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;
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:
quinidine procainamide phenytoin digoxin warfarin BBs/CCBs "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
|
hyper/hypothyroidism
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
verapamil other agents that cause prolongation of QT interval (TCAs, phenothiazines, cisapride, some macrolides) |
|
Agents for LVEF>40%
|
1st=BB
2nd=CCB 3rd=digoxin |
|
Agents for LVEF<40%
|
1st=digoxin
2nd=BB 3rd=CCB If patient with mild/mod and stable sxs => use digoxin and BB |
|
What is the goal HR with agents for ventricular rate control?
|
<100bpm
|
|
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?
|
Digoxin
|
|
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
or 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
|