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Naplex 2023 > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

conduct

A

transmit electrical charges

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2
Q

cardiac conductive system

A

electrical signalizing system that causes the atria and ventricles to contract

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3
Q

auscultation

A

listening to heart with stethoscope

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4
Q

arrhythmia

A

abnormal heart rhythm
can result in bradycardia (slow) or tachycardia (fast)zz

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5
Q

symptoms of arrythmia

A

heart “fluttering” or “skipping a beat”
dizziness
SOB
fatigue

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6
Q

diagnosis of arrhythmia

A

`ECG

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7
Q

Holter monitor

A

ambulatory ECG
detects intermittent arrythmias

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8
Q

normal sinus rhythm (NSR)

A

starts at SA node = pacemaker
60-100 BPM

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9
Q

conduction pathway

A

SA node
R and L atrium
AV node
Bundle of His
R bundle branch and R ventricle
L bundle branch and L ventricle
Purkinje fibers

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10
Q

source of arrhythmias

A

SA node firing abnormal rate/rhythm
scar tissue from past heart attack blocks/diverts signals
another part of the heart is acting as pacemaker

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11
Q

action potential

A

movement of ions through channels in myocytes that cause electrical impulses in the cardiac conduction pathway
give electricity to power heart

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12
Q

SA

A

pacemaker that has automaticity in cells = initiate own action potentials

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13
Q

Phase 0

A

heartbeat initiated
rapid ventricular depolarization = influx of Na = ventricular contraction
QRS complex

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14
Q

Phase 2

A

plateau response to influx of Ca and efflux of K

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15
Q

Phase 3

A

rapid ventricular repolarization bc efflux of K = ventricular relaxation
T wave

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16
Q

most common cause of arrhythmias

A

myocardial ischemia or infarction

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17
Q

non-cardiac conditions that can cause arrhythmias

A

electrolyte imbalances - K, Mg, Na, Ca
high sympathetic state - hyperthyroidism, infection, drugs (illicit drugs, antiarrhythmics, drugs that inc QT

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18
Q

origins of arrhythmias

A

supraventricular (above AV node)
ventricular (below AV node)

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19
Q

most common type of arrhythmia

A

atrial fibrillation
irregular/usually rapid ventricular response
inc risk of clot = stroke risk = may need anticoagulation

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20
Q

ventricular arrhythmias

A

premature ventricular contractions = skipped heartbeat; related to stress or too much caffeine
if in series = HR >100 = ventricular tachycardia
untreated VT can degenerate into ventricular fibrillation = completely disorganized electrical activation of ventricles = medical emergency

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21
Q

prolongation of QT interval

A

risk for Tosade de Pointes = can cause sudden cardiac death

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22
Q

QT prolongation risk factors

A

high dose of drug
multiple drugs
reduced drug clearance (drug interaction)
electrolytes: hypokalemia, hypomagnesemia
other cardiac conditions

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23
Q

drugs that inc or prolong QT interval

A

antiarrhythmics: !a, !c, III
hydroxychloroquine
azoles (except isavuconazaonium)
macrolies
quinolones
Lefamulin
SSRIs (worst w citalopram and escitalopram)
TCAs
mirtazapine
trazodone
venlafaxine
setrons
droperidol
metopclopramide
promethazine
First generation antipsychotics (haloperidol,
chlorpromazine, thioridazine)
Second generation antipsychotics (ziprasidone worst)
androgen deprivation therapy (leuprolide)
TKIs (nilotinib)
oxaliplatin
other: cilostazol, donepezil, fingolimod, hydrozyzine, loperamide, methadone, ranolazine, solifenacin, tacrolimus

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24
Q

what to do before starting drug from non-life-threatening arrythmia

A

check electrolytes/tox screen for reversible cause

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25
Q

Vaughan Williams classification

A

categorizes antiarrhymic drugs based on dominant electrophysiological effect
Double Quarter Pounds, Lettuce, Mayo, Fries Please
Because Dieting During Stress Is Always Very Difficult

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26
Q

Class I drugs

A

Na-channel blockers
proarrhythmic; caution with cardiac disease

Ia: disopyramide, quinidine, procainamide

Ib: lidocaine, mexiletine

Ic: flecainide, propafenone

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27
Q

Class II drugs

A

Beta-blockers
slow ventricular rates

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28
Q

Class III drugs

A

K-channel blockers
Dronedarone
Dofetilide
Sotalol
Ibutilide
Amiodarone

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29
Q

Class IV

A

Ca-channel blockers, non-DHP
verapamil
diltiazem
amiodarone and dofetilide preferable for AF in pts with HF
Sotalol
low ventricular rate

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30
Q

digoxin

A

Na-K-ATPase blocker

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31
Q

adenosine

A

activates adenosine receptors
used for paroxysmal supraventricular tachycardia

32
Q

rate control goals

A

goal HR <80 BPM if symptomatic
lenient <110 BPM maybe if asymptomatic and have preserved L ventricular function

33
Q

rate control meds

A

BB preferred
non-DHP CCB - do not give to HFrEF patients

34
Q

rhythm control

A

convert to NSR and maintain NSR

cardioversion has high risk of thromboembolism; have anticoagulation at least 3 weeks before cardioversion and continue at least 4 weeks after cardioversion

NOACs preferred over warfarin in non-valvular AF
warfarin indicated in AF and mechanical heart valve

can cardiovert with Class Ia, Ic, or III antiarrhythmic drugs or electrical cardioversion (do not use drugs if permanent AF)

