5 Written Questions

1. inward depolarizing Ca currents
   outward hyperpolarizing K current
2. CAT X
   numerous drug-drug interactions (TCAs, macrolides, class I and IV -> torsades)
   SE: hypoK, hypoMg, QT prolong, D/N/V/abd pain, asthenia, rash, pruritus, eczema, photosensitivity
   FAIL: renal, liver and TdP
3. prolongs repolarization by inhibiting the delayed rectifier K current
   ADE's: prolong QT and torsades
   not given with hx of prolonged QT
4. high dose or increased duration increases SE
   brady, AV block, HF, HTN, neutropenia, hepatic fail, pulmonary fibrosis, thyroid dysfunction, fatigue, corneal microdeposits, photosensitivity, blue-gray skin
   inhibits conversion of T4 to T3 in periphery (structurally similar to thyroxine)
   10%-20% -> abnormal liver enzymes
   MONITOR: pulm, thyroid & liver fcn
5. prolongation of plateau -> increased risk of early after depolarizations and torsades

5 Matching Questions

1. Class III Antiarrhythmics
2. Amiodarone Class I Mech
3. Sotalol
4. Amiodarone Class IV Mech
5. Droneradone Met

1. a K channel blockers
2. b mixed class II (B) and III (K)
   non-selective antagonist B adrenergics
   increases AP by blocking K channels (III)
   USE: severe V arrhythmia & cannot tol. amiodarone
   prevents fib/flut -> NSR
   Class II ADE: fatigue/brady
   Class III ADE: torsades
3. c 3A4/2D6
   strong inhibitors -> stopped or close monitor (statins, ketocanozole, gf juice)
   Strong inducers -> decrease avail.
   (rifampin, carbamazepine, st. John's wort)
   increases creat (levels at 7 days, new baseline)
4. d Ca channel blocker
   can get significant AV node block and brady
5. e Blocks Na channels -> decreases rate of firing in pacemaker cells (class I effect; inactive conformation)

5 Multiple Choice Questions

1. PO only
   inhibits Rapid component of delayed rectifier K current
   no effect on Na current
   increases AP and prolongs QT (dose dependent)
   can unduce vent arrhythmia-A-Fib/Flut only
   effective in maintenance of NSR after cardioversion
   no negative inotropic -> can use with low EF
   ADEs: torsaades, renal dosing
   1. Dofetilide
   2. Sotalol
   3. Ibutilide
   4. Dofetilide dosing
2. Non-competitively antagonizing alpha adrenergic and B adrenergic recepetors
   1. Amiodarone Class IV Mech
   2. Amiodarone Class III Mech
   3. Amiodarone Class II Mech
   4. Amiodarone Class I Mech
3. AP Prolongation most pronounced at slow rates (undesireable) and least pronounced at fast rates (desireable)
   no effect on upstroke or conduction velocity
   1. Reverse Use Dependency
   2. Droneradone ADE
   3. Dofetilide dosing
   4. Droneradone Met
4. IV or PO
   acts as a class I, II, III, & IV
   Mech: alters lipid membrane of cell where ion channels are located
   Acts on all cardiac tissues
   Preferred for hemodynamic unstable VTach/fib
   prevents arrhythmia in HF or hx MI
   1. Amiodarone
   2. Ibutilide
   3. Dofetilide
   4. Sotalol
5. cardiogenic shock
   severe SA-node dysfcn with marked sinus brady/syncope
   2/3 degree Heart Block
   1. Amiodarone Contraindications
   2. Amiodarone Class IV Mech
   3. Amiodarone Class II Mech
   4. Amiodarone Class III Mech

5 True/False Questions

1. Droneradone (Multag) → PO, similar to amniodarone
   decreased thryroid, pulmonary, vision SE profile
   Afib/flut
   contraindicated in class IV or II/III HR with recent decomp
   MUST Stop tx with other I or IV agents before starting

   True        False

2. What happens when K channel is blocked → Blocks Na channels -> decreases rate of firing in pacemaker cells (class I effect; inactive conformation)

   True        False

3. Amiodarone Class III Mech → Non-competitively antagonizing alpha adrenergic and B adrenergic recepetors

   True        False

4. Upside of inhibiting repolarization → prolongation of plateau -> increased risk of early after depolarizations and torsades

   True        False

5. Dofetilide dosing → daily wts
   daily k level>4
   daily serum creat clear (<20 ml-> DONOT GIVE)
   Daily QT measurements

   True        False