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PHRM 845 > 15 AFib > Flashcards

15 AFib Flashcards

1
Q

Normal ECG Values

PR ___ - ___ ms
QRS ___ - ___ ms
QT ___ - ___ ms
QTc ___ - ___ ms (men)
QTc ___ - ___ ms (women)

A

120-200
80-120
380-460
360-450
360-460

nervous for TdP around 500

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2
Q

Torsades de Pointes

when QTc interval is greater than ___ ms, there is increased risk of drug induced arrhythmia (TdP)
- drug induced
- cause sudden cardiac ___

A

500
death

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3
Q

what is this?

A

TdP

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4
Q

drugs that may cause TdP
- 5 A’s
- opioids

A
  • antiarrhythmics
  • antimicrobials
  • antidepresents
  • antipsychotics
  • anticancer
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5
Q

superventricular arrhythmias

  • sinus ___ and ___
  • ___ block
  • atrial ___
  • supraventricular ___
A
  • bradycardia, tachycardia
  • AV
  • fibriliation
  • tachycardia
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6
Q

ventricular arrhythmias

  • ___ ventricular compexes
  • ventricular ___ and ___
A

premature
tachycardia, fibrillation

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7
Q

superventricular arrhythmias

sinus bradycardia
- HR < ___ bpm
- impulses originating in ___ node (decreased)

A

60
SA
automaticity

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8
Q

what is this

A

superventricular arrhythmias
- sinus bradycardia

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9
Q

supraventricular arrhythmias - sinus bradycardia

etiologies/risk factors
- MI/ischemia
- abnormal SNS/PSNS tone
- electrolytes abnormalities ( ___ and ___ )

drugs
- dig
- BB
- CCB ( ___ and ___ )
- amiodarone, dronedarone
- ivabradone

A

K, Mg
verapamil, diltiazem

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10
Q

supraventricular arrhythmias - sinus bradycardia

symptoms

A

hypotension
dizziness
syncope

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11
Q

supraventricular arrhythmias - sinus bradycardia

treatment
only necessary if patient is ___
- ___ 0.5-1 mg IV, repeat every 5 min

AE: ___ cardia, urinary retention, ___ vision, dry mouth, mydriasis

anti-muscarinic: cant pee, cant see, cant spit

A

symptomatic
atropine
tachycardia, blurred

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12
Q

supraventricular arrhythmias - sinus bradycardia

treatment is not responsive to atropine
- transcutaneous pacing
- ___ (5-20 mcg/kg/min) or ___ (0.1-0.5 mcg/kg/min)
- ___ 20-60 mcg IV bolus followed by doses of 10-20 mcg or infusion of 1-20 mcg/min

A

dopamine
epinephrine
isoproterenol

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13
Q

supraventricular arrhythmias - sinus bradycardia

treatment after heart transplant or spinal cord injury
- ___ 6 mg/kg IV over 20-30 min OR
- ___
- (heart transplant) 300 mg IV followed PO 5-10 mg/kg/day titrated to effect
- (spinal cord injury) PO 5-10 mg/kg/day titrated to effect

A

aminophylline
theophylline

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14
Q

supraventricular arrhythmias - sinus bradycardia

long term treatment
- some patients require a permanent ___

A

pacemaker

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15
Q

supraventricular arrhythmias - atrial fibrillation

  • atrial activity - chaotic and disorganized
  • ventricular rate: 120-180 bpm
  • rhythm: irregularly irregular
  • ___ waves: absnet
A

P

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16
Q

what is this?

A

Afib

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17
Q

Afib

stage 1) presence of modifiable and nonmodifiable risk factors assocaited with AF

stage 2) pre-atrial fib - ___ or ___ findings that further predispose patients to AF

stage 3)
- A) paroxysmal
- B) persistent
- C) long standing persistent
- D) successful ___

stage 4) permanent

A

electrical, structural
ablation

18
Q

Afib

mechanisms
- abnormal atrial/pulmonary vein ___
- atrial ___

A

automaticity
re-entry

19
Q

Afib

etiologies of reversible Afib
hyper ___
thoracic surgery
- CABG
- lung resection
- esophagectomy

A

hyperthyroidism

20
Q

Afib

mortality
- stroke/systemic embolism - 5x increased risk
- HF - increased 3x risk
- dementia - 2x increased risk
- mortality - 2x increased risk

A
21
Q

Afib goals of therapy

1) prevent ___ /systemic ___

___ ventricular response by inhibiting conduction of impulses to ventricles

convert Afib to ___

reduce ___ of episodes

A

stroke, embolism
slow
NSR
frequency

22
Q

Afib - preventioini of stroke/systemic embolism

whats the CHAsDS2-VASc scoring

A
23
Q

Afib - preventioini of stroke/systemic embolism

oral anticoag recommended for:
- ___ or greater (men)
- ___ or greater (women)

reasonable for
- ___ (men)
- ___ (women)

A

2
3
1
2

24
Q

Afib - preventioini of stroke/systemic embolism

___ are preferred over warfarin for most patients

warfarin only preferred in Afib patients with
- ___ heart valves (INR 2.5-3.5)
- moderate to severe ___ valve stenosis (INR 2-3)

