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Pharmacology > Antiarrhythmics > Flashcards

Antiarrhythmics Flashcards

1
Q

How do you identify A fib?

A

irregularly irregular rhythm, NO P WAVES

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2
Q

Rate of A fib vs A flutter

A

A fib: usually 100-140 bpm

A flutter: >140 bpm

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3
Q

What are class I antiarrhythmics

A

Na channel blockers

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4
Q

Na channel blocker examples most often used (according to Kim’s notes)

A

Flecanide (tambacor)

Rythmol (propafenone)

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5
Q

what are class II antiarrhythmics

A

beta blockers

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6
Q

beta blocker examples

A

lopressor/Metoprolol - go to agent
Carvedilol/Coreg
atenolol (Tenormin)

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7
Q

what are class III antiarrhythmics

A

potassium channel blockers

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8
Q

potassium channel blocker examples

A

dofetilide (Tikosyn)
sotalol (beta pace)
amiodarone
dronedarone (Multaq)

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9
Q

special considerations with potassium channel blockers

A

pt must be admitted to hospital for observation when initiating medication b/c can cause QT prolongation

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10
Q

potassium channel blocker CI

A
  1. renal dysfunction

2. many drug interactions (other drugs that cause QT prolongation)

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11
Q

Special considerations for amiodarone

A

very effective but lots of bad side effects

only use short-term or in elderly

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12
Q

What do you have to test when giving amiodarone

A
  1. thyroid
  2. PFTs
  3. Liver function
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13
Q

what are class IV antiarrhythmics

A

non-dihydropyridine calcium channel blockers

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14
Q

non-dihydropyridine calcium channel blocker examples

A

verapamil (calan)

diltiazem (cardizem)

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15
Q

Causes of arrhythmia

A
  1. Coronary artery disease/MI
  2. altered impulse formation (ectopic foci, changes in automaticity)
  3. altered impulse conduction (block of conduction)
  4. heart failure
  5. drug/medication induced
  6. electrolyte disturbance
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16
Q

Three R’s of arrhythmia management

A
  1. rate control
  2. rhythm control
  3. risk of stroke/need for anticoagulation
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17
Q

Sodium Channel Blockers MOA

A

block Na channels –> slower conduction of AP
1A - moderate slowing
1B - minimal slowing
1C - maximal slowing

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18
Q

Subclass 1A of Sodium Channel Blockers indications

A

atrial and ventricular arrhythmias

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19
Q

Subclass 1A of Sodium Channel Blockers examples

A

procainamide

quinidine

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20
Q

Risk factors for A fib

A

HTN, DM, obesity, sleep apnea

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21
Q

paroxysmal A fib

A

goes about 48 hours then stops by itself

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22
Q

Sodium channel blockers classes

A

1A, 1B, 1C

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23
Q

Sodium channel blockers MOA

A

slow conduction –> influence QT interval

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24
Q

Where is quinidine initiated

A

hospital setting b/c can prolong QT interval, risk for ventricular tachycardia

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25
Q

Quinidine S/E

A

severe GI upset, diarrhea

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26
Q

Quinidine drug interactions

A

digoxin

warfarin

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27
Q

1B Sodium channel blockers indications

A

ventricular arrhythmias

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28
Q

1B Sodium channel blockers examples and route of administration

A

Lidocaine (Xylocaine) - IV

Mexiletine - oral

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29
Q

Mexiletine initiation setting

A

often in hospital but can be outpatient

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30
Q

Mexiletine S/E

A

Tremor, seizure, N/V

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31
Q

1C Sodium channel blockers MOA

A

prolongs the AV node refractory period

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32
Q

1C Sodium channel blockers indications

A

a fib

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33
Q

1C Sodium channel blockers CIs

A

CAD, MI, LV dysfunction, ischemic arrhythmia, decreased EF

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34
Q

1C Sodium channel blockers examples

A

propafenone (rhythmol)

flecainide (tambocor) - will see a lot!

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35
Q

Flecainide initiation setting

A

outpatient

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36
Q

monitoring when giving flecainide

A

exercise stress test w/o imaging 1-2 weeks after initiation to evaluate possible QRS widening

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37
Q

what must you always prescribe with flecainide

A

a rate controlling agent

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38
Q

Flecainide S/E

A

dizziness, headache, blurred vision

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39
Q

Beta Blockers MOA

A

decrease automaticity, slow conduction velocity, prolongs refractory period (depresses AV node)

40
Q

metoprolol forms and differences

A

Metoprolol tartrate: short acting, dosed BID (don’t use if LV dysfunction)
Metoprolol succinate: long acting, dosed QD

41
Q

Beta Blocker side effects

A
  1. fatigue
  2. GI disturbances
  3. insomnia, nightmares
  4. lethargy
  5. erectile dysfunction
  6. bradycardia
42
Q

Potassium Channel Blockers MOA

A

blocks potassium channels in phase 3 of AP –> slows efflux of K back out of myocyte –> lengthens plateau phase

43
Q

Dofetilide (Tikosyn) initiation setting

A

hospital 72 hour admission (continuous telemetry, regular ECG, daily BMP)

44
Q

Dofetilide (Tikosyn) indications

A

a fib

45
Q

Dofetilide (Tikosyn) S/E

A

QT prolongation

Torsades

46
Q

Dofetilide (Tikosyn) drug interactions

A

thiazide diuretics

47
Q

downside to Dofetilide (Tikosyn)

