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Cardio 3

disopyramide Class 1A
procainamide Class 1A
quinidine Class 1A
class 1A effect on SA nodal cells block Na+ channels, prolong phase 4, inc threshold for AP
class 1A effect on myocytes block Na+ channels, prolong depolarization, inhibit K+, inc AP duration
class 1A effect on EKG prolong QRS and QT
uses of class 1A drugs A fib/flutter, paroxysmal SVT
signs of class 1A toxicity torsade de points, syncope
use with caution in pts w/LV dysfunction Class 1A
byproduct that causes QT prolongation NAPA- product of procainamide
produces NAPA liver
most effective for new onset A fib IV ibutilide
used for atrial arrhythmias, new onset A fib, VT, and to dec occurrence of reentry arrhythmias procainamide
type of procainamide to treat VT Slow IV
signs of procainamide toxicity SLE-like sx, hypotension, ND, rash, fever, hepatitis, agranulocytosis
procainamide effects that cause hypotension ganglionic blocking effects
action of NAPA pure class 3 action
caused by NAPA in renal insufficiency torsade de points
dec dose in pts w/heart failure procainamide
eliminates NAPA kidneys
quinidine effect on AV node inc conduction
quinidine effects that cause hypotension anti-alpha effects
use with caution in pts w/implanted defibrillators Class 1A
quidine effects that cause inc AV conduction anti-cholinergic effects
often administered w/beta blockers, verapamil, digoxin, or diltiazem quinidine
signs of quinidine toxicity QT prolongation, tinnitus, GI disturbances, immunological effects
contraindicated in long QT, SSS, BBB, MG, and liver failure quinidine
type of disopyramide used for life-threatening ventricular arrhythmias oral
anti-muscarinic effects exceed those of quinidine disopyramide
strong negative ionotropi effect disopyramide
disopyramide effects that cause urinary retention, dry mouth, blurred vision anti-muscarinic effects
contraindicated in heart failure, LV dysfunction, obstructive uropathy, glaucoma, conduction block, and SA nodal dysfunction disopyramide
used for atrial tachycardia, hypertrophic obstructive cardiomyopathy, and neurocardiogenic syncope disopyramide
norpace disopyramide
lidocaine Class 1b
mexiletine class 1b
phenytoin class 1b
not effective in a flutter, a fib, or SVTAs class 1b
used to treat ventricular arrhythmias class 1b
used as prophylaxis for V fib after DC conversion in an ischemic setting lidocaine
DOC for acute suppression of acute ventricular arrhythmias lidocaine
type of lidocaine used in heart failure pts low dose
signs of lidocaine toxicity confusion, dizziness, seizures
may cause lidocaine to accumulate beta blocker
phenytoin MOA blocks Na+ channels
induces CYP450 3A4 phenytoin
affects metabolism of lidocaine, mexiletine, and quinidine phenytoin
signs of phenytoin toxicity gingival hyperplasia, horizontal gaze nystagmus, increased suicidal ideation
used to treat seizures, congenital long QT, vent tachycardia, digoxin-induced arrhythmias phenytoin
useful in pt population with concurrent seizures and ventricular arrhythmias phenytoin
flecainide group 1C
propafenone group 1C
must have normal EF to be used group 1C
analog of lidocaine mexiletine
used for life-threatening vent arrhythmias, peripheral neuropathy pain mexiletine
may improve mexiletine side effects taking with food
signs of mexiletine toxicity dizziness, tremor, slurred speech, NV
class 1C effect on conduction velocity decreased in all
class 1C effect on refractory period inc in AV node and accessory bypass tracts
used for SVTA in non-MI pts and APCs group 1C
propafenon effect on APs does not prolong
primarily used for SVTAs propafenone
signs of propafenone toxicity metallic taste, constipation, bradycardia, bronchospasm
beta blockers Class 2
most useful anti-arrhythmic drugs class 2
used for atrial arrhythmia, recurrent MI, exercise induced arrhythmia class 2
signs of class 2 toxicity bronchospasm, cold extremities, impotence, negative ionotropic effect, AV blockade, acute HR, sleep disturbance/depression
amiodarone class 3
bretylium class 3
dronedarone class 3
sotalol class 3
dofetilide class 3
ibutilide class 3
class 3 effect on repolarization block K+ current
class 3 effect on AP prolong in Purkinje and ventricular muscle fibers
class 3 effect on phase 0 none
class 3 effect on conduction velocity none
used for vent arrhythmias and SV arrhythmias amiodarone
used for maintenance/restoration of sinus rhymthm in a fib class 3
signs of class 3 toxicity bradycardia, heart block, torsade de pointes
amiodarone effects on AP and refractories prolongs both
amiodarone effects on depolarization (phase 0) blocks Na+ and Ca++ channels, dec slope of phase 0
amiodarone effects on HR slows
amiodarone effects on AV conduction decreases
amiodarone effects on alpha and beta channels blocks both
DOC for vent arrhythmias in pts w/recent MI amiodarone
signs of amiodarone toxicity pneuomonitis, bradycardia, vision issues, long QT, hypotension, hepatic toxicity, thyroid issues, blue skin, NV, constipation
type of amiodarone that can cause heart failure IV
causes Smurf Syndrome amiodarone
increases activity of warfarin and digoxin amiodarone
used w/caution in pts w/SSS amiodarone
structural analog of amiodarone dronedarone
non selective beta blocker sotalol
inhibits conduction in accessory bypass tracts sotalol
excreted solely by kidneys sotalol
can cause orthostatic hypotension bretylium
prevents NE release bretylium
bretylium effect on atrial tissues none
used to treat life-threatening v tachycardia when all else has failed bretylium
dofetilide effect on K+ current blocks delayed K+
given w/EKG monitoring dofetillide
contraindicated in pts w/hypokalemia or bradycardia dofetillide
dose depends on creatinine clearance dofetillide
verapamil class 4
diltiazem class 4
most potent in SA/AV nodes class 4
contraindicated in SSS and AV block class 4
used for SVTA, reentry SVT, hypertension, and prinzmetal angina class 4
class 4 effects on threshold potential elevates
class 4 effects on AP prolongs
class 4 effects on refractory pd prolongs in AV
class 4 effects on conduction decreases
signs of class 4 toxicity hypotension, constipation, bradyarrhythmias
use caution w/beta blockers and Ca++ channel blockers class 4
adenosine effect on K+ increases outward current via G-pro coupled channels
effects inhibited by caffeine and theophylline adenosine
DOC for rapid termination of narrow-complex PSVT adenosine
signs of adenosine toxicity flushing, SOB, chest burning sensation
digoxin MOA vagal stimulation
digoxin effect on conduction slows through AV node and His bundle
signs of digoxin toxicity bradycardia, AV block, V-bigeminy
toxicity exacerbated by low K+ digoxin
Mg MOA influences Na/K ATPase, Na+, K+, and Ca++ channels
used for digitalis-induced arrhythmias, torsade de pointes Mg
prevents ibutilide-induced VT/VF Mg
can cause AV block Mg
increases risk of EAD/DADs and ectopic pacemaker activity hypokalemia
decreases ectopic pacemaker activity, suppresses SA node hyperkalemia
hyperkalemia changes on EKG peak T waves and slurred QRSs
Created by: drhermy