Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
40 Cards in this Set
- Front
- Back
|
PO beta blocker agents
|
- bisoprolol
- nabirolol |
|
|
IV beta blocker agents
|
- esmolol
|
|
|
PO and IV beta blocker agents
|
- stenolol
- metoprolol - propranolol (Beta non-selective) |
|
|
beta blocker uses and MOA
|
- used for rate control in pts. w/ A-fib
MOA: blocks effects of sympathetic neurotransmitters (NE) to the heart and vasculature - decreases ventricular arrhythmias by decreasing ventricular response rate/ AV node conduction/ impulse transmission |
|
|
beta blocker adverse effects
|
- hypotension
- decreased heart rate - AV block - fluid retention - fatigue/weakness - sexual dysfunction |
|
|
beta blocker cautions
|
- severe asthma
- bradycardia - 2nd and 3rd degree heart block |
|
|
beta blocker pearls
|
- 1st line acute therapy for rate control in pts with normal L ventricular function
- chronic control in pts. w/ normal or impaired L ventricular function. - higher doses needed for acute rate control compared to HF |
|
|
Non-dihydropyridine calcium channel blocker agents
|
- diltiaze
- verapmil - both IV and PO |
|
|
Non-dihydropyridine calcium channel blocker uses and MOA
|
- used for rate control in pts w/ A-fib
MOA: decreases the influx of calcium - decreases ventricular arrhythmias by decreasing response rate, AV node conduction and impulse transmission |
|
|
Non-dihydropyridine calcium channel blocker adverse effects
|
- hypotension
- decreased HR - fluid retention - dizziness - flushing - constipation |
|
|
Non-dihydropyridine calcium channel blocker cautions
|
- sick sinus syndrome
- wolff-parkinson white syndrome - 2nd and 3rd degree heart block |
|
|
Non-dihydropyridine calcium channel blocker pearls
|
- agent of choice for acute rate control
- avoid as chronic therapy in patients with impaired LV function - IV route preferred for acute management- not to exceed 48hours of therapy |
|
|
Digoxin uses and MOA
|
- used for rate control in patients w/ A-fib
MOA: inhibits Na-K adenosine triphosphatase - increases AV node activation through vagal tone - increases refractory period - decreased ventricular impulses and response rate |
|
|
digoxin adverse effects
|
toxicities
- cardiac: arrhythmias, blocks, bradycardias - GI disturbances - CNS: confusion, vision changes (yellow/green halos) risk factors for toxicity: - decreased K/Mg - increased Ca - hypothyroidism - interacting meds - baseline renal insufficiency |
|
|
digoxin contraindications and cautions
|
contraindicated in 2nd and 3rd degree heart block
caution on: - amiodarone - diuretics - cholestyramine - spironolactone - verapamil |
|
|
digoxin monitoring parameters
|
- BMP: K/SCr
- digoxin level: 1-2 mg/mL - sxs of toxicity increase monitoring if: - change in renal function - change in EKG - sxs of toxicity - initiation or d/c of interacting meds |
|
|
digoxin pearls
|
- not indicated for acute control
- IV used only in pts who are unable to take PO - decrease starting dose in pts. w/ conduction abnormalities, decreased renal function and low lean body mass - decrease starting dose by 50% with amiodarone |
|
|
Dafetilide uses and MOA
|
- used for rhythm control in pts. w/ A-fib
MOA: class III- blocks potassium channels --> increase in action potentials d/t delayed repolarization |
|
|
dafetilide adverse effects
|
- hypotension
- decreased HR - QTc prolongation - syncope - dizziness |
|
|
dafetilide cautions
|
- QTc >440 msec -- monitor EKG
- CrCl < 20 mL/min = renal insufficiency - use w/ verapamil |
|
|
dafetilide pearls
|
- prolonged QTc requires dose decrease by 50%
- potential for proarrhythmic effects - safe and effective in heart failure patients |
|
|
sotalol uses and MOA
|
- used for rhythm control in pts. w/ A-fib
MOA: class II/III - BB effects: class II- Beta adrenoreceptor blocking/ cardiac AP prolongation - class III effect: block K channel |
|
|
sotalol adverse effects
|
- hypotension
- decreased heart rate - AV block - QTc prolongation - arrhythmias - dizziness - fatigue |
|
|
sotalol cautions
|
- severe asthma
- 2nd and 3rd degree heart block - uncontrolled heart failure - renal failure |
|
|
sotalol pearls
|
- potential for proarrhythmic effects
- titrate dose only after 5-6 doses have been administered - decrease or d/c if QTc is > 25% of baseline --> usually just decrease b/c of potential for a-fib relapse |
|
|
flecanide uses and MOA
|
- used for rhythm control in pts w/ A-fib
MOA: class Ic - blocks sodium channels to prolong refractory periods and increase electrical threshold - moderate negative inotropic effects --> decrease in strength of contractions |
|
|
flecanide adverse effects
|
- dizziness
- visual disturbances - dyspnea - ventricular arrhythmias - worsening HF |
|
|
flecanide cautions and contraindications
|
cautions:
- 1st and 2nd degree heart block - renal disease contraindicated in pts w/: - congestive heart failure - post MI |
|
|
flecanide pearls
|
- DOC for non heart disease pts.
- titrate dose by lowest possible amt. not > than 1x/week - decrease dose by 50% in impaired renal function - severe impairment may require larger decrease |
|
|
propafenone uses and MOA
|
- used for rhythm control in pts w/ A-fib
MOA: Class Ic - blocks Na channels to prolong refractory periods and increase electrical thresholds - exhibits some beta block activity |
|
|
propafenone adverse effects
|
- decrease HR
- QTc prolongation - bronchospasms - worsening HF - arrhythmias - impaired taste sensations - dizziness |
|
|
propafenone contraindications
|
- severe asthma
- CHF - liver disease - increased ANA titers |
|
|
propafenone pearls
|
- titrate not more often than every 4-5 days
- decrease dose by 25-50% in pts. w/ liver disease, QRS widening, and heart block - immediate release for acute control - extended release for chronic control |
|
|
amiodarone uses and MOA
|
- used for both rate and rhythm control in pts. w/ A-fib
- fits all VW rhythm control classifications MOA: all classes - acts as Na/beta/K/Ca channel blocker - half life depends on it's site of action - minutes- weeks/months - longer in PO |
|
|
amiodarone adverse effects
|
- decrease in BP/HR
- QTc prolongation - phlebitis - AV block - fibrosis - optic neuropathy/neuritis - hepatitis - hypo/hyperthyroidism - blue-gray skin discoloration |
|
|
amiodarone cautions
|
- iodine allergies
- 2nd and 3rd degree heart block - hepatic disease - drug interactions = warfarin - QTc prolongation |
|
|
amiodarone monitoring
|
- pulmonary testing for lung fibrosis
- thyroid testing - opthalmic testing |
|
|
amiodarone pearls
|
- IV route preferred in symptomatic pts. b/c quicker onset of action
- safe and effective in Afib and HF pts. - FDA requires new leaflet on rx |
|
|
aspirin in stroke prevention
|
- 1st choice for prevention --> depending on risk
- caution in kids recovering from viral illnesses d/t risk of Reyes syndrom |
|
|
warfarin in stroke prevention
|
- increased adversed effects w/ genetic variations
- purple toe syndrome: decreased peripheral perfusion - prevents late claudication- bridge w/ Heparin/ Lovenox - INR : 2-3 |
