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NAPLEX > AAR > Flashcards

AAR Flashcards

1
Q

What are the four types of atrial fibrillation?

A
  1. Paroxysmal - terminates spontaneously and recurs
  2. Persistent - 7D, requiring cardioversion
  3. Permanent - >1 year, failed cardioversion
  4. Lone afib - afib in young patient (<60) with no cardio-pulmonary disease
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2
Q

When do you implement rate control?

A

In patients who have failed rhythm control, have permanent afib, or no chance of NSR after cardioversion

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3
Q

What is the time period that you are monitoring for Afib if someone comes in claiming heart palpitations and what are the interventions?

A
  1. Afib <48 hours - start IV anticoag, cardiovert, do 4 weeks of oral anticoag after
  2. Afib >48 hours - Echo for clot
    * If clot - anticoagulate for 4-12 weeks
    * If no clot - cardiovert same day then 4 weeks of anticoag
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4
Q

What are the approved PO anticoag’s for Afib?

A

Warfarin
Dabigatran
Rivaroxaban
Apixaban
Edoxaban

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5
Q

What is the CHA2DS2-VASc score?

What is the scoring system?

A

CHF - 1
HTN - 1
Age >75 - 2
DM - 1
Stroke/TIA - 2
Vascular disease (MI/ACS/PAD) - 1
AGE (64-74) - 1
Sex (Female) - 1

If >2 (M) or >3 (F) - start anticoagulation

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6
Q

When is warfarin preferred in Afib?

A

In valvular heart disease/Afib or mechanical heart valves or if they are on CYP3A4 inhibitors/inducers.

If ESRD or CrCl <15

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7
Q

What anticoagulant do you choose for pregnant patients?

A

LMWH

AVOID WARFARIN AND DOAC

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8
Q

Is heparin or LMWH preferred in CrCl <30?

A

Heparin - because it is hepatically cleared and has a short half life

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9
Q

What are the 4 phases of action potential?

And what class of medications do you use for each?

A

Phase 0 - Depolarization | Class I
Phase 1 - Ca2+ entry/contraction | No meds
Phase 2 - Plateau phase | Class 4
Phase 3 - Repolarization | Class 3
Phase 4 - Na+ out, K+ in | Class 2

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10
Q

What are the vaugham williams classifications?

A

Class 1 - Na+ channel blockers
Class 2 - beta blockers
Class 3 - K+ channel blockers
Class 4 - Non-DHP CCB’s

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11
Q

List class 1 medications

A

Class 1a - (QDP) - Quinidine, disopyramidde, procainamide

Class 1b (PLM) - Phenytoin, lidocaine, mexiletine

Class 1c (PF) - propafenone, flecainide

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12
Q

List Class 3 medications

A

IASDD

Ibutilide (only IV)
Amiodarone
Sotalol - it is a BB but it is class 3 NOT class 2
Dofetilide
Droneadarone

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13
Q

Quinidine

Class
Levels
Indications
ADE
Interaction

A

Class 1a

2-5mcg/mL

Arrhythmias, life threatening malaria

DIARRHEA, CINCHONISM (ringing in ear), hypotension, QT prolongation, thrombocytopenia

Increase digoxin

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14
Q

Disopyramide

Class
Brand
Indication
Form
ADE

A

Class 1a

Norpace

V.arrythmias

ORAL on empty stomach

Anti-cholinergic(anti-sludge), negative inotropic (so NOT for CHF) , QT prolongation

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15
Q

Procainamide

Class
Indication
Dosage forms
ADE

A

Class 1a

threatening v.arrythmias

IV/IM

Lupus-like syndrome , hypotentsion, torsades, agranulocytosis

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16
Q

Lidocaine

Class
Brand
Indication
Dose
Plasma levels
ADE

A

Class 1b

Xylocaine

VF or pulseless VT - NEVER AFIB

IV bolus 1mg/kg
IV infusion 1-4 mg/min in D5W

1.5-5mcg/mL

CNS (SEIZURE), LIGHTHEADES

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17
Q

Mexiletine

Class
Dosage
Food counseling

A

Class 1b

ORAL

Give with food or antacid

18
Q

Propafenone

Class
Brand
Indication
Dose
ADE

A

Class 1c

Rythmol

Afib or PSVT

PO TID

BB activity, negative ionotropic (so NOT for CHF)

19
Q

Flecainide

Class
Indication
ADE
Dose

A

Class 1c

Ventricular and supraventricular arrythmias

Proarrythmic, exacerbate CHF

PO BID

20
Q

Which class has no effect on QT interval?

