Pharmacology Class 1B: LIDOCAINE Overview

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Questions and Answers

What common gastrointestinal symptoms may indicate digitalis toxicity?

Blood in stools

Anorexia, nausea, vomiting, and diarrhea (correct)

Sharp abdominal pain

Severe constipation

Which electrolyte imbalance facilitates the enzyme-inhibiting actions of cardiac glycosides?

Hypokalemia (correct)

Hyperkalemia

Hypercalcemia

Hyponatremia

Which class of drugs is effective for treating atrial and ventricular arrhythmias but has potential lupus-related side effects?

Class 3

Class 4

Class 1A (Procainamide) (correct)

Class 1B

Which drug class decreases ventricular filling pressures while increasing cardiac output?

Beta-agonists Signup and view all the answers

What is a common adverse effect associated with using Class 1A antiarrhythmic agents like prcainamide and quinidine?

Lupus-like syndrome Signup and view all the answers

Which of the following adverse effects is most commonly associated with digoxin therapy?

Second-degree atrioventricular blockage Signup and view all the answers

What effect does hypercalcemia have in relation to digoxin therapy?

Increases the risk of digitalis-induced arrhythmias Signup and view all the answers

Which of the following strategies is NOT commonly used for managing heart failure?

Antidepressants for mood stabilization Signup and view all the answers

What is the primary mechanism of action of Milrinone in heart failure management?

Inhibition of phosphodiesterase isozyme 3 (PDE-3) Signup and view all the answers

Which of the following adverse effects is characteristic of disopyramide?

Blurred vision and dry mouth Signup and view all the answers

What is the most significant adverse effect associated with Amiodarone?

Dose-related pulmonary toxicity Signup and view all the answers

Which Class 1B antiarrhythmic drug is primarily used for termination of ventricular tachycardia?

Lidocaine Signup and view all the answers

Which of the following statements is true regarding beta-blockers like Propranolol?

They possess antiarrhythmic properties due to β-receptor-blocking action. Signup and view all the answers

What is the primary action of Verapamil in treating arrhythmias?

It causes ventricular rate reduction in atrial fibrillation. Signup and view all the answers

Which adverse effect is associated with Class 3 antiarrhythmic agents such as Amiodarone?

Gray-blue skin discoloration Signup and view all the answers

Which drug is specifically noted for its selective blocking of If current?

Ivabradine Signup and view all the answers

Which of the following drugs is known for causing heart block in patients with preexisting conditions?

Amiodarone Signup and view all the answers

What is a key characteristic of dihydropyridine calcium channel blockers?

They may precipitate arrhythmias. Signup and view all the answers

Which adverse effect is most commonly associated with Digoxin?

Bradycardia Signup and view all the answers

What is the primary mechanism of action of Digoxin in heart failure treatment?

Inhibiting Na+/K+-ATPase Signup and view all the answers

Which of the following is a goal of heart failure treatment?

Reducing symptoms and slowing progression Signup and view all the answers

Why is therapeutic drug monitoring crucial for patients on Digoxin?

Due to its extremely narrow therapeutic window Signup and view all the answers

Which drug is primarily used to manage intermittent claudication in patients with peripheral artery disease?

Cilostazol Signup and view all the answers

What distinguishes high-output heart failure from low-output heart failure?

High-output heart failure typically has a normal cardiac output. Signup and view all the answers

What is a common side effect when using Ranolazine?

Dizziness Signup and view all the answers

Which type of drug is Ivabradine classified as?

Sinoatrial node inhibitor Signup and view all the answers

Study Notes

Class 1: Sodium Channel-Blocking Drugs

Lidocaine: Preferred for ventricular tachycardia termination and fibrillation prevention post-cardioversion in acute ischemia; low toxicity and effective for myocardial infarction-related arrhythmias; acts by blocking sodium channels with rapid kinetics.
Mexiletine, Flecainide, Propafenone, Moricizine: Reading assignment focused on additional sodium channel blockers.
Procainamide: Effective for most atrial and ventricular arrhythmias; associated with frequent dosing and lupus-like side effects; prolongs action potential duration and QRS interval; can cause hypotension, torsade de pointes, and syncope.
Quinidine: Similar actions to procainamide; rarely used due to adverse effects like cinchonism.
Disopyramide: Similar actions but with significant antimuscarinic effects; adverse effects include urinary retention and dry mouth.

Class 2: Beta-Adrenoreceptor Blocking Agents

Propranolol: Provides antiarrhythmic effects through β-receptor blockade; prevents recurrent infarction and sudden death after myocardial infarction recovery.
Esmolol: Used for managing intraoperative and acute arrhythmias.

Class 3: Drugs that Prolong Action Potentials

Amiodarone: Treats serious ventricular arrhythmias and atrial fibrillation; widely used; side effects include vasodilation, potential bradycardia, heart block, pulmonary toxicity, liver dysfunction, skin discoloration, and visual disturbances.
Dronedarone, Sotalol: Additional class 3 agents listed for reading.

Class 4: Calcium Channel Blockers

Verapamil and Diltiazem: Exhibit antiarrhythmic properties; dihydropyridine CCBs do not share antiarrhythmic efficacy and may worsen arrhythmias.
Verapamil: Blocks activated and inactivated L-type calcium channels; used for supraventricular tachycardias and controlling ventricular rates in atrial fibrillation; rarely converts atrial flutter to sinus rhythm.

Miscellaneous Antiarrhythmic Drugs

Ivabradine: Selectively blocks If current.
Digoxin: Increases cardiac contractility through calcium concentration modulation; adverse effects include gastrointestinal issues, hyperkalemia, hypokalemia, and hypercalcemia which can lead to arrhythmias.

BIPYRIDINES

Milrinone: Phosphodiesterase-3 inhibitor; enhances myocardial contractility via calcium influx and intracellular calcium movements.

Beta-Agonists

Dobutamine: Raises cardiac output while decreasing ventricular filling pressure; carries risks of angina and arrhythmias, especially in coronary artery disease patients.

Drugs Without Positive Inotropic Effects Used in Heart Failure

Diuretics: Spironolactone and eplerenone aid fluid management;
ACE Inhibitors: Captopril reduces afterload and improves long-term outcomes.
Beta Blockers: Reduce mortality in stable severe heart failure patients, excluding bucindolol.

Arrhythmias Overview

Caused by abnormal pacemaker activity or impulse conduction; categorized into:
- Class 1: Sodium channel blockade (subdivided into 1A, 1B, 1C);
- Class 2: Beta-blockers;
- Class 3: Prolong APD and block IKr;
- Class 4: Calcium channel blockade.

Heart Failure

Characterized by inadequate cardiac output; can be systolic or diastolic; symptoms include tachycardia, diminished exercise tolerance, and edema.
Goals of Treatment: Symptom relief, progression slowing, and acute decompensation management.

Digoxin as Heart Failure Therapy

Derived from Digitalis lanata; has a half-life of 36-40 hours; functions by inhibiting Na+/K+-ATPase; narrow therapeutic window; may not reduce mortality in chronic failure cases.

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Description

This quiz covers Class 1B sodium channel-blocking drugs, focusing on LIDOCAINE as a primary agent for managing ventricular tachycardia and preventing ventricular fibrillation during acute ischemia. Learn about its effectiveness, low toxicity, and its mechanism of action in blocking sodium channels. Reading assignments include other related agents like Mexiletine and Flecainide.