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Pharm II Exam 3 > Anti-arrhythmic drugs: Afib and SVT > Flashcards

Anti-arrhythmic drugs: Afib and SVT Flashcards

1
Q

What is A-fib?

A

Loss/incoordination of atrial activity

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2
Q

What can A-fib increase the risk of?

A

-Blood pooling due to inadequate emptying of the ventricle
-Thrombosis

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3
Q

What is SVT?

A

Tachyarrhythmia originating at the atrial or atrioventricular (AV) nodal tissue

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4
Q

SVT is most commonly due to what?

A

AV nodal re-entry

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5
Q

Acute SVT can be caused by what?

A

Alcohol, excessive caffeine, recreational drugs, hyperthyroidism

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6
Q

Vaughan-Williams Classification of Antiarrhythmics for Class Ic?

A

Na+ channel blockers w/ slow association/dissociation (Flecainide, Propafenone)

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7
Q

Vaughan-Williams Classification of Antiarrhythmics for Class II?

A

Beta Blockers (Propanolol, Metoprolol)
*Propanolol also shows some class I action

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8
Q

Vaughan-Williams Classification of Antiarrhythmics for Class III?

A

K+ channel blockers (Amiodarone, Sotalol, Dronedrone, Dofetilide)
*Sotalol is also a BB
*Amiodarone has class I, II, III, and IV activity

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9
Q

Vaughan-Williams Classification of Antiarrhythmics for Class IV?

A

Ca2+ channel blockers (Verapamil, Diltiazem)

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10
Q

Vaughan-Williams Classification of Antiarrhythmics for Class V?

A

Work by unknown mechanisms (Adenosine, Digoxin)

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11
Q

Phase 0 of cardiac action potential?

A

Depolarization (Open Na+ channels)

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12
Q

Phase 1 of cardiac action potential?

A

Initial Repolarization (K+ leaves)

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13
Q

Phase 2 of cardiac action potential?

A

Plateau (K+ out, Ca2+ in)

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14
Q

Phase 3 of cardiac action potential?

A

Rapid Repolarization (K+ rushes out, Ca2+ starts to close)

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15
Q

Phase 4 of cardiac action potential?

A

Resting potential

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16
Q

MOA of Propafenone?

A

Blocks fast inward Na+ current, slows increase of action potential, prolongs conduction and refractoriness in all areas of the myocardium, reduced spontaneous automaticity and exhibits some BB activity

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17
Q

Indications for Propafenone?

A

-A-fib (to prevent recurrence)
-Paroxysmal SVT (to prevent recurrence)

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18
Q

Any change in dosing of Propafenone in geriatric patients?

A

No, use adult dosing

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19
Q

Renal adjustment for Propafenone?

A

None (yet use w/ caution as 50% metabolites are excreted through the urine)

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20
Q

Hepatic adjustment for Propafenone?

A

None (yet consider adjustment if necessary as drug undergoes hepatic metabolism)

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21
Q

ROA for Propafenone?

A

PO
*swallow whole: do not chew/crush
*with or w/o meals

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22
Q

Side effects of Propafenone?

A

N/V, loss of strength/energy, constipation, change in taste, headache, anxiety

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23
Q

Frequency of Propafenone?

A

BID or TID

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24
Q

Seek assistance/report to prescriber for Propafenone when…?

A

Infection, angina, bradycardia, tachycardia, severe dizziness, passing out, abnormal heartbeat, SOB, excessive wt. gain, swelling in arms/legs, blurred vision

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25
Q

Drug-drug interactions of Propafenone?

A

-QT prolongation w/ fluoxetine (paroxetine increases serum conc. of Propafenone)
-Apiprazole (increased serum conc. when taken w/ Propafenone)
-May inc. serum conc. levels of BB

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26
Q

Monitoring parameters for Propafenone?

A

BP, ECG, Pulse

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27
Q

Is Propafenone absorbed well?

A

Yes

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28
Q

How much of Propafenone is protein bound?

