1. Ventricular Arrhythmias Flashcards
(93 cards)
1
Q
What are the 2 subtypes of ventricular arrhythmias?
A
- ventricular fibrillation
- ventricular tachycardia
2
Q
What are the 2 subtypes of ventricular tachycardia?
A
- monomorphic VT
- polymorphic VT
3
Q
Torsades de pointes belongs to what VT subtype?
A
polymorphic VT
4
Q
How does a patient with ventricular arrhythmia present?
A
- with or without pulse
- syncope
- chest pain
- lightheaded or dizziness
- palpitations
- dyspnea
5
Q
What does ACLS stand for?
A
Advance Cardia Life Support
6
Q
What are the 3 components of the first step of ACLS?
A
- start CPR
- give oxygen
- attach monitor
7
Q
What are the 2 drug therapy options for pulseless VT/VF ACLS?
A
- epinephrine 1 mg q 3-5 minutes
- amiodarone 300 mg bolus, second dose 150 mg followed by continuous infusion
8
Q
What are the 5 H’s that cause cardiac arrest?
A
- hypovolemia
- hypoxia
- hydrogen ion (acidosis)
- hypo/hyperkalemia
- hypothermia
9
Q
What are the 5 T’s that cause cardiac arrest?
A
- tension pneumothorax
- tamponade, cardiac
- toxins
- thrombosis, pulmonary
- thrombosis, coronary
10
Q
What should you check for in the second step of ACLS?
A
Is the rhythm shockable?
11
Q
What rhythms are considered unshockable?
A
- asystole
- pulseless electrical activity (PEA)
12
Q
What rhythms are considered shockable?
A
- ventricular fibrillation
- pulseless ventricular tachycardia
13
Q
After defibrillating a patient, what is the next step?
A
- CPR for 2 minutes
- IV access
14
Q
If patient is able to be shocked for a 2nd time, what is the next step?
A
- CPR for 2 minutes
- epinephrine q 3-5 minutes
- consider advanced airway and capnography
15
Q
What is capnography?
A
the monitoring of the concentration or partial pressure of carbon dioxide
16
Q
If a patient is able to be shocked for a 3rd time, what is the next step?
A
- CPR for 2 minutes
- amiodarone
- treat reversible causes
17
Q
If a patient is NOT a candidate for defibrillation, what is the next step?
A
- CPR for 2 minutes
- IV access
- epinephrine q 3-5 minutes
- consider advanced airway and capnography
18
Q
What are the characteristics of return of spontaneous circulation?
A
- pulse and blood pressure
- abrupt sustained increase in PETCO2
- spontaneous arterial pressure waves with intra-arterial monitoring
19
Q
What is first line therapy for pulseless VT/VF?
A
defibrillation
20
Q
What are the “shockable rhythms”?
A
pulseless VT and VF
21
Q
Defibrillation “jump starts” the heart. (T/F)
A
False
22
Q
Defibrillation produces temporary ________.
A
asystole
23
Q
What is the purpose of producing temporary asystole?
A
- completely depolarizes the heart
- allows the nodes to restore normal activity
24
Q
Following asystole due to defibrillation, if sufficient store of ______ remain in the heart, it should restore normal sinus rhythm.
A
ATP
25
What are the roles of the pharmacist in ACLS?
- anticipate and prepare medications for administration
- communicate instructions for medical administration
- aide in medication choices
26
What does VT look like on ECG?
wide QRS complex arrhythmia
27
Ventricular tachycardia is defined as at least __ consecutive premature ventricular contractions at a rate of > ____ beats/minute.
- 3
| - 100
28
NSVT spontaneously terminates in what amount of time?
< 30 seconds
29
What does NSVT stand for?
non-sustained ventricular tachycardia
30
SVT lasts for what amount of time?
> 30 seconds
31
What intervention can be made for SVT?
cardioversion
32
What does SVT stand for?
sustained ventricular tachycardia
33
What is ventricular storm?
3 or more sustained episodes of VT/VF or appropriate shocks from implacable cardioverter-defibrillator within 24 hours.
34
What are the medication options for ventricular storm?
- Class III agents: amiodarone
- β blockers
- Class Ib agents: lidocaine, mexiletine
- Procainamide
35
What medication should be avoided in VT storm?
catecholamines
36
What are the 2 treatment options for VT storm?
- medication therapy
| - perform revascularization if indicated
37
VT/VF is often driven through excessive systemic _________.
catecholamines
38
What are the catecholaminergic agents that should be avoided in VT/VF?
- epinephrine
- norepinephrine
- dopamine
- dobutamine
- phenylephrine
39
Which β blocker agents should be chosen first?
cardiac-specific
40
If a patient has underlying HF, what β blocker agent should be chosen in VT/VF?
- carvedilol
- metoprolol
- bisoprolol
41
What is the dose of carvedilol for HF patient in VT/VF?
25 mg BID (50 mg BID if > 80 kg)
42
What is the dose of metoprolol XL for HF patient in VT/VF?
200 mg daily
43
What is the dose of bisoprolol for HF patient in VT/VF?
10 mg daily
44
If a HF patient is in VT/VF and is unstable or has no oral access, what are the β blocker options?
- Metoprolol IV
| - Esmolol IV
45
What is the IV dose of metoprolol?
