Arrhythmia Guideline

Question 1

Step 1: Unstable?

Answer 1

YES
= shock, heparin 60/12 or lmwh 1 mg/kg sq BID
+ 4 week OAC (WARED)

NO
*heparin/lmwh still
- DHF = Amiodarone or Digoxin
- No DHF = EDMV (+/- dig, amio if - for clot)

Question 2

Dosing for Step 1 (DOACs)

Answer 2

A Fib Dosing

Warfarin:
- < 70 kg: AA 7.5, WH 5, As 2.5
- > 70 kg: AA 5, WH 2.5-5, As 2.5

Apix: 5 mg BID

Riva: 20 mg QD

Edox: 60 mg QD

Dabi: 150 mg BID

Question 3

Step 2: Control

Answer 3

Rate

• 40 + : DMV +/- Dig
• < 40 : MC +/- Dig

Rhythm

48 hr + and + clot: 3-6 week OAC (WARED)

< 48 hr or - clot: cont H/L
-Shock + 4 week OAC
or
-Pharm + 4 week OAC
* < 40: Amio
* NI: PIA (order AIP)
* NO: FF

Question 4

Dosing for Step 2: DOACs

Answer 4

VTE Dosing

-Apixaban: 10 (7), 5 (3mo), 2 (>6mo) mg BID

-Rivaroxaban: 15 (21) mg BID, 20 mg QPM with food, 10 mg QD

Question 5

Digoxin Dosing

Answer 5

-LD: 15 mcg/kg
(50-25-25%)
-MD: 0.125-0.375 QD

CrCl < 20
-LD: 7 mcg/kg (50-50%)
-MD: 0.125 QD

Question 6

Amiodarone Dosing

Answer 6

150 mg over 10 min, 1 mg/min over 6 hours, 0.5 mg/min for 18 hours

PO is 200 mg qd

Question 7

Diltiazem Dosing

Answer 7

0.25 mg/kg/min over 2 min, then can do 0.35 mg/kg/min for 15 min
*then 5-15 mg/hr

PO is 120-480 mg QD

T in diltiazem for TWENTY FIVE 0.25 - 0.35 - 5-15

Question 8

Esmolol Dosing

Answer 8

LD: 500 mcg/kg/min

MD: 50-300 mcg/kg/min

Question 9

Metoprolol Dosing

Answer 9

2.5-5 mg/kg in 5 min
*can repeat q 4-6 hours

PO is 25-400 mg (QD-BID)

Question 10

Step 3: Prevention

Answer 10

Stroke:
*Mechanical Valve or Mitral Stenosis = Warfarin
*Everyone else
-High: Male 2, Female 3 points
(age 75+ is 2, stroke/tia/TE is 2, female, diabetes htn, vd, hf)
= DOACs
A 5 bid R 20 E 60 D 150 bid

NSR:
-Normal: DADSPF
-MI/SHD/<40: DADS
*drone don’t use in Class 3-4 CHF or recent ADF

Question 11

Disopyramide AE

Answer 11

-Anticholinergic (DM, cons, UR, glaucoma)
-Proarrhythmias
-HF
-Hypotention

die HAHA

Question 12

Quinidine AE

Answer 12

-Cinchonism
-Hypotension
-Thrombocytopenia
-QTp, TDP
-Diarrhea

Q for QT DiTCH

Question 13

Procainamide AE

Answer 13

Negative inotrope
*monitor PA, NAPA

-Hypotension
-TDP, QTp
-Lupus like syndrome

pro not an LL (lupus, low bp)

Question 14

Mexiletine AE

Answer 14

-CNS (ataxia, slurry speech, BV, memory)
-GI upset
-Thrombocytopenia
-Proarrthymia

CAT G

Question 15

Flecainide AE

Answer 15

Negative inotrope

-Proarrhythmic
-HF exacerbation
-Heart block

Flec and ABE

Question 16

Propafenone AE

Answer 16

-Proarrhythmia
-CHF worsens
-Bronchospasm
-CNS effects
-Bitter metallic taste

none CC BAB

Question 17

Amiodarone AE

Answer 17

-Pulmonary fibrosis
-Increase LFTs + IODINE allergy
-Derm rxns
-Thyroid

D TIP

Question 18

Ibutilide AE

Answer 18

-AV/bundle blocks
-Arrhthmias
-HA, NV, hypotension

BIA

Question 19

Sotalol AE

Answer 19

-Bradycardia, fatigue, depression, bronchospasm, impotence

DIB on mh BF

Question 20

Adenosine AE

Answer 20

-Asystole
-Flushing
-Chest pain
-Bronchospasm
-Dyspnea

ABCDF

Question 21

Digoxin AE

Answer 21

-Arrhythmias, nausea, cognitive, yellow or blurry vision

YACN