Pharm Ch 48 anti dysrhythmics
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| dysrhythmias can be supraventricular or ventricular - which are more dangerous | ventricular far more dangerous
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| classes of drugs used to treat dysrthymias | sodium channel blockers---Beta blockers---K channel blockers---Ca channel blockers---digoxin ---and others
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| if SA node is damaged, what is outcome | dec impulse formation results-->tachydysrhythmia
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| if AV block, what happens | AV block --> disturbance of conduction-->tachydysrythmia
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| Sodium channel blockers MOA | this class slows impulse conduction---delays repolarizaiton---with ANTICHOLINERGIC properties (increased SA automaticity, AV node conduction--> inc. HR)
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| name 6 Na channel blockers | quinidine---procainamide---lidocaine---phenytoin---mexiletine---tocainide
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| What Na channel blocker with SE of diarrhea, must be given with food | quinidine
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| Is quinidine cardiotoxic | yes, it is as well as procainamide
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| so if quinidine slows HR, but it's anticholinergic SE increases HR, how do we dose with digoxin | often digoxin given first, then quinidine
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| procainamide ADRs | serious SEs more serious/frequent than others in class---lupus like syndrome---cardiotoxicity---Torsade ---blood dyscrasias (dec platelets, WBCs)
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| lidocaine special admin | only IV admin used exclusively for ventricular dysrhythmias, esp post-MI. huge first pass effect. no anticholinergic effect
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| phenytoin also special admin | IV only---hypoTN more likely due to solvent alkalinity-->phlebitis.
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| which 2 Na channel blockers most likely TdeP | quinidine, procainamide share this
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| Which Na channel blockers not particularly prodysrhythmic | lidocaine, phenytoin, mexiletine, tocainide
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| 2 Na channel blockers that are derivatives of lidocaine---but ar ORALLY bioavailable | mexiletine and tocainide ---not commonlyused due to wicked SEs
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| mexiletine SEs | 40% compliance limiting n/v/d/c-----neuro disturbances
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| tocainide SEs | pulmonary fibrosis --- serious blood dyscrasias/agranulocytosis
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| MOA of Beta Blockers in dysrhythmias | dec SA automaticity---dec AV conductivity---dec contractility--------------coupled with Ca++ channels, so CCB actions are similar
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| Indication of Na channel blockers | used for both supraventricular and ventricular dysrhythmias
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| indication of Beta blockers | used in tachydysrhythmias - esp caused by sympathetic stimulation
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| ADRs Beta-blocker - propanolol | AV block---bronchospasm---HF bwo negative inotropy dec contractility---sinus arrest bwo dec SA automaticity
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| acebutolol unusual ADR | is B-1 specific yet causes BRONCHOSPASM---oral admin
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| esmolol Beta Blocker admin | given IV due to 9 minute half life
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| what are the only 3 beta blockers used in dysrhythmia tx | propanolol, acebutolol and esmolol
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| Name 1 K channel blocker | amiodarone
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| amiodarone is last-line drug EXCEPT for tx of ventricular tachycardia and has this half-life | a half life of 1-4 MONTHS
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| Amiodarone has wicked, wicked SEs that are | brady/AV block/HF---hepatotoxic---thyroid dysfunction---CNS disturbances, along with many others---including pulmonary fibrosis with long term use
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| Calcium channel blockers used to treat only | supraventricular dysrhythmias bwo of decreasing SA/AV/contractility
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| ADRs of calcium channel blockers being used here - verapamil and diltiazem | ADRs of brady---AV block---HF ---hypoTN---periph edema ---CONSTIPATION
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| diltiazem SEs relative to verapamil | less likely to cause cardiac effects and constipation
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| What is digoxin MOA in dysrhythmias | mostly related to dec SA/AV conduction, which is mediated by vagal stimulation----unfortunately digoxin increases HPS automaticity which contributes to its cardiac toxicitys and dysrhythmias
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| balancing act of all anti-dysrhythmics | many also have significant toxicities including pro-dysrhythmias that lead to cardiotoxicities or TdeP----limit their use or consider non-drug txs
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| what drug produces lupus-like syndrome | procainamide
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| what drug LEAST likely to cause torsade de pointes | phenytoin
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| drug LEAST likely to cause pulmonary fibrosis witih short-term use | amiodarone - only causes pulmonary fibrosis long-term, dose related use
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