Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Cardiology > Arrhythmias II > Flashcards

Arrhythmias II Flashcards

(86 cards)

Start Studying
1
Q

What phase of AP = Automaticity?

A

phase 4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What phase of AP = conduction velocity

A

phase 0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What phase of AP = refractory period

A

phase 2 & 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what phase of AP’s do BB’s effect?

A 
Phase 4 (slows automaticity)
- also slows SAN & AVN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

which node do CCB’s slow more?

A

AVN> SAN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Mech of Class I antiarrhythmics

A

Na+ blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Class Ia anti arrhythmic and mech

A

Procainamide (Quinidine, Disopyramide)

Na+ blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Class Ib anti arrhythmic and mech

A

Lidocaine (IV) and Mexilitine (PO)

Na+ blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Class IC anti arrhythmic and mech

A

Flecainide and Propafenone

Na+ blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Mech of Class III antiarrhythmics

A

K+ blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Class III antiarrhythmics

A

Amio
Sotalol
(Ibutilide, Dofetilide, Dronedarone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What phase do class I antiarrhythmics effect mainly?

A

Phase 0 (and 2 & 3)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What to watch out for w/ class Ia drugs (procainamide, disopyramide, quinidine)

A

QT prolonging

Renal dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Most common use for class Ia drugs

A

VT (monomorphic)

[also SVT]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

are class Ib (lido/mex) use dependent? What does that mean?

A

Yes, better effect at faster HR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Do lido/mex effect QT?

A

No!
Can use for afterdepolarizations (dig-induced VT)
Can use for torsades

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

2 cautions for lido/mex

A

CHF

Hepatic dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which antiarrhythmics are the most potent Na+ blockers?

A

Class Ic (flecainide, Propafenone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Because they are the most potent Na+ blockers, what widens on ECG with Propafenone/flec?

A

QRS (not QT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Used for a fib or refractory SVTs (refused ablation, other meds didn’t work)?

A

Class Ic (flec/propafenone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When is mortality increased with Class Ic (flec/propafenone)

A

structural heart dz (LV dysfxn, LVH, MI, ischemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is a common/serious pro arrhythmic effect of class Ic? what is the Rx for it?

A

Can slow Aflutter and cause 1:1 AV conduction.

Use with AVN blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

which trial showed that class Ic meds (flecainide, propafenone) had increased mortality with structural heart dz?

A

CAST

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Even thoughts it a Class III (phase 3), what phases of AP does Amio effect?

