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What is the major toxicity of ibutilide and at what rate does it occur?
Torsades de pointes at ~6%
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How is Ibutilide administered?
Rapid infusion (1mg/10 minutes)
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What is Ibutilide given for?
Immediate conversion of atrial fibrillation or flutter to sinus rhythm
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What is the MOA of Ibutilide?
I(Kr) blocker that also activates an inward Na current
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What is the MOA o Dofetilide?
Pure class III, I(Kr) selective inhibitor that prolongs the QT interval
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What is the incidence of torsades with Dofetilide?
1-3%
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How is Dofetilide administered?
In a hospital with72 hours of monitoring (due to risk of torsades)
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What is Dofetilide used for?
Maintenance of sinus rhythm in patients with atrial fibrillation
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What is the risk of torsades de pointes with Quinadine?
2-8%
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What is the risk of torsades de pointes with Procainamide?
2-3%
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What is the risk of torsades de pointes with Disopyramide?
2-3%
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What is the risk of torsades de pointes with d,l-Sotalol?
1-5%
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What is the risk of torsades de pointes with d-Sotalol?
1-2%
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What is the risk of torsades de pointes with Ibutilide?
6%
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What is the risk of torsades de pointes with Dofetilide?
1-3%
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What is the risk of torsades de pointes with Amiodarone?
<1%
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What effects do CCBs like Verapamil and Diltiazem have on the heart?
Reduce automaticity, Increase RP, Decrease Velocity of AV node, Inhibit contractility
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What effect do CCBs like Verapamil and Diltiazem have on the blood vessels?
Vasodilators
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What is the MOA for CCBs like Verapamil and Diltiazem?
Block slow inward Ca current
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What are the adverse effect sof CCBs, like Verapamil and Diltiazem?
Flushing, Reduced contraction, AV node conduction effects, constipation
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What type of arrhythmias are CCBs used for?
Supraventricular arrhythmias
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What are the Antiarrhythmic Na channel blockers?
Lidocaine, Phenytoin, Mexiletine, Procainamide, quinidine and “amiodarone”
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What are the K channel blocking antiarrhythmics?
Dofetilide, ibutilide, amiodarone, sotalol, quinidine, procainamide
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What are the Ca channel blocker antiarrhythmics?
Verapamil, Amiodarone and Diltiazem
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What are the B blocker antiarrhythmics?
Propranolol, esmolol, sotalol and amiodarone
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What types of Arrhythmias can be treated by Ranolazone?
AF and Ventricular tachyarrhythmia
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How does Ranzoline prevent arrhythmias?
Blocks Na channel late phase influx, blocks I(Kr) at therapeutic concentration
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How many adenosine receptor types are there and what are they?
4, A(1), A(2A), A(2B), A(3)
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What type of receptors are the adenosine receptor?
G protein coupled
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What are competitive antagonists for the Adenosine receptors?
Methylxanthines, such as caffeine and theophylline
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What is a normal plasma level of Adenosine?
300 nM (can reach mM conc.)
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Which cells release Adenosine?
Most cells
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What is the trade name for Adenosine?
Adenocard
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Which Adenosine receptors are stimulatory?
A(2A) and A(2B)
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Which adenosine receptors are inhibitory?
A1 and A3
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What is the MOA of adenosine in the treatment of arrhythmias?
Stimulates A1 adenosine receptors on the heart, ↑K conductance, inhibits opening of Ca channels, ↓ NOR release, ↓ automaticity and AV nodal conduction
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What are the adverse effects of Adenosine?
Flushing, Asthma, chest pain, dyspnea, SA nodal arrest, AV nodal block
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