A

have to monitor ECG and BMP every 6 months

48
Q

sotalol initiation setting

A

hospital 72 hour admission - daily ECG, BMP, continuous telemetry

49
Q

sotalol indications

A

atrial and ventricular arrhythmias

50
Q

amiodarone indications

A

most effective of antiarrhythmic drugs

51
Q

amiodarone s/e

A

liver, thyroid, GI, skin, CNS (tremor), visual (corneal deposits, optic neuropathy), photosensitivity, pulmonary fibrosis

52
Q

What do you have to get before starting amiodarone

A

baseline thyroid labs, LFTs, PFTs w/ DLCO

53
Q

what do you have to monitor when taking amiodarone

A

LFTs, TSH, CXR, PFTs every 6 months

54
Q

how long does it take amiodarone to leave the body

A

6 weeks

55
Q

amiodarone cardiac SE

A

bradycardia
heart block
Hypotension

56
Q

amiodarone noncardiac SE

A 
pulmonary fibrosis
thyroid dysfunction (MC)
blue skin
nausea
constipation
anorexia
liver damage
57
Q

what is dronedarone / multaq and where is it initiated

A

modified amiodarone molecule (deionization) - can be started outpatient

58
Q

dronedarone / multaq CIs

A

hx of heart failure!!!! or permanent AF

59
Q

calcium channel blockers MOA

A

blocks calcium channels in phase 0 of AP –> slower pacemaker in SA node, longer refractory period in AV node

60
Q

diltiazem/cardizem is often given for

A

rapid A fib in ER

61
Q

diltiazem/cardizem SE

A

headache, dizziness, bradycardia

62
Q

important things to remember when giving diltiazem/cardizem

A

take thorough history
monitor labs q6 months - serum electrolytes, renal function
routine monitoring of renal and hepatic function
ECG every 6-12 mo

63
Q

which version of metoprolol do you give for heart failure

A

long acting version - succinate

64
Q

what is MC beta blocker used for CHF and A fib

A

carvedilol

65
Q

carvedilol vs. metoprolol

A

carvedilol often well tolerated but not as strong for limiting rate as metoprolol

66
Q

CI for atenolol

A

poor kidney function

67
Q

What do you need to watch for with tikosyn/dofetilide

A

hypokalemia, magnesium labs

68
Q

CI for tikosyn/dofetilide

A

kidney dysfunction - could build up and cause QT prolongation

69
Q

drug interactions with tikosyn

A

A LOT

zofran, tagamet, etc.

70
Q

CI for sotalol

A

kidney impairment - will build up and cause QT prolongation, bradycardia

71
Q

dosing for amiodarone

A

have to take higher dose initially to build it up in the system then gradually drop down to lower dose over 1 month to reach maintenance dose

72
Q

amiodarone uses by age

A

give to old people

young: used peri-procedurally for ablation, ideally <12 month, bridge therapy

73
Q

sign of amiodarone toxicity

A

SOB + regular rhythm

74
Q

warfarin indications

A

prophylaxis for DVT, PE, post-MI, mechanical valves!

75
Q

warfarin dosing

A

must be adjusted to each pt’s metabolism, INR response

76
Q

what does CHADS2-VASc stand for

A 
CHF
HTN
Age 75+ (2)
DM
Prior stroke or TIA (2)
vascular disease
Age 65-74
Sex category - female
77
Q

scoring for CHADS2-VASc

A

2+ for men

3+ for women

78
Q

what does HAS-BLED stand for

A 
HTN
Abnormal renal and liver function (1 each)
Stoke
Bleeding
Labile INR
Elderly (>65)
Drugs or alcohol (1 each)
79
Q

HAS-BLED score

A

3+ = high risk

80
Q

oral anticoagulants

A
  1. vitamin K antagonist
  2. direct thrombin inhibitors
  3. factor Xa inhibitors
81
Q

vitamin K antagonist example

A

warfarin

82
Q

direct thrombin inhibitors example

A

dabigatran / pradaxa

83
Q

factor Xa inhibitor examples

A

rivaroxiban / xarelto
apixaban / eliquis
endoxaban / savaysa

84
Q

how long does it take warfarin to become effective

A

48-72 hours

85
Q

DOAC indications

A

prevention of thromboembolism in non-valvular A fib
treatment of DVT/PE
a fib

86
Q

DOAC examples

A

pradaxa
xarelto
eliquis
savaysa

87
Q

DOAC with most indications and most dosages available

A

xarelto

88
Q

DOAC CIs

A 
active pathological bleeding
known hypersensitivity
mechanical prosthetic heart valves
severe renal dysfunction
severe hepatic impairment
P-gp and strong CYP34A inhibitors or inducers
89
Q

reversal agent for warfarin and how fast does it work

A

phytonadione (vitamin k), 12-24 hours
fresh frozen plasma
prothrombin complex concentrate

90
Q

reversal agent for pradaxa

A

idarucizumab

91
Q

what is triple therapy for a fib

A

warfarin, aspirin, clopidogrel

goes INR is 2-2.5

92
Q

antiplatelets vs. anticoagulants (the ones we talked about)

A

antiplatelets for artery things

anticoagulants for venous things

93
Q

who is eliquis really good for?

A

patients >80, also renal dysfunction

94
Q

special consideration for xarelto

A

requires protein for absorption (Take with biggest meal of day at consistent time)

95
Q

when do DOACs become effective after given

A

2 hours after dosing

96
Q

reversal agent for Xarelto and eliquis

A

andexxa

Pharmacology (27 decks)

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