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957 Block 4 > 1. Ventricular Arrhythmias > Flashcards

1. Ventricular Arrhythmias Flashcards

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1
Q

What are the 2 subtypes of ventricular arrhythmias?

A
  • ventricular fibrillation

- ventricular tachycardia

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2
Q

What are the 2 subtypes of ventricular tachycardia?

A
  • monomorphic VT

- polymorphic VT

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3
Q

Torsades de pointes belongs to what VT subtype?

A

polymorphic VT

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4
Q

How does a patient with ventricular arrhythmia present?

A
  • with or without pulse
  • syncope
  • chest pain
  • lightheaded or dizziness
  • palpitations
  • dyspnea
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5
Q

What does ACLS stand for?

A

Advance Cardia Life Support

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6
Q

What are the 3 components of the first step of ACLS?

A
  1. start CPR
  2. give oxygen
  3. attach monitor
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7
Q

What are the 2 drug therapy options for pulseless VT/VF ACLS?

A
  • epinephrine 1 mg q 3-5 minutes

- amiodarone 300 mg bolus, second dose 150 mg followed by continuous infusion

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8
Q

What are the 5 H’s that cause cardiac arrest?

A
  • hypovolemia
  • hypoxia
  • hydrogen ion (acidosis)
  • hypo/hyperkalemia
  • hypothermia
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9
Q

What are the 5 T’s that cause cardiac arrest?

A
  • tension pneumothorax
  • tamponade, cardiac
  • toxins
  • thrombosis, pulmonary
  • thrombosis, coronary
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10
Q

What should you check for in the second step of ACLS?

A

Is the rhythm shockable?

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11
Q

What rhythms are considered unshockable?

A
  • asystole

- pulseless electrical activity (PEA)

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12
Q

What rhythms are considered shockable?

A
  • ventricular fibrillation

- pulseless ventricular tachycardia

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13
Q

After defibrillating a patient, what is the next step?

A
  • CPR for 2 minutes

- IV access

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14
Q

If patient is able to be shocked for a 2nd time, what is the next step?

A
  • CPR for 2 minutes
  • epinephrine q 3-5 minutes
  • consider advanced airway and capnography
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15
Q

What is capnography?

A

the monitoring of the concentration or partial pressure of carbon dioxide

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16
Q

If a patient is able to be shocked for a 3rd time, what is the next step?

A
  • CPR for 2 minutes
  • amiodarone
  • treat reversible causes
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17
Q

If a patient is NOT a candidate for defibrillation, what is the next step?

A
  • CPR for 2 minutes
  • IV access
  • epinephrine q 3-5 minutes
  • consider advanced airway and capnography
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18
Q

What are the characteristics of return of spontaneous circulation?

A
  • pulse and blood pressure
  • abrupt sustained increase in PETCO2
  • spontaneous arterial pressure waves with intra-arterial monitoring
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19
Q

What is first line therapy for pulseless VT/VF?

A

defibrillation

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20
Q

What are the “shockable rhythms”?

A

pulseless VT and VF

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21
Q

Defibrillation “jump starts” the heart. (T/F)

A

False

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22
Q

Defibrillation produces temporary ________.

A

asystole

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23
Q

What is the purpose of producing temporary asystole?

A
  • completely depolarizes the heart

- allows the nodes to restore normal activity

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24
Q

Following asystole due to defibrillation, if sufficient store of ______ remain in the heart, it should restore normal sinus rhythm.

A

ATP

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25
Q

What are the roles of the pharmacist in ACLS?

A
  • anticipate and prepare medications for administration
  • communicate instructions for medical administration
  • aide in medication choices
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26
Q

What does VT look like on ECG?

A

wide QRS complex arrhythmia

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27
Q

Ventricular tachycardia is defined as at least __ consecutive premature ventricular contractions at a rate of > ____ beats/minute.

A
  • 3

- 100

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28
Q

NSVT spontaneously terminates in what amount of time?

A

< 30 seconds

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29
Q

What does NSVT stand for?

