Ventricular Antiarrhythmatics Flashcards Preview

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Flashcards in Ventricular Antiarrhythmatics Deck (15):
1

Prevention of Ventricular Arrhythmias 

(Primary vs Secondary)

Primary Prevention: At elevated risk, but have never had an episode

  • Post MI (>40 days after MI), with EF less than 30-35%
  • Ventricular arrhythmias found on ambulatory monitoring
  • Hx of syncope/cardiac arrest where all other causes are r/o

Secondary Prevention: Have survived or experienced V tach without a precipitating cause or experience syncope though to be caused by tachyarrhythmia 

2

Long term treatment of ventricular arrhythmias

  1. Electrophysiology assessment 
  2. Automatic Implantable Cardioverter/Defibrillator (AICD, ICD)
  3. Antiarrhythmic drug therapy may still be needed to decrease number of shocks
  • CAST trial has shown that drug therapy alone increases mortality because proarrhythmic 

3

Treatment of Acute Ventricular Arrhythmia 

Non Cardiac Arrest--Stable and Unstable

Drugs used more often:

  • Amiodarone
  • Lidocaine
  • Procainamide 

For Torsades de pointes with prolonged baseline QT interval 

  • Correct electrolytes
  • Give magnesium 

Unstable: first line is to use syncronized cardioversion 

4

Arrhythmia recognized for ACLS

V fib

V tach

Asystole 

PEA

5

If peripheral drug administration used, what should a bolus injection be followed with?

IV fluid flush 

6

If IV access isn't available, what is another route of administration that is equally effective? 

interosseous 

7

Drugs to improve perfusion 

Epinephrine 

Vasopressin 

8

Drugs to fix the rhythm 

Amiodarone 

Lidocaine 

Procainamide 

9

Epinephrine 

Augments perfusion to heart and brain during CPR 

Increases aortic diastolic pressure and increased cardiac conduction

Stimulates adrenergic nervous system 

10

Vasopressin

Alternative to epinephrine 

Nonadrenergic peripheral vasoconstrictor 

Increase coronary perfusion pressure, vital organ blood flow, cerebral blood flow 

11

Amiodarone 

has effects on potassium, sodiu, and calcium channels as well as alpha and beta adrenergic effects 

helps to fix the rhythm 

12

Lidocaine

2nd behind amiodarone to fix the rhythm if unresponsive to defibrillation 

13

Magnesium Sulfate Indications

Torsades de pointes

suspected hypomagnesemic state

dig toxicity 

refractory ventricular arrhythmias 

14

Atropine

 Drug to fix the rhythm in Asystole or PEA

15

Asystole/PEA

Potential reversible causes 

5 H's 

  • Hypovolemia 
  • Hypoxia 
  • Hydrogen ions (acidosis)
  • hyper/hypokalemia 
  • hypothermia 

5 T's 

  • Tablets (OD) 
  • Tamponade
  • Tension Pneumothorax
  • Thrombosis, coronary (MI)
  • Thrombosis, pulmonary (PE)