A

95%

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29
Q

How long does Propafenone take to peak?

A

3-8 hours

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30
Q

Half life of Propafenone?

A

2-32 hours

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31
Q

MOA of Flecainide?

A

Slows conduction in cardiac tissue by altering transport of ions across cell membrane, slight prolongation of refractory periods, decreases rate of rise of action potential w/o affecting its duration

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32
Q

Indications for Flecainide?

A

-Paroxysmal A-fib
-Paroxysmal SVT (prevention)

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33
Q

Any changes in dosing for Flecainide in geriatric patients?

A

No, adult dosing used

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34
Q

Renal adjustment for Flecainide?

A

Decrease dose/interval

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35
Q

Hepatic adjustment for Flecainide?

A

None (yet use w/ caution, check plasma conc.)

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36
Q

ROA for Flecainide?

A

PO
*may need to watch dietary changes of milk intake

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37
Q

Side effects of Flecainide?

A

Headache, dizziness, visual disturbances, dyspnea, nausea, fatigue, tremor

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38
Q

Seek assistance/report to prescriber for Flecainide when…?

A

Hepatic impairment, angina, severe dizziness, syncope, arrhythmia, bradycardia, tachycardia, dyspnea, excessive wt. gain, edema in extremities, tremors, vision changes, ecchymosis (bleeding under skin), hemorrhage

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39
Q

Disease related concerns for Flecainide?

A

Contraindicated in those w/ structural heart disease

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40
Q

Drug-drug interactions of Flecainide?

A

Watch meds w/ QT prolongation effects

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41
Q

Monitoring for Flecainide?

A

ECG, BP, Pulse, Periodic serum trough concentrations

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42
Q

When does Flecainide peak?

A

3 hours

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43
Q

Half life of Flecainide?

A

8-20 hours depending upon age

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44
Q

Selectivity of Metoprolol?

A

B-1 selective

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45
Q

MOA of Metoprolol?

A

Select inhibitor of B-1-adrenergic receptors, competitively blocks B-1 R’s w/ little to no efffect on B-2 R’s at oral doses <100mg in adults

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46
Q

Indications for Metoprolol?

A

-A-fib: acute & maintenance
-SVT: off label use for acute & maintenance

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47
Q

Any dose changes for Metoprolol in geriatric patients?

A

No, use adult dosing

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48
Q

Renal or Hepatic adjustments for Metoprolol?

A

None

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49
Q

ROA of Metoprolol?

A

IV bolus or PO (with food)

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50
Q

Side effects of Metoprolol?

A

Diarrhea, loss of strength/energy, vomiting, hypotension, dizziness, fatigue

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51
Q

Dose frequency of Metoprolol?

A

QD or BID

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52
Q

Seek assistance/report to prescriber for Metoprolol when…?

A

Depression, illogical thinking, memory impairment, severe dizziness, passing out, skin discoloration, sensation of cold, angina, arrhythmias, bradycardia, SOB, excessive wt. gain, swelling of extremities, vision changes

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53
Q

Disease related concerns with Metoprolol?

A

DM, bradycardia, peripheral vascular disease/Raynaud’s, thyroid disease, depression

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54
Q

Can you withdraw Metoprolol abruptly?

A

NO, slow taper over 1-2 weeks to avoid rebound tachycardia

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55
Q

Drug-drug interactions with Metoprolol?

A

NSAIDs, Sulfonylureas, Theophylline

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56
Q

Monitoring with Metoprolol?

A

IV: ECG, HR, BP
PO: HR, Rhythm, BP

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57
Q

Onset of action for PO Metoprolol?

A

3-6 hours

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58
Q

Onset of action for IV Metoprolol?

A

20 min

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59
Q

Half life of Metoprolol?

A

3-9 hours depending on Hepatic function

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60
Q

MOA of Amiodarone?

A

Adrenergic stimulation (alpha & beta blocking properties), affects sodium, potassium, and calcium channels, prolongs action potential and refractory period in myocardial tissue, decreases AV conduction and sinus node function

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61
Q

Indications for Amiodarone?

