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