Pathophysiology and Pharmacotherapy of Cardiac Arrhythmias

Question 1

Which antiarrhythmic agents could cause torsades de pointes?

Answer 1

Procainamide, flecainide, ibutilide, dofetilide, sotalol, amiodarone, dronedarone

Question 2

Which antimicrobials could cause torsades de pointes?

Answer 2

• Macrolides (azithromycin, clarithomycin, erthromycin)
• Fluoroquinolones (levofloxacin, moxifloxacin, ciprofloxacin)

Question 3

Which antidepressants could cause torsades de pointes?

Answer 3

Citalopram, escitalopram, clomipramine, desipramine, lithium, mirtazapine, venlafaxine

Question 4

Which antipsychotics could cause torsades de pointes?

Answer 4

Chlorpromazine, haloperidol, pimozide, thioridazine, aripiprazole, clozapine, iloperidone, olanzapine, paloperidone, quetiapine, risperidone, sertindole, ziprasidone

Question 5

Which anticancer drugs could cause torsades de pointes?

Answer 5

Arsenic trioxide, eribulin, vandetanib (and most drugs ending in -nib)

Question 6

Which opioid could cause torsades de pointes?

Answer 6

Methadone

Question 7

What are the types of supraventricular arrhythmias?

Answer 7

• Sinus bradycardia
• AV block
• Sinus tachycardia
• Afib
• Supraventricular tachycardia

Question 8

What are the types of ventricular arrhythmias?

Answer 8

• Premature ventricular complexes (PVCs)
• Ventricular tachycardia
• Ventricular fibrillation

Question 9

What is the general HR of sinus bradycardia?

Answer 9

<60 bpm

Question 10

Where does sinus bradycardia impulses originate from?

Answer 10

SA node

Question 11

What is the mechanism of sinus bradycardia?

Answer 11

Decreased automaticity of SA node

Question 12

What are the risk factors of sinus bradycardia?

Answer 12

• MI or ischemia
• Abnormal sympathetic or parasympathetic tone
• Idiopathic

Question 13

What are the electrolyte abnormalities that are risk factors for sinus bradycardia?

Answer 13

• Hyperkalemia
• Hypermagnesemia

Question 14

What are the drugs that are risk factors for sinus bradycardia?

Answer 14

• Dig
• BBs
• Non-DHP CCBs
• Amiodarone
• Dronedarone
• Ivabradine

Question 15

What are the sxs of sinus bradycardia?

Answer 15

• Hypotension
• Dizziness
• Syncope

Question 16

What can happen if you go above max of 3 mg for atropine?

Answer 16

Could cause paradoxical response or tachycardia

Question 17

What are the AEs of atropine?

Answer 17

• Tachycardia
• Urinary retention
• Blurred vision
• Dry mouth
• Mydriasis

Question 18

What are features ONLY of afib?

Answer 18

• Rhythm is irregularly irregular
• P waves are absent

Question 19

What does irregularly irregular mean?

Answer 19

Interval between R waves are irregular and there are no distinct pattern in the irregularity

Question 20

What is stage 1 afib?

Answer 20

Presence of modifiable and nonmodifiable risk factors associated w afib

Question 21

What is stage 2 afib?

Answer 21

Pre-atrial fibrillation
- Evidence of structural or electrical findings further predisposing a pt to afib (atrial enlargement, frequent atrial premature beats, atrial flutter)

Question 22

What is stage 3A afib?

Answer 22

Paroxysmal Afib
- Afib that is intermittent and terminates within <= 7 days of onset

Question 23

What is stage 3B afib?

Answer 23

Persistent afib
- Afib that is continuous and sustains >7 days and requires intervention

Question 24

What is stage 3C afib?

Answer 24

Long standing persistent afib
- Afib that is continuous for >12 months in duration

Question 25

What is stage 3D afib?

Answer 25

Successful afib ablation - Freedom from afib after percutaneous or surgical intervention to eliminate afib

Question 26

What is stage 4 afib?

Answer 26

No further attempts at rhythm control after discussion between pt and clinician

Question 27

What is the mechanisms behind afib?

Answer 27

- Abnormal atrial/ pulmonary vein automaticity - Atrial reentry

Question 28

What is the only social determinants of health for afib?

Answer 28

Socioeconomic status

Question 29

What are the etiologies of reversible afib?

Answer 29

- Hyperthyroidism - Sepsis - Thoracic surgery (CAGB, lung resection, esophagectomy, valve replacement surgery)

Question 30

What is the tx plan if pt has reversible afib due to hyperthyroidism?

Answer 30

Don't need to tx afib, tx hyperthyroidism and afib resolves on its own

Question 31

How much increase in risk is there for stroke/systemic embolism in pts w afib?

Answer 31

risk increased 5 fold

Question 32

How much increase in risk is there for heart failure in pts w afib?

Answer 32

risk increased 3 fold

Question 33

How much increase in risk is there for dementia in pts w afib?

Answer 33

risk increased 2 fold

Question 34

How much increase in risk is there for mortality in pts w afib?

Answer 34

risk increased 2 fold

Question 35

What are the goals of afib drug therapy?

Answer 35

- Prevent thrombosis and embolism leading to stroke and systemic embolism - slow ventricular response by inhibiting conduction of impulses to ventricles - Convert afib to NSR - Maintain NSR

Question 36

What is the antidote for dabigatran?

Answer 36

Idarucizumab

Question 37

What is the antidote for rivaroxaban, apixaban, and edoxaban?

Answer 37

Andexanet alfa

Question 38

Are the DOACs all p-glycoprotein subrates?

Answer 38

Yes

Question 39

What are AEs of diltiazem?

Answer 39

Hypotension, bradycardia, HF exacerbation, AV block

Question 40

What are AEs of verapamil?

Answer 40

Hypotension, HF exacerbation, bradycardia, AV block, constipation (oral)

Question 41

What are AEs of BBs used in afib ventricular control?

Answer 41

Hypotension, bradycardia, AV block, HF exacerbation

Question 42

What are the AEs of digoxin?

Answer 42

Nausea, vomiting, anorexia, ventricular arrhythmias

Question 43

What are the AEs of amiodarone?

Answer 43

Hypotension (IV), bradycardia, blue grey skin, photosensitivity, corneal microdeposits, PULMONARY FIBROSIS, hepatotoxicity, hypo- or hyperthyroidism

Question 44

What is the dose of flecainide if <70 kg?

Answer 44

200 mg single oral dose

Question 45

What is the dose of flecainide if >70 kg?

Answer 45

300 mg single oral dose

Question 46

What is the dose of propafenone if <70 kg?

Answer 46

450 mg single oral dose

Question 47

What is the dose of propafenone if >70 kg?

Answer 47

600 mg single oral dose