A

-A-fib: acute, maintenance, off-label
-SVT: not first line, acute

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62
Q

Changes for Amiodarone dosing in geriatric patients?

A

Adult doses but typically on the lower end of dosing, slow taper

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63
Q

Renal adjustment for Amiodarone?

A

None

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64
Q

Hepatic adjustment for Amiodarone?

A

In more severe impairment, dose reduce or avoid

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65
Q

ROA of Amiodarone?

A

-IV over 1 or more hours
-PO (with food, divide dose if GI upset, avoid grapefruit juice**)

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66
Q

Black box warning/side effects for Amiodarone?

A

Arrhythmia, pulmonary toxicity
Constipation, N/V, loss of strength/energy, lack of appetite

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67
Q

Seek assistance with Amiodarone if…?

A

Liver problems, signs of severe pulmonary disorder, signs of thyroid problems, signs of SJS-TEN, bradycardia, vision changes, eye pain, severe eye irritation, sensitivity to light, SOB, bruising/bleeding, joint/muscle pain

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68
Q

Drug-drug interactions of Amiodarone?

A

-Numerous due to extensive metabolism (CYP3A4, 2C8, 2C9, 2D6, 1A2)
-MAJOR INTERACTION: Sofosbuvir (severe bradycardia)
-Watch w/ meds that have QT prolongation effects

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69
Q

Monitoring for Amiodarone?

A

BP, HR (ECG) & rhythm throughout therapy, lethargy, edema of hands/feet, weight loss, pulm. toxicity (Baseline PFTs & CXR, continue monitoring CXR annually w therapy), LFTs (semiannually), serum electrolytes (esp. K+ and Mg), thyroid function tests

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70
Q

Onset of Amiodarone?

A

2 days-3 weeks

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71
Q

Half life of Amiodarone?

A

40-55 days

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72
Q

How much of Amiodarone is protein bound?

A

96%

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73
Q

MOA of Dronedarone?

A

Structurally related to amiodarone.
Inhibits sodium and potassium channels prolonging AP and refractory period in myocardial tissue w/o reverse-use dependent effects, decreases AV conduction & sinus node function through inhibition of calcium channels, Beta-1 R blocking activity

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74
Q

Indications for Dronedarone?

A

Paroxysmal or persistent A-fib

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75
Q

Any changes in dosing of Dronedarone in geriatric patients?

A

No, use adult dosing

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76
Q

Renal adjustments for Dronedarone?

A

None

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77
Q

Hepatic adjustments for Dronedarone?

A

Contraindicated in severe impairment

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78
Q

ROA for Dronedarone?

A

PO (w/ morning & evening meal, avoid grapefruit**)

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79
Q

Side effects of Dronedarone?

A

Diarrhea, N/V, loss of strength/energy, abdominal pain

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80
Q

Frequency of dosing for Dronedarone?

A

BID

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81
Q

Seek assistance with Dronedarone if…?

A

Signs of kidney problems, signs of heart problems, signs of liver problems, signs of severe pulmonary disorder, dizziness, bradycardia, abnormal heartbeat, QT prolongation

82
Q

Drug-Drug interactions of Dronedarone?

A

-Increases conc. of Atorvastatin
-BB: bradycardia
-CCB
-Avoid cyclosporine
-Reduce Digoxin by 50%
-Avoid propafenone (QT-prolongation)
-Increases conc. of Fentanyl

83
Q

Monitoring for Dronedarone?

A

ECG (at least q3months), BP, HR & rhythm throughout, signs of lethargy, edema of hands/feet, serum electrolytes (esp. K+ & Mg), serum liver enzymes & bilirubin (periodically, esp. in first 6 months)

84
Q

Peak for Dronedarone?

A

3-6 hours

85
Q

Half life of Dronedarone?

A

13-19 hours

86
Q

How much of Dronedarone is protein bound?

