Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

UBSPPS PHM601 Cardio/Renal Pharmacotherapeutics > Afib > Flashcards

Afib Flashcards

1
Q

True or False: Apixaban dosing for Afib is 10mg 2x/day for 1 week then 5mg 2x/day?

A

False, this is VTE dosing. In Afib, dosing is 5mg 2x/day.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the renal dosing adjustments for Afib in Apixaban?

A

2.5mg 2x/day if 2 of 3 items are met: 1)SCr:>1.5 2) Weight is under 60kg 3) Age: >80 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

True or False: Afib dosing of Rivaroxaban is 20mg daily?

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the renal adjustments for rivaroxaban for Afib?

A

In Afib it is 15mg daily, as long as CCL is between 15-50ml/min; avoided if under that value

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the generic name for Betapace?

A

Sotalol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the MOA of Sotalol (Betapace)?

A

(potassium channel blockade) Extends the refractory period (prolongs action potential
duration) + beta-blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Are there any DDI or metabolism concerns with Sotalol?

A

Additive QT prolongation with other medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What needs to happen at the start of Sotalol initiation?

A

3 day hospital stay for initiation to monitor QT prolongation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the dosing scheme for Sotalol?

A

Dose: 40-120 mg depending on QT prolongation (start = 80)
Frequency: dependent on renal function
• CrCl > 60 mL/min: Q12H
• CrCl 40-60 mL/min: Q24H

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Sotalol is contraindicated in what populations?

A

CrCl < 40 mL/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What class of Antiarrhythmics is Sotalol in?

A

CLASS III ANTIARRHYTHMICS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Sotalol is part of a first line treatment option in _________ and can also be used to treat_________.

A

Patients with no structural Heart

Disease ; CAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What type of administration should be used in ACUTE rate control?

A 
IV agents (bolus +/- IV infusion) 
Transition to oral agents
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What type of administration should be used in CHRONIC rate control?

A

Oral agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

True or False: both acute and chronic rate control may require multiple agents in order to control symptoms.

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What two agents used to control rate should NOT be used in combination if possible in both acute and chronic rate control?

A

Beta Blockers with Non-DHP Calcium Channel Blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Amiodarone:

What Class of antiarrythmic is Amiodarone/it’s MOA?

A

Amiodarone is a Class 3 antiarrhythmic, with class 3 being potassium channel blockers BUT amiodarone has characteristics of ALL classes as well (1,2,3,&4 ie Sodium, Beta [Receptor], Potassium, and Calcium channel Blockade)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the Half-Life of Amiodarone?

A

50 Days!

Hence why it needs a loading period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How effective is amiodarone compared to other antiarrhythmics?

A

Amiodarone is the Best One but…. it also comes with the most side effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which CYPs or Transporters does Amiodarone inhibit which lead to many of its DDI’s?

A

Amiodarone inhibits CYP3A4, 2D6, 2C9, and P-gp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Besides its enzyme/transporter inhibition, what other DDIs can amiodarone have?

A

It can have additive QT prolongation with other QT prolonging drugs (Can lead to Torsades de Pointes which is deadly!)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the side effects of Amiodarone?

A

The usual ones + Some unique ones
Usual:
•Bradycardia
•QT prolongation
Then:
•Pulmonary Fibrosis (Don’t use with COPD!)
•Hypo OR Hyperthyroidism (The hypothyroidism is relatively easy to treat but the hyperthyroidism can be a reason to stop amiodarone)
•Corneal Deposits (Adds up over time/years, can lead to progressive vision loss)
•Acute OR Chronic Hepatotoxicity (not as bad as dronedarone)
•Bluing/Graying of the skin (This is harmless but it is PERMANENT!- also it’s on by sun exposure!)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What’s the initial dosing for Amiodarone?

A

8-10 grams over 2-4 weeks –> varies by clinician but as long as you meet the total dosage and timeline its fine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What’s the maintenance dosing of Amiodarone?