21
Q

Which class shortens QT interval?

22
Q

What are the acute ventricular rate control options in Afib or flutter?

A

Metoprolol
Esmolol
Propranolol

23
Q

What is the antidote to beta blockers?

24
Q

Ibutilide

Class
Brand
Form
Indication
ADE

A

Class 3

Corvert

IV only

Afib - a chemical cardioversion

Torsades (within 3 hours typically)

25
Q

Amiodarone

Class
Brand
Indications
Dosage forms
ADE
Monitoring
Half-life
Drug interactions
Stability

A

Class 3

Tablets - cordarone/pacerone
IV - Nexterone

V.arrythmias

PO/IV

Photosensitivity, pulmonary toxicity, corneal microdeposits, thyroid dysfunction, gray/blue skin, torsades, LFT

TSH, LFT, eyes, Chest XRAY, PFT’s, ECG, electrolytes

30-60 days

Increase digoxin, increase INR

Stable for 24 hours in glass and 2 hours in PVC - store at room temp

26
Q

Dronedarone

Class
Brand
Indication
Dose
ADE
Interactions

A

Class 3

Multaq

Afib/flutter

400mg BID with FOOD

Liver failure, heart failure

Drugs that prolong QT

27
Q

which medication should you avoid giving harvoni with and why?

A

Amiodarone because it has sofosbuvir in it which increases bradycardic effect

28
Q

Sotalol

Class
Brand
Dosage forms
Monitoring
Renal adjustment

A

Class 3

Betapace, betapace AF - NOT INTERCHANGEABLE

IV/ solution/ PO

Betapace - v.aarythmias
Betapace AF - Afib

PT should be in facility for >3 days with ECG monitoring

Contraindicated in CrCl <40

29
Q

Dofetilide

Class
Brand
Indication
Monitoring
Renal adjustments

A

Class 3

Tikosyn

Afib/flutter

Placed in facility for 3 days to monitor CrCl, ECG, K+/Mg2+

Contraindicated CrCl <20

30
Q

What are the dosage forms and indications for verapamil?

A

PSVT - PO

Afib - IV/PO

31
Q

What are the dosage forms and indications for Diltiazem?

A

Afib/ PSVT - IV

Afib rate control (off label) - PO

32
Q

Adenosine

Brand
Indication
Dose
Monitoring

A

Adenocard

PSVT

6mg rapid IV push

Will cause asystole for a few seconds then revert to NSR

33
Q

What is the main purpose of IV magnesium?

A

Treat Torsades

34
Q

What is the most effective therapy for ventricular fibrillation?

What is the treatment algorithm?

A

Defibrillation

Continious CPR –> shock –> Epi 1mg –> shock –> amiodarone/lidocaine

35
Q

What is the most effective therapy for PSVT?

36
Q

What is the DOC for pulseless electrical activity or asystole?

A

Epinephrine 1mg IV q3-5min

37
Q

What is DOC for symptomatic bradycardia?

What if it doesn’t work?

A

Atropine 0.5mg Q3-5 min (max 3mg)

Dopamine or epinephrine

38
Q

What is DOC for SVT? (HR >150)

What if it doesn’t work?

A

Adenosine IV push - 6mg –> NS flush –> 12mg NS flush –> 12mg NS flush

BB or NonDHP CCB( IV verapamil )

39
Q

What are the preferred options for acute BP control during CVA?

What is the goal BP before IV tPA?

What is the goal glucose?

A

Labetalol, nicardipine, clevidipine

<185/110 before administration and keep <180/105 for the first 24 hours after administration

140-180

NAPLEX (10 decks)

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