A

> 98%

87
Q

Sotalol has what kind of slectivity?

A

Non-selective BB

88
Q

MOA of Sotalol?

A

Increased sinus cycle length, slowed HR, decreased AV nodal conduction, increased AV nodal refractoriness, has both Beta-1 & Beta-2 R blocking activity

89
Q

Seek assistance with Sotalol if..?

A

Dizziness, passing out, angina, bradycardia, tachycardia, abnormal heartbeat, severe loss of strength/energy, vision changes, SOB, excessive wt. gain, swelling of extremities, *injection site pain/irritation/edema, *excessive sweating

90
Q

Warnings for Sotalol?

A

Proarrhythmia, QT-prolongation, do not stop abruptly, avoid if asthma, use w/ caution in DM

91
Q

Drug-drug interactions with Sotalol?

A

Watch for additive effects (esp. meds that may cause bradycardia or QT prolongation)

92
Q

Monitoring for Sotalol?

A

Serum creatinine, magnesium, & potassium
HR, BP, ECG

93
Q

Onset of IV Sotalol?

A

5-10 min

94
Q

Onset of PO Sotalol?

A

1-2 hrs

95
Q

Half life of Sotalol?

A

12 hrs (up to 69 hrs in renal impairment)

96
Q

Labelling of Sotalol (Betapace brand)?

A

“AF” - drug more expensive but is the same drug w/ the same efficacy

97
Q

Frequency of dosing for Sotalol?

A

BID

98
Q

Indications for Sotalol?

A

-Symptomatic A-fib
-SVT (off label)

99
Q

Any dose changes for Sotalol in geriatric patients?

A

No, use adult dosing

100
Q

Renal adjustment for Sotalol?

A

Extend interval if CrCl <60 mL

101
Q

Hepatic adjustment for Sotalol?

A

None

102
Q

ROA for Sotalol?

A

IV over 5 hours
PO (without regards to meals)

103
Q

Side effects of Sotalol?

A

Headache, diarrhea, N/V, fatigue, weakness, sleep disorders

104
Q

MOA of Dofetilide?

A

Blockade of cardiac K+ ion chqannel using delay of repolarization

105
Q

Indications for Dofetilide?

A

A-fib
SVT (ongoing managment, off label use)

106
Q

Dose changes for Dofetilide in geriatric patients?

A

Adult dosing, but be cautious with renal dysfunction

107
Q

Renal adjustment for Dofetilide?

A

Dose reduction necessary

108
Q

Hepatic adjustment for Dofetilide?

A

None, but use w/ caution

109
Q

ROA for Dofetilide?

A

PO (with or w/o food)

110
Q

Side effects of Dofetilide?

A

Headache, common cold/flu-like sx, nausea, dizziness

111
Q

Frequency of dosing for Dofetilide?

A

BID

112
Q

Seek assistance with Dofetilide if…?

A

Angina, dizziness, passing out, bradycardia, tachycardia, abnormal heartbeat, SOB, *Torsades de pointes

113
Q

Drug-drug interactions with Dofetilide?

A

-Cimetidine: increases serum conc. of Dofetilide (avoid)
-Antifungals: decrease metabolism of Dofetilide (avoid)
-QT prolongation meds (avoid)
-Verapamil: increases serum conc. of Dofetilide

114
Q

Monitoring for Dofetilide?

A

ECG (w/ attention to QT), serum creatinine (baseline and changes), K+ and Mg levels

115
Q

Peak of Dofetilide?

A

Fasting: 2-3 hours

116
Q

Half life of Dofetilide?

A

10 hours (prolonged w/ renal impairment)

117
Q

What kind of CCBs are Verapamil and Diltiazem?

A

Non-dihydropyridine

118
Q

MOA of Diltiazem?

A

Inhibits Ca2+ from entering slow channels during depolarization, produces relaxation of coronary vascular smooth muscle/coronary vasodilation

119
Q

Indications for Diltiazem?

