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NAPLEX Prep > Arrhythmias > Flashcards

Arrhythmias Flashcards

(63 cards)

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1
Q

How to diagnose arrhythmias

A

ECG
Holter monitor (ambulatory ECG device)

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2
Q

Describe the conduction pathway

A
  1. SA node
  2. Right and left atrium
  3. AV node
  4. Bundle of His
  5. Left and right bundle branches
  6. Left and right ventricle
  7. Purkinje fibers
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3
Q

Describe the electrically signaling of cardiac action potential

A

Phase 0: Rapid ventricular depolarization → influx of Na → ventricular contraction
Phase 1: Rapid repolarization (Na channel closes)
Phase 2: Plateau to an influx of Ca and efflux of K (End of ventricular depolarization and beginning of repolarization (relaxation))
Phase 3: Rapid ventricular repolarization (relaxation) → efflux of K
Phase 4: Resting membrane potential is established and atrial depolarization occurs leading to its contraction

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4
Q

Non cardiac conditions that cause arrhthymia

A

Electrolyte imbalances (K, Mg, Na, Ca)

Hyperthyroidism, infection
Illicit drugs

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5
Q

What is a normal QTc

A

> 440-460 ms

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6
Q

Drugs that cause QTc prolongation

A

Antiarrhymthmics: Class 1a, 1c, and III
Anti-infectives: Antimalarial, Azole, Macrolides, GQ, Lefumulin
Antidepressants: SSRI, TCA, Mirtazipine, trazodone, venlafaxine
Zofran
Antipsychotics
ADT, TKI

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7
Q

Class 1

A

Sodium channel blockers (Phase 0):
1a: Disopyramide, Quinidine, Procainamide
1b: Lidocaine, Mexiletine
1c: Flecainide, Propafenone

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8
Q

Class 2

A

Beta blockers

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9
Q

Class 3

A

Potassium Channel Blocker (Phase 3)
Dronedarone, Sotalol, Amiodarone, Dofetalide, Ibutilide

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10
Q

Class 4

A

Non-DHP CCB: Verapamil, Diltiazem

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11
Q

What is the half-life of amiodarone

A

40-60 days

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12
Q

What is the preferred antiarrhythmic for HF

A

Amiodarone
Dofetilide

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13
Q

BBW of Amiodarone

A

Pulmonary toxicity, hepatotoxicity, proarrhythmias

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14
Q

CI of amiodarone

A

Iodine hypersensitivity

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15
Q

ADR of Amiodarone

A

Hypo/hyperthyroidism, optic neuropathy, corneal micro deposits, photosensitivity (blue-gray skin), bradycardia (slower infusion), hypotension

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16
Q

Compounding of amiodarone

A

Non-PVC container
0.22 micron filter → central line

Incompatible with heparin

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17
Q

Digoxin and amiodarone adjustments

A

Reduce digoxin by 50%

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18
Q

Warfarin and amiodarone adjustment

A

Reduce warfarin by 30-50%

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19
Q

Amiodarone enzyme activity

A

CYP2C9, 3AA4, 2D6, P-gp inhibitor

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20
Q

ADR of disopyramide

A

Anticholinergic

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21
Q

Common ADR of antiarrhthmics

A

Cause proarrhymthmias to some extent (Class Ia, Ic, III)

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22
Q

Quinidine ADR

A

Hemolytic risk (G6PD and Coombs), DILE, diarrhea, stomach cramping

Cinchonism

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23
Q

Sx of cinchonism

A

Tinnitus, hearing loss, blurred vision, HA, delirium

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24
Q

Counseling of quinidine

A

Take with food

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25
Active metabolite of procainamide
NAPA → renally cleared
26
Theraputic level of procainamide
4-10
27
BBW of procainamide
Agranulocytosis Long term use → Antinuclear antibodies (ANA) → DILE
28
DDI of procainamide
Metabolism of procainamide → NAPA occurs by acetylation Slow acetylator are at risk for toxicity and drug accumulation
29
Indications of Class Ib
V. Tach not AF
30
Injecatable Class I drugs
Procainamide Lidocaine
31
Indication for IV lidocaine
Refractory VT/cardiac arrest
32
CI of class 1c drugs
HF, MI (structural heart disease)
33
ADR of Propafenone
Taste disturbances (metallic)
34
Activity of amiodarone
Blocks K, Na, Ca and alpha, beta adrenergic receptors
35
BBW of dronedarone
Decompensated HF, permanent AF → ↑ death, stroke, and HF
36
CI of dronedarone
Concurrent use with CYP3A4 inhibitors and QTc prolonging drugs
37
ADR of dronedarone
Hepatic failure, pulmonary toxicity No iodine → no effect of thyroidB
38
BBW of dofetalide
Initiated with continuous ECG monitoring (Hoffman) Assess CrCl for minimum of 3 days
39
Dosing adjustment of sotalol
Adjust dose based on CrCl <60 (↓ frequency) QTc prolongation is directly related to stool concnetration
40
ADR of sotalol
Bradycardia, bronchoconstriction
41
MOA of sotalol
Non-selective BB and K channel blocker
42
Injectable Class 3 drugs
Sotalol Ibutilide
43
MOA of adenosine
Activates adenosine receptors → reduce AV node conductiob
44
Dosing of adenosine
6 mg IV push
45
Half life od adenosine
10 sec
46
Indications for adenosine
Supraventricular re-entrant tachycardia Not V tach, AF, or A flutter
47
Define paroxysmal AF
Intermittent AF that terminates within 7 days of onset
48
Define persistant AF
Continuous AF >7 days
49
Long-standing AF
Continuous for >12 months
50
Permanent AF
No further attempt at rhythm control
51
Rate control drugs
Class 2 and 4 (BB and Non-DHP CCB) Sometimes digoxin
52
Rate control goal for AF
Resting HR: <80 (symptomatic) <110 (asymptomatic)
53
Rhythm control strategies
Class 1a, 1c, III, or electrical cardioversion
54
Treatment of permanent AF
Sx control but avoid rhythm control strategy → risk outweighs benefit
55
Stroke prophylaxis for AF
DOACs (non-valvular) Warfarin (mechanical heart valve)
56
Digoxin therapeutic ranges
AF: 0.8-2 HF: 0.5-0.9
57
Digoxin conversion from PO to IV
Reduce PO dose by 20-25%
58
Typical dose of digoxin
0.125 -0.25 mg PO QD
59
Sx of digoxin toxicity?
NV, loss of appetite, blurred/double vision, greenish-yellow halos, bradycardia, arrhythmias Hypokalemia, hypermagnesimea, hypercalcemia
60
Antidote of digoxin
DigiFab
61
Drugs used for pharm cardioversion
Dofetalide, amiodarone, flecainide, ibutilide, propefenone
62
What is the purpose of the CHADS Vasc Score
CHF HTN Age ≥75 (2+) Diabetes Prior stroke/TIA Vascular Disease Age 65-74 (1+) Sc: Female (1+) ≥2 males and ≥3 females (DOAC is recommended)
63
Counseling of digoxin
Drink plenty of water to avoid overdose

NAPLEX Prep (71 decks)

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