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NAPLEX Prep > Antiarrhythmics > Flashcards

Antiarrhythmics Flashcards

1
Q

Nexterone, Pacerone

A

Class III antiarrhythmic
Amiodarone

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2
Q

Nexterone, Pacerone:
Boxed Warnings

A

Pulmonary toxicity -> baseline CXR & PFTs

Hepatotoxicity -> baseline LFTs

For life-threatening arrhythmias only; proarrhythmic, must be hospitalized for IV loading dose

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3
Q

Nexterone, Pacerone:
Contraindications

A

Iodine hypersensitivity

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4
Q

Nexterone, Pacerone:
Warnings

A

Hyper & Hypothyroidism (hypo more common) - amiodarone partially inhibits peripheral conversion of T4 to T3

visual impairment

photosensitivity (slate blue skin)

peripheral neuropathy

SJS/TENS

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5
Q

Nexterone, Pacerone:
ADE

A

hypotension
bradycardia
corneal microdeposits
photosensitivity (sun protection required)

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6
Q

Nexterone, Pacerone:
Monitoring

A

ECG, BP, HR, electrolytes
LFTs Q6 months
Thyroid function Q3-6 months
CXR annually
regular eye exams

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7
Q

Nexterone, Pacerone:
Notes

A
  • infusions > 2h require non-PVC container (PVC tubing is fine)
  • choice antiarrhythmic in HF
  • decrease infusion rate or DC as needed with hypotension or bradycardia
  • IV admin: use 0.22 micron filter; central line preferred
  • incompatible with heparin (flush with saline)
  • many Y-site additive incompatibilities
  • t1/2 40-60 days
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8
Q

Nexterone, Pacerone:
this drug is an ______ of CYP ___, ___, ___, & ___

A

inducer of CYP 2C9, 2D6, 3A4, & P-gp

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9
Q

Nexterone, Pacerone:
Dose adjustments to other CV meds when starting this agent

A

decrease digoxin by 50%
decrease warfarin by 30-50%
do not exceed:
- 20 mg/day simvastatin
- 40 mg/day rosuvastatin

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10
Q

Nexterone, Pacerone:
DDI with NDHP CCBs, digoxin, BB, & clonidine

A

additive effect
bradycardia

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11
Q

Sofosbuvir can ______ the _______ effect of amiodarone. Do not use together.

A

Sofosbuvir can enhance the bradycardic effect of amiodarone

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12
Q

Digitek, Lanoxin

A

Na-K-ATPase blocker
Digoxin

decreases HR by increasing force of contraction (positive inotrope)

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13
Q

Digitek, Lanoxin:
Contraindication

A

Ventricular fibrillation

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14
Q

Digitek, Lanoxin:
Warnings

A

vesicant

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15
Q

Digitek, Lanoxin:
ADE

A

dizziness
mental disturbances
N/V/D

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16
Q

Digitek, Lanoxin:
Monitoring

A

take levels 12-24hr after first dose
therapeutic range: 0.8-2 ng/mL for AF

17
Q

Digitek, Lanoxin:
Toxicity

A

Symptoms: N/V, loss of appetite, blurred/double vision, altered color perception, bradycardia, life-threatening arrhythmias

Hypokalemia & hypomagnesemia inc risk of toxicity

Hypothyroidism can inc digoxin levels

Antidote: DigiFab

18
Q

Digitek, Lanoxin:
Dosing & adjustments

A

typical dose: 0.125-0.25 mg PO once daily

CrCl < 50 mL/min -> dec dose or frequency, hold in acute renal failure

Decrease dose 20-25% when switching from PO to IV

19
Q

Digitek, Lanoxin:
DDI

A

increased digoxin levels with P-gp inhibitors (amiodarone, dronedarone, diltiazem, verapamil)
- w/ amiodarone & dronedarone dec digoxin dose by 50%

additive effects with other drugs that decrease HR (amiodarone, NDHP CCBs, BBs, clonidine, dexmedetomidine (Precedex)

20
Q

Class 1a drugs + warnings

A

Disopyramide (Norpace)
- proarrhythmic, anticholinergic effects
Quinidine
- proarrhythmic, hemolysis risk (avoid in G6PD deficiency), DILE, diarrhea & cramping, take with food
Procainamide
- BW for agranulocytosis, long term use -> DILE

21
Q

Class 1c drugs + warnings

A

Flecainide
- proarrhythmic (do not use in chronic AF), CI in HF & MI
Propafenone (Rythmol SR)
- proarrhythmic, taste disturbance, CI in HF & MI

22
Q

Class 3 antiarrhythmics:
agents + warnings

A

Dronedarone (Multaq)
- BW: inc risk of death, stroke, and HF in pts with decompensated HF or permanent AF
- CI with CYP3A4 inhibitors and QT prolonging drugs
- Warnings: hepatic failure, pulmonary disease
Sotalol (Betapace, Sotylize, Sorine)
- BW: renal dose adjustments to reduce QT prolongation risk
Ibutilide (Corvert)
- correct hypokalemia & hypomagnesemia prior to use
Dofetilide (Tikosyn)
- BW: must be initiated in setting with continuous ECG monitoring, assess CrCl for a minimum of 3 days, proarrhythmic

23
Q

Adenocard

A

Adenosine
antiarrhythmic not covered by Vaughan Williams classification
Use: supraventricular re-entrant tachycardias
t1/2 less than 10 sec

NAPLEX Prep (40 decks)

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