- 5 mg IV push
- repeating q 5 minutes up to 3 doses
- maintenance of 5-10 mg IV q 4-6 hours until oral conversion is possible
46
What is the dose of IV esmolol?
continuous infusion 25 - 300 mcg/kg/min
47
What is the dose of amiodarone in patient with VT with pulse?
- 150 mg IV bolus
- followed by 1 mg/min continuous infusion for 6 hours
- decrease to 0.5 mg/min for 18 hours
48
When should amiodarone be converted to oral therapy?
after first 24 hours if patient remains in sinus rhythm
49
What is the oral dose of amiodarone?
- oral load to total of 10 g : 200-400 mg given 2-3x / day
| - maintenance dose: 400 mg PO daily
50
Amiodarone is a CYP _______
inhibitor
51
What should be monitored during the administration of amiodarone? (5)
- thyroid function test
- pulmonary function test
- liver function test
- eye exam
- EKG
52
How often should a patient on amiodarone get a thyroid function test?
baseline and every 6 months
53
How often should a patient on amiodarone get a pulmonary function test?
baseline and every 12 months
54
How often should a patient on amiodarone get a liver function test?
baseline and every 6 months
55
How often should a patient on amiodarone get an eye exam?
baseline and every 12 months
56
How often should a patient on amiodarone get an EKG?
baseline and every 3–6 months
57
What are some counseling points for amiodarone?
- wear sunscreen and avoid excessive sun exposure
| - report any signs of possible ADRs
58
What are ADRs that patients on amiodarone should report to their doctor?
- dyspnea
- tachycardia/bradycardia
- abdominal pain
- lethargy/fatigue
- vision change
59
Which β blocker is not effective for cardioversion?
sotalol
60
What receptor does stall block?
β1 and β2
61
What are the ADRs of sotalol?
- CHF exacerbation
- bradycardia
- Torsades
- QT prolongation
62
What is the dose of sotalol?
- 80 mg BID
| - increase every 3 days until QTc ~ 500 msec
63
In what patients is sotalol contraindicated?
- baseline QTc > 440 msec
- ClCr < 40 mL/min in atrial arrhythmias and slightly lower for ventricular arrhythmias
- heart block
- pre-existing severe pulmonary disease
- asthma
64
Sotalol should be decreased in ______ dysfunction.
renal
65
What is the sotalol dose with CrCl 40–60 mL/min?
80 mg daily
66
In what patients is amiodarone contraindicated?
- pre-existing severe hepatic failure
- pre-existing severe pulmonary disease (documented DLCO < 50%)
- heart block
- hyperthyroidism
67
Class Ib agents control what?
ventricular arrhythmias only
68
What is the dose of lidocaine?
- 1 mg/kg IV bolus
| - 1–4 mg/min
69
What are ADRs for lidocaine?
- hypotension
- bradycardia
- nystagmus
- dizziness
- seizure
- confusion/disorientation
70
In what patients is lidocaine contraindicated?
3rd degree block
71
In what patients should the dose of lidocaine be decreased?
- liver dysfunction
- renal dysfunction
- HF
- cirrhosis
- elderly patients
72
Lidocaine requires ________ to adjust dose.
PK monitoring
73
What are the Class Ib agents used for ventricular arrhythmias?
- lidocaine
| - mexiletine
74
The oral dose of mexiletine is equivalent to what?
lidocaine
75
What is the dose of PO mexiletine?
200 mg PO q8h
76
What are the ADRs of mexiletine?
- NVD
- anorexia
- tremor
- blurry vision
- confusion
- ataxia
77
Mexiletine is used ____-line to suppress ventricular arrhythmias.
last
78
Mexiletine should be used only after trying to suppress the ventricular arrhythmia with what agents?
- amiodarone
| - sotalol
79
Procainamide is used it what situations?
refractory ventricular arrhythmias
80
What is the dose of procainamide?
- 10 mg/kg bolus
| - consider following with 2–6 mg/min infusion
81
What should be monitored during procainamide administration?
procainamide + NAPA level
82
What is the goal level of procainamide + NAPA?
3–10 mcg/mL
83
What are the ADRs of procainamide?
- Lupus erythematous-like syndrome
- hematologic dysfunction
- GI disturbances
- anticholinergic side effects
84
What is the purpose of device therapy in patients with ventricular arrhythmias?
prevention of sudden cardia death
85
When might device therapy be used for primary prevention?
following episodes of
- syncope
- proarrhythmic events but not sudden cardiac death
86
When might device therapy be used for secondary prevention?
following episodes of sudden cardiac death
- VT/VF
- asystole
- PEA
87
Torsades de pointes is a serious, but not life-threatening event. (T/F)
False: life-threatening
88
Describe the EKG of tornadoes de pointes.
QRS intervals twist around the isoelectric line of the EKG
89
Torsades de pointes can be acquired or inherited. (T/F)
True
90
Torsades de pointes results from myocardial depolarization due to what?
efflux of potassium ions
91
What electrolyte imbalances can contribute to the development of TDP?
Low Ca, K, Mg
92
What cardiac diseases can contribute to the development of TDP?
- MI / CAD
- HF
- heart block
- bradycardia
93
What are the sole treatments for TDP?
- direct current cardioversion (DCCV)
| - IV magnesium