A

A-fib (acute) (rate control -off label)
SVT (ongoing management, off label)

120
Q

Changes in dosing of Diltiazem in geriatric patients?

A

None, adult dosing used

121
Q

Renal and Hepatic adjustment for Diltiazem?

A

None, but use w/ caution

122
Q

ROA for Diltiazem?

A

IV bolus over 2 min, then continuous infusion
PO (depends on formulation-> w/ meals, empty stomach, or before bedtime)

123
Q

Side effects of Diltiazem?

A

Edema, *flushing, headache, nausea, loss of strength/energy, *rhinorrhea, *pharyngitis, *infection site irritation

124
Q

Frequency of dosing for Diltiazem?

A

QD or QID

125
Q

Seek assistance with Diltiazem if….?

A

Liver problems, severe dizziness, passing out, bradycardia, abnormal heartbeat, SOB, excessive wt. gain, swelling of extremities, signs of *SJS-TEN

126
Q

Drug-drug interactions of Diltiazem?

A

-Atorvastatin: each can inc. serum concentration of other
-Cimetidine: increases serum conc. of CCB
-Increases serum conc. of Fentanyl

127
Q

Monitoring for Diltiazem?

A

LFTs, kidney function, BP, ECG, HR

128
Q

Onset for Diltiazem?

A

IV: 1-3 min
PO: 30-60 min

129
Q

Half life of Diltiazem?

A

IV: 3.5-4 hrs
PO: 3-9.5 hrs (depending on formulation)

130
Q

Changes in Verapamil for geriatric patients?

A

None, use adult dosing

131
Q

MOA for Verapamil?

A

Inhibits calcium from entering slow channels during depolarization, relaxation of coronary vascular smooth muscle/coronary vasodilation, slows automaticity and conduction of AV node

132
Q

Indications for Verapamil?

A

-A-fib (rate control)
-SVT (acute treatment, off label)

133
Q

Renal adjustment for Verapamil?

A

None unless Verelan PM (initial 100mg QD at bedtime), otherwise just use w/ caution

134
Q

Hepatic adjustment for Verapamil?

A

Reduce dose, % reduction dependent on formulation

135
Q

ROA of Verapamil?

A

IV over 2-3 min
PO dependent upon formulation (w/ food, watch splitting, no crushing!)

136
Q

Side effects of Verapamil?

A

Constipation, headache, gingival hyperplasia, edemae

137
Q

Frequency of dosing for Verapamil?

A

QD or QID

138
Q

Monitoring for Verapamil?

A

BP, HR, periodic LFTs, ECG

139
Q

Onset of Verapamil?

A

IV 3-5 min
PO 1-2 hrs

140
Q

Half life of Verapamil?

A

4-12 hours

141
Q

How much of Verapamil is protein bound?

A

90%

142
Q

Drug-drug interactions of Verapamil?

A

-Antifungals
-May increase conc. of Dofetilide and Fentanyl
-Simvistatin: limit adult max of Simv. to 10mg/day
-Ethanol: may increase blood ethanol levels, prolong effects
-Grapefruit juice may increase serum conc. of Verapamil

143
Q

Seek assistance with Verapamil if…?

A

Liber problems, bradycardia, arrhythmia, severe dizziness, passing out, SOB, excessive wt. gain, swelling of extremities

144
Q

MOA of Digoxin?

A

Direct suppression of AV nodal conduction increasing effective refractory period and decreasing conduction velocity, positive inotropic effect, enhanced vagal tone, dec. ventricular rate to fast atrial arrhythmias

145
Q

Indications for Digoxin?

A

A-fib (rate control) (off label dose)
SVT (rate control, off label use)

146
Q

Adjustment of Digoxin for geriatric patients?

A

Do not exceed 0.125 mg/day in pts 65+y/o

147
Q

Renal adjustment for Digoxin?

A

Reduce by 50% or avoid (may need to alter dose interval to q48hrs)

148
Q

Hepatic adjustment for Digoxin?