35
Q

amiodarone BBW

A

pulmonary toxicity

hepatotoxicity

for life-threatening arrhythmias only

proarrhythmic, must be hospitalized for IV loading dose

36
Q

amiodarone dosing

A

T1/2 = 40-60 days

37
Q

amiodarone CI

A

iodine HSN

38
Q

amiodarone warnings

A

hyper/hypothyroidism - amio inhibitors conversion of T4 to T3
optic neuropathy
photosensitivity (slate-blue skin discoloration)

39
Q

amiodarone side effects

A

hypotension
bradycardia
cornealmicrodeposits
photosensitivity

40
Q

amiodarone monitoring

A

ECG
BP
HR
electrolytes
LFTs
thyroid function

41
Q

amiodarone notes

A

infusions >2 hrs need non-PVC container (polyolefin/glass)

premixed IV bags: Nexterone comes in non-PVC, non-DEHP container

antiarrhythmic DOC in HF

decrease infusion rate/dc prn for hypotension or bradycardia

IF: use 0.22 micron filter; central line preferable

incompatibile with heparin in IV

contains iodine

42
Q

amiodarone DI

A

inc levels of others - inhibitor of CYP450 2C9, 2D6, 3A4, and P-gp

dec digoxin by 50%, warfarin by 30-50%

do not exceed simvastatin 20 mg/day or lovastatin 40 mg/day

additive dec HR w: non-DHP CCB, digoxin, BB, clonidine

Sofosbuvir: inc bradycia; do not use together

43
Q

diltiazem/verapamil CI

A

HFrEF

44
Q

diltiazem/verapamil warnings

A

may worsen HF symptoms

45
Q

diltiazem/verapamil side effects

A

edema
arrhythmias
constipation (more w verapamil)
gingival hyperplasia

46
Q

diltiazem/verapamil notes

A

non-DHP CCBs only CCBs used as antiarrhythmics

47
Q

verapamil and diltiazem DI

A

additive dec HR: amiodarone, digoxin, BB, clonidine

CYP3A4 substrates: check drugs, do not take with grapefruit

substrates of P-gp; inhibitors of CYP3A4: inc conc of many drugs; lower doses of simvastatin or lovastatin

48
Q

digoxin dosing

A

therapeutic range 0.8-2 ng/mL for AF

CrCl <50: dec dose or frequency

dec dose 20-25% when going oral to IV

49
Q

digoxin monitoring

A

draw digoxin level

50
Q

digoxin toxicity

A

initial toxicity s/sx: N/V, loss of appetite, bradycardia

severe: blurred/double vision; greenish-yellow halos

51
Q

digoxin notes

A

used w/ BB or non-DHP CCB for rate control

antidote: DigiFab

hypokalemia, hypomagnesemia, hypercalcemia inc risk of toxicity

52
Q

digoxin DI

A

substrate of P-gp - inc with inhibitors like amiodarone, diltiazem, verapamil; with amiodarone - dec digoxin 50%

additive with dec HR: amiodarone, non-DHP CCB, BB, clonidine

53
Q

disopyramide warnings

A

proarrhythmic

anticholinergic effects

54
Q

disopyramide side effects

A

anticholinergic effects

55
Q

quinidine dosing

A

take with food

56
Q

quinidine warnings

A

proarrhythmic

hemolysis risk (avoid in G6PD deficiency)

can cause positive Coombs test

57
Q

quinidine side effects

A

drug-induced lupus erythematosus (DILE)
diarrhea
stomach cramping
cinchonism (overdose): tinnitus, hearing loss, blurred vision, HA, delirium

58
Q

procainamide dosing

A

injection
active metabolite N-acetyl procainamide NAPA is renally cleared
therapeutic levels procainamide: 4-10 mcg/mL

59
Q

procainamide BBW

A

granulocytosis

long-term leads to positive ANA = result in DILE

60
Q

procainamide warnings

A

proarrhythmic

61
Q

procainamide notes

A

metabolism by acetylation - slow acetylators risk for toxicity

62
Q

lidocaine

A

injection
used for refractory VT/cardiac arrest

63
Q

fkecainide BBW

A

proarrhythmic effects

64
Q

flecainide CI

A

HF

MI

65
Q

propafenone CI

A

HF

MI

66
Q

propafenone warnings

A

proarrhythmic

67
Q

propafenone side effects

A

taste disturbance (metallic)

68
Q

dronedarone BBW

A

inc death, sstroke, HF in those with decompensated HF or permanent AF

69
Q

dronedarone CI

A

use of strong CYP3A4 inhibitors and QT-prolonging drugs

70
Q

dronedarone warnings

A

hepatic failure

pulmonary disease (fibrosis)

71
Q

dronedarone side effects

A

QT prolongation

72
Q

dronedarone notes

A

does not have iodine

little effect on thyroid

avoid use with strong inhibitors.inducers of CYP3A4 and those that inc QT interval

73
Q

sotalol dosing

A

non-selective BB

CrCl <6-: dec frequency

74
Q

sotalol BBW

A

adjust interval based on CrCl

concentration dec QT prolongation risk

75
Q

ibutilide

A

injection

correct hypokalemia and hypomagnesmia prior and during

76
Q

dofetilide BBW

A

initiate with continuous ECG monitoring
assess CrCl for >=3 days
proarrhythmic

77
Q

dofetilide notes

A

DOC in HF

Naplex 2023 (21 decks)

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