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