Mastering Antiarrhythmic Drug Therapy
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Questions and Answers

Which ions are of primary importance in the action of antiarrhythmic drugs?

  • Na+
  • Ca++
  • K+
  • All of the above (correct)

    • What is the pharmacological goal of antiarrhythmic drug therapy?

  • To increase ectopic pacemaker activity
  • To produce minimum side effects
  • To modify critically impaired conduction (correct)
  • To increase mortality

    • What is the ideal characteristic of an antiarrhythmic drug in terms of its effect on different tissues?

  • To decrease mortality
  • To be more effective on normally depolarizing tissues
  • To produce maximum side effects
  • To be more effective on ectopic pacemaker and depolarized tissues (correct)

    • How does the Singh-Vaughn Williams system classify antiarrhythmic drugs?

    <p>By their effect on ion channels</p> Signup and view all the answers

    What is the effect of many of the drugs presently available for treating arrhythmias?

    <p>They increase mortality</p> Signup and view all the answers

    What leads to differential sensitivity to antiarrhythmic drugs?

    <p>Differential expression of ion channels, particularly Na+ channels</p> Signup and view all the answers

    What is the mechanism of action of antiarrhythmic drugs?

    <p>Altering ion fluxes within excitable tissues</p> Signup and view all the answers

    What is the ideal characteristic of an antiarrhythmic drug in terms of side effects?

    <p>To produce minimum side effects</p> Signup and view all the answers

    Which subclass of Class I drugs has the highest potency as sodium channel blockers and prolongs repolarization?

    <p>Subclass IA</p> Signup and view all the answers

    Which subclass of Class I drugs has the lowest potency as sodium channel blockers and may shorten repolarization (decrease QT interval)?

    <p>Subclass IB</p> Signup and view all the answers

    Which subclass of Class I drugs is the most potent sodium channel blocking agents (prolong QRS interval) and has little effect on repolarization (no effect on QT interval)?

    <p>Subclass IC</p> Signup and view all the answers

    Which class of antiarrhythmic drugs act indirectly on electrophysiological parameters by blocking beta-adrenergic receptors?

    <p>Class II</p> Signup and view all the answers

    Which class of antiarrhythmic drugs prolongs repolarization, increases refractoriness, and has no effect on QRS interval?

    <p>Class III</p> Signup and view all the answers

    Which class of antiarrhythmic drugs are relatively selective AV nodal L-type calcium-channel blockers and slow sinus rhythm?

    <p>Class IV</p> Signup and view all the answers

    Which of the antiarrhythmic drugs have minimal effects on AV node depolarization?

    <p>Dihydropyridines</p> Signup and view all the answers

    Which class of antiarrhythmic drugs is not included in the standard classes?

    <p>Miscellaneous</p> Signup and view all the answers

    Which class of antiarrhythmic drugs binds most strongly when the Na+ channels are open and is termed 'use dependent'?

    <p>Class Ia</p> Signup and view all the answers

    Which class of antiarrhythmic drugs is involved in blocking some of the K+ channels involved in repolarisation?

    <p>Class III</p> Signup and view all the answers

    Which class of antiarrhythmic drugs acts by blocking the fast inward sodium channel?

    <p>Class I</p> Signup and view all the answers

    Which class of antiarrhythmic drugs acts indirectly on electrophysiological parameters by blocking beta-adrenergic receptors?

    <p>Class II</p> Signup and view all the answers

    Which class of antiarrhythmic drugs blocks the fast outward potassium current?

    <p>Amiodarone, sotalol, dofetilide</p> Signup and view all the answers

    Which of the antiarrhythmic drugs blocks the slow inward sodium current?

    <p>Ibutilide</p> Signup and view all the answers

    Which class of antiarrhythmic drugs blocks the sodium channels preferentially in refractory phase?

    <p>Class Ib</p> Signup and view all the answers

    Which class of antiarrhythmic drugs associate and dissociate very slowly from the sodium channels?

    <p>Class Ic</p> Signup and view all the answers

    Which class of antiarrhythmic drugs extends the duration of the action potential?

    <p>Class III</p> Signup and view all the answers

    Which class of antiarrhythmic drugs blocks voltage dependent calcium channels?

    <p>Class IV</p> Signup and view all the answers

    Which class of antiarrhythmic drugs inhibits conduction through the Bundles of His and Purkinje fibers, thus prolonging QRS complex?

    <p>Class Ic</p> Signup and view all the answers

    Which class of antiarrhythmic drugs impairs impulse propagation in nodal and damaged areas?

