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Pharm > Arrhythmia meds > Flashcards

Arrhythmia meds Flashcards

1
Q

Major problems w/ A-Fib

A

Atrial thrombi
Right atrium: PE
Left atrium: cerebral emboli (stroke)

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2
Q

How much greater risk are a-fib pts of stroke than pts w/o afib

A

2xs

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3
Q

What percent of people who could use prophylactic anticoagulation therapy recieve treatment?

A

15-44%

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4
Q

AF treatment strategy

A

See slide 17

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5
Q

How do you treat a pt who is not compromised and >48 hours (or dont know how long) pt is in a-fib?

A

With rate control anticoagulation

conversion to an sinus rhythm might dislodge a thrombus

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6
Q

Oral anticoagulation-warfarin therapeutic INR

A

See slide 21 for graph

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7
Q

What is the safest antiarrythmic?

A

Amiodarone

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8
Q

What is the IV loading dose of amiodarone?

A

150 mg over 10 minutes

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9
Q

Can you give amiodarone if you have an iodine allergy?

A

Yes

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10
Q

Side effects of amidarone

A 
Hypothyroid
Hyperthyroid
Pulmonary fibrosis
Lenticular opacities
Blue skin discolorations
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11
Q

What is the rate of conversion rate w/ amiodarone?

A

60%

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12
Q

What do we use Dronedarone (amiodarone “lite”) for?

A

For a-fib/flutter who have converted

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13
Q

Is dronedarone affected by iodine?

A

Yes; no iodine to limit toxicity

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14
Q

What is the black box warning for dronedarone?

A 
Dronedarone is contraindicated in NYHA class IV HF or NYHA class II-III HF w/ recent decomepnsation
(increased HF deaths in clinical trials)
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15
Q

What is the MOA of sotalol?

A

Blocks beta 1 and beta 2 receptors

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16
Q

What is sotalol used for?

A

Used to maintain sinus rhythm after conversion

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17
Q

How is sotalol eliminated? Does it need an adjustment?

A

Renally

Yes, dose needs to be adjusted for impairment

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18
Q

When is sotalol contraindicated for A-Fib?

A

If CrCl < 40 mL/min

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19
Q

What is the dose adjustment for ventricular arrhythmia with a CrCL<10?

A

Individualize it based on pt presentation

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20
Q

What is propafenone indicated for?

A

Atrial fibrillation/flutter

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21
Q

What is Diltiazem?

A

A rate controlling calcium channel blocker (CCB)

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22
Q

How is diltiazem dosed?

A

IV and PO

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23
Q

What form of diltiazem do you use when giving PO?

A

CD form

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24
Q

What beta blockers can you use for rate control?

A

Metoprolol

Carvedilol

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25
Q

What populations does Digoxin work better with?

A

Pts w/ EF <40%
Pts w/ low BP
Pts w/ positive inotrope

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26
Q

What does a positive inotrope indicate

A

Increases force myocardial contraction

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27
Q

How is digoxin dosed?

A

Micrograms

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28
Q

Is the half-life of digoxin long or short? Give time

A

Long

36-48 hours

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29
Q

How do you dose IV digoxin for atrial fibrillation

A

500 mcg IVP x1; then 250 mcg q 6 hours x2 doses

30
Q

How do you dose oral digoxin for a-fib?

A

0.5 mg once daily x2 days

31
Q

What is the dosing of digoxin for supraventricular tachycardia?

A

Total dizitizing dose (TDD) = 10-15 mcg/kg

32
Q

What is included in the CHADS2 index and how many points do you get for each thing?

A 
1 point for each:
CHF, recent
HTN
Age >= 75
DM
Stroke (hx or TIA)
33
Q

Stroke risk w/ non-valvular AF-CHADS2 index

A

see slide 44

34
Q

Conclusions from study

A

none of the postulated benefits of a rhythm – control strategy were confirmed. The rate – control strategy eliminated the need for rerpeated cardioversion and reduced rates of hospitalization

Rate control should be considered a primary approach for patients with atrial fibrillation and congestive heart failure

35
Q

Do you want to pursue or avoid anti-arrhythmic drugs?

