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53 Cards in this Set
- Front
- Back
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which drugs increase the defib threshod and thus require higher energy for defib. a Vent. arrhythmia into sinus rythm?
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Amiodarone
lidocaine mexiletine |
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Which drug lowers the defib threshold thus requiring less energy?
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Sotalol, other BBs have no effect on threshold
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What is the Goal in A Fib?
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Rate Control
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What are the 3 rate control meds?
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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) |
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what are the side effects of Verapamil?
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Edema and Constipation
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What do you do for Rhythm control in A Fib with onset of less than 48 hrs.
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Anticoagulate with Heparin then DCC
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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. |
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which antiarrhythmics slow depolarization and are a IA drug? Name them.
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Na Channel Blockers
Quinidine Procainamide Disopyramide > QRS, QT |
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Which antiarrythmics are Class II and slow AV nodal conduction? Name them.
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BBs Class II
Metoprolol Esmolol Atenolol > PR |
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Which antiarrythmics slow repolarization and name them.
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K channel blockers Class III
Amiodarone Sotalol Dofetilide Ibutilide > QT |
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Which antiarrythmics are Class IV and slow AV nodal conduction? Name them.
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Ca channel blockers Class IV
Diltaizem Verapamil > PR |
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which antiarrhythmics slow depolarization and are a IB drug? Name them.
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Na channel blockers
Lidocaine Mexiletene >QRS, <QT |
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which antiarrhythmics slow depolarization and are a IC drug? Name them.
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Na channel blockers
Propafenone Flecainide Moriczine >QRS |
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Which drug will give you a lupus-like syndrome as a side effect
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Procainamide
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which Class IA drug has a strong negative inotropic effects
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Disopyramide
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Which Class 1B drug can give you periorbital numbness and seizures as a side effect
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Lidocaine
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which Na channel blockers are contra indicated with 3rd degree heart block?
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Class 1B
Lidocaine and Mexiletene |
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which drug increases ICD firing, gives you a metallic taste as a side effect and is contra indicated with hepatic disease?
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Propafenone because its metabolized by the liver
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which drug affects Na, K, Ca, BBs
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Amiodarone, a Class III K channel blocker
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what are the adverse effects of amiodarone?
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Pulmonary fibrosis
hypothyroidism blue-gray skin torsades neurologic toxicities |
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what should you do before starting a patient on Amiodarone?
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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. |
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What are the contra indications of Amiodarone?
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Iodine hypersensitivity
Hyperthyroidism Heart block |
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What are the drug interactions of Amiodarone?
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warfarin
digoxin dilantin It's metabolized by CYP 450(2C9, 2D6, 3A4) |
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Name a Class III drug that blocks Beta I, II, and K channels
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Sotalol
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with which Class III med do you worry about Torsades?
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All Class III meds because they increase the QT interval
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when do you increase the risk of Torsades when using Sotalol?
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when the QTC is greater than 440
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Is Sotalol effective in A Fib?
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No, only used for A Fib and VT maintenance
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You've tried Amiodarone and Sotalol to try to convert A-Fib, however they didn't work. Which drug can you try next?
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Dofetilide
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Which Class III drug is solely a K channel blocker and is never used as a first line agent?
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Dofetilide
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Which drug do you have to calculate Creatine clearance to adjust dose?
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Dofetilide
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what are the C.I. for Dofetilide?
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QT > 440
CrCl < 20ml/min because its renally cleared |
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What is the dosing of Dofetilide?
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CrCl:
20-30 = 125mcg PO Q12 30-60 = 250 mcg PO Q12 >60 = 500 mcg PO Q12 |
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What do you need to do before giving Dofetilide?
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baseline EKG
Sr Cr Ht/Wt |
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Which drugs do you use for cardioversion if duration is < 48 hrs?
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Propafenone
Flecainide Ibutilide Dofetilide |
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Which drugs do you used if pt has LV dysfunction (CHF)?
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Amiodarone
Dofetilide |
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Which drugs are contra indicated with CHF pts?
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Propafenone
Flecainide |
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What is considered Moderate stroke risk factors?
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65-75 y/o
Diabetic CAD |
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If you are 67 y/o and a diabetic, what anticoagulation therapy would you be on?
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Warfarin (2-3) and low dose ASA
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what are the high stroke risk factors?
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>75 y/o
HTN CHF Heart valve prior stroke TIA thromboembolism |
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How do you calculate CrCl?
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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 |
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How do you calculate IBW?
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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. |
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wich drugs interfere with digoxin?
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Propafenone
Flecainide Amiodarone |
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which anti-arrythmics will you use with normal LV w/o CAD?
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Propafenone
Flecainide Sotalol Disopyramide |
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which anti-arrythmics will you use with normal LV with CAD?
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Amiodarone
Dofetilide Sotalol |
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which anti-arrythmics will you use with LV dysfunction?
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Amiodarone
Dofetilide |
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For PVCs and NSVT, what drug do you use and which do you avoid?
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Use BBs, avoid Class I
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which drug is contraindicated with glaucoma?
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Disopyramide
It has ACH side effects |
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T/F procainamide is used for sustained VT (QT not prolonged) with EF >40
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TRUE
other drugs you can use are: Amiodarone Lidocaine |
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which drugs should you avoid for A-fib conversion?
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Quinidine (GI effects)
Sotalol (not effective) |
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which drugs are used for pulseless VT/VF?
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Lidocaine
Amiodarone |
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name a drug that can give you seizures if given too quick?
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Lidocaine
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name 2 drugs you can use for VT maintenance
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Mexiletine
Sotalol |
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which drugs interact with warfarin?
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Quinidine
Propafenone Amiodarone |
