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97 Cards in this Set

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during what part of the action potential does Na rush into the cell and increase membrane potential?
depolarization
what phase does Ca enter into the cell?
plateau phase
when does potassium rush out of the cell?
Repolarization
what part of the QRS complex represents the beginning of ventricular depolarization through repolarization?
QT interval
what is the term for the QT interval that is corrected for heart rate?
QTc
what are four examples of arrythmias with a narrow QRS?
AFIB
atrial flutter
atrial tachy
paroxsysmal supraventricular tachy
what are three examples of arrythmias with a wide QRS?
ventricular tachy-3 consecutive pVC
Non-sustained ventricular tachy
Sustained ventricular tachy
a new type of arrhythmia or worsening of an arrhythmia or worsening due to starting on an antiarrhymthmic?
proarrhythmic event
what is the defibrillation threshold?
the energy requirement necessary for defibrillation of a ventricular arrhythmia into sinus rhythm
what are examples of meds that increase the defibrillation threshold?
Amiodarone
Lidocaine
Mexiletine
what is an example of a med that lowers the defib threshold?
Sotalol
what is the only BB that has an effect on the defibrillation threshold?
sotalol
what is the HR in AFIB?
>300/min
absolute arrhythmia
ventricular rate >90/min
what are typical EKG findings for afib?
no P waves
narrow QRS
irregularly irregular
what is the HR for atrial flutter?
250-350bpm
less stable than afib
what is the classic findings on EKG for atrial flutter?
sawtooth pattern
the "grab-bag" of tachyarrhythmias originating above the ventricle?
supraventricular tachycardia SVT
Defined as 3 or more consecutive PVC's and lasts more than 30 seconds
ventricular tachy
what are examples of meds used to control AFIB/rate control?
BB: avoid pindolol and acebutolol=ISA
CCB: diltiazem & Verapamil (preferred in COPD)
Digoxin: controls HR at rest
what are some common side effects of Diltaizem and Verapamil (the CCB used in rate control)
peripheral edema
constipation
what is the dosage for DIGOXIN?
0.5mg IV then
.25 q6 hours x 2
what is the onset of action for DIGOXIN?
6-12 hours.
what is the danger of using CCB + DIGOXIN together?
"stone heart"
what are some complications for DCC?
bradycardia, skin burns, thrombus forming, proarrhythmic events
what is initial treatment if patient goes into AFIB within the last 48 hours?
Direct current cardioversion.
Heparin should be iniated prior to DCC to avoid clotting.
what is the classic findings on EKG for atrial flutter?
sawtooth pattern
the "grab-bag" of tachyarrhythmias originating above the ventricle?
supraventricular tachycardia SVT
Defined as 3 or more consecutive PVC's and lasts more than 30 seconds
ventricular tachy
what are examples of meds used to control AFIB/rate control?
BB: avoid pindolol and acebutolol=ISA
CCB: diltiazem & Verapamil (preferred in COPD)
Digoxin: controls HR at rest
what are some common side effects of Diltaizem and Verapamil (the CCB used in rate control)
peripheral edema
constipation
what is the treatment for a patient who went into Atrial flutter longer than 48 hours ago?
Check TEE for thrombus, add heparin and perform DCC.
IF STABLE: rate controle and iniate warfarin 2-3 weeks prior to DCC
which antiarrhythmics slow depolarization?
Na Channel Blockers: class IA, IB, IC
which antiarrhythmics slow AV nodal conduction (class II)?
Beta-Blockers: class II
which antiarrhythmics slow repolarization?
K channel blockers: class III
which antiarrhythmics slow av nodal conduction (class IV)?
Ca channel blockers: class IV
what is the treatment for a patient who went into Atrial flutter longer than 48 hours ago?
Check TEE for thrombus, add heparin and perform DCC.
IF STABLE: rate controle and iniate warfarin 2-3 weeks prior to DCC
which antiarrhythmics slow depolarization?
Na Channel Blockers: class IA, IB, IC
which antiarrhythmics slow AV nodal conduction (class II)?
Beta-Blockers: class II
which antiarrhythmics slow repolarization?
K channel blockers: class III
which antiarrhythmics slow av nodal conduction (class IV)?
Ca channel blockers: class IV
what is a TEE?
trans esophageal echocardiogram: to visualize if there is a thrombus around the heart
what are 3 examples of CLASS IA antiarrhythmics?
Quinidine
Procainamide
Disopyramide
which antiarrhythmic should not be used for AFIB cardioversion due to GI effects?
QUINIDINE
Na channel blocker
which antiarrhythmics have drug interactions with warfarin?
"PAQ"
Propafenone
Amiodarone
Quinidine
what effects are seen on the ekg for the Na channel blockers from class IA?
prolonged QRS, QT
what effects on the EKG are seen if patient is taking a Na channel blocker from Class IB?
prolonged QRS
Shortened PT
what is seen on the ekg of P taking a Na channel blocker from class IC?
prolonged QRS.
what is seen on the ekg of P taking beta-blockers (classII) for an antiarrhythmia?
prolonged PR
what is seen on the EKG of P taking K channel blockers (classIII) for antiarrhythmia?
prolonged QT
what changes are seen on an ekg of a patient on Ca channel blockers for Class IV antiarrhythmics?
prolonged PR
what effects on the EKG are seen if patient is taking a Na channel blocker from Class IB?
prolonged QRS
Shortened PT
what is seen on the ekg of P taking a Na channel blocker from class IC?
prolonged QRS.
what is seen on the ekg of P taking beta-blockers (classII) for an antiarrhythmia?
prolonged PR
what is seen on the EKG of P taking K channel blockers (classIII) for antiarrhythmia?
prolonged QT
what changes are seen on an ekg of a patient on Ca channel blockers for Class IV antiarrhythmics?
prolonged PR
which two classes of antiarrhythmics both slow AV nodal conduction and therefore prolong the PR interval?
