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therapeutics 3 - exam 2 > arrhythmias pt 3 > Flashcards

arrhythmias pt 3 Flashcards

tisdale pg 23 - 31 (50 cards)

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1
Q

if a person is administered to the emergency room with AF needing acute ventricular rate control, what is the first question you would ask?

A

are they hemodynamically stable?

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2
Q

if a person is admitted for acute ventricular rate control and hemodynamically UNstable, what would you do?

A

direct current (electrical) cardioversion
cannot wait for the drugs to take effect

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3
Q

if a person is admitted for acute ventricular rate control and hemodynamically stable, what would you do?

A

see if they have decompensated HF

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4
Q

if a person is admitted for acute ventricular rate control, is hemodynamically stable, and has decompensated HF, how would you treat them?

A

IV amiodarone

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5
Q

if a person is admitted for acute ventricular rate control, is hemodynamically stable, and does not have decompensated HF, how would you treat them?

A

BB, diltiazem, or verapamil as first line
then digoxin
then amiodarone
all IV

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6
Q

for a patient being admitted for acute ventricular rate control, what type of dosage form for drugs is needed?

A

IV
needs a response fast

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7
Q

with each therapy change, what should be monitored when admitted for acute ventricular rate control?

A

assess HR
goal of under 100-110 bpm and asymptomatic

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8
Q

if a person is admitted for long-term ventricular rate control, what type of drugs is necessary?

A

oral

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9
Q

if a person is seeking therapy for long-term ventricular rate control, what is the first thing you should assess?

A

their LVEF

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10
Q

if a person is needing long-term ventricular rate control and has HFrEF, how should they be treated?

A

BB
then digoxin

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11
Q

if a person is needing long-term ventricular rate control and has a LVEF over 40%, what should they be treated

A

first line of BB, diltiazem, or verapamil
then digoxin

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12
Q

why is it important to not administer diltiazem or verapamil with HFrEF pts?

A

negative inotropes and could make things worse

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13
Q

if a person is hemodynamically unstable but needs to be converted to sinus rhythm, how should they be treated?

A

always use emergent DCC

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14
Q

if a person is hemodynamically stable AF for under 48 hours, can they be converted to normal sinus rhythm?

A

yes considered safe

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15
Q

if a person has hemodynamically stable AF for over 48 hours, can they be converted to normal sinus rhythm?

A

no, not until pt has been anticoagulated for over 3 weeks or until a TEE has been performed to rule out clot in atrium

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16
Q

what are the different treatment options for conversion to sinus rhythm?

A

synchronized DCC
amiodarone
ibutilide
procainamide
flecainide
propafenone

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17
Q

what is the MOA of synchronized DCC?

A

simultaneously depolarizes all myocardial cells, allowing the sinus node to take over as pacemaker

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18
Q

what are AE of synchronized DCC?

A

risk of general anesthesia (needs to be sedated if possible) –> aspiration, allergic rxn to anesthetics

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19
Q

when used to tx sinus rhythm conversion, what are the AE of amiodarone?

A

hypotension
bradycardia
QT prolongation

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20
Q

when used to tx sinus rhythm conversion, what are the drug interactions of amiodarone?

A

inhibits elimination of digoxin, warfarin, and statins

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21
Q

what is the AE of ibutilide?

Study These Flashcards
A

torsades de pointes

22
Q

when used to tx sinus rhythm conversion, what are the MOA of amiodarone?

23
Q

when used to tx sinus rhythm conversion, what are the MOA of ibutilide?

24
Q

when used to tx sinus rhythm conversion, what are the MOA of procainamide?

25
when used to tx sinus rhythm conversion, what are the AE of procainamide?
QT prolongation TdP hypotension HFrEF exacerbation agranulocytosis neutropenia
26
when used to tx sinus rhythm conversion, what are the AE of flecainide and propafenone?
dizziness blurred vision HFEF exacerbation
27
when used to tx sinus rhythm conversion, what are the MOA of flecainide/propafenone?
class Ic
28
what drugs are considered pill in the pocket and why?
flecainide and propafenone because people will keep it in their pocket and sometimes go months between episodes of taking it to relieve symptoms
29
if a person has hemodynamically stable AF and needs to convert to sinus rhythm, what is the first thing that needs to be assessed?
what their LV function is
30
for pts wanting to convert from hemodynamically stable AF to sinus rhythm and have normal LV function, how should they be treated?
with IV amiodarone or ibutilide if for some reason those cannot be used, then procainamide
31
for pts wanting to convert from hemodynamically stable AF to sinus rhythm, but has HFrEF, how should they be treated?
IV amiodarone
32
for pts wanting to convert from hemodynamically stable AF to sinus rhythm but is occurring outside of the hospital and has normal LV function, how should they be treated?
with pill in the pocket flecainide/propafenone
33
why should procainamide not be used if a pt already received amiodarone or ibutilide?
risk of excessive QT interval prolongation and TdP
34
what drugs are used for maintenance therapy of sinus rhythm?
amiodarone dofetilide dronedarone sotalol propafenone flecainide
35
if a person is on digoxin and starts amiodarone, what should happen to their doses?
reduce dig dose by half
36
what are the important drug-drug interactions of dofetilide?
cimetidine thiazide diuretics KTZ trimethoprim verapamil megestrol
37
what is the AE of dofetilide?
TdP
38
what classes/MOA are dofetilide, dronedarone, and sotalol are?
all Class III, but sotalol is also class II
39
what are the AE of dronedarone?
bradycardia ND asthenia rash
40
what are the important drug-drug interactions of dronedarone?
inhibits elimination of digoxin, statins, verapamil, diltiazem, and dabigatran metabolism is inhibited by KTZ, ITZ, ribavirin, grapefruit juice
41
how does dronedarone differ from amiodarone?
no interaction with warfarin not as effective cYP3A4 reactions no thyroid and no pulmonary fibrosis
42
how does CrCl affect sotalol dose?
over 60 --> 80 to 160 mg BID 40-60 --> 80 to 160 mg QD under 40 --> CI
43
what are the AE of sotalol?
B-blockade TdP
44
how does CrCl affect dofetilide dosing?
over 60 --> 500 mcg BID 40-60 --> 250 mcg BID 20-39 --> 125 mcg BID under 20 --> CI
45
while taking amiodarone, when and why should a TSH test be taken?
at baseline, 3-6 months, and then every 6 months due to AE of hypo OR hyper thyroidism
46
while taking amiodarone, when and why should a liver function test be taken?
at baseline, every 3-6 months, every 6 months due to AE of hepatotoxicity ALT, AST
47
while taking amiodarone, when and why should an ECG be taken?
at baseline then annually due to AE of QT interval prolongation
48
while taking amiodarone, when and why should a chest x-ray be taken?
at baseline and if a pt develops unexplained cough/dyspnea/other symptoms suggestive of lung disease due to AE of pulmonary fibrosis pt will usually start corticosteroid and it goes away
49
if a pt is taking amiodarone, when and why should a pt have an ophthalmologic exam?
only recommended if pt develops visual abnormalities due to AE of corneal microdeposits
50
if a pt is taking amiodarone, when and why should a physical exam be taken?
annual and if development of skin discoloration/photosensitivity due to AE of dermatologic conditions like blue-grey skin discoloration and photosensitivity

therapeutics 3 - exam 2 (13 decks)

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