CARDIAC

Question 1

phase 0

Answer 1

when rapid depolarization occurs due to the rapid influx of na+

Question 2

phase 2

Answer 2

plateau period during which there is little change in the membrane potential the outward k+ current and the influx of ca2+ through calcium channels typify the plateau period. the offsetting effect of these currents create only a mill net change in potential thus creating a plateu

Question 3

increase in heart rate

Answer 3

tachyarrhymias

Question 4

decrease in heart rate

Answer 4

brady

Question 5

conditions causing arrhythmias

Answer 5

Myocardial ischemia; chronic HF
Hypertension; valvular heart disease
Hypoxemia
Thyroid abnormalities
Electrolyte disturbances; drug toxicity
Excessive caffeine or ethanol ingestion
Anxiety; exercise

Question 6

cause of tachyarrhythmias

Answer 6

abnormal automaticity; triggered activity; abnormal reentry

Question 7

Sinus tachycardia; sinus bradycardia
Paroxysmal supraventricular tachycardia
Atrial fibrillation
Atrial flutter
Atrial tachycardia
Premature atrial contractions
Wolff-Parkinson-White syndrome

Answer 7

supra ventricular arrhythmias

Question 8

Junctional escape rhythm (heart rate 40–60 beats/minute)
Premature AV junctional complexes
AV dissociation
First-degree heart block; second-degree heart block (Mobitz type I [Wenckebach], Mobitz type II)
Third-degree (complete) heart block

Answer 8

junctional

Question 9

ventricular arrhythmias

Answer 9

Premature ventricular contractions
Ventricular tachycardia
Ventricular fibrillation
Torsades de pointes (a rapid form of polymorphic ventricular tachycardia associated with a long QT interval)

Question 9

Impulse generation and conduction from the SA node to the AV node; time interval for conduction; heart rate within a normal range that is age specific; patterns of AV and ventricular conduction

Answer 9

outcomes to monitor for arrhythmic drugs

Question 10

Relieve the acute episode of irregular rhythm; establish sinus rhythm (SR); prevent further episodes of the arrhythmia

Answer 10

goal of anti arrhythmic drugs

Question 11

Ia (intermediate onset/offset)
Disopyramide; procainamide; quinidine
Ib (fast onset/offset)
Lidocaine; mexiletine
Ic (slow onset/offset)
Flecainide; propafenone

Answer 11

class 1 na blocker

Question 12

Pulseless VT/VF: Adult: 1–1.5 mg/kg IV push/IO; may give additional 0.5–0.75 mg/kg IV push/IO every 5–10 minutes, if persistent VT/VF (maximum cumulative dose = 3 mg/kg); if stable rhythm achieved, initiate continuous infusion of 1–4 mg/min
Stable VT (with a pulse): Adult: 1–1.5 mg/kg IV push; may give additional 0.5–0.75 mg/kg IV push every 5–10 minutes, if persistent VT (maximum cumulative dose = 3 mg/kg); if stable rhythm achieved, initiate continuous infusion of 1–4 mg/min
Neurotoxic at >5mcg/mL

Answer 12

lidocaine

Question 13

Atenolol
Esmolol
Metoprolol
Propranolol
Esmolol (Brevibloc) IV Only

Answer 13

class 2 bb

Question 14

Toxicity, Adverse Effects
AF: Adult IV: 5 mg/kg over 30 minutes, then continuous infusion of 1 mg/min for 6 hours, then 0.5 mg/min; convert to PO when hemodynamically stable and able to take PO medications
Adult PO: 400 mg bid–tid for 1 wk, until patient receives ~10 g total, then 200 mg PO daily

Answer 14

amiodarone

Question 15

Stable VT (with a pulse)
Adult IV: 150 mg (diluted in 100 mL of D5W or saline) over 10 minutes; may repeat dose every 10 minutes, if necessary for breakthrough VT; if stable rhythm achieved, initiate continuous infusion at 1 mg/min for 6 hours, then 0.5 mg/min; convert to PO when hemodynamically stable and able to take PO medications
Adult PO: 1,200–1,600 mg/d in two or three divided doses for 1 wk, until patient receives ~15 g total, then 300–400 mg PO daily

Answer 15

amiodarone

Question 15

Pulseless VT/VF: Adult IV: 300 mg IV push/IO; can give additional 150 mg IV push/IO if persistent VT/VF; if stable rhythm achieved, initiate continuous infusion at 1 mg/min for 6 hours, then 0.5 mg/min; convert to PO when hemodynamically stable and able to take PO medications (see PO dose under stable VT)

Answer 15

amiodarone

Question 16

Increased mortality in patients with systolic heart failure; derivative of amiodarone with less toxcity

Answer 16

mulga (dronedarone)

Question 17

Verapamil (Calan) Angina, Migraines
Diltiazem (Cardizem): Adult IV: 0.25 mg/kg over 2 minutes; if ventricular rate remains uncontrolled after 15 minutes, can repeat with 0.35 mg/kg over 2 minutes; then initiate continuous infusion of 5–15 mg/h; Adult PO: Start with 30 mg four times daily and  to 180–480 mg/d in divided doses (SR can be given once daily)
SVT, AF, VT (avoid in HF)

Answer 17

CCB

Question 18

Adult: 6 mg IV push over 1–2 seconds; repeat with 12 mg IV push if sinus rhythm not obtained within 1–2 minutes after first dose; may repeat 12-mg dose a second time if no response in 1–2 minutes
SVT but not WPW

Answer 18

adenosine

Question 19

Adult: 0.5 mg IV every 3–5 minutes; not to exceed 3-mg total dose
Can be IV, ETT, SQ, IM
Symptomatic bradycardia

Answer 19

atropine

Question 20

Polymorphic VT (with pulse) associated with QT prolongation (torsades de pointes)

VF/pulseless VT associated with torsades de point…..administered as a bolus

can be given in Preeclampsia

Answer 20

magnesium sulfate

Question 21

used for af,hf, toxicity above 2; check levels after 6-8 hours after dosing

Answer 21

digoxin

Question 22

preventing SCD with HF medicines

Question 23

class 0 Ivabradine

Answer 23

Heart Failure in Adult Patients

Corlanor®is indicated to reduce the risk of hospitalization for worsening heart failure in adult patients with stable, symptomatic chronic heart failure with left ventricular ejection fraction≤35%, who are in sinus rhythm with resting heart rate≥70 beats per minute and either are on maximally tolerated doses of beta-blockers or have a contraindication to beta-blocker use.

Question 24

Neprilisyn inhibitor +ARB NAME:

Answer 24

sacubitril valsarten ENTRESTO

Question 25

Bad- pul tox 15% (pneumonitits leads to pulm fibrosis)
Overtime- 50% some side effects
Does have iodine/hypo or hyper thryroid
Liver toxicity
Hallmark- blue skin discoloration*

Answer 25

amiodarone toxicity adverse effects

Question 26

class 4 ccb verapamil and dilitazem are non or dihydr

Answer 26

nondihydra

Question 27

cardiac glycoside; inc ca influx positive inotrope; slow the heart rate by blocking na;

Answer 27

digoxin