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Theraputics Winter > Arrhythmias > Flashcards

Arrhythmias Flashcards

(92 cards)

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1
Q

PR interval

A

(0.12-0.2 sec)

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2
Q

QRS complex

A

(0.04 – 0.14 sec)

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3
Q

QT interval

A

( < 0.42 sec)

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4
Q

What can we stop if we see a phase 4 slope (no meds)

A
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5
Q

Double quarter pound lettuce mayo fries please

A

Class 1A - Disopyramide, Quinidine, Procainamide
Class 1B - Lidocaine, Mexilitine
Class 1C - Flecainide, Propafenone

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6
Q

Disopyramide dose

A
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7
Q

Disopyramide SV, AV, or both

A

Both

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8
Q

Disopyramide 4 AD

A

THE BIGGEST ANTICHOLINERGIC AND PROLONGED QTC
HF

hypotension
Tdp

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9
Q

Quinidine dose

A
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10
Q

Quinidine SV, AV, or both

A

Both

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11
Q

Quinidine AD

A

BIGGEST cinchonism[ diarrhea,nausea,
tinnitus, visual changes, dizziness, headache]

thrombocytopenia
diarrhea

hypotension
Tdp

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12
Q

Procainamide Dose

A

Only IV

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13
Q

Procainamide Lab monitoring

A

PA 4-8 mcg/mL
NAPA 4-10 mcg/mL
one of the drugs we can monitor

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14
Q

Procainamide SV, AV, or both

A

Both

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15
Q

Procainamide AD

A

BIGGEST - LUPUS-LIKE SYNDROME (oral long-term use)

Hypotension with IV
Tdp
LESS QTC prolonged than quinidine

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16
Q

Procainamide what is special about this class 1A drug

A

It a negative inotrope
worsens heart failure

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17
Q

Procainamide elimination

A

Renal and hepatic

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18
Q

pot k and mg levles

A

4 and 2

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19
Q

what 3 questions should I ask before using Arrhythmias drugs

A

should we treat
do they have symptoms
need pros and cons of drugs

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20
Q

What drugs are the best at post MI patients

A

2 A
lidocaine and mexiletine

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21
Q

Lidocaine dose

A
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22
Q

Lidocaine SV, AV, or both

A

ventricular but only 20% effective need combo

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23
Q

What 2 disease affect Lidocaine?

A

liver disease
heart failure

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24
Q

Lidocaine Lab monitoring

A

1.5 - 5 mcg/mL

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25
Lidocaine AD
A lot of CNS
26
Mexiletine dose
good for long term use bc analog of lidocaine
27
Mexiletine SV, AV, or both
ventricular but only 20% effective need combo
28
Mexiletine AD
CNS GI upset
29
Flecainide dose
30
Flecainide SV, AV, or both
both but used for only Ventricular
31
Flecainide AD
proarrhythmic exacerbate heartfailure heartblock
32
what is unique about flecainide and propafenone
can use as a single dose of a drug in the pocket
33
Propafenone dose
34
Propafenone SV, AV, or both
both but usually supraventricular
35
Propafenone elminiation
hepatic and renal
36
What class A drugs do we see in practice
Diosprimide and Flecainide
37
Propafenone AD
pro-arrhythmia worsening CHF bronchospasm CNSeffects
38
What are the class II drugs
Esmolol
39
Esmolol dose
loading: dose 500mcg/kgIV over 1minute maintenance: dose50mcg/kg/min to start and may increase by 50 mcg/kg/min every 4 minutes until a maximum of 300 mcg/kg/min may rebolus w/500mcg/kg before each dose increase
40
Esmolol SV, AV, or both
41
why is Esmolol good in the ICU
bc low half-life that makes adjusting everything easy
42
Esmolol AD
43
What does ADiDas mean
Class III Amiodarone, Dronedarone, Ibutilide, Dofetilide, and Sotalol
44
Amiodarone dose
45
Amiodarone SV, AV, or both
Both
46
Amiodarone AD
Slow onset Large loading dose iodine allergy pulmonary fibrosis - over 400mg daily for the long term WATCH OUT hypotension bradycardia eye floaters Photosensitivity SMURF SYNDROME
47
what drug causes smurf syndrome?
Amiodarone
48
What baseline labs do we monitor for Amiodarone?
thyroid and liver
49
What do we do for Amiodarone AD
50
What drug can not be given if I have Iodine allergies?
Amiodarone
51
Why is Amiodarone given to almost every patient
highly effective less Tdp than sotalol CAN BE USED IN MI and CHF w/ low EF
52
What is one anti-arrhythmias drug that can be used in both CHF and MI
Amiodarone
53
Dronedarone dose
54
What is the benefit of Drodedarone
can be used in Iodine allergy and less side effects
55
Cons of Drodedarone?
Not a great and effective drug cant be used in afib or aflutter no bradycardic patietns No HF cant be used in 30 days of heartfailure
56
Patient comes in with heart failure <30 days ago can i use Dronedarone
No
57
Dronedarone SV, AV, or both
58
Dronedarone AD
59
Ibutilide dose
Dose for <60-kg: 0.01mg/kg IV over 10minutes Dose for ≥60-kg: 1mgIV over 10 minutes Stop once the arrhythmia is terminated.
60
Pro of Ibutilide
61
Ibutilide SV, AV, or both
niche drug
62
Ibutilide AD
AV and bundle branch blocks every kind of arrhythmia HA hypotension nausea/vomiting
63
Cons of ibutilide
64
Dofetilide dose
500 mcg
65
Dofetilide SV, AV, or both
66
what is the issue of Dofetilide
Renal clearance requires 3 day hospital
67
When do we usually use Dofetilide
works well in patients with structural heart disease
68
What happens if they are on a renal cation drug for Dofetilide and what are the drugs
must stop dofetilide verapamil, cimetidine, trimethoprim, ketoconazole, prochlorperazine, megestrol
69
Dofetilide AD
Big - QTC prolongation
70
Sotalol dose
71
Sotalol SV, AV, or both
both
72
Sotalol AD
Bradycardia, fatigue, depression, bronchospasm, impotenceincreased QT interval, Tdp
73
What is the range to be concerned on QTC
450ms
74
What limits Sotalol QTC or renal?
QTC, but renal adjustment is a good starting point
75
What 2 drugs that are unclassified
Adenosine and Digoxin
76
Class IV drugs
Diltiazem and Verapamil
77
Diltiazem and Verapamil use in arrhythmia
78
Adenosine dose
79
Adenosine SV, AV, or both
80
Adenosine AD
flushing, dyspnea, chest pain, asystole but short HL so not a big worry, bronchospasms, abdominal discomfort
81
Adenosine patient education
going to feel really bad but will go away
82
stop AV node signals so can tell the difference
83
What is the on issue of Adenosine?
the short half-life and the dosing
84
How do we administer Adenosine
85
Digoxin Dose
86
Digoxin SV, AV, or both
87
Digoxin AD
88
What reduces the effectiveness of Digoxin
high resting heartrate
89
What are the DDI with Digoxin
p-glycoprotein pump
90
What labs do we monitor for Digoxin
0.5-0.9 ng/mL (heart failure) – 0.5-1.2 ng/mL (rate control – atrial fib/flutter)
91
What do we use to reverse Digoxin
Managing toxicity could include atropine (minor toxicity), magnesium, and/0r digoxin immune fab (ovine)
92

Theraputics Winter (16 decks)

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