    <p>Class IV</p> Signup and view all the answers

    Which class of antiarrhythmic drugs blocks the slow inward sodium current?

    <p>Class III</p> Signup and view all the answers

    Which class of antiarrhythmic drugs prolongs repolarization and increases refractoriness?

    <p>Class III</p> Signup and view all the answers

    Which class of antiarrhythmic drugs has little preference for refractory channels?

    <p>Class Ic</p> Signup and view all the answers

    Which class of antiarrhythmic drugs reduces the force of contraction?

    <p>Class IV</p> Signup and view all the answers

    Which adverse effect of chronic amiodarone use is fatal in 10% of patients?

    <p>Pulmonary fibrosis</p> Signup and view all the answers

    What is the incidence of hyperthyroidism and hypothyroidism in patients on chronic amiodarone?

    <p>2-24%</p> Signup and view all the answers

    What adverse effect of chronic amiodarone use can result in blue-gray skin color?

    <p>Dermatological reactions</p> Signup and view all the answers

    What adverse effect of chronic amiodarone use can interfere with vision?

    <p>Corneal micro deposits</p> Signup and view all the answers

    How often are clinical assessments and chest x-rays required in patients on chronic amiodarone?

    <p>Every 3 months</p> Signup and view all the answers

    What is the mean elimination half-life of amiodarone?

    <p>26-107 days</p> Signup and view all the answers

    What percentage of patients on chronic amiodarone develop hepatotoxicity, (looking for the percent of patients that have elevated serum liver enzyme?

    <p>30%</p> Signup and view all the answers

    What adverse effect of chronic amiodarone use has an incidence of 20-40% but is reversible by lowering dose?

    <p>Peripheral neuropathy</p> Signup and view all the answers

    Which drug, although formally classified as class III antiarrhythmic, it has multiple actions and is more appropriately considered a 'broad spectrum' antiarrhythmic?

    <p>Amiodarone</p> Signup and view all the answers

    What is the approved use of amiodarone?

    <p>To treat refractory life-threatening ventricular arrhythmias</p> Signup and view all the answers

    What makes amiodarone a good drug when compared to other class III agents?

    <p>ts potential to cause proarrhythmias (torsades) is significantly lower than other Class III agents.</p> Signup and view all the answers

    Which antiarrhythmic drug is superior to lidocaine for the treatment of ventricular fibrillation?

    <p>Amiodarone</p> Signup and view all the answers

    What is a potential risk of using amiodarone for chronic therapy?

    <p>All of the above</p> Signup and view all the answers

    Which patients should not use Flecainide (class IC) as an antiarrhythmic drug?

    <p>All of the above</p> Signup and view all the answers

    What is the effect of Flecainide on ventricular function?

    <p>It lowers ventricular function in most patients</p> Signup and view all the answers

    Which antiarrhythmic drug has consistently decreased mortality in many clinical trials?

    <p>Amiodarone</p> Signup and view all the answers

    Which patients should Flecainide be used with caution in?

    <p>All of the above</p> Signup and view all the answers

    How long does it take to achieve steady-state plasma levels of amiodarone without loading doses?

    <p>Several weeks - months</p> Signup and view all the answers

    What is the primary use of flecainide?

    <p>Treating supraventricular arrhythmias and documented life-threatening ventricular arrhythemias</p> Signup and view all the answers

    Which class of antiarrhythmic drugs is flecainide classified under?

    <p>Class IC</p> Signup and view all the answers

    What is the primary mechanism of action of flecainide?

    <p>Blocking sodium channels</p> Signup and view all the answers

    Which antiarrhythmic drug is specifically used for symptomatic supraventricular arrhythmias?

    <p>Flecainide</p> Signup and view all the answers

    Which class of antiarrhythmic drugs does procainamide belong to?

    <p>Class IA</p> Signup and view all the answers

    What is the major metabolite of procainamide?

    <p>N-acetylprocainamide (NAPA)</p> Signup and view all the answers

    What percentage of the population are fast acetylators of procainamide?

    <p>50%</p> Signup and view all the answers

    What is the recommended initial dosing of procainamide when given orally?

    <p>Conservative</p> Signup and view all the answers

    What percentage of patients discontinue procainamide therapy within 6 months due to side effects?

    <p>40%</p> Signup and view all the answers

    What percentage of patients develop a lupus-like syndrome with procainamide therapy?

    <p>Between 15 and 20%</p> Signup and view all the answers

    What are the early warning symptoms of the lupus-like syndrome associated with procainamide therapy?