A

200mg QD –> 100-200mg QD technically but 100mg QD is rarely used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

MOA of class IC antiarrhythmics (flecainide and propafenone)

A

sodium channel blockade (membrane stabilizers) decrease the excitability of cardiac tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

metabolism of class IC antiarrhythmics (flecainide and propafenone)

A

metabolized by CYP2D6, some people can be fast or slow metabolizers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

flecanide acute dosing

A

50mg BID (MDD 300mg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

propafenone acute dosing IR

A

150mg Q8H (MDD 900mg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

propafenone acute dosing ER

A

225mg BID (MDD 850mg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

propafenone AE

A

metallic taste

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

MOA of class 3 antiarrhythmic drugs (dofetilide, amiodarone, ibutilide)

A

potassium channel blockade, extends the refractory period preventing another depolarization/action potential

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What’s required when starting a patient on a class 3 antiarrhythmic like dofetilide?

A

3 day hospital stay to monitor QT prolongation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

drug interactions with dofetilide

A
  1. verapamil: increases absorption of dofetilide which can cause QT prolongation
  2. HCTZ: effects clearance and electrolytes (must maintain K>4 and Mg >2)
  3. metformin and trimethoprim will decrease the clearance of dofetilide from the body due to competing for active tubular secretion in the kidneys, increasing the risk of QT prolongation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

dosing of dofetilide in someone with normal renal function

A

500mcg PO BID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

dosing of dofetilide in someone with CrCL 40-60ml/min

A

250mcg PO BID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

dosing of dofetilide in someone with CrCl 20-40ml/min

A

125mcg PO BID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

dosing of dofetilide in someone with CrCl <20ml/min

A

contraindicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

amiodarone MOA

A

class 3 antiarrythmic, has all the properties of all the classes of antiarrythmics: sodium channel blocker, potassium channel blocker, calcium channel blocker. beta blocker: it is the most effective antiarrhythmic but comes with a lot of side effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

half life of amiodarone

A

about 50 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

metabolism of amiodarone

A

inhibits CYP3A4, CYP2D6, CYP2C9, and PGP

take caution with other medications that have QT prolongation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

loading dose of amiodarone

A

8-10 grams over 2-4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

maintenance dose of amiodarone

A

100-200mg PO daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

adverse effects of amiodarone

A

bradycardia, QTc prolongation, pulmonary fibrosis, thyroid dysfunction (hypo and hyperthyroidism), corneal deposits (blindness), hepatotoxicity, blue/gray skin color (permanent)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

amiodarone monitoring

A
  1. ECG at baseline and every 3-6 months
  2. thyroid function tests at baseline and every 6 months
  3. LFTs at baseline and every 6 months
  4. Chest x ray at baseline and every 12 months
  5. pulmonary function tests at baseline and every 12 months
  6. eye tests (corneal deposits)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q 
All of the following can be used for chronic afib treatment in patients with coronary artery disease EXCEPT
A. Dofetilide
B. Propafenone
C. Dronedarone
D. Sotalol
E. Amiodarone
A

B. Propafenone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

True or False: Propafenone is appropriate for acute cardioversion when DCCV is unsuccessful and the patient has an ejection fraction of AT LEAST 40%

A

true

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Specific adverse effect of Propafenone

A

metallic taste

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is unique about Propafenone as a Class 1C antiarrhythmic?

A

Class 1C has the highest potency so they can also cardio convert

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What antiarrhythmic class does Dronedarone belong to?

A

Class III

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is Dronedarone’s MoA?

A

Structural analog of amiodarone (minus the iodine), exhibits properties of all the classes of antiarrhythmics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Dronedarone is contraindicated in patients with ___?

A

Heart failure and permanent AF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Dronedarone inhibits ___?

A

CYP3A4, CYP2D6, PGP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

When taken with other medications, dronedarone can have additive ___?

A

QT prolongation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Dronedarone dosing

A

400mg PO q12h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Adverse effects of dronedarone

A

Bradycardia, QTc prolongation, hepatotoxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What kinds of patients would we use dronedarone in?

