Feb 23, 2023
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Antiarrhythmics are usually more of a "can you figure out which class this drug is in" and I give you a number of mnemonics to put the right drug in the right place.
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Welcome to the Memorizing Pharmacology podcast. I’m Tony Guerra, pharmacist and author of the Memorizing Pharmacology book series, bringing you mnemonics, cases, and advice for succeeding in Pharmacology. Sign up for the email list at memorizingpharm.com to get your free suffixes cheat sheet or find our mobile-friendly self-paced online pharmacology review course at residency.teachable.com/P/mobile. Let’s get started with the show.
Alright, we’re going to go into antiarrhythmics or antidysrhythmics is really more correct pharmacology mnemonics and the first step is really to see where these are. You’re going to hear class one usually with Roman numerals rather than these kind of numbers but class 1 sodium channel blockers. Class 2 is the beta blocker, class 3 are potassium channel blockers, class 4 calcium channel blockers and class 5 are kind of the unknown or extras. Beta blockers and calcium channel blockers may be familiar from hypertension drugs but these other ones might be a little bit new.
So there’s Vaughn Williams which is how we kind of classify these and usually your questions are going to be in some way you have to know what the sodium channel blockers are or which ones are potassium channel blockers. So we’re going to do a couple of mnemonics to just kind of get you knowing what’s what and then we’ll go from there.
So, I made up a little story: NAB money in Kansas City, police are mad. A way to remember that number one is NA which is it’s actually for natrium but it’s sodium so sodium channel blockers and then the B in NAB and you can put two B’s here to make it more clear that it’s going to be beta blockers. And then Kansas City represents three and four which are going to be potassium which is calcium or calium that’s the K and then CA are the calcium from calcium channel blockers so NAB KC and then mad. The others that are kind of in this fifth group are magnesium, adenosine, and digoxin.
That’s kind of one way to do it. Another way is to maybe make a sentence like some block Kings and castles with mad moves. So the sum is for sodium okay and that would be NA plus block would be for beta blockers. K would be for potassium and kings CA from castles would be calcium channel blockers and then mad moves. The Mad represents the Magnesium, adenosine, and digoxin.
I’ve got a little picture here of a king and a Castle in chess okay so two different ways to remember those but some students have to remember like all of them like a lot of the drugs within the classes so the class ones actually divided up into class one A, one B, and one C.
Traditional way to remember this is Double Quarter Pounder with lettuce tomato mayo and more fries please so class 1A is disopyramide, quinidine, procainamide that’s the Double Quarter Pounder. The lettuce tomato Mayo is class 1B lidocaine, mexiletine, tocainide and then class 1C more fries please is moricizine, flecainide, propafenone.
So if you have to remember all of those then hopefully this is helpful and then we kind of add the other ones so a beta blocker. The nice thing is that the endings are the same so it’s like bisoprolol, atenolol, metoprolol ending with the OLOL. I just put the three Bam Bam for bisoprolol atenolol metoprolol you can think of Class 2 because they are they are you know have two B’s in beta blocker to remind you that’s class two.
Class three is potassium blockers: The sad poets so sad is for sotalol amiodarone dofetilide and The Poets is for potassium to remember that one, class four is the calcium channel blockers with four very dill pickles. So it’s class four and the Very Dill stands for verapamil and diltiazem. Okay, and then the class five, the Mad group is magnesium, adenosine, and digoxin. So if you have to remember all of them, this is a way to do it. So we can do a little quiz here, make sure that you’ve got this down. So on the left I have sodium, beta blockers, potassium, calcium channel blockers, and then the unknown. And then adenosine, procainamide, metoprolol, diltiazem and amiodarone are not in the right order.
So how do we get the right order? Well we think about our mnemonics here and our sodium again it’s going to be that Double Quarter Pounder so the P from procainamide. The beta blockers end in OLOL so that’s group two and again two B’s to remind you it’s group two. The potassium is going to be that sad poet and the A in sad poet is amiodarone. Then our four very dill pickles are the diltiazem and the verapamil that’s four. And then the Mad group is adenosine so that magnesium adenosine digoxin that’s in our fifth group.
And so it would look like this if the answers are correct. Okay so let’s just take a look at some of the characteristics of some of these. So for example if you’ve got group 1A procainamide this is the P in the Double Quarter Pounder it’s good for atrial fib supraventricular tachycardia vtac it’s really chemical cardioversion our mechanism is sodium and hypotension is really the big one here can cause a wide QRS but if we have hypotension as an adverse effect we probably don’t want to give it to a hypotensive patient then congestive heart failure second third degree heart block all of these would be contraindications.
And then what are we going to do? Well we’ll make sure to watch their labs and then an ECG would also be important as well so that’s procainamide. Get to amiodarone now we’re talking about ventricular fibrillation rather than atrial fibrillation resistant v-tac you can give it for atrial and ventricular dysrhythmias but that’s probably where you would put it potassium is our mechanism again this is group three we kind of skipped over the beta blockers.
And there’s a number of things that you’re going to have with adverse effects you really want to tell the patient about first the hypotension so just get that blood pressure just kind of dropping blue facial hue I couldn’t use the Blue Man Group because those guys are actually a thing so I just found this picture of and I thought it was clever that they’re kind of pacing and waiting in line and they’ve got blue faces and well blue bodies too and then vision changes.
So while it’s kind of tough to say well what does vision change look like having this rainbow iris just kind of reminds you that vision changes so hypotension blue facial hue and vision changes bradycardia and shock are really contraindications for this one. And then what do we want to monitor? We want to make sure to put cardiac monitor on and modified valsalva maneuver has just proven to be a bit better.
And then the Valsalva if you aren’t familiar with it it’s where you kind of plug your nose to pop your ears alright so again this is informational purposes only it’s not medical advice if you have a medical condition contact a medical professional.
Thanks for listening to the Memorizing Pharmacology podcast. You can find episodes cheat sheets and more at memorizingpharm.com. Again you can sign up for the email list at memorizingpharm.com to get your free suffixes cheat sheet or find our mobile friendly self-paced online pharmacology review course at residency.teachable.com/P/mobile. Thanks again for listening.
Like to learn more?
Find my book here: https://geni.us/iA22iZ
and subscribe to my YouTube Channel TonyPharmD here: https://www.youtube.com/c/tonypharmd
Here is the Link to my Pharmacy Residency Courses: residency.teachable.com