Afibrilation

Question 1

Rhytm control strategy

Answer 1

converting Afib back to normal sinus rhythm
- via Electrical or pharmacological
- Pharmacological : flecande, dofeltide, propafenone, ibultide, amidorane

if abif <48 hours : start anticoag & cardioversion

if afib>48h
- if clot: anticoag
- if no clot: cardiover same day and anticoagulant

Question 2

Rate control strategy

Answer 2

• blocking some of arterial electrical imuplse at AV node before they reach ventricles by AV blocker

1st line: BB or Non DHP CCb

Question 3

AV blocker

Answer 3

• bradycardia, hypotension

A: amiodorane
B: BB
C: CCB (Non DHP)
D: Digoxin

Question 4

AFib flutter managment

Answer 4

1. Rhytm control
2. Rate control
3. clot control

Question 5

Clot control

Answer 5

by anticoagulant. Approved anticoagulant for Afib
- Warfarin (VKA)
- Dabigatroban (Pradaxa)
- Apixaban (Eliquis)
- Rivaroxaban (Xarelto)
- Edoxaban (Savaysa)

war pref for pt with valvular hear dx or mechanical heart valve

Question 6

ASsesing risk of stroke in AFib

Answer 6

CHA2DS2- VAS

C: CHF- 1pt
H: HTN- 1 pt
A: Age > 75 - 2pt
DM: 1pt
Stroke/TIA: - 2 pt
V: Vascular Dx- 1pt
A: Age 65-74 - 1pt
S: Sex: Fem-1 pt

Question 7

Afib Anticoagulation guideline

Answer 7

chest 2018 Afib guideline
- atleast 1 non sex risk factor

AHA/ACC 2019 Afib guideline
- atleast 2 non-sex risk factor

Question 8

warfarin pref for

LMWH

Answer 8

• valvular heart dx or mechanical heart valve
• recommend for ESRD

LMWH pref of pregnant pt.

for preg pt use LMWH

Question 9

phases of A.potential

Answer 9

phase 0: depolarizaiton; Na entry
- Na+ channel work her

Phase 2: plateau phase: ca+ chan works here

Phase 3: Repolarizaiton: k+chanel works
- IASDD — amiodorane works her

Phase 4: BB

Question 10

Class I a (QDP)
class I b (LM)
class 1c (FP)

Answer 10

doubel quarter pounder
-quinidine
-Procainamide (Pronestyl)
- Disopyranimide (norpace)

Lettuce and mayo
- Lidocaine (Xylocaine )
- Mexilitene

Fries please
- Flecanide (Tambocor)
- Propafenon (Rhytmol)

Question 11

Quinidine

Answer 11

Q: Quinidine
- SE: diarhea, QT, Cinchonnism, thrombocytopenia , hemolytic anemia

Question 12

Disopyramide

Answer 12

Norpace

Side Effect
- Anticholinergic
- neg ionotorpic (don’t give to pt with CHF), hypotension
- torsade
- indication: Ventricular arrythmia

Question 13

Procainamide

Answer 13

used for ventricular arrythmia
- ANA+ ( lupus)
- hypotension
- bradycardia
- Diarhea

Question 14

class i b
Lidocaine

Mexilitene

Answer 14

IV Xylocaine
- light headed
- seizure
- Dilute in d5w

Mexiltene: PO

Question 15

Class I c
- flecandie
- Propafenone

Answer 15

flecanide ( Tambocor)
- arrythmia, lighthead, torsade

Propafenon ( Rhytmol)
-neg ionotrope
- BB activity
- seizure

Question 16

class II b

Answer 16

BB
- RAte control in Afib

IV BB: Maples
- metoprol
- atenolol
- propanolol (inderall)
- labetaol
- esmolol (breviloc)
- sotalol

Antidoe: Glucagon

Question 17

if pt has arrythmia and HF best BB

Answer 17

bismolol (zebeta)
Metoprolol succinate (Toprol xL)
carvedilol (coreg)

Question 18

Class III “IASDD”

Answer 18

• Ibutilide (corver)
• Amiodorane (Nexterone, pacerone)
• Sotalol (betapce)
• Dronaderone (multaq)
• Dofeltide (Tikosyn)

Question 19

Ibutilide

Answer 19

• corvet
• for acute arrythmia
• SE: fatal arrythmia

Question 20

Amiodorane

Answer 20

Pacerone tablets
Nexterone premixed Inj

indication: ventricular arrythmia & Afib

SE:
- photosenistiviy
- pulmonary toxicity
- corneal micro deposit
- thyroid dysfunction
- smurfig
- inc QT
- LFT
- CNS
- Hypotension, Bradycardia

Question 21

amiodorane monitor

Answer 21

• TSH
• LFT
• eyes
• chest
• Pulmonary fxn
• ECG (HR)
• Electrolyte: Low K and Mg cause arrythmia
• ## amiodorane long half life 30-60 days

Question 22

amiodorane DUR

Answer 22

• inc digoxine level by 70%
• cyp3A4 substrated and inhib
• warfarin and digoxine dose reduced by 30-50% when starting amiodorane
• Sofosbuvir may inc bradycardia effect. AVoid combination - Harvoni ( Ledipasvir + sofosbuvir)
• quinolone, macrolide and azole cause QT prolongation

Question 23

amiodorane store and stabiltiy

Answer 23

for infusion >2hr use non-pvc bag or glass
- use 0.22 mciron filter
-

Question 24

amiodorane

Answer 24

a: alveoli (CXR) & AV blocker (bradycardia)

iod: TSH

o: corneal deposit & photosensitivy

E: electrolyte monitor (low K, Mg), ECG

N: non pvc bag if inf>2hr and 0.22 micron

D: DUR ( inc dig level, warfarin levels so decr dig and warfarin by 30-50%, avoid sofosbuvir- including Harvoni, cyp3a4 subrate and inhibitor)
- monitor LFT

Blue man

Question 25

Dronaderone

Answer 25

Maltaq
- used for Afib
- Dose : 400mg BID with food
- SE: Liver failure/ HF
- CYP3A4 subrstrate/Inhib

Question 26

sotalol

Answer 26

betapace, Betapace AF

do not subsitiute one for another

Question 27

Dofelitide

Answer 27

Tikosyn

Question 28

verapmil

Answer 28

Calan, Verelan

Question 30

PSVT

Answer 30

paroxysmal supraventricular Tachycardia

Question 31

Adenosine (Adenocard)

Answer 31

• used for PSVT (paroxysmal supraventricular Tachycardia)

if adenosine fails to convert to SVT
then use
- BB or
- NON DHP CCB

Question 32

VF/ pulseless (Ventricular fibrilation) TX

Answer 32

• CPR–shock (defibrilate)—-Epinephrine—shock —-amiod or Lidocaine
• ephinephrine 1mg Q3-5min
• Amiodorane

Question 33

PUlseless electrical activity or Asystole (flat line)

Answer 33

-Epi is DOC for PEA of asystole

Question 34

Symptomatic bradycardia

Answer 34

DOC: Atropine IV

if atropine ineffective then
- Dopamine
- Epinephrine