A

Patients with structurally normal hearts (and CAD is also okay)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Dronedarone brand name

A

Multaq

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What rate control drugs are options in patients who have no other CV disease?

A

beta blockers, diltiazem, verapamil, and amiodarone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What rate control drugs are options in patients who have HTN or HFpEF?

A

beta blockers, diltiazem, verapamil, and amiodarone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

MOA of edoxaban

A

factor Xa inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Afib dose of edoxaban

A

60mg daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

VTE dose of edoxaban

A

(after 5 days parenteral) > 60kg: 60mg daily; if < or = 60kg: 30mg daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is the route of administration for edoxaban?

A

oral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

MOA of dabigatran

A

direct thrombin inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Afib dose of dabigatran

A

150mg twice daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

VTE dose of dabigatran

A

(after 5 days parenteral) 150mg twice daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

route of administration of dabigatran

A

oral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Edoxaban monitoring?

A

monitor hemoglobin, hematocrit, platelets & serum creatinine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Afib dosing for Edoxaban

A

60 mg daily

70
Q

What population do you want to avoid Edoxaban in?

A

> 120 kg or BMI > 40 kg/m^2 (basically obese pts)

71
Q

Clinical pearl of Edoxaban

A

it is rarely used

72
Q

What is the CHA2DS2VASc Score used for?

A

Anticoagulation: Determine Risk of Stroke

73
Q

What does the “C” stand for within the CHA2DS2VASc Score?

A

Congestive Heart Failure

74
Q

How many points is Congestive Heart Failure, “C,” worth?

75
Q

What does the “H” stand for within the CHA2DS2VASc Score?

A

Hypertension

76
Q

How effective is direct current cardioversion (DCCV) in converting an irregular heart rhythm, into a sinus rhythm (normal heart rhythm)?

A

Almost 100%.

It can reset the heart to a sinus rhythm but the problem is keeping the patient in a sinus rhythm.

77
Q

What does the “A2” stand for within the CHA2DS2VASc Score?

78
Q

How many points is Age > 75, “A2,” worth?

79
Q

What does the “D” stand for within the CHA2DS2VASc Score?

A

Diabetes Mellitus

80
Q

How many points is Diabetes Mellitus, “D,” worth?

81
Q

What does the “S2” stand for within the CHA2DS2VASc Score?

A

Stroke/TIA/Systemic Embolism

82
Q

How many points is Stroke/TIA/Systemic Embolism, “S2,” worth?

83
Q

What does the “V” stand for within the CHA2DS2VASc Score?

A

Vascular Disease

84
Q

How many points is Vascular Disease, “V,” worth?

85
Q

What does the “A” stand for within the CHA2DS2VASc Score?

86
Q

How many points is Age 65-74, “A,” worth?

87
Q

What does the “Sc” stand for within the CHA2DS2VASc Score?

A

Sex Category (Female)

88
Q

How many points is being the Female sex, “Sc,” worth?

89
Q

What score would indicate that a male patient would need to have an anticoagulation agent added?

A

> or equal to a score of 2

90
Q

What score would indicate that a female patient would need to have an anticoagulation agent added?

A

> or equal to a score of 3

91
Q

What is the Stroke Risk per Year?

A 
This would depend on the patient's CHA2DS2VASc Score.
1 Point = 1.3%
2 Points = 2.2%
3 Points = 3.2%
4 Points = 4.0%
5 Points = 6.7%
6 Points = 9.8%
7 Points = 9.6%
8 Points = 6.7%
9 Points = 15.2%
92
Q

Why would you want to delay cardioversion (ex. DCCV) in a patient with MILD symptoms who has AFIB for over 48 hours?

A

To allow time (3 weeks) for anticoagulation therapy and reduce the risk of a clot being dislodged and causing a stroke in the patient.

93
Q

True of False: In early cardioversion, if a thrombus is observed on a transesophageal echocardiogram (TEE), we should immediately consider DCCV.

A

False: Anticoagulate the patient for 4 weeks, then repeat the TEE.

