Arrhythmias: important stuff

Question 1

Counseling point: What are 2 potential negatives of Antiarrhythmic drugs (AADs)?

Answer 1

Proarrhythmic effects and organ toxicities

Question 2

List the 3 groups of Na+ channel blockers

Answer 2

Antiarrhythmic drugs classes:
1a) Quinidine, procainamide, disopyramide (don’t rlly use)
1b) Lidocaine, mexiletine (hospital drugs)
1c) Flecainide, propafenone (pill in pocket drugs)

Question 3

Antiarrhythmic drugs: List classes 2-3

Answer 3

2) Beta blockers
3) Amiodarone, dofetilide, dronedarone, sotalol, ibutilide

Question 4

Antiarrhythmic drugs: List the 2 members of class 4

Answer 4

Verapamil & Diltiazem

Question 5

Amiodarone: What are the monitoring recommendations for pulmonary fibrosis? How is this side effect managed?

(starred slide)

Answer 5

1) Chest radiograph (baseline, then every 12 months)
2) D/c amiodarone immediately; may consider corticosteroid therapy

Question 6

Amiodarone: What are the monitoring recommendations for hypothyroidism? How is this side effect managed?

(starred slide)

Answer 6

1) TFTs (baseline, then every 6 months)
2) Thyroid hormone supplementation (e.g. levothyroxine)

Question 7

Amiodarone: What are the monitoring recommendations for hyperthyroidism? How is this side effect managed?

(starred slide)

Answer 7

1) TFTs (baseline, then every 6 months)
2) Antithyroid drugs (methimazole, propylthiouracil) or corticosteroids; many need to d/c amiodarone

Question 8

Amiodarone: What are the monitoring recommendations for optic neuritis/ neuropathy? How is this side effect managed?

(starred slide)

Answer 8

1) Ophthalmologic examination (baseline [only if visual impairment present] and then if s/x develop)
2) D/c amiodarone immediately

Question 9

Amiodarone: What are the monitoring recommendations for bradycardia/ heart block? How is this side effect managed?

(starred slide)

Answer 9

1) ECG (baseline, then every 3-6 months)
2) Lower the dose, if possible, or d/c amiodarone if severe (or install pacemaker)

Question 10

Amiodarone: What are the monitoring recommendations for tremor, ataxia, and peripheral neuropathy? How is this side effect managed?

(starred slide)

Answer 10

1) Hx/ PE (each office visit)
2) Lower the dose, if possible, or d/c amiodarone if severe

Question 11

Amiodarone: What are the monitoring recommendations for photosensitivity? How is this side effect managed?

(starred slide)

Answer 11

1) Hx/ PE (each office visit)
2) Lower the dose; advise pts to wear sunblock while outdoors

Question 12

Chronic therapy – anti-arrhythmic therapy:
1) Avoid what 2 things if structural heart disease is identified?
2) What is superior to most anti-arrhythmics to maintain sinus rhythm?
3) Sotalol cannot convert a patient to sinus rhythm but can do what?

Answer 12

1) Flecainide and propafenone
2) Amiodarone
3) Maintain sinus rhythm

Question 13

Dronedarone is contraindicated in and has received a black box warning for patients with advanced ________ and for pts with ___________________

Answer 13

HF; permanent AF

Question 14

Adenosine (Adenocard): What is the indication for this?

Answer 14

Restoring sinus rhythm in paroxysmal supraventricular tachycardia

Question 15

Digoxin (Digox):
1) What is the target serum concentration?
2) When do you renally dose?
3) What should you do when going from oral to IV?

Answer 15

1) 0.8 – 2.0 ng/mL (doses lower for heart failure)
2) Decrease dose @ CrCL < 50 mL / min
3) Decrease dose by 20 – 25%

Question 16

Digoxin (Digox):
1) What is the antidote?
2) What are the contraindications?
3) You should reduce digoxin by 50% with concomitant ______________ or _____________

Answer 16

1) DigiFab
2) Ventricular fibrillation
3) amiodarone or dronedarone