Antiarrhythmics, Sedatives, and Lipid-lowering Agents

Question 1

What is the best treatment for ventricular tachycardia (VT) associated with hypotension and reduced mental status?

Answer 1

Direct current cardioversion

This is to rapidly restore sinus rhythm.

Question 2

Which ACLS drugs are the choice for hemodynamically stable VT?

Answer 2

Amiodarone and lidocaine

These drugs are used when the patient is stable.

Question 3

What is the initial loading dose of amiodarone for stable VT?

Answer 3

150 mg

A higher loading dose (300 mg) may be preferred in a pulseless scenario.

Question 4

Why is rapid infusion of IV amiodarone associated with hypotension?

Answer 4

It contains a polysorbate compound

This can cause hemodynamic instability.

Question 5

What type of therapy is indicated for patients with known coronary artery disease (CAD)?

Answer 5

Statin therapy

Statins have shown regression in coronary artery plaque.

Question 6

What is the primary indication for pharmacologic reversal in patients with altered mental status after opiate therapy?

Answer 6

Respiratory depression

Naloxone is the most appropriate choice in this scenario.

Question 7

What is the maximum dose of simvastatin recommended with warfarin when amiodarone is initiated?

Answer 7

20 mg/day

Close monitoring is necessary for warfarin adjustments.

Question 8

True or False: Atropine is contraindicated in patients with bradycardia and hemodynamic compromise.

Answer 8

False

Atropine can quickly reverse bradycardia and hypotension.

Question 9

What is the recommended level of sedation for cardiac catheterization procedures?

Answer 9

Conscious (or moderate) sedation

This allows patients to respond to commands while maintaining vital functions.

Question 10

Which local anesthetic is regarded as having the most potential for cardiotoxicity?

Answer 10

Bupivacaine

Cardiotoxicity can result from nerve blocking mechanisms affecting myocardial conduction.

Question 11

Fill in the blank: The combination of statin and fibrates may increase the risk of _______.

Answer 11

Muscle toxicities

Rhabdomyolysis is a significant risk with this combination.

Question 12

What is the main mechanism of action for atropine?

Answer 12

Antagonism of muscarinic receptors

This leads to increased heart rate and reduced vagal tone.

Question 13

What is the duration of effect for naloxone after administration?

Answer 13

5–10 minutes

It can last up to 1–4 hours depending on the dose.

Question 14

What should be done if a patient receiving digoxin is initiated on amiodarone?

Answer 14

Reduce the dose of digoxin

Amiodarone inhibits P-glycoprotein, affecting digoxin levels.

Question 15

What is the potential effect of amiodarone on warfarin metabolism?

Answer 15

It inhibits CYP3A4

This necessitates careful monitoring and possible dose adjustment.

Question 16

What is contraindicated in patients with heart failure among antiarrhythmic drugs?

Answer 16

Sotalol

It is not recommended for patients with structural heart disease.

Question 17

What is the initial treatment strategy for a patient with symptomatic atrial fibrillation and bradycardia?

Answer 17

Rhythm-control strategy

Diltiazem and metoprolol would primarily be rate-control strategies.

Question 18

What is a potential effect of certain receptors that may lead to hypotension?

Answer 18

Hypotension.

Question 19

In the context of atrial fibrillation, what may be a reasonable strategy for a symptomatic patient despite a slow ventricular rate?

Answer 19

Rhythm-control strategy.

Question 20

Which two medications are primarily rate-control strategies but may help maintain sinus rhythm?

Answer 20

• Diltiazem
• Metoprolol

Question 21

Why are diltiazem and metoprolol contraindicated in patients with bradycardia?

Answer 21

Effects on AV and SA node conduction.

Question 22

What is an effective antiarrhythmic that has effects on beta and calcium channels?

Answer 22

Amiodarone.

Question 23

Why is dofetilide considered an ideal choice for a patient with normal serum creatinine?

Answer 23

It is a pure potassium channel antagonist and does not significantly affect chronotropy.

Question 24

What must be done during the first 3 days of dofetilide therapy?

Answer 24

Hospitalization.

Question 25

What is the reason for hospitalization during the first 3 days of dofetilide therapy?

Answer 25

Potential for QT prolongation and fatal ventricular arrhythmias.

Question 26

What common issue do dofetilide and amiodarone share in their prescribing?

Answer 26

Numerous contraindicated drug interactions.

Question 27

What recent change has occurred regarding the prescribing of dofetilide?

Answer 27

The REMS program no longer mandates that only certified physicians and pharmacies can prescribe and dispense dofetilide.