A

non-sustained ventricular tachycardia

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30
Q

SVT lasts for what amount of time?

A

> 30 seconds

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31
Q

What intervention can be made for SVT?

A

cardioversion

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32
Q

What does SVT stand for?

A

sustained ventricular tachycardia

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33
Q

What is ventricular storm?

A

3 or more sustained episodes of VT/VF or appropriate shocks from implacable cardioverter-defibrillator within 24 hours.

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34
Q

What are the medication options for ventricular storm?

A
  • Class III agents: amiodarone
  • β blockers
  • Class Ib agents: lidocaine, mexiletine
  • Procainamide
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35
Q

What medication should be avoided in VT storm?

A

catecholamines

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36
Q

What are the 2 treatment options for VT storm?

A
  • medication therapy

- perform revascularization if indicated

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37
Q

VT/VF is often driven through excessive systemic _________.

A

catecholamines

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38
Q

What are the catecholaminergic agents that should be avoided in VT/VF?

A
  • epinephrine
  • norepinephrine
  • dopamine
  • dobutamine
  • phenylephrine
39
Q

Which β blocker agents should be chosen first?

A

cardiac-specific

40
Q

If a patient has underlying HF, what β blocker agent should be chosen in VT/VF?

A
  • carvedilol
  • metoprolol
  • bisoprolol
41
Q

What is the dose of carvedilol for HF patient in VT/VF?

A

25 mg BID (50 mg BID if > 80 kg)

42
Q

What is the dose of metoprolol XL for HF patient in VT/VF?

A

200 mg daily

43
Q

What is the dose of bisoprolol for HF patient in VT/VF?

A

10 mg daily

44
Q

If a HF patient is in VT/VF and is unstable or has no oral access, what are the β blocker options?

A
  • Metoprolol IV

- Esmolol IV

45
Q

What is the IV dose of metoprolol?

A
  • 5 mg IV push
  • repeating q 5 minutes up to 3 doses
  • maintenance of 5-10 mg IV q 4-6 hours until oral conversion is possible
46
Q

What is the dose of IV esmolol?

A

continuous infusion 25 - 300 mcg/kg/min

47
Q

What is the dose of amiodarone in patient with VT with pulse?

A
  • 150 mg IV bolus
  • followed by 1 mg/min continuous infusion for 6 hours
  • decrease to 0.5 mg/min for 18 hours
48
Q

When should amiodarone be converted to oral therapy?

A

after first 24 hours if patient remains in sinus rhythm

49
Q

What is the oral dose of amiodarone?

A
  • oral load to total of 10 g : 200-400 mg given 2-3x / day

- maintenance dose: 400 mg PO daily

50
Q

Amiodarone is a CYP _______

A

inhibitor

51
Q

What should be monitored during the administration of amiodarone? (5)

A
  • thyroid function test
  • pulmonary function test
  • liver function test
  • eye exam
  • EKG
52
Q

How often should a patient on amiodarone get a thyroid function test?

A

baseline and every 6 months

53
Q

How often should a patient on amiodarone get a pulmonary function test?

A

baseline and every 12 months

54
Q

How often should a patient on amiodarone get a liver function test?

A

baseline and every 6 months

55
Q

How often should a patient on amiodarone get an eye exam?

A

baseline and every 12 months

56
Q

How often should a patient on amiodarone get an EKG?

A

baseline and every 3–6 months

57
Q

What are some counseling points for amiodarone?

A
  • wear sunscreen and avoid excessive sun exposure

- report any signs of possible ADRs

58
Q

What are ADRs that patients on amiodarone should report to their doctor?

A
  • dyspnea
  • tachycardia/bradycardia
  • abdominal pain
  • lethargy/fatigue
  • vision change
59
Q

Which β blocker is not effective for cardioversion?

A

sotalol

60
Q

What receptor does stall block?

A

β1 and β2

61
Q

What are the ADRs of sotalol?

