Anti-Arrythmics Mjm

Front 1

action potential phases?

Back 1

Phase 0: influx of Na
Phase 1: K, Cl out
Phase 2: Ca in, K out
Phase 3: K out
Phase 4: resting potential

Front 2

class I agents vs class Ia agents vs class III?

Back 2

class Ia and III prolong the refractory period
class I make the membrane potential less negative

Front 3

why is the SA node the dominant pacemaker?

Back 3

it reaches threshold faster than the other nodes

Front 4

some causes of abnormal automaticity?

Back 4

hypoxia, ischemia, excessive catecholamines

Front 5

supraventricular arrythmias?

Back 5

sinus brady and tach, PSVT, afib, aflutter, WPW, PAC

Front 6

ventricular arrythmias?

Back 6

PVC, vtach, vfib

Front 7

classes of anti-arrythmic drugs?

Back 7

class 1: na blockade (A, B, C based on speed)
class 2: B adrenergic blockers
class 3: K channel blockers
class 4: Ca channel blockers

Front 8

class 1a drugs?

Back 8

quinidine, procainamide, disopyramide

Front 9

adverse effects of quinidine?
DI?

Back 9

Torsades, nausea/vomitting/diarrhea
warfarin, digoxin

Front 10

MOA of quinidine?
used for?

Back 10

decrease in excitability and contraction and conduction velocity. depresses phase 0
AF conversion and maintenance

Front 11

adverse effects of procainamide?
contraindications?

Back 11

torsades, hypotension, lupus-like syndrome
LVEF <40

Front 12

MOA of procainamide?
used for?

Back 12

depresses contractability, decreases excitability and contraction
AF and VT (conversion and maintenance)

Front 13

adverse effects of disopyramide?
contraindications?

Back 13

anticholinergic effects, torsades, heart failure
cardiogenic shock, 2nd and 3rd degree heart block

Front 14

MOA of disopyramide?
Used for?

Back 14

lowers the disparity of the refractory period between well perfused cells and infarcted cells
increases action potential duration
AF (conversion and Maintenance)

Front 15

class 1b drugs?

Back 15

lidocaine, mexilitine

Front 16

Adverse effects of lidocaine?
DI of lidocaine?

Back 16

seizures, confusion, blurry vision, tinnitus
amiodarone

Front 17

MOA of lidocaine?
Used for?

Back 17

suppresses automaticity of cardiac tissue and inhibition of depolarization
pulseless VT and VF (DOC for both is amiodarone) and VT maintenance

Front 18

Adverse effects of mexilitine?
Contraindications?

Back 18

tinnitus, tremor, dizzy, ataxia
3rd degree heart block

Front 19

MOA of mex?
used for?

Back 19

increase refractory period and decreases rate of phase 0
VT maintenance

Front 20

class 1c drugs?

Back 20

propafenone, flecainide

Front 21

propafenone AE/DI?

Back 21

AE: metallic taste, dizzy, ADHF, hrt block, bronchospasm, rady
DI: wrfarin and digoxin increase the levels

Front 22

who should you not give class 1c drugs to?

Back 22

ppl with HF, CVD, post MI, LVEF

Front 23

flecainide AE/DI?

Back 23

AE: dizzy, tremor, ADHF (neg inotrope)
DI: digoxin

Front 24

flecainide and propafenone are used for and their MOA is?

Back 24

AF (coversion and maintenance)
prolong refractory period and conduction velocity

Front 25

class III drugs?

Back 25

amiodarone, sotalol, dofetalide, ibutilide, dronedarone

Front 26

AE of amiodarone?

Back 26

heart block, blue gray skin, photosensitivity, pulm fibrosis, thyroid dz, neurologic toxicity, hypotension

Front 27

when should u not give amio?
DI's?

Back 27

3rd degree heart block, iodine sensitive, hyperthyroid
warfarin, digoxin, statins, b blocker, ca channel

Front 28

MOA of amio?
used for?

Back 28

inhibits adrenergic stim, prolongs action potential and refractory period, decreases AV conduction
AF, pulseless VT/VF, VT/VF (maintenance and conversion)

Front 29

adverse effects of sotalol?

Back 29

adhf, heart block, wheezing bradycardia, bronchospasm
don't give to pt with renal dz

Front 30

Effects of sotalol

Back 30

class 2: slow HR, decreased AV nodal conduction
Class 3: prolongation od refractory period and conduction

Front 31

sotalol is used for?

Back 31

maintenance of AF and VT

Front 32

AE of dofetilide?
DI?

Back 32

diarrhe, TDP
CYP3A4 inhibitors and drugs secreted by kidney, HCTZ

Front 33

dofetilide is used for?

Back 33

AF conversion and maintenance

Front 34

AE of ibutilide?
DI's

Back 34

heart block, TDP
CYP3a4 inhibitors and QT prolongers

Front 35

Contraindications of ibutilide?

Back 35

long QT, LVEF, antiarrythmic drugs

Front 36

MOA of ibutilide and use?

Back 36

prolongs the action potential
AF conversion

Front 37

adverse effects of drondarone?

Back 37

worsens HF, prolongs QT, hypokal, hypomag with K sparing diuretics, hepatic issue

Front 38

DIs of dronedarone?

Back 38

CYP3A4 inhibitors, QT-prolonging drugs, impastation, tacrolimus/sirolimus, warfarin, and other CYP3A4 substrates with narrow therapeutic range, digoxin and other pap substrates (dabigatran

Front 39

contraindications of dronedarone?
MOA?
used for?

Back 39

heart block, liver failure, long QT interval, brady
inhibits na, k, ca channels and is a alpha beta antagonist
AF maintenance

Front 40

cardiac causes of a fib?