94
Q

A patient presents to the ER with a systolic blood pressure of 85 mmHg and an abnormal heart rhythm: Which cardioversion method should be used in this patient?
A) Chemical Cardioversion
B) Direct Current Cardioversion (DCCV)
C) Both

A

B) DCCV

Hemodynamically unstable

95
Q

What is DCCV?

A

Direct current cardioversion, and it involves utilizing a defibrillator to shock the patients heart into normal sinus rhythm

96
Q

How effective is direct current cardioversion(DCCV) in converting an irregular heart rhythm, into a sinus rhythm(normal heart rhythm)?

A

Almost 100%. Can reset the heart to a sinus rhythm but the problem is keeping the patient in a sinus rhythm.

97
Q

True or False: You can earn multiple points per section of the CHA2DS2VASc Score.

A

False

You would NOT count multiple disease states for each section.

For example, if a patient had PAD, DVT, CAD, and T2DM, and age >75, then the score would be 4.

2 Points = A2
1 Point = D
1 Point = V

PAD, DVT and CAD are all vascular diseases, however, they would not earn a point each; instead, the entire category of “V” would only earn 1 point regardless of the amount of vascular diseases present.

98
Q

Paroxysmal Atrial fibrillation

A

Terminates within 7 days of onset

99
Q

Persistent Atrial Fibrillation

A

Last > 7 days

100
Q

Longstanding, Persistent

A

Lasts > 12 months

101
Q

Permanent Atrial Fibrillation

A

Patient and Clinician have decided that there will be no more effort to restore or maintain sinus rhythm

102
Q

The following conditions require amiodarone as a second line option for rate control:

A

No other CV disease
HTN or HfPEF
LV dysfunction or HF

103
Q

Which condition does not require amiodarone as a second line option for rate control?

104
Q

True or false: we give IV bolus always in acute rate control

A

True, we +/- IV infusion

105
Q

What is the MOA for flecainide (how does it work)

A

Sodium Channel Blocker = membrane stabilizer. Decrease excitability of cardiac tissue.

106
Q

What class antiarrhythmic does flecainide fall into. Use the Vaughan-Williams classification.

107
Q

True or false. Flecainide is a high potency sodium channel blocker.

108
Q

True or false. Flecainide can be used for acute chemical cardioversion if a patient has a EF<40%

109
Q

When can flecainide be used for chronic rhythm control?

A

It can be used as a first line agent in patients with no structural disease.

110
Q

What are two structural heart disease conditions in which flecainide cant be used for chronic rhythm control?

A
  1. Heart failure

2. Coronary Artery Disease

111
Q

True or false. Flecainide is metabolized by CYP3A4

A

False. Metabolized by CYP2D6 and some of the population may be fast of slow metabolizers.

112
Q

How do we monitor dronedarone?

A

ECG- look out for QT prolongation

113
Q

Name the 4 types of Afib.

A

Paroxysmal, Persistent, Longstanding Persistent, Permanent Afib

114
Q

What are you able to conclude from knowing the type of Afib a patient has?

A

You are able to know how frequent the Afib occurs and how it will respond to treatment.

115
Q

How is Propafenone metabolized?

A

Metabolized by CYP2D6

116
Q

What is the mechanism of action of propafenone?

A

Sodium channel blocker → membrane stabilizer (decrease excitability of cardiac tissue). It has the highest potency in this specific antiarrhythmic class.

117
Q

Define Afib

A

Disorganized and irregular atrial electrical activity

-“quivering”

118
Q

What triggers Afib to occur?

A

-triggered by rapidly firing ectopic beats in the atria

119
Q

What the are risk factors for Afib?

A
  • concomitant cardiac disease
  • DM
  • obesity
  • obstructive sleep apnea
  • hyperthyroidism
  • smoking
  • etc.
120
Q

What portion of the ECG will appear abnormal during Afib

A

No visible P waves and an irregular QRS complex

121
Q

What is the HASBLED score?

A

Determines Bleed Risk during anticoagulation

122
Q

What does each letter in HASBLED stand for?

