Naplex 2023 > Arrhythmias > Flashcards

Arrhythmias Flashcards

(77 cards)

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1
Q

conduct

A

transmit electrical charges

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2
Q

cardiac conductive system

A

electrical signalizing system that causes the atria and ventricles to contract

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3
Q

auscultation

A

listening to heart with stethoscope

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4
Q

arrhythmia

A

abnormal heart rhythm
can result in bradycardia (slow) or tachycardia (fast)zz

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5
Q

symptoms of arrythmia

A

heart “fluttering” or “skipping a beat”
dizziness
SOB
fatigue

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6
Q

diagnosis of arrhythmia

A

`ECG

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7
Q

Holter monitor

A

ambulatory ECG
detects intermittent arrythmias

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8
Q

normal sinus rhythm (NSR)

A

starts at SA node = pacemaker
60-100 BPM

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9
Q

conduction pathway

A

SA node
R and L atrium
AV node
Bundle of His
R bundle branch and R ventricle
L bundle branch and L ventricle
Purkinje fibers

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10
Q

source of arrhythmias

A

SA node firing abnormal rate/rhythm
scar tissue from past heart attack blocks/diverts signals
another part of the heart is acting as pacemaker

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11
Q

action potential

A

movement of ions through channels in myocytes that cause electrical impulses in the cardiac conduction pathway
give electricity to power heart

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12
Q

SA

A

pacemaker that has automaticity in cells = initiate own action potentials

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13
Q

Phase 0

A

heartbeat initiated
rapid ventricular depolarization = influx of Na = ventricular contraction
QRS complex

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14
Q

Phase 2

A

plateau response to influx of Ca and efflux of K

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15
Q

Phase 3

A

rapid ventricular repolarization bc efflux of K = ventricular relaxation
T wave

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16
Q

most common cause of arrhythmias

A

myocardial ischemia or infarction

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17
Q

non-cardiac conditions that can cause arrhythmias

A

electrolyte imbalances - K, Mg, Na, Ca
high sympathetic state - hyperthyroidism, infection, drugs (illicit drugs, antiarrhythmics, drugs that inc QT

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18
Q

origins of arrhythmias

A

supraventricular (above AV node)
ventricular (below AV node)

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19
Q

most common type of arrhythmia

A

atrial fibrillation
irregular/usually rapid ventricular response
inc risk of clot = stroke risk = may need anticoagulation

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20
Q

ventricular arrhythmias

A

premature ventricular contractions = skipped heartbeat; related to stress or too much caffeine
if in series = HR >100 = ventricular tachycardia
untreated VT can degenerate into ventricular fibrillation = completely disorganized electrical activation of ventricles = medical emergency

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21
Q

prolongation of QT interval

A

risk for Tosade de Pointes = can cause sudden cardiac death

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22
Q

QT prolongation risk factors

A

high dose of drug
multiple drugs
reduced drug clearance (drug interaction)
electrolytes: hypokalemia, hypomagnesemia
other cardiac conditions

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23
Q

drugs that inc or prolong QT interval

A

antiarrhythmics: !a, !c, III
hydroxychloroquine
azoles (except isavuconazaonium)
macrolies
quinolones
Lefamulin
SSRIs (worst w citalopram and escitalopram)
TCAs
mirtazapine
trazodone
venlafaxine
setrons
droperidol
metopclopramide
promethazine
First generation antipsychotics (haloperidol,
chlorpromazine, thioridazine)
Second generation antipsychotics (ziprasidone worst)
androgen deprivation therapy (leuprolide)
TKIs (nilotinib)
oxaliplatin
other: cilostazol, donepezil, fingolimod, hydrozyzine, loperamide, methadone, ranolazine, solifenacin, tacrolimus

