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Questions and Answers
What is the indication for using a pacemaker in patients?
What is the indication for using a pacemaker in patients?
- Unresponsive to sodium bicarbonate therapy (correct)
- Ventricular arrhythmias
- Supraventricular rhythm disorders
- Unresponsive to quinidine therapy
What is a side effect of disopyramide?
What is a side effect of disopyramide?
- Tachycardia
- Urinary retention (correct)
- Increased heart rate
- Hypotension
Which of the following is NOT a method of enhanced elimination for quinidine?
Which of the following is NOT a method of enhanced elimination for quinidine?
- Activated charcoal
- Acidification of urine (correct)
- Dialysis
- Hemoperfusion
Which anti-dysrhythmic drug has alpha-adrenergic receptor-blocking activity?
Which anti-dysrhythmic drug has alpha-adrenergic receptor-blocking activity?
What type of arrhythmias do quinidine and procainamide suppress?
What type of arrhythmias do quinidine and procainamide suppress?
Which of the following is a clinical presentation of anti-dysrhythmic overdose?
Which of the following is a clinical presentation of anti-dysrhythmic overdose?
What is the class of anti-dysrhythmic drugs that includes Tocainide, Mexiletine, and Lidocaine?
What is the class of anti-dysrhythmic drugs that includes Tocainide, Mexiletine, and Lidocaine?
What is the effect of disopyramide on the heart rate?
What is the effect of disopyramide on the heart rate?
Which of the following is a method of decontamination for anti-dysrhythmic overdose?
Which of the following is a method of decontamination for anti-dysrhythmic overdose?
What is the primary mechanism of toxicity for the drugs mentioned?
What is the primary mechanism of toxicity for the drugs mentioned?
What is the effect of Reflex sympathetic response on the heart?
What is the effect of Reflex sympathetic response on the heart?
What is the excretion route for 60% of Prazosin and other newer α1 specific agents?
What is the excretion route for 60% of Prazosin and other newer α1 specific agents?
What is the purpose of repeat-dose activated charcoal in the treatment of toxicity?
What is the purpose of repeat-dose activated charcoal in the treatment of toxicity?
Which laboratory studies are recommended in the treatment of toxicity?
Which laboratory studies are recommended in the treatment of toxicity?
What is the primary goal of emergency and supportive measures in the treatment of toxicity?
What is the primary goal of emergency and supportive measures in the treatment of toxicity?
Which of the following drugs is not associated with specific blood levels that are routinely available or clinically useful?
Which of the following drugs is not associated with specific blood levels that are routinely available or clinically useful?
What is the effect of Terazosin and doxazosin on the body?
What is the effect of Terazosin and doxazosin on the body?
What is the purpose of decontamination measures such as activated charcoal, ipecac-induced emesis, and cathartics in the treatment of toxicity?
What is the purpose of decontamination measures such as activated charcoal, ipecac-induced emesis, and cathartics in the treatment of toxicity?
Which of these drugs is NOT a Type Ia antiarrhythmic?
Which of these drugs is NOT a Type Ia antiarrhythmic?
What is the primary mechanism of action for Type Ia antiarrhythmics?
What is the primary mechanism of action for Type Ia antiarrhythmics?
What is a potential side effect of prolonged use of procainamide?
What is a potential side effect of prolonged use of procainamide?
Which of the following is a characteristic of the prolonged QT interval that can occur with Type Ia antiarrhythmics?
Which of the following is a characteristic of the prolonged QT interval that can occur with Type Ia antiarrhythmics?
Which of the following is a potential adverse effect of Type Ia antiarrhythmics related to myocardial contractility?
Which of the following is a potential adverse effect of Type Ia antiarrhythmics related to myocardial contractility?
Which of the following is NOT a typical treatment for Type Ia antiarrhythmic overdose?
Which of the following is NOT a typical treatment for Type Ia antiarrhythmic overdose?
How do Type Ia antiarrhythmics affect the cardiac action potential?
How do Type Ia antiarrhythmics affect the cardiac action potential?
What is the relationship between the prolonged QT interval and polymorphic ventricular tachycardia?