A 
H= Hypertension (SBP >160mmHg)
A= Abnormal liver or kidney function 
S= Stroke history
B= Bleeding risk
L= Labile INR
E= Elderly (> 65)
D= Drug or Alcohol abuse
123
Q

How do you score each letter in HASBLED?

A 
H= 1
A= 1 each (If patient has both abnormal liver function and abnormal kidney function they score 2)
S= 1
B= 1
L= 1
E= 1
D= 1 each (If patient abuses both drugs and alcohol then they score 2)
124
Q

How does the HASBLED score correlate to bleed risk?

A 
0= 1.13 bleeds/ 100 patient years
1= 1.02 bleeds/ 100 patient years
2= 1.88 bleeds/ 100 patient years
3= 3.74 bleeds/ 100 patient years
4= 8.70 bleeds / 100 patient years
5= 12.5 bleeds/ 100 patient years
125
Q

HASBLED pearls

A
  • No “threshold for withholding anticoagulation
  • Only validated for Warfarin (not DOACs)
  • Can be used in a risk-benefit discussion to determine safety of anticoagulation
126
Q

What first line rate control drugs are options in patients who have HFrEF?

A

beta blockers or digoxin

127
Q

What rate control drugs are options in patients who have COPD?

A

beta blockers, diltiazem, verapamil

128
Q

True/False: dabigatran is recommended for patient with Afib and ESRD

A

False. Direct thrombin inhibitor is not recommended.

129
Q

True/False: Dabigatran is used as a chronic anticoagulation for patients w/ A.fib

130
Q

What are the clinical manifestations of AFIB?

A 
Fatigue
Palpitations
Shortness of breath
Hypotension
Dizziness, light-headedness
Syncope
131
Q

True or False, a patient can have AFIB and be asymptomatic

132
Q

When are dabigatran and edoxaban recommended?

A

For patients with Afib and an elevated CHA2DS2VASc score of 2 or greater in men or 3 or greater in women

(oral anticoagulation is recommended)

133
Q

What chronic rhythm control options are available for CAD patients with Afib?

A

Dofetilide, dronedarone, sotalol, amiodarone

134
Q

What is a second line option for chronic rhythm control in patients with CAD?

A

amiodarone

135
Q

What are first line options for chronic rhythm control in patients with CAD?

A

dofetilide, dronedarone, sotalol, amiodarone

136
Q

When do patients require conversion to sinus rhythm?

A

When they are:

  1. ) Hemodynamically unstable (SBP<90, or patient loses a pulse)
  2. ) Symptomatic despite rate control
  3. ) Inability to achieve rate control (when you’ve tried everything & patient is still not able to achieve goal).
137
Q

What treatment options are available to patients who have chronic rhythm control and NO structural heart disease?

A 
ALL 5 of them!
Dofetilide
Dronedarone
Flecainide
Propafenone
Sotalol
138
Q

Why is Amiodarone second line in chronic rhythm control with NO structural heart disease?

A

Because of all its side effects (Bradycardia, QTc prolongation, pulmonary fibrosis, thyroid dysfunction, corneal deposits, hepatotoxicity, blue/gray skin color)

139
Q

What is first line treatment for chronic rhythm control with no structural heart disease?

A

First line treatment is pending patient preference: we could do a catheter ablation or dofetilide, dronedarone, flecainide, propafenone, sotalol treatment

140
Q

What is ablation?

A

Catheter inserted through groin or neck and guided through the vessel until they reach the heart.

141
Q

When is ablation not feasible?

A

When many areas/the whole heart has diseased tissue.

142
Q

What are the two methods used to treat chronic rhythm control?

A

Chemical (treat with antiarrhythmic drugs to keep sinus rhythm)
&
Ablation

143
Q

What does HASBLED stand for?

A 
Hypertension
Abnormal liver or kidney function
Stroke history
Bleeding history
Labile NR
Elderly >65
Drug or acohol abuse
144
Q

What does the HASBLED score measure?

