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?
  5. What can cause a flattened or inverted T wave?
    Hypocalcemia, Hypokalemia, Digoxin, ischemia
  6. What can cause peaked T wave?
  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?

    • 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
  13. Vaughn Williams Class IV are what type of drugs?
  14. Vaughn Williams Class V are what type of drugs?
    Adenosine, digoxin
  15. Which Vaughn Williams Class can treat both Ventricular and atrial arrhythmias?
    • IA
    • Disopyramide, quinidine, procainamide
  16. Lidocaine is a first or second line therapy?
    2nd line, would use amiodarone first
  17. What Vaughn Williams Class would be used to only treat ventricular arrhythmias?
    Class IB
  18. What is Mexiletine used for?
    Refractory arrhythmia
  19. What are 1C antiarrhythmics Na used for?
    • Atrial arrhythmia
    • Afib
    • in patients W/O underlying heart disease
  20. What group of patients are flecanide and propafenone (1C) contraindicated in?
    Structural heart disease or HF
  21. What Vaughn Williams Class II drugs used for (BBs)?
    Rate control, usually in atrial fibrillation
  22. What Vaughn Williams Class III drugs, amiodarone and sotolol are used for what purposes?
    Atrial or ventricular arrhythmias
  23. Dofetilide, ibutilide, dronedarone ( Class III) are only indicated for what?
    • Afib
    • A flutter
  24. What are amiodarone and sotolol (III) used for?
    Ventricular and Atrial arrhythmia
  25. Why is amiodarone so versatile?
    BB, Ca channel blocker, Na channel blocker and K channel blocker
  26. Class II Dofetilide, ibutilide, dronedarone are indicated for what?
    A fib or A flutter
  27. Which of Amiodarone’s properties kicks in first?
    BB (slow HR and lower BP)
  28. Which of Amiodarone’s properties kicks in after the BB property?
    • K channel blocker
    • (rhythm conversion)
  29. What are the routes of admin for Amiodarone?
    Oral and IV
  30. What patients should you use sotolol in caution with?
    Asthma, COPD and renal insufficiency (strict dosing)
  31. What properties other than K channel blocker does Sotolol have?
  32. What is Dofetilide (Tikosyn) used for?
    A fib or A flutter
  33. What is route of admin for Dofetilide (Tikosyn)?
  34. Ibutelide is what admin route?
    IV only
  35. 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
  36. What is the route of admin for Dronedarone (newest antiarrhythmic) (Multaq)?
    Oral only
  37. 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
  38. What action does Adenosine have (Class V)?
    “S” = slows down the heart, blocks conduction across AV node
  39. What is the route of admin for Adenosine?
    Available in IV only
  40. What is adenosine used for?
    Acute situation then a patient presents w/ tachycardia
  41. Digoxin has what MOA?
    Blocks conduction across the AV node = used for rate control
  42. What routes of admin is Digoxin available in?
    IV and oral
  43. Which class of antiarrhythmics prolongs the QT interval but has a low incidence of torsades?
  44. What is the MOA of Class 1A antiarrhythmics?
    • Na channel blockers
    • Decrease conduction velocity
    • Prolong repolarization
    • Treat both ventricular and atrial arrhythmia
  45. Class 1C do not impact ___________ but do decrease __________.
    • Repolarization
    • Conduction velocity
  46. Class 1C do not impact repolarization but do _________ conduction velocity.
  47. How do BBs treat atrial arrhythmias?
    Slow ventricular response
  48. What is the main MOA of Class III drugs?
    • K channel blockers
    • Prolong repolarization
  49. 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
  50. How is Lidocaine excreted/metabolized?
    98% hepatic, 2% hepatic
  51. How is Mexilatine excreted/metabolized?
    80% CYP, 20% renal
  52. How is Quinidine (1A) cleared?
    60-80% CYP 3A4 and 2D6; 15-40% renal
  53. How is Procainamide (1A) cleared?
    50% renal; 50% n-acetyl-transferase
  54. How is Disopyramide (1A) cleared?
    55% renal; 45% hepatic
  55. How is Flecainide (1C) cleared?
    60% CYP 2D6; 40% renal
  56. How is Propafenone (1C) cleared?
    95% CYP 2D6
  57. What is the clearance for amiodarone (III)?
    100% hepatic CYP 3A4 and 2C9
Card Set
Therapeutics: Arrhythmia 1
Therapeutics: Arrhythmia 1
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