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31 Cards in this Set

  • Front
  • Back
When is direct current cardioversion (electrical cardioversion) indicated for patients?
In patients with:
1)severe sxs
2)hemodynamic instability
Type 1a drugs
quinidine, procainamide, disopyramide
type 1b drugs
lidocaine, mexilitine, tocainide
Type 1c drugs
flecainide, propafenone, moricizine
Type 2 drugs
beta blockers
Type 3 drugs
amiodarone, dofetilide, sotalol

ibutilide, bretylium (acute)
Type 4 drugs
CCBs - diltiazem, verapamil
Agents used for cardioversion to NSR
1a, 1c, 3
Indications for maintenance of sinus rhythm with antiarrhythmic agents
frequent occurrences with severe symptoms (syncope, chest pain, hypotension, multiple hospitalizations for HF exacerbation)
Preferred agents in patients with AF and HF
amiodarone, dofetilide
Preferred agetns in patients with AF and CAD
amiodarone, dofetilide, sotalol (class 3)

disopyramide, procainamide, quinidine (class 1a)
Preffered agents in patients with AF and no heart disease
Flecainide, propafenone (class 1c)

or class 1a or 3
Amiodarone drug interactions
Increases levels of:


"Would Dannannamen Quit Playing Poker"
Amiodarone CV adverse effects and monitoring
AV nodal block, sinus bradycardia, QT prolongation

ECG baseline, q3 months
Amiodarone GI adverse effects and monitoring
Hepatic transaminase elevation

SGOT/SGPT baseline, q6 months
Amiodarone pulmonary adverse effects and monitoring
hypersensitivity pneumonitis, insterstitial/alveolar pneumonitis

CXR, PFTs baseline, if sx
Amiodarone thyroid adverse effects and monitoring

TFT baseline, q6 months
Amiodarone ophthalmologic adverse effects and monitoring
corneal microdeposits, optic neuropathy and blindness

Fundoscopic and slit-lamp exam baseline, q1 year
Dofetilide adverse effects
Torsades de pointes

Increased risk if patient is hypokalemic, or hypomagnesemic
Dofetilide drug interactions
cimetidine,ketoconazole, trimethoprim, HCTZ, prochlorperazine, megestrol


other agents that cause prolongation of QT interval (TCAs, phenothiazines, cisapride, some macrolides)
Agents for LVEF>40%
Agents for LVEF<40%

If patient with mild/mod and stable sxs => use digoxin and BB
What is the goal HR with agents for ventricular rate control?
Agents used for control of ventricular rate
Digoxin, Non-dihydropyridine CCBs, BB, Adenosine
What are the effects on the AV node by the agents used to control ventricular rate?
Slow conduction velocity;

prolong refractory period
Which agent for ventricular rate control is less effective in patients with increased sympathetic activity?
Guidelines for stroke prevention in patients with AF
Oral anticoagulants (INR 2-3) given 3 weeks before elective cardioversion in patients with AF for more than 2 days and be continued until NSR is maintained for 4 weeks
When is antithrombic therapy not recommended in patients?
Cardioversion of supraventricular tachycardia
AF less than 2 days duration
Antithrombotic agent selection in patients <65
Risk factors=warfarin INR 2-3

No risk factors=ASA or nothing
Antithrombotic agent selection in patients 65-75
Risk factors=warfarin INR 2-3
No risk factors=warfarin or ASA
Antithrombotic agent selection in patients >75
warfarin INR 2-3