Back 40

atrial septal defect, cardiomyopathy (low EF), cardiac surgery, ischemic hrt dz, mitral valve dz, pericarditis,

Front 41

systemic causes of a fib?

Back 41

alcohol, cerebrovascular accident, chronic pulm dz, electrolyte abnormalities, fever, hypothermia, pneumonia, pulm embolism

Front 42

clinical findings in AF?

Back 42

SOB, heart palpitations, light-headed, dizzy, reduced exercise capacity, periferal edema
Pt are at increased risk of thrombolic stroke

Front 43

what are the goals for someone in AF?

Back 43

reduce vent rhythm and decrease potential for stroke

Front 44

what should do before drug therapy for person with Afib?

Back 44

thyroid function test, electrolyte levels, make sure QT interval is below 500

Front 45

goal heart rate for rapid vent rate?

Back 45

60-80
90-115 during exercise

Front 46

can beta blocker cardiovert AF?

Back 46

no

Front 47

what drugs are preferred for slowing the rate?

Back 47

metoprolol and atenolol
if rate control id necessary then give sotalol or propafenone

Front 48

who should avoid using nondihydropyridines?

Back 48

ppl with concomitant systolic dysfunction and WPW

Front 49

when are verapamil and diltiazem preferred over b blocker?

Back 49

in copd and asthma, also good for exercise induced tachy

Front 50

when would you include digoxin?

Back 50

often ineffective by itself in contolling vent rate but in ppl with systolic HF is can be used. also cn be used with b blocker, diltazem, or verapamil
avoid in pt with WPW

Front 51

CHADS2 score

Back 51

congestive HF
HTN 140/90
age >75
DM
stroke (2pts)

Front 52

rhythm vs rate control?

Back 52

typically it is good lower vent rate. however in some pts sinus rhythm should be achieved (intractable/intolerable symptoms and when vent control cant be achieved)

Front 53

rhythm vs rate control 2?

Back 53

rate control is easy to attain but may leave the pt with inability to attain sr.
rhythm control may reduce symptoms further but it is difficult to monitor and is expensive

Front 54

what must you do before you cardiovert?

Back 54

ensure there are no thromboli via TEE and anticoagulate for 3+ weeks (INR 2+)

Front 55

2nd and 3rd line drugs for maintaning and inducing SR?

Back 55

Class 1 (flecainide, quinidine, disopyramide, propafenone)
however flec and propa may be first line in people without heart dz
all are CI in HF

Front 56

best choice for AF control?

Back 56

amiodarone

Front 57

using sotalol for AF?

Back 57

renally excreted so pt must be hospitalized to monitor renal function and QT interval (min of 3 days)
don't use in pt with HF or CKD

Front 58

contrindications of dofetilide?

Back 58

QT interval >400, CKD, liver dz
pt must be hospitalized

Front 59

people taking which drugs should avoid dofetilide?

Back 59

cimetidine, verapamil, ketoconazole, nctz, trimethoprim, sulfamethoxazole

Front 60

who should dronedarone not be used in?
positives?

Back 60

NYHA class 2-4 hf, severe liver impairment, HR less than 50, and with cyp3a4 inhibitors
amiodarone analogue that does decrease af recurrence of af and death from af

Front 61

what are the drug interactions of dronedarone?

Back 61

digoxin, nondihydropyridines, b blockers, statins, cyp3a4 inhibitors

Front 62

slide 42 and 43

Back 62

???

Front 63

non-pharmocologic therapy for AF?

Back 63

electrical cardioversion, AV nodal ablation, pulm vein ablation

Front 64

tx of symptomatic bradycardia?
alternative?

Back 64

atropine
pace or dopamine or epi infusion

Front 65

tx for symtomatic tachy (unstable)?
stable?

Back 65

synchronized cardioversion
determine wide or narrow qrs

Front 66

If the QRS is narrow what should u do?

Back 66

vent rhythm is regular. you should try vagal manuevers or give 6 mg of adenosisne.
if they convert it was probably a tach, PSVT, WPW

Front 67

if the cardioversion is temporary?

Back 67

probably PSVT try diltazem or verapamil or digoxin
don't use in WPW

Front 68

1st degree AV block?

Back 68

prolonged PR interval
can be caused digoxin, b blocker, CCB

Front 69

second degree block (type 1)?

Back 69

PR interval grows longer and longer until there is a drop

Front 70

second degree type 2?

Back 70

qrs complex is dropped every second or third p wave

Front 71

third degree block?

Back 71

ventricles and atria are regular but are not talking to eachother
can be caused by MI, amyloidosis, drugs

Front 72

tx for blocks?

Back 72

atropine or pacemaker

Front 73

NSVT vs SuVT

Back 73

NSVT: 3 or more PVCs lasting <30sec and abruptly stopping
SuVT: PVCs lasting longer than 30 sec and rate of 150-200

Front 74

causes of vent arrythmias?

Back 74

ischemia, heart dz, exercise, metabolic/electrolyte imbalance, digoxin

Front 75

2 approaches to evaluating arrythmias?

Back 75

holter monitor, electrophysiologic study

Front 76

presence of frequent PVCs is a risk factor for?

Back 76

sudden cardiac death

Front 77

preventing VF after an MI?

Back 77

use beta blockers
amiodarone can be considered if beta blockers cant be used

Front 78

treament for NSVT?

Back 78

EF >40 and no symptoms = no therapy
if symptoms = beta blockers
EF <40 = titrate beta blocker carefully

Front 79

Tx of VT (or unknown mech)?

Back 79

consider adenosine if regular
IV procainamide, amiodarone or sotalol
if QT prolonged avoid sotalol

Front 80

irregular VT

Back 80

induced by QT interval >500
withdraw QT prolonging drugs, correct low Mg and K
No class 1 or 3 antiarrythmics
if unstable cardiovert
if stable give Mg