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CVR Biweekly 3 > Rx of Arrhythmias- Al-Mehdi > Flashcards

Rx of Arrhythmias- Al-Mehdi Flashcards

1
Q

automaticity of the heart determined by

A

HCN channel of SA node

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2
Q

NCX channel (Na+ in and Ca2+ out but then L type Ca2+ channel brings in Ca2+ and more from RyR) can also contribute to what

A

SA node automaticity

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3
Q

autonomic modulation of SA node automaticity: positive chronotropy

A

sympathetic (NE) binding B1 (Gs)

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4
Q

autonomic modulation of SA node automaticity: negative chronotropy

A

vagus (parasympathetic) Ach binding M2 (Gi)

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5
Q

antiarrhythmic drugs goal

A

restore electrical system of heart (by prolonging AP to try and figure itself out)

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6
Q

what do Na channel blockers for arrhythmia ultimately do to AP

A

1A: prolongs AP
1B: shortens AP
1C: no change

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7
Q

what do K channel blockers for arrhythmias ultimately do to AP

A

slower phase 3, 4, 1 (PROLONGS AP)

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8
Q

what do K channel openers for arrhythmias ultimately do to AP

A

speed up phases 3, 4, and 1 (shortens AP duration)

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9
Q

effect of Ca2+ channel blockers on nodal myocytes

A

prolonged phase 0 (prolonged AP)

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10
Q

beta blockers effect on SA/AV nodes

A

slower phase 4 (decrease chronotropy and dromotropy)

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11
Q

anti-arrhythmic drug that decreases diastolic potential (making it harder to reach threshold)

A

Adenosine

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12
Q

1A Na+ channel blockers mneumonic

A

Double Quarter Pounder

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13
Q
A

1A Na+ channel blockers

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14
Q

1B Na+ channel blockers mneumonic

A

Lettuce, mayo, tomato

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15
Q
A

1B Na+ channel blockers

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16
Q

1C Na+ channel blockers mneumonic

A

More Fries Please

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17
Q
A

1C Na+ channel blockers

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18
Q

what prolongs Na+ slope (phase 0) the most out of the Na+ channel blockers

A

1C class

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19
Q

“PACE Maker”

A

class II: beta blockers (SA node)

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20
Q
A

class II: beta blockers

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21
Q

“A Big Dog Is Scary”

A

class III: K+ channel blockers

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22
Q
A

class III: K+ channel blockers

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23
Q

Diltiazem
Verapamil

A

class IV: Ca2+ channel blockers (AV node)

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24
Q

most important and widely used class III: K+ channel blocking drug

A

Amiodarone

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25
Q

anti-arrhythmic drugs acting on cardiomyocytes in reentry

A

1A, 1B, 1C, III

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26
Q

drugs used in most atrial and ventricular arrhythmias (AVNRT, AFLUT, AFIB, VTACH)

A

1A (D,Q,P)

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27
Q

drug used as second choice in sustained VTACH in MI

A

Procainamide

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28
Q

SE’s for class 1A Na+ channel blockers

A

long QT
TdP

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29
Q

SE of this 1A Na+ channel blocker is CINCHONISM

A

Quinidine

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30
Q

SE of this 1A Na+ channel blocker is drug induced lupus

A

Procainamide

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31
Q

group of drugs that abolishes unidirectional block (treats diseased heart)

A

class 1B (L,M,T)

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32
Q

what is a concern for long QT

A

Torsades de pointes

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33
Q

good for post MI VTACH; preferentially binds to ischemic and disease cells (BEST FOR MI PATIENTS)

A

class 1B Na+ channel blockers

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34
Q

SE of class 1B drugs

A

CNS toxicity

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35
Q

contraindicated in diseased hearts (proarrhythmic)

A

class 1C Na+ channel blockers

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36
Q

SE of class 1C drugs (M,F,P)

A

produce arrhythmia

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37
Q

SE of this class 1C drug is metallic taste

A

Propafenone

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38
Q

Na+ channel blocker class with strongest binding

A

1C

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39
Q

Na+ channel blocker class with weakest binding

A

1B

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40
Q

class II (beta blockers) ultimately do what

A

decrease chronotropy and dromotropy

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41
Q

class II (beta blockers) SE

A

heart block, failure
fatigue, asthma
masks hypoglycemia
nightmares, erectile dysfunction

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42
Q

class III (K+ channel blockers) has highest risk of what

A

Torsades de pointes

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43
Q

safest class III (K+ channel blocker) to prescribe; it decreases sinus rate, increases PR, QRS, QT

A

Amiodarone

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44
Q

class III (K+ channel blockers) SE

A

long QT, TdP

45
Q

SE’s of Amiodarone:

A

pulmonary fibrosis (do PFTs)
hyper/hypothyroidism (do TFT)
hepatotoxicity (do LFT)

46
Q

DO NOT USE IN VTACH or WPW syndrome (worsen arrhythmia)

A

class IV (Ca2+ channel blockers)

47
Q

SE’s of Diltiazem and Verapamil

A

edema, heart block, constipation

48
Q

CYP3A4 inhibitors

A

Diltiazem and Verapamil

49
Q

short acting anti-arrhythmic drug that can produce complete heart block (block AV node) (can completely stop heart in 60 sec)

A

Adenosine

50
Q

short acting anti-arrhythmic drug that is used in AV nodal reentry tachycardia (AVNRT)

A

Adenosine

51
Q

Adenosine blocks _____and opens_____ channel; what does it do to cAMP

A

Ca2+; K+; decreases (Gi)

52
Q

SE of Adenosine

A

bronchospasm

53
Q

do NOT use adenosine in what patients

A

asthma

54
Q

MoA of Digoxin

A

blocks Na+/K+ ATPase and NCX activity and leading to increased intracellular Ca2+ and +inotropy

55
Q

primary effect of Digoxin

A

+ inotropy

56
Q

Digoxin is contraindicated in what

A

hypokalemia and WPW syndrome(causes + dromotropy in atria)

57
Q

signs of Digoxin toxicity

A

yellow vision
anorexia

58
Q

Rx Digoxin toxicity:

A

Anti-Digoxin fragements

59
Q

this pathway is related to what arrhythmia

A

AFib

60
Q

this pathway is related to what arrhythmia

A

AFlut

61
Q

indicative of what arrhythmia

A

AV nodal reentry tachycardia

62
Q

indicative of what arrhythmia

A

WPW syndrome

63
Q

can extreme tachy or bradycardia maintain CO?

A

no; anything outside (50-150) CO drops

64
Q

origin of SVTs

A

AV node/Bundle of His or above

65
Q

indicative of what arrhythmia

A

Atrial Tachycardia

66
Q
A

Atrial Tachycardia

67
Q

why inverted p in atrial tachycardia?

A

signal travels backwards to SA node

68
Q

most common pediatric arrhythmia

A

Atrial Tachycardia

69
Q

wavy baseline; irregularly irregular

A

AFib

70
Q

most common sustained arrhythmia

A

AFib

71
Q

Acute Rx of AFib w/ no CHF:

A

I.V. beta blockers and Ca2+ channel blockers

72
Q

Acute Rx of AFib w/ CHF:

A

I.V. AMIODARONE (b/c beta blockers and Ca2+ could make CHF worse)
OR DIGOXIN

73
Q

long term Rx of AFib w/out CHF

A

beta blockers and Ca2+ channel blockers

74
Q

long term Rx of AFib w/ CHF

A

DIGOXIN

75
Q

to control rhythm in AFib

A

Class III (K+ channel blockers)

76
Q

sawtooth

A

Atrial Flutter

77
Q

Rx Atrial Flutter

A

class III (IBUTILIDE)

78
Q

NO p waves

A

AV nodal reentry tachycardia

79
Q

SVT that occurs in normal heart

A

AVNRT

80
Q

Acute Rx of hemodynamically stable patient with AVNRT

A

carotid massage; valsalva

81
Q

what do administer if carotid massage and valsalva don’t help with AVNRT

A

I.V ADENOSINE

82
Q

Acute Rx of hemodynamically unstable patient with AVNRT

A

emergency cardioversion

83
Q

chronic Rx of AVNRT

A

ablation

84
Q

PR short; NO delta wave

A

LGL syndrome

85
Q

in LGL syndrome, why is the PR interval short

A

b/c bypass AV node through James fiber

86
Q

wide QRS, short PR; DELTA waves

A

WPW syndrome

87
Q

why does WPW syndrome have short PR

A

bypass AV node through Bundle of Kent

88
Q
A

PVC (preventricular contraction)

89
Q
A

VTACH to VFib

90
Q
A

STEMI on L
Torsades de pointes on R

91
Q

2 main treatments for VTACH

A

I.V. AMIODARONE
cardioversion

92
Q

what drug if used in patient with VTACH will produce VFIB

A

CCB’s

93
Q

_____mostly occurs in diseased heart (MI)

A

ventricular tachycardia

94
Q

what will be ineffective for Rx of VTACH

A

carotid massage

95
Q

polymorphic VTACH w/ long QT

A

Torsades de pointes

96
Q

Rx Torsades de pointes

A

I.V. MgSO4

97
Q

B1B2 agonist used to treat Torsades de pointes

A

ISOPROTERENOL

98
Q

main reason for 3rd degree heart block

A

age related fibrosis

99
Q

drugs (I.V.) to use to control rate in acute AFIB

A

beta blockers and Ca2+ channel blockers

100
Q

AFIB + CHF

A

AMIODARONE

101
Q

AFIB + CAD

A

Sotalol

102
Q

AFIB + WPW

A

Ibutilide

103
Q

AFIB + WPW that can turn into VFIB

A

cardioversion (if hemodynamically unstable)
Flecainide

104
Q

can be used in acute and longterm AFIB + CHF

A

DIGOXIN

105
Q

what drugs need to be administered in patient with AFIB + CHF

A

DIGOXIN
FUROSEMIDE and ACEI
ANTICOAGS (WARFARIN)

106
Q

In a patient with WPW syndrome who experiences atrial fibrillation with anterograde (AV) conduction over the accessory pathway (antidromic reciprocal tachycardia), the drug of choice is:

A

Procainamide (the other choices CI in WPW)

107
Q

why can you use procainamide in WPW?

A

it prolongs the refractory period of atrial myocardium (AP duration is prolonged); reduces ventricular response

108
Q

Which of the following statements regarding lidocaine is NOT correct?

  1. It is a local anesthetic that causes sodium-channel blockade.
  2. It has activity on both atrial and ventricular myocardium.
  3. The drug mexiletine is an oral drug with properties very similar to those of lidocaine.
  4. Prophylactic administration of lidocaine in the setting of myocardial infarction is not recommended.
A
  1. it does not work on atrial myocardium (only ventricular myocardium)

CVR Biweekly 3 (12 decks)

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