Antiarrhythmics, Sedatives, and Lipid-lowering Agents Flashcards
What is the best treatment for ventricular tachycardia (VT) associated with hypotension and reduced mental status?
Direct current cardioversion
This is to rapidly restore sinus rhythm.
Which ACLS drugs are the choice for hemodynamically stable VT?
Amiodarone and lidocaine
These drugs are used when the patient is stable.
What is the initial loading dose of amiodarone for stable VT?
150 mg
A higher loading dose (300 mg) may be preferred in a pulseless scenario.
Why is rapid infusion of IV amiodarone associated with hypotension?
It contains a polysorbate compound
This can cause hemodynamic instability.
What type of therapy is indicated for patients with known coronary artery disease (CAD)?
Statin therapy
Statins have shown regression in coronary artery plaque.
What is the primary indication for pharmacologic reversal in patients with altered mental status after opiate therapy?
Respiratory depression
Naloxone is the most appropriate choice in this scenario.
What is the maximum dose of simvastatin recommended with warfarin when amiodarone is initiated?
20 mg/day
Close monitoring is necessary for warfarin adjustments.
True or False: Atropine is contraindicated in patients with bradycardia and hemodynamic compromise.
False
Atropine can quickly reverse bradycardia and hypotension.
What is the recommended level of sedation for cardiac catheterization procedures?
Conscious (or moderate) sedation
This allows patients to respond to commands while maintaining vital functions.
Which local anesthetic is regarded as having the most potential for cardiotoxicity?
Bupivacaine
Cardiotoxicity can result from nerve blocking mechanisms affecting myocardial conduction.
Fill in the blank: The combination of statin and fibrates may increase the risk of _______.
Muscle toxicities
Rhabdomyolysis is a significant risk with this combination.
What is the main mechanism of action for atropine?
Antagonism of muscarinic receptors
This leads to increased heart rate and reduced vagal tone.
What is the duration of effect for naloxone after administration?
5–10 minutes
It can last up to 1–4 hours depending on the dose.
What should be done if a patient receiving digoxin is initiated on amiodarone?
Reduce the dose of digoxin
Amiodarone inhibits P-glycoprotein, affecting digoxin levels.
What is the potential effect of amiodarone on warfarin metabolism?
It inhibits CYP3A4
This necessitates careful monitoring and possible dose adjustment.
What is contraindicated in patients with heart failure among antiarrhythmic drugs?
Sotalol
It is not recommended for patients with structural heart disease.
What is the initial treatment strategy for a patient with symptomatic atrial fibrillation and bradycardia?
Rhythm-control strategy
Diltiazem and metoprolol would primarily be rate-control strategies.
What is a potential effect of certain receptors that may lead to hypotension?
Hypotension.
In the context of atrial fibrillation, what may be a reasonable strategy for a symptomatic patient despite a slow ventricular rate?
Rhythm-control strategy.
Which two medications are primarily rate-control strategies but may help maintain sinus rhythm?
- Diltiazem
- Metoprolol
Why are diltiazem and metoprolol contraindicated in patients with bradycardia?
Effects on AV and SA node conduction.
What is an effective antiarrhythmic that has effects on beta and calcium channels?
Amiodarone.
Why is dofetilide considered an ideal choice for a patient with normal serum creatinine?
It is a pure potassium channel antagonist and does not significantly affect chronotropy.
What must be done during the first 3 days of dofetilide therapy?
Hospitalization.
What is the reason for hospitalization during the first 3 days of dofetilide therapy?
Potential for QT prolongation and fatal ventricular arrhythmias.
What common issue do dofetilide and amiodarone share in their prescribing?
Numerous contraindicated drug interactions.
What recent change has occurred regarding the prescribing of dofetilide?
The REMS program no longer mandates that only certified physicians and pharmacies can prescribe and dispense dofetilide.