A

Avoid

36
Q

Is there a mortality benefit for rhythm control?

A

No

37
Q

Is rate control the primary approach?

A

Yes

38
Q

Can you abandon rhythm control?

A

Yes, early, if not satisfactory

39
Q

Is pharmacological conversion as efficacious as electrical?

A

No, but it is simpler

40
Q

Is there a risk of toxicity of antiarrhythmic drugs?

A

Yes, there is a major risk

41
Q

When is pharmacologic conversion most effective?

A

If performed <= 7 days of onset of AF

42
Q

When is pharmacological conversion less effective?

A

If AF started > 7 days ago

43
Q

What risk do electrical and pharmacological conversion methods carry if AF > 48 hours?

A

Thromboembolism

44
Q

What is the difference in thromboembolism risk between pharmacological and electrical conversion methods?

A

Not much, similar risk

45
Q

What drugs are commonly used for AF conversion?

A

Amiodarone (IV/po)
Ibutilide (IV)
Dofetilide (PO)

46
Q

What is the most preventable cardiac arrhythmia?

A

Atrial fibrillation

47
Q

How much more at risk are pts w/ afib of having a stroke

A

> 5xs increased stroke risk

48
Q

What anticoagulant has shown to reduce ischemic stroke risk?

A

Warfarin

49
Q

What RFs are associated with intracranial hemorrhage?

A

Age, INR

50
Q

What is ventricular tachycardia often precipitated by?

A

Electrolyte disturbances
Hypoxemia
Digitalis toxicity
Acute MI or ischemia (MC)

51
Q

What is the drug of choice for ventricular arrhythmias (VA)?

A

Amiodarone!

52
Q

What IV load of amiodarone do you give for VA

A

300 mg IV load

53
Q

What are the risks of drugs used for v-tach?

A

All cause ventricular arrhythmias

All are potentially dangerous

54
Q

What is adenosine?

A

An anti-arrhythmic and a diagnostic agent

55
Q

How long is the half life of adenosine?

A

Short -> seconds

56
Q

What is the MOA of adenosine?

A

Slows conduction through AV node -> Interrupts re-entrant pathways -> restores sinus rhythm

57
Q

What is a negative SE of adenosine?

A

Prolonged sinus pauses

58
Q

What is a rare risk of adenosine

A

Prolonged asystole

59
Q

Does adenosine convert AF/flutter to sinus rhythm?

A

No

60
Q

When is adenosine used diagnostically?

A

When the underlying rhythm is not apparent

61
Q

How is adenosine delivered?

A

Over 1-2 seconds via a peripheral line

62
Q

What do you follow each adenosine bolus with?

A

20 mL normal saline

63
Q

Where do you want to administer adenosine?

A

As close to the trunk as possible

64
Q

Where can you not deliver adenosine through?

A

Hand
Lower arm
Lower extremity

65
Q

When is adenosine contraindicated

A 
2nd or 3rd degree heart block
Sick sinus syndrome
Symptomatic bradycardia (except w/ functioning PM)
AF/flutter w/ underlying WPW syndrome
Asthma
66
Q

Why do you want to avoid anti-arrhythmic drugs?

A

Most are pro-arrhythmic, especially when used long term

67
Q

How do you classify antiarrhythmic drugs?

A

By the Vaughan Williams classification

68
Q

What is the MOA of class 1 VW antiarrhythmics?

A

Sodium channel blockage

69
Q

What is the MOA of class 2 VW antiarrhythmic drugs?

A

Beta adrenoceptor antagonists

70
Q

What is the MOA of class 3 VW antiarrhythmic drugs?

A

Prolong action potential and refractory period

71
Q

What is the MOA of class 4 VW antiarrhythmic drugs?

A

Calcium channel antagonists

Pharm (32 decks)

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