A

DOACs
mechanical
mitral

dabigitran, rivaroxaban, apixaban, edoxaban

25
Q

Afib - preventioini of stroke/systemic embolism

warfarin or ___ are preferred in the following
- end stage CKD (CrCl < ___ )
- hemodialysis

A

abixaban
15

26
Q

Afib - drugs of ventricular rate control

MOA: direct AV node inh
- CCB: ___ and ___
- BB: ___ , ___ , and ___

MOA: vagal stimulation/direct AV node inh
- ___

MOA: BB and CCB activity
- ___

A
  • diltiazem, verapamil
  • propranolol, metoprolol, esmolol
  • digoxin
  • amiodarone
27
Q

Afib - drugs of ventricular rate control (IV)

if not stable, shock

if stable, do the have HF?
- if yes: ___
- if no: __ , ___ , or ___ (if that doesnt work, dig, if that doesnt work, ___ )

A
  • amiodarone
  • BB, verap, dilt
  • ami
28
Q

Afib - drugs of ventricular rate control (IV)

goal: < ___ - ___ bpm AND ___
do not administer ___ or ___ to patients with decomp HF

A

100-110, asymptomatic
- dilt, verap

29
Q

Afib - drugs of ventricular rate control (PO)

EF < 40
- ___
- if doesnt work: ___

EF >40
- ___ , ___ , or ___
- if doesnt work: ___

do not administer ___ or ___ to patients with HFrEF

A
  • BB
  • dig
  • BB, dilt, vera
  • dig

dilt, verap

30
Q

T or F: we can convert pateints with stage 4 Afib back to NSN

A

F
they are permanently stuck like that

31
Q

Afib - conversion to NSN

if AF has been present < 48 hours, conversion is safe

if > 48 hours, conversion to NSN chould not be performed until patient has been ___ for 3 weeks (TEE can also rule out clot)

A

anticoagulated

32
Q

Afib - conversion to NSN

DC cardioversion

drugs (5)
___ (class I-IV)
___ (class III) - risk of TdP
___ (class 1A) - risk of TdP

pill in pocket
___ and ___ (class 1C)

A
  • amiodarone
  • ibutilide
  • procainamide
  • flecanide, propafenone
33
Q

Afib - conversion to NSN drugs

normal LVEF
- IV ___ or ___
- or ___

EF < 40
- IV ___

AF occuring outiside of hospital in patients with normal LVEF (pill in the pocket)
- ___ and ___

A
  • amiodarone, ibutilide
  • procainamide
  • amiodarone
  • felcainide, propafenone
34
Q

Afib - conversion to NSN drugs

do not administer procainamide if patient has already recieved amiodarone or ibutilide due to the risk of excessive ___ prolongation and ___

A

QTc, TdP

35
Q

Afib - maintenance of sinus rhythm/prevention of recurrence

drugs (6)
___ and ___(class I-IV)
___ and ___ (class III)
___ and ___ (class 1C)

A
  • amiodarone, dronedarone
  • sotalol, dofetilide
  • flecainide, propafenone
36
Q

Afib - dofetilide dose

CrCl > 60: ___ mcg PO BID
CrCl 40-60: ___ mcg PO BID
CrCl 20-39: ___ mcg PO BID
CrCl < 20: ___

2-3 h after 1st dose, check ___ interval
- less than 15% increase, continue current dose
- greater than 15% or greater than 500 ms, cut dose in half

if > 500 ms any time after 2nd dose, D/C

proceed with first dose only if < 440 ms

A

500
250
125
CI

37
Q

Amiodarone - monitoring

  • hyper/hypo ___
  • hepatotoxicity
  • ___ interval prolongation
  • pulmonary ___
  • ___ microdeposits
  • dermatologic blue/grey, photosensitivty
A
  • thyroidism
  • QTc
  • fibrosis
  • corneal
38
Q

Afib - maintenance of NSR following conversion/paroxysmal AF

normal LV, no prior MI or structutal HD
- ___ , ___ , ___ , or ___
- if doesnt work: ___
- if doesnt work: ___ (least preferred)

prior MI, structial HD, HFrEF
- ___ or ___
- if doesnt work: ___
NYHA III or IV or recent decom HF
- no: ___
- yes ___ CI

A
  • dofetilide, dronedarone, flecainide, propafenone
  • amiodarone
  • sotalol
  • amiodarone, dofetilide
  • sotalol
  • dronedarone, dronedarone
39
Q

neither ___ nor ___ should be administered to patients with prior MI, significant structrual HD, and/or HFrEF

A

flecainide, propafenone

negative inotropes

40
Q

Afib - sotalol dose

  • CrCl > 60 - 80 mg ___
  • CrCl 40-60 - 80 mg ___

2-4 h after, check ___ interval
- if < 500 ms after 3 days, increase, pt can be discharged or dose can increase to ___ daily
- if > 500 ms: ___

only do first dose if < 450 ms

A
  • BID
  • daily
  • QTc
  • 120
  • D/C
41
Q

Afib

catheter ablation
- used for pts who found anti-arrhythmic drugs ineffective, CI, or not preferred
- selected patients are younger, less comorbidities
- symptomatic ___ Afib first line to prevent from progression to persistent

A

paroxysmal

PHRM 845 (62 decks)

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