Class 7 Deck 2

Question 1

What is adenosine MOA

Answer 1

-Activates K channels that hyperpolarize nodal tissue causing transient 3rd degree block

Question 2

What drug inhibits the action of adensoine

Answer 2

-Methylxanthines

Question 3

What are the indication for adenosine?

Answer 3

• PSVT

- No effect on arrhythmias originating distal to AV node

Question 4

Adenosine toxicity

Answer 4

• Facial flushing
• Dyspnea
• Chest pressure
• Exacerbate bronchoconstriction in asthma

Question 5

What is Prodysrhythmic Effects?

Answer 5

-New Brady or Tachy arrhythmias associated with chronic antidysrhythmias drug treatment

Question 6

A K channel blockade may do what?

Answer 6

-Prolong QT causing polymorphic Vtach or VFib

Question 7

What 2 classes of antidysrhythmic meds may block K channels and prolong QT?

Answer 7

• Class 1A

- Class 3

Question 8

How to treat torsades

Answer 8

• Correct electrolytes
• Mag 2 grams
• Increase HR w/ temp pacing or isoprotenerol
• Cardiovert if hemodynamically unstable

Question 9

Incessant ventricular tachycardia is precipitated by what 2 antiarryhthmic drug classes?

Answer 9

-Class 1A and 1C (drugs that slow conduction of cardiac impulses)

Question 10

Wide complex ventricular rhythm is associated with what antiarryhthmic drug class and in what setting?

Answer 10

-Class 1C w/ structural heart disease

Question 11

What are the 3 treatment goals for antiarrhythmic drugs?

Answer 11

• Restore NSR
• Abolish ectopic beats
• Control HR

Question 12

What are the easy fixes when treating arrhythmias?

Answer 12

• Hypoxia
• Hypercarbia
• Acidosis/Alkalosis
• Electrolyte imbalance
• Temp

Question 13

What inhalational agent sensitizes myocardium to catecholamines that can lead to ventricular arrhythmias?

Answer 13

-Halothane

Question 14

How do inhalation agents effect cardiac rhythms?

Answer 14

-Affect conduction and cause junctional rhythms

Question 15

What 2 muscle relaxants are vagolytic?

Answer 15

• Pancuronium

- Gallamine

Question 16

Repeated doses of succs can lead to what types of arrhythmias?

Answer 16

• SB
• Junctional
• Ventricular arrhhythmias
• Asystole

Question 17

What may be the first sign of myocardial ischemia?

Answer 17

• PVC’s

- Changes in conduction

Question 18

What are 6 therapeutic alternatives to help slow the heart?

Answer 18

• Treat underlying cause
• Increase anesthetic depth
• Vagal maneuvers
• Drugs
• Overdrive pacing
• DC shock

Question 19

What are 6 therapeutic alternatives to help increase heart rate?

Answer 19

• Stop manipulation
• Atropine
• Pancuronium / gallamine
• Isoproterenol
• Ephedrine
• Pacing

Question 20

Intraop brady can be treated with what?

Answer 20

• Lighten anesthesia
• Anticholinergic (glyco/atropine)
• Beta agonist (isoproterenol/ephedrine)
• Pacemaker

Question 21

How should intraop SVTs be treated?

Answer 21

• Cardioversion if SBP is <80
• Focus on reversible causes
• Adenosine (PSVT)
• Procainamide (WPW)

Question 22

What drugs should be avoided in SVTs and why?

Answer 22

• Class 2 & 4 (AV nodal blocking)

- Induce VF

Question 23

AFib /Flutter should be treated how?

Answer 23

• Control ventricular rate using:
• Class 2&4 (AV nodal blockers)
• Esmolol/propanolol
• Diltiazem/Verapamil
• Tensilon/Neostigmine
• Digoxin (CHF)
• Vagal/overdrive pacing/DC cardioversion

Question 24

What class of drugs are more likely to terminate Afib/flutter?

Answer 24

• Class 1A (procainamide)

- Class 3 (Amiodarone)

Question 25

What 2 meds may be prior to DC cardioversion to help maintain sustained cardioversion?

Answer 25

• Procainamide

- Amiodarone

Question 26

How to treat sustained VT or VF?

Answer 26

• Lidocaine / Procainamide

- Amiodarone

Question 27

How to treat polymorphic VT

Answer 27

-Asynchronous DC countershocks

Question 28

How to prevent further polymorphic VT

Answer 28

• Mag
• K
• Increase HR
• Class 1B (lidocaine/phenytoin)