Arrhythmias Flashcards
(75 cards)
1
Q
What are the common SEs of anti-arrhythmics?
A
Pro-arrhythmic -Ventricular arrhythmias -Torsades de Pointes Exacerbate HF Drug interactions: Any other agents that increase QT interval= increased TdP risk
2
Q
What are the lowest risk agents for Torsades de Pointes?
A
Amiodarone and dronedarone
3
Q
What are safe agents for HF?
A
Dofetilide and amiodarone
4
Q
When is sotalol safe to use?
A
Hx of MI
5
Q
When is sotalol unsafe to use?
A
HF
6
Q
What are the class Ia drugs?
A
Quinidine, procainamide, disopyramide
7
Q
Quinidine dosing considerations
A
PO (q6h, q8h,
q12h)
8
Q
What do class Ia meds treat?
A
Supraventricular and ventricular arrhythmias
9
Q
SEs of quinidine
A
cinchonism
GI disturbances
Hypotension
Thrombocytopenia
10
Q
Monitoring for quinidine
A
CBC
BMP
LFTs
11
Q
BBW for quinidine
A
Increased mortality
12
Q
Dosing considerations for procainamide
A
IV bolus followed by infusion
13
Q
Dose adjustment for quinidine
A
Hepatic
14
Q
Dose adjustment for procainamide
A
Hepatic
Renal
15
Q
SEs of procainamide
A
Hypotension
Drug induced lupus (BW)
Agranulocytosis (BW)
16
Q
Dosing considerations for disopyramide
A
PO (IR-q6h, SR BID)
17
Q
Dose adjustment for disopyramide
A
Hepatic, renal
18
Q
SEs of disopyramide
A
Anticholinergic sx (xerostomia), nausea, anorexia, constipation
19
Q
Monitoring for disopyramide
A
Urinary retention
Anticholinergic sx
BP
20
Q
What are the class Ib meds?
A
Lidocaine
Mexiletine
21
Q
Dosing considerations lidocaine
A
IV push: continuous infusion
22
Q
Dose adjustment in lidocaine
A
Liver dz
HF
23
Q
Indication for lidocaine
A
Vfib
Vtach
24
Q
SEs of lidocaine
A
Neurotoxicity: psychosis, seizures, paresthesia, confusion
25
Monitoring for lidocaine
Drug levels >24h
| EKG
26
Dosing considerations for mexiletine
200-300 mg PO q8h
27
Dose adjustment for mexiletine
Hepatic dysfunction (esp if HF as well)
28
Indication for mexiletine
Ventricular arrhythmias
29
SEs of mexiletine
```
Dizziness
Sedation
Paresthesia
Seizure
Confusion
N/V
```
30
Monitoring for mexiletine
LFTs
| ECG
31
Considerations for mexiletine
Hepatotoxicity (BW)
32
What are class Ic meds?
Flecainide
| Propafenone
33
Dosing considerations flecainide
50-200 mg q12h
34
Dose adjustment for flecainide
Hepatic and renal
35
Indications for flecainide
Atrial and ventricular arrhythmias
36
SEs of flecainide
Dizziness
Blurred vision
HF exacerbation
Dyspnea
37
Monitoring for flecainide
Measure trough levels
Renal/hepatic impairment
Pediatric: use with amiodarone
38
Considerations for flecainide
Pill in the pocket: 300 mg PO x 1
39
Dosing considerations propafenone
150-300 mg q8h
| 225-425 mg q12h
40
Dosing adjustments for propafenone
Hepatic
41
Indication for propafenone
Atrial arrhythmias
42
SEs of propafenone
```
Dizziness
Blurred vision
Bronchospasm
Taste disturbance
HF exacerbation
```
43
Monitoring for propafenone
Pulse (at beginning of therapy)
44
Considerations for propafenone
Pill in the pocket: 450 mg PO x 1
45
What are the class III meds?