A

Determines patietn’s bleeding risk

145
Q

If a patient has been in Afib for more than 48 hours what is the treatment regimen for acute cardioversion?

A

anticoagulate for 3 weeks then DCCV

146
Q

Why does Amoidarone need close monitoring?

A

The half-life of Amiodarone is 50 days, and there are many potential drug interactions with drugs metabolized with CYP3A4, CYP2D6, CYP2D9, PGP, and other QT elongating drugs.

147
Q

What are the necessary monitoring tests during Amoidarone therapy?

A
  • ECG at baseline and every 3-6 months
  • Thyroid function tests at baseline and every 6 months
  • Liver function tests at baseline and every 6 months
  • Chest X-ray at baseline and every 12 months
  • Pulmonary function tests at baseline and every 12 months
148
Q

What are some adverse effects associated with Amiodarone therapy?

A
  • Bradycardia
  • QTc Prolongation
  • Pulmonary fibrosis
  • Thyroid dysfunction
  • Corneal deposits
  • Hepatotoxicity
  • Irreversible Blue/gray skin tone
149
Q

How fast do adverse effects from Amiodarone culminate? (AE other than Bradycardia & AV block)

A

AEs like pulmonary fibrosis, corneal deposits, the skin tone change & thyroid dysfunction generally develope slowly over 10 years. Bradycardia & AV block develops quickly.

150
Q

what is the extremely common type of A.fib?

A

Paroxysmal A.fib

151
Q

Is DRONEDARONE commonly used?

152
Q

DRONEDARONE brand name

153
Q

DRONEDARONE MOA

A

Structural analog of amiodarone (without the iodine) -

exhibits properties of all the classes of antiarrhythmics

154
Q

DRONEDARONE ci

A

Contraindicated in patients with HF and permanent AF

155
Q

DRONEDARONE adverse effects

A

Bradycardia, QTc prolongation, hepatoxicity

156
Q

DRONEDARONE okay to use in patients with structurally abnormal heart rates?

A

no- normal only

157
Q

DRONEDARONE okay in CAD?

158
Q

T/F:

The first-line agents for No Structural Heart Disease are Dofetilide, Dronedarone, Sotalol, and Amiodarone

A

False because Amiodarone is second line agent

159
Q

What is the minimal duration of hospital monitoring when initiating Dofetilide

A

3 days to monitor QT prolongation

160
Q

Dofetilide

A

Class 3

extends refractory period (repolarization)

161
Q

When to DCCV?

A

Symptomatic despite rate control, OR unable to reach rate control, OR hemodynamically unstable.

162
Q

When to DCCV ONLY

A

Hemodynamically unstable, sbp greater than 90 or no pulse (syncope)

163
Q

DCCV success rate in cardioverting?

164
Q

What are the two methods of chronic rhythm control?

A

Chemical and Ablation

165
Q

What is the chemical method?

A

Utilizes antiarrhythmic drugs to maintain sinus rhythm

166
Q

What is the Ablation method?

A

Utilizes a procedure to block conduction in the tissue causing the arrhythmia.

167
Q

What are the three types of ablation?

A

Radiofrequency, cryotherapy, and thermal.

168
Q

Chronic rhythm control class I drug

A 
Sodium Channel Blockade =
membrane stabilizers (decrease excitability
of cardiac tissue)
Ia. Moderate potency:
Disopyramide, quinidine, procainamide
Ib. Low potency:
Lidocaine, mexiletine
Ic. High potency:
Flecainide, propafenone
169
Q

Chronic rhythm control class II drug

A

Beta-Blockade = blocks sympathetic input

All beta-blockers

170
Q

Chronic rhythm control class III drug

A

Potassium Channel Blockade = extends refractory period

Sotalol, dofetilide, amiodarone,
dronedarone, ibutilide

171
Q

Chronic rhythm control class IV drug

A

Calcium Channel Blockade =
negative inotrope and chronotrope

Verapamil, diltiazem

UBSPPS PHM601 Cardio/Renal Pharmacotherapeutics (32 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions