A Fib

Question 1

What is the greatest adverse effects of antiarrhythmic drugs?

Answer 1

Arrhythmia

Question 2

SHould all arrhythmias be treated?

Answer 2

No

Question 3

What are the 2 main goals of arrythmia pharmacotherapy?

Answer 3

Control heart rate
Control coagulation

Question 4

____ is a measure of conduction time from atrium to
ventricle

Answer 4

PR interval

Question 5

_________ indicates the time required for all of the
ventricular cells to be activated

Answer 5

he QRS duration

Question 6

_____ reflects the duration of the ventricular action
potential

Answer 6

he QT interval

Question 7

What are the 2 disturbances that all arrhythmias result from?

Answer 7

(1) disturbances in impulse formation
(2) disturbances in impulse conduction

Question 8

What is one of the most common risks of a fib that is untreated?

Answer 8

Cerebral ischemia/stroke via blood clot due to a fib

Question 9

• characterized by disorganized, rapid, and
  irregular atrial activation with loss of atrial
  contraction and with an irregular ventricular
  rate that is determined by AV nodal conduction
• the ventricular rate tends to be rapid and
  variable, between 120 and 160 beats/min, but
  in some patients, it may exceed 200 beats/min
• patients with high vagal tone or AV nodal
  conduction disease may have slow ventricular
  rates

Answer 9

A fib

Question 10

— episodes that start spontaneously and stop
within 7 days of onset
— often initiated by small reentrant or rapidly
firing foci in sleeves of atrial muscle that extend
into the pulmonary veins (PV)
— catheter ablation that isolates these foci usually
abolishes paroxysmal AF, although some
patients also have initiating foci in other
locations.

Answer 10

Paroxysmal A fib

Question 11

What is typically present in persistent a fib?

Answer 11

Fibrosis

Question 12

What other heart condition is common to increase the risk for?

Answer 12

Heart failure

Question 13

▪ Signs & Symptoms
* irregular and rapid heartbeat
— wearables helping to identify
* heart palpitations or rapid thumping
inside the chest
* dizziness, sweating and chest pain or
pressure
* shortness of breath or anxiety
* tiring more easily when exercising
* fainting (syncope)

Answer 13

A fib

Question 14

What is the class 1 Singh/Vaughan-Williams (Mechanism-
Based) Classification used to treat a fib?

Answer 14

Na channel blocker
Lidocaine

Question 15

What is the class 2 Singh/Vaughan-Williams (Mechanism-
Based) Classification used to treat a fib?

Answer 15

Beta blocker
Esmolol

Question 16

What is the class 3 Singh/Vaughan-Williams (Mechanism-
Based) Classification used to treat a fib?

Answer 16

Potassium blocker
amiodarone

Question 17

What is the class 4 Singh/Vaughan-Williams (Mechanism-
Based) Classification used to treat a fib?

Answer 17

Calcium blocker
Dilatezem

Question 18

What are the most common types of drugs due to increased effects to help control ventricular rate by slowing av node conduction?

Answer 18

Beta blockers: Esmolol
Calcium blockers: Dilatezem

Question 19

Which agents prolong action potentials and block potassium channels?

Answer 19

Amiodarone

Question 20

— can be useful to lessen stress and anxiety that may come from anticipation of a dental procedure
* perhaps prevent/reduce increased release of catecholamines that can exacerbate AFib or other arrhythmias
— diazepam, alprazolam, lorazepam, etc

Answer 20

anxiolytics

Question 21

— non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin
— interfere with anticoagulants that are highly bound to plasma proteins (e.g. warfarin)

Answer 21

analgesics

Question 22

• can signficiantly inhibit cytochromes P-450 in liver and GI tract

Answer 22

macrolide antibiotics (e.g. erythromycin, azithromycin, clarithromycin)

Question 23

• can inhibit the organic cation transporter in the kidney to inhibit renal elimination of some drugs

Answer 23

trimethoprim (e.g. sulfamethoxazole-trimethoprim)

Question 24

• many potential adverse effects
• can inhibit cytochromes P-450 and some can affect cardiac ion currents

Answer 24

fluoroquinolones (e.g. ciprofloxacin, ofloxacin, levofloxacin)