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Antiarrhythmics

FA Classes I-IV

QuestionAnswer
On which phase of the action potential do sodium channel blockers work? Phase 0
Which "kind" of cells are more attractive for sodium channel blockers? Depolarized cells
Arrange antiarrhythmic strength in the three classes of Na-channel blockers? IC > IA > IB
Which are the Class IA sodium channel blockers? Quinidine, Procainamide, and Disopyramide
What are the effects on the ventricular action potential caused by Class IA sodium channel blockers? ↑ AP duration and ↑ effective refractory period (ERP)
How are Sodium channel blockers represented in an EKG? ↑ QT interval
What are the shared adverse effects of Class IA Na-channel blockers? Thrombocytopenia, and Torsade de pointes due to ↑ QT interval
What is the main adverse effect of Quinidine? Cinchonism
What is the associated adverse effect of Procainamide? SLE-like syndrome
What is the associated adverse effect of Disopyramide? Heart failure
Which class of sodium channel blockers have a weak profile? Class IB
Which are the Class IB sodium channel-blockers? Lidocaine, Phenytoin, and Mexiletine
Which class of sodium channel blockers preferentially affect ischemic or depolarized Purkinje and ventricular tissue? Class IB
What class of antiarrhythmic is Phenytoin? Class IB
Is AP duration increased or decreased by Class IB Sodium channel blockers? ↓ AP duration
Which Na+ channel blockers are often used in Digitalis-induced arrhythmias? Class IB
What are the main adverse effects of Class IB Sodium channel blockers? CNS stimulation/depression, CV depression
Which class IB antiarrhythmic is associated with GI intolerance? Mexiletine
Which class of Na+ channel blockers have the STRONGEST effect? Class IC
What is the main mechanism of action of Class IC Na channel blockers? Significantly prolongs ERP in AV node and accessory bypass tracts
What class of sodium channel blockers is contraindicated in HF patients or post-MI patients? Class IC
Which are the Class-IC antiarrhythmics? Flecainide and Propafenone
On which phase of the action potential do ß-blockers work on? Phase 4
What is the mechanism of action of ß-blockers? 1. Decrease SA and AV node activity by ↓ cAMP, ↓ Ca2+ currents 2. Suppress abnormal pacemakers by ↓slope of phase 4
Which node, AV or SA, is most susceptible to beta blockers? AV node --> ↑ PR interval
Which are common arrhythmias treated with ß-blockers? SVT, ventricular rate control of AFIB and A-FLUTTER
Why are beta blockers not used in diabetic patients? They mask the signs of hypoglycemia
What are some general adverse effects of ß- blockers? Impotence, exacerbation of COPD and asthma, cardiovascular effects (bradycardia, AV block, HF), CNS effects (sedative, sleep alteration)
What is a specific adverse effect of Metoprolol? Dyslipidemia
Which beta blocker is known to cause exacerbation of vasospasms in vasospastic angina? Propranolol
Which are the non-selective beta blockers? Carvedilol and Labetalol
What is the problem of all beta blockers, except those that are non-selective? May cause unopposed α1-agonism (vasoconstriction)
How is B-blocker toxicity treated? Saline, atropine, and glucagon
What are some common B-blockers? Metoprolol, Propranolol, esmolol, timolol, and carvedilol
Which B-blocker is the shortest acting? Esmolol
What are the class III antiarrhythmics? Potassium channel blockers
Which are the class III antiarrhythmics? Amiodarone, Ibutilide, Dofetilide, and Sotalol
What are the effects of class III K+ blockers on the AP and EKG? ↑ AP duration, ↑ ERP, and ↑ QT interval
What is the associated adverse effect of Sotalol? Torsade de Pointes and excessive ß-blockade
Which fatal arrhythmia is associated with most Potassium channel blockers? Torsade de Pointes
What are the most significant adverse effects of Amiodarone? 1. Lungs --> pulmonary fibrosis 2. Liver --> Hepatotoxicity 3. TH gland --> hypo/or hyperthyroidism Acts as a hapten --> corneal deposits, blue/gray skin deposits in skin CV --> bradycardia, HF, and heart block
Why does Amiodarone have class I, II, III, and IV effects? Due to its lipophilic structure
What are the two main Calcium antiarrhythmics? Diltiazem and Verapamil
What is the MOA of Calcium channel blockers? Decrease conduction velocity, ↑ERP, ↑ PR interval
What are common adverse effects of calcium channel blockers? Constipation, flushing, edema, CV effects (HF, AV block, sinus node depression)
What is the drug of choice for terminating SVT? Adenosine
MOA of adenosine ↑ K+ out of cells ==> hyperpolarizing the cell and ↓ intracellular calcium --> decreasing AV node conduction
What substances may affect and blunt the effect of Adenosine? Caffeine and Theophylline
Which are common uses for Magnesium as an antiarrhythmic? Torsade de Pointes and Digoxin toxicity
Which IV drug selectively inhibits the "funny" sodium channels? Ivabradine
Which is the DOC in patients that cannot tolerate ß-blockers? Ivabradine
What are associated adverse effects of Ivabradine? Luminous phenomena/visual brightness, HTN, and bradycardia
Created by: rakomi
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