A
  • CHF exacerbation
  • bradycardia
  • Torsades
  • QT prolongation
62
Q

What is the dose of sotalol?

A
  • 80 mg BID

- increase every 3 days until QTc ~ 500 msec

63
Q

In what patients is sotalol contraindicated?

A
  • baseline QTc > 440 msec
  • ClCr < 40 mL/min in atrial arrhythmias and slightly lower for ventricular arrhythmias
  • heart block
  • pre-existing severe pulmonary disease
  • asthma
64
Q

Sotalol should be decreased in ______ dysfunction.

A

renal

65
Q

What is the sotalol dose with CrCl 40–60 mL/min?

A

80 mg daily

66
Q

In what patients is amiodarone contraindicated?

A
  • pre-existing severe hepatic failure
  • pre-existing severe pulmonary disease (documented DLCO < 50%)
  • heart block
  • hyperthyroidism
67
Q

Class Ib agents control what?

A

ventricular arrhythmias only

68
Q

What is the dose of lidocaine?

A
  • 1 mg/kg IV bolus

- 1–4 mg/min

69
Q

What are ADRs for lidocaine?

A
  • hypotension
  • bradycardia
  • nystagmus
  • dizziness
  • seizure
  • confusion/disorientation
70
Q

In what patients is lidocaine contraindicated?

A

3rd degree block

71
Q

In what patients should the dose of lidocaine be decreased?

A
  • liver dysfunction
  • renal dysfunction
  • HF
  • cirrhosis
  • elderly patients
72
Q

Lidocaine requires ________ to adjust dose.

A

PK monitoring

73
Q

What are the Class Ib agents used for ventricular arrhythmias?

A
  • lidocaine

- mexiletine

74
Q

The oral dose of mexiletine is equivalent to what?

A

lidocaine

75
Q

What is the dose of PO mexiletine?

A

200 mg PO q8h

76
Q

What are the ADRs of mexiletine?

A
  • NVD
  • anorexia
  • tremor
  • blurry vision
  • confusion
  • ataxia
77
Q

Mexiletine is used ____-line to suppress ventricular arrhythmias.

A

last

78
Q

Mexiletine should be used only after trying to suppress the ventricular arrhythmia with what agents?

A
  • amiodarone

- sotalol

79
Q

Procainamide is used it what situations?

A

refractory ventricular arrhythmias

80
Q

What is the dose of procainamide?

A
  • 10 mg/kg bolus

- consider following with 2–6 mg/min infusion

81
Q

What should be monitored during procainamide administration?

A

procainamide + NAPA level

82
Q

What is the goal level of procainamide + NAPA?

A

3–10 mcg/mL

83
Q

What are the ADRs of procainamide?

A
  • Lupus erythematous-like syndrome
  • hematologic dysfunction
  • GI disturbances
  • anticholinergic side effects
84
Q

What is the purpose of device therapy in patients with ventricular arrhythmias?

A

prevention of sudden cardia death

85
Q

When might device therapy be used for primary prevention?

A

following episodes of

  • syncope
  • proarrhythmic events but not sudden cardiac death
86
Q

When might device therapy be used for secondary prevention?

A

following episodes of sudden cardiac death

  • VT/VF
  • asystole
  • PEA
87
Q

Torsades de pointes is a serious, but not life-threatening event. (T/F)

A

False: life-threatening

88
Q

Describe the EKG of tornadoes de pointes.

A

QRS intervals twist around the isoelectric line of the EKG

89
Q

Torsades de pointes can be acquired or inherited. (T/F)

A

True

90
Q

Torsades de pointes results from myocardial depolarization due to what?

A

efflux of potassium ions

91
Q

What electrolyte imbalances can contribute to the development of TDP?

A

Low Ca, K, Mg

92
Q

What cardiac diseases can contribute to the development of TDP?

A
  • MI / CAD
  • HF
  • heart block
  • bradycardia
93
Q

What are the sole treatments for TDP?

A
  • direct current cardioversion (DCCV)

- IV magnesium

957 Block 4 (3 decks)

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