of refractory period
Potassium and sodium channel blocking
Reduces automaticity of SA Node
Reductions of contractility and conduction velocity in AV Node, Ventricles, Bundle of His and Purkinje system |
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Term
| Amiodarone is 37% __ by weight and has a really long elimination half life (14-53 days) |
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Definition
iodine
it is also very lipophyllic and gets concentrated in the thyroid, adipose, muscle, liver, and lungs |
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Term
| Amiodarone adverse effects: |
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Definition
Thyroid abnormalities 2%
In the US
the prevalence of AI-thyrotoxicosis is 3%
the prevalence of AI-hypothyroidism is 22%.
Pulmonary fibrosis
Corneal deposits |
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Term
| B/c Amiodarone may cause __ __, must have patient get a __ __ every 6 months and a pulmonary function test at beginning and throughout treatment. |
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Definition
- pulmonary fibrosis
- chest xray |
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Term
| whorl-like opacities in the corneal epithelium. They appear in most patients treated for more than six months with amiodarone (brand name Cordarone), an anti-arrhythmic |
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Definition
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Term
| Other adverse effects of Amiodarone: |
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Definition
- grey/blue skin
- CNS/GI disturbances
- pro-arrhythmic effects
- heart block
- nightmares 25%
- abnormal liver fx test 20%
- interacts with warfarin and digoxin (decreases clearance) |
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Term
| MAJOR DRUG INTERACTIONS OF AMIODARONE: |
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Definition
- WARFARIN
- DIGOXIN
AMIODARONE DECREASES CLEARANCE OF WARFARIN AND DIGOXIN THEREBY INCREASING THE CONCENTRATION OF THESE DRUGS. |
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Term
| More amiodarone drug interactions: |
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Definition
- 1A2: Theo
- 2C9: Warfarin, Diazepam, Phenytoin
- 2D6: TCA's, SSRIs, beta blockers
- 3A4: statins, calcium channel blockers, and many more |
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Term
| Verapamil is a class __ antiarrhythmic with a major side effect of ___. |
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Definition
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Term
| Class IV calcium channel blocker mechanism: |
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Definition
Actions – on SA and AV nodes
depressed spontaneous depolarization of SA node
decreased AV node conduction
decreased ventricular response in AF and flutter
suppress AV nodal re-entry tachyarrhythmia |
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Term
| Adenosine aka ___ ___ is an antiarrhytmic drug. |
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Definition
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Term
| Adenosine slows the __ __ current and increases __ __, therefore __ the cell. It is used to stop __ __ __, though its effects won't last long though. |
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Definition
- slows the inward calcium current
- increases potassium conductance
- hyperpolarizing the cell
- stops rapid onset tachycardia |
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Term
| Drug interactions of adenosine: |
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Definition
| - methylxanthines are competitive antagonists (caffeine/theophylline) |
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Term
| side effects of adenosine: |
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Definition
AFib/ sinus arrest/ sinus bradycardia
Bronchospasm
Flushing/headache – vasodilator actions
Nausea |
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Term
| adenosine is a good medicine. has quick onset quick offset. |
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Definition
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Term
| Digoxin works by __ __ ___ inhibition. It has positive __ effects and is ___. |
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Definition
- Na-K ATPase inhibition
- positive inotropic effects
- vagomimetic (slows heart like vagus would) |
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Term
| Digoxin is alternative choice to ___. |
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Definition
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Term
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Definition
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Term
| Digoxin drug interactions: |
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Definition
- Coumadin, digoxin increases INR/PT
- Quinidine
- Amiodarone
- Verapamil
- Spiranolactone |
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Term
| The combination of ___ and __ __ is highly suggestive of digitalis toxicity. Also if patient gets a ___ vision, then they have digoxin toxicity. |
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Definition
- SVT
- AV block
- yellow-green vision |
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Term
| ___ predisposes one to dig toxicity. |
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Definition
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Term
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Definition
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