A

Phase 0, 3, 4.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
can you get sinus brady with amio?
yes!
26
What is mech of class III? What are its 2 clinical uses?
K+ channel blockers Afib VT
27
**Side effects of Class III drugs? Why?
Long QT/Torsades;, exacerbated by hypo Mg/K. Reverse-use dependence (works at slower HR---> torsades)
28
What to monitor with Class III meds?
``` Renal dysfxn (contraindicated) QT ```
29
most effective drug for preventing recurrent AF and for VT/VF?
Amio
30
Cardiac and Neuro side effects of Amio
``` bradycardia Long QT/Torsades Hypotension ATAXIA (falling) TREMOR NEUROPATHY ```
31
Pulm/Thyroid/GI Side effects of Amio
pneumonitis/fibrosis hyper/hypothyroidism increased LFTs/nausea
32
Ocular/Derm side effects of Amio
corneal deposits retinopathy photosensitivity/blue skin
33
*Important Drug interactions w/ Amio
warfarin, Dig (have to decrease their dosing) | statins
34
Dronedarone indications and contraindications
Indication: PAF w/ 1 assoc. risk factor (age, HTN, LA>5cm, EF<40%) Contraindication: Chronic AF- inc. mortality/CVA/HF! Acute/severe CHF cirrhosis
35
Class IV agents, mech
diltiazem verapamil L-type CCB's (phase 0 and 4)
36
what do Class IV CCB's do to AVN?
prolong conduction and refractoriness
37
Dig mech.
1) BLOCKS Na-K ATPase -> increases intracellular Ca-->inotropy 2) increases vagal tone in central CNS 3) decreases AVN conduction/increases refractoriness
38
Best use for Dig
AF w/ RVR in CHF
39
what arrhythmia can dig overdose cause?
SVT Bidirectional VT PAT w/ variable AVB
40
*Adenosine mech
- binds to Adenosine (A1) receptor - causes compete AVB transiently (dec. cAMP--> dec Ca/Na into cells) - reduces automaticity (hyperpolarizes cell men by inc. K+ outward)
41
*what is adenosine's action in the atria? What is Rx?
shortens atrial refractoriness--> propensity for AF (b/c of inc'd outward K+ flow). Do nothing
42
*adenosine contraindication/indication
asthma/diagnose and treat SVT
43
*adenosine response for: AVNRT/AVRT Focal AT AF/Flutter
AVNRT/AVRT - terminates Focal AT- AV block can inc./doesnt usu. terminate AF/Flutter- unmasks AF/FL/AVB can inc.
44
which patients cannot get adenosine due to hypersensitivity?
OHT
45
Dig tox Rx?
Digibind | Do NOT check dig levels after (they will be very high)
46
atropine mech
acetylcholine blocker
47
atropine indications
bradycardia | AVB
48
ocular side effect of atropine
glaucoma
49
which gender is more likely to get a fib?
male
50
A/C protocol for AF DCCV
TEE-guided or 3 weeks w/ INR>2.
51
at CHADS=2, what is annual stroke rate?
4% (start A/C)
52
CHADSVASC score = CHADS of 2?
4
53
what age gets a point in CHADSVASC?
65
54
Dabigatran (Pradaxa) mech/trial/dose/M&M
- direct thrombin inhibitor - RE-LY - 150 BID - superior to warfarin (dec mortality, ICH) but more GIB
55
which NOAG is potentially dialyzable? does it have a reversal agent?
Dabigatran (Pradaxa) | No
56
Rivaroxaban (Xarelto) mech/trial/dose/M&M
- Factor Xa Inhibitor - ROCKET-AF - 20 BID - Noninf. to warfarin/dec. ICH
57
how are the NOAGs mainly excreted?
renal and feces
58
Apixaban (Eliquis) mech/trial/dose/M&M
- Factor Xa - ARISTOTLE - 5 BID - superioir to warfarin/marked dec. in major bleeding/dec. ICH
59
what type of bleeding do all the NOAGs decrease c/t warfarin?
ICH
60
who do you rhythm control in a fib?
young highly symptomatic PAF CHF from AF
61
if no cardiac dz, what antiarrhytmics do you use for a fib?
``` Class III (all but ibutilide: dronedarone/sotalol/amio for refractory AF/dofetilide Class Ic (flecainide/propfenone) ```
62
if pt. has CAD, best rhythm control strategy for AF?
Class III or ablation | no flecainide/propafenone
63
If pt. has HTN, best rhythm control strategy for AF?
Class III/Ic drugs | **if bad LVH (>1.5cm thick): have to use AMIO or ablation
64
*if pt. has CHF, rhythm control strategy for AF?
Amio Dofetilife (not if on HD) ablation
65
contraindicated meds in AF w/ bypass tracts
BB CCB Dig
66
Treatment for AF w/ bypass tracts
``` DCCV PROCAINAMIDE IBUTILIDE sotalol amio ablation ```
67
why ablate AF?
sxs
68
which patients do you never send for AVN ablation?
young
69
AF ablation success rates after 1st and 2nd procesure?
1 procedure: 60-80% | 2nd procedure: >80%
70
major complication rate s/p AF ablation?
2-12%
71
which pts do best after AF ablation?
``` young, very symptomatic, PAF, normal EF, LA < 5cm, no pulm dz/OSA. ```
72
ibutilide use and monitoring protocol?
- acute conversion of afib (better for AFl) | - >4hrs of monitoring QT.
73
at what QTc is dofetilide (Tikosyn) contraindicated?
440ms
74
what is the dosing algorithm for dofetilide accoridng to CrCl?
60ml/min: 500 BID
75
what happens if, after 2nd dose of dofetilide, QTc>500ms
D/C dofetilide
76
after checking QTc 2h after dofetilide, what is protocol?
if QTc inc'd >15% or is >500ms, decrease dose
77
Name 3 factors that can make a prolonged QT turn into torsades
Bradycardia Hypomagnesemia Hypokalemia
78
Do you treat torsades with IV mag even if Mag level is normal?
Yes
79
Antiarrhythmic to Rx torsades
Lidocaine
80
When is no anticoagulatuon or ASA OK in afib?
Age<60 | No heart dz
81
HAS-BLED
``` HTN (uncontrolled) Abnormal liver or kidneys (Cr>2.6) Stroke Bleeding Labile INR Elderly (>65) drugs or alcohol ```
82
What HAS-BLED score indicates high risk?
3
83
Which NOAG can actually reduce mortality c/t warfarin?
Apixaban
84
When is Amio a first line agent as an antiarrhythmic in afib?
In CHF or Severe LVH (>1.5cm)
85
If a pt with multiple comorbidities (76y, HTN, DM, etc) comes in to clinic with afib and sxs but stable, what is your initial recommendation ?
Warfarin
86
Are lidocaine or Ibutilide in the algorithm for antiarrhythmic treatment of afib?
No

Cardiology (32 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions