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

Rx of Arrhythmias- Al-Mehdi Flashcards

(108 cards)

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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
anti-arrhythmic drugs acting on cardiomyocytes in reentry
1A, 1B, 1C, III
26
drugs used in most atrial and ventricular arrhythmias (AVNRT, AFLUT, AFIB, VTACH)
1A (D,Q,P)
27
drug used as second choice in sustained VTACH in MI
Procainamide
28
SE's for class 1A Na+ channel blockers
long QT TdP
29
SE of this 1A Na+ channel blocker is CINCHONISM
Quinidine
30
SE of this 1A Na+ channel blocker is drug induced lupus
Procainamide
31
group of drugs that abolishes unidirectional block (treats diseased heart)
class 1B (L,M,T)
32
what is a concern for long QT
Torsades de pointes
33
good for post MI VTACH; preferentially binds to ischemic and disease cells (BEST FOR MI PATIENTS)
class 1B Na+ channel blockers
34
SE of class 1B drugs
CNS toxicity
35
contraindicated in diseased hearts (proarrhythmic)
class 1C Na+ channel blockers
36
SE of class 1C drugs (M,F,P)
produce arrhythmia
37
SE of this class 1C drug is metallic taste
Propafenone
38
Na+ channel blocker class with strongest binding
1C
39
Na+ channel blocker class with weakest binding
1B
40
class II (beta blockers) ultimately do what
decrease chronotropy and dromotropy
41
class II (beta blockers) SE
heart block, failure fatigue, asthma masks hypoglycemia nightmares, erectile dysfunction
42
class III (K+ channel blockers) has highest risk of what
Torsades de pointes
43
safest class III (K+ channel blocker) to prescribe; it decreases sinus rate, increases PR, QRS, QT
Amiodarone
44
class III (K+ channel blockers) SE
long QT, TdP
45
SE's of Amiodarone:
pulmonary fibrosis (do PFTs) hyper/hypothyroidism (do TFT) hepatotoxicity (do LFT)
46
DO NOT USE IN VTACH or WPW syndrome (worsen arrhythmia)
class IV (Ca2+ channel blockers)
47
SE's of Diltiazem and Verapamil
edema, heart block, constipation
48
CYP3A4 inhibitors
Diltiazem and Verapamil
49
short acting anti-arrhythmic drug that can produce complete heart block (block AV node) (can completely stop heart in 60 sec)
Adenosine
50
short acting anti-arrhythmic drug that is used in AV nodal reentry tachycardia (AVNRT)
Adenosine
51
Adenosine blocks _____and opens_____ channel; what does it do to cAMP
Ca2+; K+; decreases (Gi)
52
SE of Adenosine
bronchospasm
53
do NOT use adenosine in what patients
asthma
54
MoA of Digoxin
blocks Na+/K+ ATPase and NCX activity and leading to increased intracellular Ca2+ and +inotropy
55
primary effect of Digoxin
+ inotropy
56
Digoxin is contraindicated in what
hypokalemia and WPW syndrome(causes + dromotropy in atria)
57
signs of Digoxin toxicity
yellow vision anorexia
58
Rx Digoxin toxicity:
Anti-Digoxin fragements
59
this pathway is related to what arrhythmia
AFib
60
this pathway is related to what arrhythmia
AFlut
61
indicative of what arrhythmia
AV nodal reentry tachycardia
62
indicative of what arrhythmia
WPW syndrome
63
can extreme tachy or bradycardia maintain CO?
no; anything outside (50-150) CO drops
64
origin of SVTs
AV node/Bundle of His or above
65
indicative of what arrhythmia
Atrial Tachycardia
66
Atrial Tachycardia
67
why inverted p in atrial tachycardia?
signal travels backwards to SA node
68
most common pediatric arrhythmia
Atrial Tachycardia
69
wavy baseline; irregularly irregular
AFib
70
most common sustained arrhythmia
AFib
71
Acute Rx of AFib w/ no CHF:
I.V. beta blockers and Ca2+ channel blockers
72
Acute Rx of AFib w/ CHF:
I.V. AMIODARONE (b/c beta blockers and Ca2+ could make CHF worse) OR DIGOXIN
73
long term Rx of AFib w/out CHF
beta blockers and Ca2+ channel blockers
74
long term Rx of AFib w/ CHF
DIGOXIN
75
to control rhythm in AFib
Class III (K+ channel blockers)
76
sawtooth
Atrial Flutter
77
Rx Atrial Flutter
class III (IBUTILIDE)
78
NO p waves
AV nodal reentry tachycardia
79
SVT that occurs in normal heart
AVNRT
80
Acute Rx of hemodynamically stable patient with AVNRT
carotid massage; valsalva
81
what do administer if carotid massage and valsalva don't help with AVNRT
I.V ADENOSINE
82
Acute Rx of hemodynamically unstable patient with AVNRT
emergency cardioversion
83
chronic Rx of AVNRT
ablation
84
PR short; NO delta wave
LGL syndrome
85
in LGL syndrome, why is the PR interval short
b/c bypass AV node through James fiber
86
wide QRS, short PR; DELTA waves
WPW syndrome
87
why does WPW syndrome have short PR
bypass AV node through Bundle of Kent
88
PVC (preventricular contraction)
89
VTACH to VFib
90
STEMI on L Torsades de pointes on R
91
2 main treatments for VTACH
I.V. AMIODARONE cardioversion
92
what drug if used in patient with VTACH will produce VFIB
CCB's
93
_____mostly occurs in diseased heart (MI)
ventricular tachycardia
94
what will be ineffective for Rx of VTACH
carotid massage
95
polymorphic VTACH w/ long QT
Torsades de pointes
96
Rx Torsades de pointes
I.V. MgSO4
97
B1B2 agonist used to treat Torsades de pointes
ISOPROTERENOL
98
main reason for 3rd degree heart block
age related fibrosis
99
drugs (I.V.) to use to control rate in acute AFIB
beta blockers and Ca2+ channel blockers
100
AFIB + CHF
AMIODARONE
101
AFIB + CAD
Sotalol
102
AFIB + WPW
Ibutilide
103
AFIB + WPW that can turn into VFIB
cardioversion (if hemodynamically unstable) Flecainide
104
can be used in acute and longterm AFIB + CHF
DIGOXIN
105
what drugs need to be administered in patient with AFIB + CHF
DIGOXIN FUROSEMIDE and ACEI ANTICOAGS (WARFARIN)
106
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:
Procainamide (the other choices CI in WPW)
107
why can you use procainamide in WPW?
it prolongs the refractory period of atrial myocardium (AP duration is prolonged); reduces ventricular response
108
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.
2. it does not work on atrial myocardium (only ventricular myocardium)

CVR Biweekly 3 (12 decks)

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