    <p>Mild arthralgia</p> Signup and view all the answers

    What is the major metabolite of procainamide and what class of antiarrhythmic actions does it have?

    <p>N-acetylprocainamide (NAPA), Class III actions</p> Signup and view all the answers

    What types of arrhythmias is procainamide effective against?

    <p>Both supraventricular and ventricular arrhythmias</p> Signup and view all the answers

    Which class of antiarrhythmic drugs is lidocaine and mexiletine classified under?

    <p>Class IB</p> Signup and view all the answers

    What is the primary route of administration for lidocaine for arrhythmias?

    <p>Intravenous (IV)</p> Signup and view all the answers

    Which drug is recommended before lidocaine for the treatment of ventricular fibrillation or pulseless ventricular tachycardia according to ECC/AHA 2000 guidelines?

    <p>Amiodarone</p> Signup and view all the answers

    Which antiarrhythmic drug can be used in patients with a history of torsades or DILQTs?

    <p>Mexiletine</p> Signup and view all the answers

    What is the primary use of lidocaine and mexiletine?

    <p>Treatment of acute, life-threatening ventricular arrhythmias</p> Signup and view all the answers

    What are the most frequent side effects of lidocaine and mexiletine?

    <p>Central nervous system (CNS) effects</p> Signup and view all the answers

    Which drug can cause severe interactions when co-administered with lidocaine or mexiletine?

    <p>Amiodarone</p> Signup and view all the answers

    Which class of antiarrhythmic drugs is more effective than digoxin in controlling ventricular rate in patients with atrial fibrillation?

    <p>Verapamil and diltiazem Class IV</p> Signup and view all the answers

    What is the most common side effect of verapamil?

    <p>Constipation</p> Signup and view all the answers

    Which combination of drugs can cause AV block or suppression of SA node when used with high doses of verapamil or diltiazem?

    <p>All of the above</p> Signup and view all the answers

    Which patients should be cautious when using verapamil or diltiazem?

    <p>All of the above</p> Signup and view all the answers

    What can happen if verapamil or diltiazem are administered to patients with atrial tachycardias resulting from WPW?

    <p>Worsen the arrhythmia</p> Signup and view all the answers

    What is a contraindication for using verapamil or diltiazem?

    <p>All of the above</p> Signup and view all the answers

    Which drug is known to increase the plasma concentrations of verapamil?

    <p>Grapefruit juice</p> Signup and view all the answers

    Which of the antiarrhythmic drugs is ineffective for prophylaxis of arrhythmias in post-MI patients?

    <p>Lidocaine</p> Signup and view all the answers

    What can high doses of verapamil or diltiazem cause in terms of AV and SA node function?

    <p>Suppression</p> Signup and view all the answers

    Which class of antiarrhythmic drugs is indicated for premature atrial, nodal or ventricular depolarization?

    <p>No drug therapy indicated</p> Signup and view all the answers

    What is the drug therapy indicated for atrial fibrillation, flutter, and PSVT?

    <p>Class II and IV</p> Signup and view all the answers

    Which arrhythmia should AV nodal blockers be avoided in?

    <p>Wolff-Parkinson-White syndrome</p> Signup and view all the answers

    Which class of antiarrhythmic drugs is indicated for ventricular tachycardia with remote myocardial infarction?

    <p>Class III and I</p> Signup and view all the answers

    Which drugs are indicated for ventricular fibrillation?

    <p>Lidocaine and amiodarone</p> Signup and view all the answers

    What is the acute treatment for Torsades de pointes?

    <p>Magnesium and Isoproterenol</p> Signup and view all the answers

    What is the chronic treatment for Torsades de pointes?

    <p>Class II</p> Signup and view all the answers

    What are the therapeutic considerations for antiarrhythmic drug therapy?

    <p>The benefits of therapy may be difficult to establish</p> Signup and view all the answers

    Which patients are most likely to benefit from antiarrhythmic drug therapy?

    <p>Patients with no symptoms at all</p> Signup and view all the answers

    What should be eliminated before starting antiarrhythmic drug therapy?

    <p>All of them</p> Signup and view all the answers

    Which statement about currently available antiarrhythmic drugs is most accurate?

    <p>They are often unpredictable and ineffective</p> Signup and view all the answers

    What should be considered when choosing an antiarrhythmic drug?

    <p>The benefits vs risks of treatment</p> Signup and view all the answers

    What is the therapeutic index of most antiarrhythmic drugs?

    <p>Narrow</p> Signup and view all the answers

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