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Therapeutics 2 > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

Define: paroxysmal AFib

A

terminates spontaneously or with intervention within 7 days, “episodic”

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2
Q

Define: Persistent AFib

A

continuously sustained > 7 days from onset

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3
Q

Define: Long-standing AFib

A

continuous sustained > 12 months

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4
Q

Define: Permanent AFib

A

not a pathophysiological state but stage of Afib aka Stage 4= no more attempts to restore or maintain normal sinus rhythm

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5
Q

What are the symptoms of AFib?

A

-fatigue
-palpitations
-dyspnea
-hypotension
-tachycardia induced cardiomyopathy

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6
Q

What are treatable risk factors for AFib?

A

-heart failure
-exercise
-tobacco
-obesity
-HTN
-ethanol
-diabetes
-sleep

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7
Q

What does CHA2DS2-VASc stand for?

A

point system for predicting stroke risk
-congestive HF: 1
-HTN: 1
-age 75+: 2
-DM: 1
-previous stroke, TIA, or thromboembolism: 2
-vascular disease (prior MI, PAD, aortic plaque): 1
-age 65-74: 1
-female: 1

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8
Q

When would oral anticoagulant therapy be recommended for stroke risk in AFib pts?

A

CHA2DS2VASc score of 2 or greater in men or 3 or greater in women OR moderate to severe mitral stenosis or mechanical valve

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9
Q

What does a HAS-BLED score 3 or greater mean?

A

high risk of bleeding

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10
Q

What is the recommended anticoagulant for stroke risk reduction?

A

DOAC > warfarin

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11
Q

When would Warfarin be preferred over DOAC for stroke reduction therapy?

A

ESRD (eGFR < 15mL/min) OR severe mitral stenosis or mechanical heart valve

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12
Q

What are the dosing recommendations for Apixaban?

A

-typically 5 mg po BID
-2.5mg po BID if pt has 2 of the following: 80+ yo, less than 60kg, SCr 1.5mg/dL or greater

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13
Q

What DOAC may be used in ESRD?

A

apixaban

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14
Q

What is the dosing recommendations of Edoxaban?

A

60mg po daily

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15
Q

When would you avoid using Edoxaban in a pt?

A

CrCl > 95mL/min due to increased risk of stroke

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16
Q

What are the monitoring parameters for DOACs?

A

-renal function
-hepatic function
-signs of bleeding
-signs of stoke

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17
Q

What may be used to reverse the effects of oral Xa inhibitors (apixaban, edoxaban, rivaroxaban)?

A

andexanet alfa

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18
Q

What can be done if pt is poor candidate for oral anticoagulation therapy?

A

watchman device

19
Q

What is the target HR for a patient with AFib?

A

resting HR < 100-110

20
Q

What are the rate control treatment options for AFib?

A

-beta blockers
-nonDHP CCB
-digoxin
-amiodarone

21
Q

When would nonDHP CCB be used for AFib?

A

rate control in pt who do not have HF (LVEF > 40%)

22
Q

How would you convert IV diltiazem to PO?

A

PO(mg)= [rate (mg/hr) x 3 + 3] x 10

23
Q

What is the usual dosing for metoporol treatment of AFib?

A

2.5-5mg IV bolus over 2 minutes for up to 3 doses

24
Q

What is the maintenance dosing of metoprolol?

A

-tartate: 25-100mg
-succinate: 50-400mg

25
Q

What is the use of beta blockers in AFib?

A

may be used first line whether pt has HF or not

26
Q

What is the risk of using Amiodarone for AFib?

A

lots of interactions and toxicity, chronic monitoring required so not preferred for long term therapy

27
Q

What are the side effects of Amiodrone?

A

-CV= bradycardia, QTc prolongation
-CNS= impaired memory, tremor
-GI= N/V, anorexia, heptotoxicity
-Ocular= halovision, photophobia
-Pulmonary= interstitial pneuonitis, fibrosis
-Skin= photosensitivity, blue discoloration
-hyper or hypo thyroidism

28
Q

What are the monitoring recommendations for Amiodarone?

A

-TSH
-hepatotoxicity= AST, ALT
-QT prolongation= ECG
-chest xray of lungs
-overall physical exam

29
Q

What is the concern of using Digoxin?

A

small therapeutic window= risk of toxicity

30
Q

What are the side effects of Digoxin?

A

-AV block
-arrhythmias
-toxicity= N/v, abdominal pain, diarrhea, yellow-green vision, fatigue, dizziness

31
Q

What needs to be done before cardioversion (whether it is electrical or pharmacological)?

A

anticoagulation therapy 3 weeks before then 4 weeks after

32
Q

When would rhythm control therapy be indicated for AFib?

A

-persistent symptoms
-cannot obtain rate control
-young
-tachycardia induced cardiomyopathy
-patient preference
-LV dysfunction

33
Q

What drugs may be used for conversion to sinus rhythm?

A

-amiodarone
-ibutilide
-procainamide
-flecainide
-propafenone

34
Q

What are the adverse effects of Ibutilide?

A

-QT prolongation, MUST MONITOR ECG
-TdP risk, do not give to patients with HFrEF

35
Q

What cardioversion drug cannot be used in patients with MI in the past 2 years (Black Box Warning)?

A

procainamide

36
Q

Which drugs for cardioversion can be given to patients as “pill in pocket” therapy?

A

propafenone and flecainide

37
Q

What drugs can be used to maintain sinus rhythm?

A

-amiodarone
-dofetilide
-dronedarone
-flecainide
-propafenone
-sotalol

38
Q

What drugs must be monitored before outpatient administration?

A

-propafenone
-flecainide
-dofetilide (at least 3 days to monitor ECG)
-sotalol

39
Q

What drugs may be used for maintenance rhythm with HFrEF?

A

amiodarone and dofetilide

40
Q

What are the adverse effects of Dofetilide?

A

QT prolongation (contraindicated if QT > 440 seconds) and must be monitored (ECG) for 3 days after initiation

41
Q

What are the dosing considerations of Sotalol?

A

must be renally adjusted

42
Q

What are the adverse effects of Sotalol?

A

QT prolongation (high risk!) must initiate inpatient to monitor ECG

43
Q

What is the pros of using Dronedarone?

A

better safety profile compared to amiodarone

Therapeutics 2 (13 decks)

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