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24
Q

what to do before starting drug from non-life-threatening arrythmia

A

check electrolytes/tox screen for reversible cause

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25
Vaughan Williams classification
categorizes antiarrhymic drugs based on dominant electrophysiological effect Double Quarter Pounds, Lettuce, Mayo, Fries Please Because Dieting During Stress Is Always Very Difficult
26
Class I drugs
Na-channel blockers proarrhythmic; caution with cardiac disease Ia: disopyramide, quinidine, procainamide Ib: lidocaine, mexiletine Ic: flecainide, propafenone
27
Class II drugs
Beta-blockers slow ventricular rates
28
Class III drugs
K-channel blockers Dronedarone Dofetilide Sotalol Ibutilide Amiodarone
29
Class IV
Ca-channel blockers, non-DHP verapamil diltiazem amiodarone and dofetilide preferable for AF in pts with HF Sotalol low ventricular rate
30
digoxin
Na-K-ATPase blocker
31
adenosine
activates adenosine receptors used for paroxysmal supraventricular tachycardia
32
rate control goals
goal HR <80 BPM if symptomatic lenient <110 BPM maybe if asymptomatic and have preserved L ventricular function
33
rate control meds
BB preferred non-DHP CCB - do not give to HFrEF patients
34
rhythm control
convert to NSR and maintain NSR cardioversion has high risk of thromboembolism; have anticoagulation at least 3 weeks before cardioversion and continue at least 4 weeks after cardioversion NOACs preferred over warfarin in non-valvular AF warfarin indicated in AF and mechanical heart valve can cardiovert with Class Ia, Ic, or III antiarrhythmic drugs or electrical cardioversion (do not use drugs if permanent AF)
35
amiodarone BBW
pulmonary toxicity hepatotoxicity for life-threatening arrhythmias only proarrhythmic, must be hospitalized for IV loading dose
36
amiodarone dosing
T1/2 = 40-60 days
37
amiodarone CI
iodine HSN
38
amiodarone warnings
hyper/hypothyroidism - amio inhibitors conversion of T4 to T3 optic neuropathy photosensitivity (slate-blue skin discoloration)
39
amiodarone side effects
hypotension bradycardia cornealmicrodeposits photosensitivity
40
amiodarone monitoring
ECG BP HR electrolytes LFTs thyroid function
41
amiodarone notes
infusions >2 hrs need non-PVC container (polyolefin/glass) premixed IV bags: Nexterone comes in non-PVC, non-DEHP container antiarrhythmic DOC in HF decrease infusion rate/dc prn for hypotension or bradycardia IF: use 0.22 micron filter; central line preferable incompatibile with heparin in IV contains iodine
42
amiodarone DI
inc levels of others - inhibitor of CYP450 2C9, 2D6, 3A4, and P-gp dec digoxin by 50%, warfarin by 30-50% do not exceed simvastatin 20 mg/day or lovastatin 40 mg/day additive dec HR w: non-DHP CCB, digoxin, BB, clonidine Sofosbuvir: inc bradycia; do not use together
43
diltiazem/verapamil CI
HFrEF
44
diltiazem/verapamil warnings
may worsen HF symptoms
45
diltiazem/verapamil side effects
edema arrhythmias constipation (more w verapamil) gingival hyperplasia
46
diltiazem/verapamil notes
non-DHP CCBs only CCBs used as antiarrhythmics
47
verapamil and diltiazem DI
additive dec HR: amiodarone, digoxin, BB, clonidine CYP3A4 substrates: check drugs, do not take with grapefruit substrates of P-gp; inhibitors of CYP3A4: inc conc of many drugs; lower doses of simvastatin or lovastatin
48
digoxin dosing
therapeutic range 0.8-2 ng/mL for AF CrCl <50: dec dose or frequency dec dose 20-25% when going oral to IV
49
digoxin monitoring
draw digoxin level
50
digoxin toxicity
initial toxicity s/sx: N/V, loss of appetite, bradycardia severe: blurred/double vision; greenish-yellow halos
51
digoxin notes
used w/ BB or non-DHP CCB for rate control antidote: DigiFab hypokalemia, hypomagnesemia, hypercalcemia inc risk of toxicity
52
digoxin DI
substrate of P-gp - inc with inhibitors like amiodarone, diltiazem, verapamil; with amiodarone - dec digoxin 50% additive with dec HR: amiodarone, non-DHP CCB, BB, clonidine
53
disopyramide warnings
proarrhythmic anticholinergic effects
54
disopyramide side effects
anticholinergic effects
55
quinidine dosing
take with food
56
quinidine warnings
proarrhythmic hemolysis risk (avoid in G6PD deficiency) can cause positive Coombs test
57
quinidine side effects
drug-induced lupus erythematosus (DILE) diarrhea stomach cramping cinchonism (overdose): tinnitus, hearing loss, blurred vision, HA, delirium
58
procainamide dosing
injection active metabolite N-acetyl procainamide NAPA is renally cleared therapeutic levels procainamide: 4-10 mcg/mL
59
procainamide BBW
granulocytosis long-term leads to positive ANA = result in DILE
60
procainamide warnings
proarrhythmic
61
procainamide notes
metabolism by acetylation - slow acetylators risk for toxicity
62
lidocaine
injection used for refractory VT/cardiac arrest
63
fkecainide BBW
proarrhythmic effects
64
flecainide CI
HF MI
65
propafenone CI
HF MI
66
propafenone warnings
proarrhythmic
67
propafenone side effects
taste disturbance (metallic)
68
dronedarone BBW
inc death, sstroke, HF in those with decompensated HF or permanent AF
69
dronedarone CI
use of strong CYP3A4 inhibitors and QT-prolonging drugs
70
dronedarone warnings
hepatic failure pulmonary disease (fibrosis)
71
dronedarone side effects
QT prolongation
72
dronedarone notes
does not have iodine little effect on thyroid avoid use with strong inhibitors.inducers of CYP3A4 and those that inc QT interval
73
sotalol dosing
non-selective BB CrCl <6-: dec frequency
74
sotalol BBW
adjust interval based on CrCl concentration dec QT prolongation risk
75
ibutilide
injection correct hypokalemia and hypomagnesmia prior and during
76
dofetilide BBW
initiate with continuous ECG monitoring assess CrCl for >=3 days proarrhythmic
77
dofetilide notes
DOC in HF

Naplex 2023 (21 decks)

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