Beta-Blockers: class II
CCB: class IV
what are some adverse effects of Quinidine?
N/V/D, tinnitus, cinchonism
when are Class IA antiarrhythmics indicated?
for atrial and ventricular tachyarrhythmias
when are class IB antiarrhythmics indicated?
a weak antiarrhythmic, slow conduction through ventricular tissue, decrease ICD firing
what are some adverse effects of Procainamide?
need to decrease dose in renal and liver dysfunction due to accumulation of NAPA (lupus-like syndrome)
which antiarrhythmics do you need to monitor levels of?
Procainamide
Lidocaine
Mexiletine
which antiarrhythmic is contra-indicated for Glaucoma?
Disopyramide.
it has AcH side effects
what are some adverse effects for lidocaine?
CNS symptoms, perioral numbness, seizures, confusion
which antiarrhythmics should be used if pulseless VT/VF, stable VT?
Lidocaine
Amiodarone
what antiarrhythmics are contraindicated in 3rd degree heart block?
Lidocaine
Mexiletine
what antiarrythmics are used for VT maintenance
Mexiletine
Sotalol
what are the indications for use of a Class IC antiarrhythmia?
atrial or ventricular tachyarrhythmia, increases ICD firing, MOST POTENT
which antiarrhythmics have drug interactions with DIGOXIN?
"FAP"
Propafenone
Flecainide
Amiodarone
what drug gives you a metallic taste, dizziness?
Propafenone
which antiarrhythmic is contraindicated for P with CHF?
Propafenone
what are some contraindications of Propafenone?
CHF
Hepatic (drug is metab. solely in the liver)
Valvular disease
which class of antiarrhythimcs are contraindicated for use in patients with CHF and valvular heart disease?
Class 1 C of the Na channel blockers
which class of antiarrhythmics are the most popular?
the Potassium channel blockers
what are some examples of Class III antiarrhythmics?
Dofetilide
Amiodarone
Sotalol
Ibutilide
which antiarrhythmic is used as a last resort, nothing else brought patient out of afib?
Dofetilide.
which antiarrhythmics can lead to torsade de pointes?
increases QT interval: the Potassium channel blockers class III
"DASI"
what are some adverse effects of Amiodarone, a potassium channel blocker class III?
pulmonary fibrosis, hypothyroidism, blue-gray skin, torsades, neurologic toxicitieis
what is the dose of IV Amiodarone to convert patient from AFIB?
150mg over 10 min bolus push.
then
hang drip: 450mg in 250cc Normal saline. at 13cc/hr x 16 hours.
which antiarrhythmics are contraindicated if the patient has a QTc > 400?
Sotalol
Dofetilide
Ibutilide
what are the drug interactions for Dofetilide?
Cimetidine, Ketoconazole, verapamil, trimethoprim, megesterol
what is sotalol used for?
only AFIB maintenance and VT maintenance.
NOT effective in afib.
what K channel blockers are used to convert AFIB?
Amiodarone
Dofetilide
Ibutilide
which strong K channel blocker (only in IV form)needs to be monitored on the ekg?
Ibutilide:
only comes in IV form
typically used in critical care clinic where P is already hooked up to EKG.
what drugs are used if AFIB duration is less than 48 hours?
"DIP F"
Dofetilide
Ibutilide
Propafenone
Flecainde
which two drugs are typically used for LV dysfunction?
Amiodarone
Dofetilide
which drugs are used with normal LV c CAD?
"sad"
Sotalol
Amiodarone
Dofetilide
Which drugs are used in normal LV w/o CAD?
Propafenone
flecainide
sotalol
disopyramide
which strong K channel blocker (only in IV form)needs to be monitored on the ekg?
Ibutilide:
only comes in IV form
typically used in critical care clinic where P is already hooked up to EKG.
what drugs are used if AFIB duration is less than 48 hours?
"DIP F"
Dofetilide
Ibutilide
Propafenone
Flecainde
which two drugs are typically used for LV dysfunction?
Amiodarone
Dofetilide
which drugs are used with normal LV c CAD?
"sad"
Sotalol
Amiodarone
Dofetilide
Which drugs are used in normal LV w/o CAD?
Propafenone
flecainide
sotalol
disopyramide
what are the "moderate" risk factors for stroke and how would you anticoagulate them?
65-75 y/o
Diabetic
CAD
asa (for 1 risk factor)
Warfarin + ASA (if >1 risk)
what are the "High" risk factors for stroke and how would you anticoagulate?
>75
HTN, CHF
Prosthetic Heart Valve
Prior stroke, TIA, thromboembolism
TX: warfarin
ASA
if your patient has sustained VT but the QTc is not prolonged and the EF > 40 what can you treat with?
"PAL"
Procainaminde
Amiodarone
Lidocaine
if you patient has sustaind VT, but the QTc is not prolonged, and the EF<40 what do you treat with?
"LA"
Amiodarone, Lidocaine
with a polymorphic ventricular tachy, and prolonged QTc, the patient goes into torsades de pointe, how do you treat?
IV mag, Isoproterenol, lidocaine, transvenous pacemaker (bedside)