```
Amiodarone
Dronedarone
Sotalol
Ibutilide
Dofetilide
```
46
Indication for amiodarone
Ventricular and atrial arrhythmias
47
Warfarin + amiodarone
Decrease warfarin dose by 30% on a pt already on warfarin
48
Digoxin + amiodarone
Reduce digoxin dose empircally by 50%
49
SEs of amiodarone
```
Severe bradycardia/heart block
Hyper and hypothyroidism
Peripheral neuropathy
GI discomfort
Photosensitivity
Blue-gray skin discoloration
Fluminant hepatitis
Pulmonary fibrosis
Optic neuropathy/neuritis (blindness)
Corneal microdeposits
```
50
Monitoring and management of severe bradycardia/heart block in amiodarone
Monitor: ECG baseline and every 3-6 mos
Management: Lower dose or d/c if severe
51
Monitoring and management of hyper and hypothyroidism in amiodarone
Monitor: TSH/T4 baseline and every 6 mos
Manage: Medication therapy- levothyroxine/methimazole
52
Monitoring and management of peripheral neuropathy in amiodarone
Monitor: PE at each office visit
Manage: Lower dose or d/c if severe
53
Monitoring and management of photosensitivity in amiodarone
Monitor: PE at each office visit
Manage: Lower dose or d/c if severe
54
Monitoring and management of blue-gray skin discoloration in amiodarone
Monitor: PE at each office visit
Manage: Lower dose or d/c if severe
55
Monitoring and management of fulminant hepatitis in amiodarone
Monitor: LFTs baseline and every 6 mos
Manage: Lower dose or d/c (if LFTs>3x ULN)
56
Monitoring and management of pulmonary fibrosis in amiodarone
Monitor: CXR baseline and every 12 mos
PFTs (if sx)
Manage: D/c amiodarone immed.
Start cortiocosteroid
57
Monitoring and management of optic neuropathy/neuritis in amiodarone
Monitor: Ophthalmologic exam baseline and if sx
Manage: D/c amiodarone immediately
58
Monitoring for corneal microdeposits in amiodarone
Slit-lamp exam
59
When should you avoid dronedarone?
With potent CYP3A4 inhibitors/inducers
60
Dose of dronedarone
400 mg PO BID with food
61
MOA of dronedarone
PGP inhibitor
Increased digoxin levels
Reduce digoxin by 50%
62
Pros of dronedarone
Shorter half life (no LD, quicker recovery from adverse effects)
No significant pulmonary, hepatic, or thyroid toxicity
Fewer DIs
63
Cons of dronedarone
```
BBW in decompensated HF
Similar to amiodarone with bradycardia, QT prolongation
Mild increase in creatinine
Less effective than amiodarone
Cost
```
64
Dosing of dofetilide
CrCL >60 mL/min: 500 mcg PO BID
65
Monitoring for dofetilide
Should be initiated in the hospital bc risk of QT prolongation causing TdP is very high
ECG after each dose and dose reduction if QT prolonged >15%
Monitor K with loop diuretics
Do not use in noncompliant pts
66
SEs of dofetilide
HA
Dizziness
TdP
67
Sotalol dosing
80-160 mg PO BID
| CrCl<50 mL/min: increase frequency to once daily
68
Monitoring for sotalol
Should be initiated in the hospital bc risk of QT prolongation causing TdP is very high
Monitor telemetry for ~5 doses
69
Adverse effects of sotalol
```
Bradycardia
AV block
TdP
Fatigue
Bronchospasm
```
70
Ibutilide dosing
1 mg IV x 1 dose, may repeat one time if unsuccessful
| May administer Mg prophylactically to minimize QT prolongation
71
Indication for ibutilide
Pharmacological cardioversion (direct current cardioversion still preferred)
72
Adverse effects of ibutilide
HA
TdP
Hypotension
73
How to treat sinus brady in hemodynamically unstable pts
Atropine 0.5 mg IV q3-5 mins (max total dose= 3 mg)
74
How to treat sinus brady in refractory pts
Dopamine IV infusion
Epinephrine IV infusion
Isoproterenol IV infusion
75
Tx of AV nodal block
Same as sinus brady
| No isoproterenol