A

None

149
Q

ROA of Digoxin?

A

Total digitalizing dose (TDD)-
-IV: 8-12 mcg/kg (administer half of TDD over 5 min w/ remaining as 25% fractions at 4-8 hr intervals) OR (may administer 0.25mg w/ repeat dosing to max of 1.5 mg over 24 hrs followed by oral maintenance regimen)
-IV over 5 min
-IM (not preferred)
-PO (maintain adequate amounts of K+)

150
Q

Side effects of Digoxin?

A

Headache, dizziness

151
Q

Dosing frequency of Digoxin?

A

QD

152
Q

Seek assistance with Digoxin if…?

A

N/V, severe diarrhea, vision changes, visual halos o bright colors around lights, weight loss, lack of appetite, black/tarry/bloody stools, confusion, brady/tachycardia, hallucinations, irregular heartbeat, mood changes, severe abdominal pain, enlarged breasts

153
Q

Condition interacting with Digoxin?

A

Hypothyroidism may cause increased digoxin levels (due to decreased clearance)

154
Q

Drug-drug interactions with Digoxin?

A

Amiodarone: increases digoxin levels

155
Q

Monitoring with Digoxin?

A

-Digoxin toxicity levels over 2ng/mL
-Electrolytes (hypercalcemia can cause toxicity despite digoxin levels)
-HR, rhythm, periodic ECGs to assess effects/signs of toxicity

156
Q

Onset of Digoxin?

A

IV 50-60 min
PO 1-2 hrs

157
Q

Half life of Digoxin?

A

36-48 hours

158
Q

MOA of Adenosine?

A

Slows conduction time through AV node, interrupting re-entry pathways through AV node, restoring NSR

159
Q

Indications for Adenosine?

A

Paroxysmal SVT

160
Q

Adjustment of Adenosine for geriatric patients?

A

None, use adult dosing

161
Q

Renal & Hepatic adjustment with Adenosine?

A

None

162
Q

ROA for Adenosine?

A

IV push

163
Q

Side effects of Adenosine?

A

Abdominal pain, flushing

164
Q

Seek assistance with Adenosine if….?

A

*Severe cerebrovascular disease (change in strength, one side > other, difficulty speaking/thinking, change in balance or vision), SOB, angina, severe dizziness, passing out, brady/tachycardia, abnormal heartbeat, seizures, severe headache, *neck pain, *jaw pain, *throat pain

165
Q

Interactions with Adenosine?

A

-Caffeine: diminishes effects of adenosine
-Nicotine: enhances effect of AV blocking, may inc. HR, inc. severity of chest pain

166
Q

Monitoring for Adenosine?

A

ECG, HR, BP

167
Q

Onset on Adenosine?

A

Rapid

168
Q

Half life of Adenosine?

A

<10 seconds

169
Q

What is the “pill-in-the-pocket” approach for single-dose outpatient tx of select patients?

A

Single PO dose of meds can be given to terminate SVT outside of hospital in selected patients once safety is established

170
Q

Who is the “pill-in-the-pocket” approach an option for?

A

-Infrequent (<few/yr) but prolonged (>1-2hrs) SVT episodes which are hemodynamically tolerated
-Only one episode of SVT

171
Q

Drug options for “pill-in-the-pocket” approach?

A

CCBs, BBs, Flecainide 100-300mg, Propafenone 150-450mg

172
Q

“ABC” treatment method for A-fib?

A

Avoid stroke, Better symptoms, Comorbidity management

173
Q

How to avoid stroke in A-fib patients?

A

Anticoagulants (VKAs-Warfarin, NOACS-dabigatran, rivaroxaban, apixaban)
LA Appendage exclusion (surgery, precutaneous)

174
Q

How to better symptoms in a-fib patients?

A

HR control (BB, CCB, Digoxin)
Rhythm control (Cardioversion, Antiarrhythmetics- Amiodarone, etc., Ablation/Surgery)

175
Q

Comorbidity management with A-fib?

