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53 Cards in this Set

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which drugs increase the defib threshod and thus require higher energy for defib. a Vent. arrhythmia into sinus rythm?
Amiodarone
lidocaine
mexiletine
Which drug lowers the defib threshold thus requiring less energy?
Sotalol, other BBs have no effect on threshold
What is the Goal in A Fib?
Rate Control
What are the 3 rate control meds?
BBs- control HR

CCBs- preferred in COPD, avoid in CHF

Digoxin- controls HR at rest; avoid monotherapy with active A Fib pts. (pt should be on a BB also)
what are the side effects of Verapamil?
Edema and Constipation
What do you do for Rhythm control in A Fib with onset of less than 48 hrs.
Anticoagulate with Heparin then DCC
What do you do for Rhythm control in A Fib with onset of greater than 48 hrs.

What if pt is stable?
Check TEE for thrombus, if no thrombus, add heparin and perform DCC.

If pt is stable, rate control and initiate warfarin (goal 2-3) for 3-4 wks prior to DCC.
which antiarrhythmics slow depolarization and are a IA drug? Name them.
Na Channel Blockers

Quinidine
Procainamide
Disopyramide

> QRS, QT
Which antiarrythmics are Class II and slow AV nodal conduction? Name them.
BBs Class II

Metoprolol
Esmolol
Atenolol

> PR
Which antiarrythmics slow repolarization and name them.
K channel blockers Class III

Amiodarone
Sotalol
Dofetilide
Ibutilide

> QT
Which antiarrythmics are Class IV and slow AV nodal conduction? Name them.
Ca channel blockers Class IV

Diltaizem
Verapamil

> PR
which antiarrhythmics slow depolarization and are a IB drug? Name them.
Na channel blockers

Lidocaine
Mexiletene

>QRS, <QT
which antiarrhythmics slow depolarization and are a IC drug? Name them.
Na channel blockers

Propafenone
Flecainide
Moriczine

>QRS
Which drug will give you a lupus-like syndrome as a side effect
Procainamide
which Class IA drug has a strong negative inotropic effects
Disopyramide
Which Class 1B drug can give you periorbital numbness and seizures as a side effect
Lidocaine
which Na channel blockers are contra indicated with 3rd degree heart block?
Class 1B

Lidocaine and Mexiletene
which drug increases ICD firing, gives you a metallic taste as a side effect and is contra indicated with hepatic disease?
Propafenone because its metabolized by the liver
which drug affects Na, K, Ca, BBs
Amiodarone, a Class III K channel blocker
what are the adverse effects of amiodarone?
Pulmonary fibrosis
hypothyroidism
blue-gray skin
torsades
neurologic toxicities
what should you do before starting a patient on Amiodarone?
Get pulmonary function test and TSH, T3, T4 test because pulmonary fibrosis and hypothyroidism are major side effects.

So don't give this to a pt with emphysema or other pulm. problem.
What are the contra indications of Amiodarone?
Iodine hypersensitivity
Hyperthyroidism
Heart block
What are the drug interactions of Amiodarone?
warfarin
digoxin
dilantin
It's metabolized by CYP 450(2C9, 2D6, 3A4)
Name a Class III drug that blocks Beta I, II, and K channels
Sotalol
with which Class III med do you worry about Torsades?
All Class III meds because they increase the QT interval
when do you increase the risk of Torsades when using Sotalol?
when the QTC is greater than 440
Is Sotalol effective in A Fib?
No, only used for A Fib and VT maintenance
You've tried Amiodarone and Sotalol to try to convert A-Fib, however they didn't work. Which drug can you try next?
Dofetilide
Which Class III drug is solely a K channel blocker and is never used as a first line agent?
Dofetilide
Which drug do you have to calculate Creatine clearance to adjust dose?
Dofetilide
what are the C.I. for Dofetilide?
QT > 440

CrCl < 20ml/min because its renally cleared
What is the dosing of Dofetilide?
CrCl:
20-30 = 125mcg PO Q12
30-60 = 250 mcg PO Q12
>60 = 500 mcg PO Q12
What do you need to do before giving Dofetilide?
baseline EKG
Sr Cr
Ht/Wt
Which drugs do you use for cardioversion if duration is < 48 hrs?
Propafenone
Flecainide

Ibutilide
Dofetilide
Which drugs do you used if pt has LV dysfunction (CHF)?
Amiodarone
Dofetilide
Which drugs are contra indicated with CHF pts?
Propafenone
Flecainide
What is considered Moderate stroke risk factors?
65-75 y/o
Diabetic
CAD
If you are 67 y/o and a diabetic, what anticoagulation therapy would you be on?
Warfarin (2-3) and low dose ASA
what are the high stroke risk factors?
>75 y/o
HTN
CHF
Heart valve
prior stroke
TIA
thromboembolism
How do you calculate CrCl?
CrCl = [(140 - age) x IBW] / (Scr x 72) (x 0.85 for females)
Note: if the ABW (actual body weight) is less than the IBW use the actual body weight for calculating the CRCL. If the patient is >65yo and creatinine<1.0, use 1 to calculate the creatinine clearance
How do you calculate IBW?
Males: IBW = 50 kg + 2.3 kg for each inch over 5 feet.

Females: IBW = 45.5 kg + 2.3 kg for each inch over 5 feet.
wich drugs interfere with digoxin?
Propafenone
Flecainide
Amiodarone
which anti-arrythmics will you use with normal LV w/o CAD?
Propafenone
Flecainide
Sotalol
Disopyramide
which anti-arrythmics will you use with normal LV with CAD?
Amiodarone
Dofetilide
Sotalol
which anti-arrythmics will you use with LV dysfunction?
Amiodarone
Dofetilide
For PVCs and NSVT, what drug do you use and which do you avoid?
Use BBs, avoid Class I
which drug is contraindicated with glaucoma?
Disopyramide

It has ACH side effects
T/F procainamide is used for sustained VT (QT not prolonged) with EF >40
TRUE

other drugs you can use are: Amiodarone
Lidocaine
which drugs should you avoid for A-fib conversion?
Quinidine (GI effects)
Sotalol (not effective)
which drugs are used for pulseless VT/VF?
Lidocaine
Amiodarone
name a drug that can give you seizures if given too quick?
Lidocaine
name 2 drugs you can use for VT maintenance
Mexiletine
Sotalol
which drugs interact with warfarin?
Quinidine
Propafenone
Amiodarone