What is the relationship between the prolonged QT interval and polymorphic ventricular tachycardia?
Which of these drugs can cause lupus-like syndrome?
Which of these drugs can cause lupus-like syndrome?
What is the primary cause of hyperglycemia in calcium channel blocker toxicity?
What is the primary cause of hyperglycemia in calcium channel blocker toxicity?
What is the term for the condition characterized by an accumulation of lactic acid in the blood?
What is the term for the condition characterized by an accumulation of lactic acid in the blood?
Which laboratory test is used to confirm the presence of lactic acidosis?
Which laboratory test is used to confirm the presence of lactic acidosis?
What medication is used to treat hemodynamically significant bradycardia in calcium channel blocker toxicity?
What medication is used to treat hemodynamically significant bradycardia in calcium channel blocker toxicity?
Which of these is a potential complication of calcium channel blocker toxicity?
Which of these is a potential complication of calcium channel blocker toxicity?
What is the recommended dose of IV calcium gluconate for calcium channel blocker toxicity?
What is the recommended dose of IV calcium gluconate for calcium channel blocker toxicity?
What medication is used to improve heart rate and contractility in calcium channel blocker toxicity?
What medication is used to improve heart rate and contractility in calcium channel blocker toxicity?
Which of these medications can be used as an alternative to dopamine or norepinephrine if a long transport time is likely?
Which of these medications can be used as an alternative to dopamine or norepinephrine if a long transport time is likely?
What is the primary reason for administering activated charcoal in calcium channel blocker toxicity?
What is the primary reason for administering activated charcoal in calcium channel blocker toxicity?
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Study Notes
Type Ia Antiarrhythmics
- Depressed myocardial contractility associated with alpha-adrenergic blockade may lead to hypotension and potential pulmonary edema.
- Examples include Quinidine, Procainamide (Pronestyl®), and Disopyramide (Norpace®).
- Mechanism of action involves depressing fast sodium-dependent channels, slowing phase zero of cardiac action potential.
- High concentrations can severely reduce myocardial contractility and depress cardiac conduction velocity.
- Common side effects of Procainamide include gastrointestinal upset and a lupus-like syndrome characterized by a butterfly rash from chronic use.
- Reduced myocardial contractility results in inhibited Na channels and prolonged QT interval, potentially leading to polymorphic ventricular tachycardia.
- A cardiac pacemaker may be required if patients do not respond to sodium bicarbonate therapy.
- Quinidine and Disopyramide possess anticholinergic properties, leading to urinary retention, constipation, and dry mouth.
- Effective for managing acute and chronic supraventricular and ventricular arrhythmias.
- Treatment strategies include emergency support measures, activated charcoal for decontamination, and enhanced elimination methods like dialysis.
Type Ib Antiarrhythmics
- Includes drugs like Tocainide, Mexiletine, and Lidocaine.
- Clinical presentations may show sedation and effects on cardiovascular performance.
- Laboratory studies to monitor involve electrolytes, blood glucose, BUN, creatinine, and ECG analysis.
Mechanism of Toxicity (Type Ib)
- Peripheral vasodilation can lead to hypotension.
- Negative effects include negative chronotropy, inotropy, and dromotropy, which can slow heart rate and conduction.
- Reflex sympathetic response can induce tachycardia and arrhythmias.
Cardiovascular Effects of Calcium Channel Blockers
- Hypotension treatment involves fluid boluses; if ineffective, dopamine or norepinephrine may be considered.
- Prolonged CPR is indicated in cases of cardiac arrest from calcium channel blocker overdose as patients can remain neurologically intact after extended resuscitation efforts.
Laboratory Studies in Toxicity Management
- Assess serum electrolytes and renal function (BUN/creatinine) for optimum treatment response.
- Administer IV calcium gluconate/chloride and glucagon if hypotension persists.
- Activated charcoal is safe if the airway is protected, but avoid ipecac syrup.
General Treatment Approaches
- Immediate supportive measures essential during toxic exposure.
- Regular monitoring of vital signs and ECG is critical during treatment of antiarrhythmic and overdose scenarios.
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