A

Obesity, BP, DM, CAD, CPAP if sleep apnea, Avoid excessive ETOH (abstinence ideal), Moderate physical activity, HF control

176
Q

What is the best option for anticoagulation in poor renal function?

A

Warfarin

177
Q

What is the best option for anticoagulation in mechanical heart valves?

A

Warfarin

178
Q

What is the best option for anticoagulation in rheumatic mitral stenosis?

A

Warfarin

179
Q

What is the best option for anticoagulation in those who may easily miss doses?

A

Warfarin

180
Q

Warfarin frequency of dosing?

A

Once daily

181
Q

INR target w/ Warfarin?

A

2-3

182
Q

Good option for anticoagulation for reducing stroke risk/major bleed?

A

Apixaban

183
Q

Apixaban frequency of dosing?

A

BID

184
Q

Which anticoagulant has an increased risk for GI bleed or MI?

A

Dabigitran

185
Q

Dabigitran frequency of dosing?

A

BID

186
Q

Which anticoagulant requires close monitoring of renal function?

A

Edoxaban

187
Q

Edoxaban frequency of dosing?

A

Once daily

188
Q

Which anticoagulant should be used in caution with Diltiazem, Dronedarone, and Verapamil, and also has an increased risk of GI bleed?

A

Rivaroxaban

189
Q

Rivaroxaban frequency of dosing?

A

Once daily

190
Q

Drugs for rate control in A-fib?

A

BB, Non-DHP CCBs, Digoxin, Amiodarone

191
Q

Which medications should be used in A-fib with COPD?

A

BB, Diltiazem, Verapamil

192
Q

Which medications should be used in A-fib with LV dysfunction or HF?

A

BB, Digoxin
Amiodarone

193
Q

Which medications should be used in A-fib with HTN or HFpEF?

A

BB, Diltiazem, Verapamil
Amiodarone

194
Q

Which medications should be used in A-fib with no other CV disease?

A

BB, Diltiazem, Verapamil
Amiodarone

195
Q

Antiarrhythmic drugs for A-fib?

A

Flecainide, Propafenone, Amiodarone, Varnakalant, Ibutilide

196
Q

Antiarrhythmic drugs for maintenance doses in A-fib?

A

Amiodarone, Flecainide, Propafenone, Disopyramide, Sotalol

197
Q

Strategies for rhythm control in patients with paroxysmal and persistent A-Fib with no structural heart disease?

A

Dofetilide, Dronedarone, Flecainide, Propafenone, Sotalol
Amiodarone
+/- Catheter ablation

198
Q

Strategies for rhythm control in patients with paroxysmal and persistent A-Fib with structural heart disease (CAD)?

A

Dofetilide, Dronedarone, Sotalol
Amiodarone
+/- Catheter ablation

199
Q

Strategies for rhythm control in patients with paroxysmal and persistent A-Fib with structural heart disease (HF)?

A

Dofetilide, Amiodarone
+/- Catheter ablation

200
Q

Acute tx of SVT of unknown mechanism?

A

Vagal maneuvers and/or IV adenosine (Class I)
–> if ineffective or not feasbile:
-Hemodynamically stable pts: IV BB, IV diltiazem or IV verapamil (Class IIa), if still ineffective: synchronized cardioversion
-Non-stable pts: Synchronized cardioversion

201
Q

Tx of ongoing SVT of unknown mechanism?

A

Ablation candidate?
Yes- EP study/catheter ablation (if pre-excitation and a candidate, or if no pre-excitation and prefers ablation)
No- med therapy (if ineffective, catheter ablation)

202
Q

Drug options for ongoing SVT of unknown mechanism?

A

-Recommended: BB, diltiazem or verapamil (in absence of pre-excitation)
-Flecainide or Propafenone (in absence of SHD)
-Amiodarone, Dofetilide, or Sotalol
-Digoxin (in absence of pre-excitation)

Pharm II Exam 3 (6 decks)

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