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Theraputics Winter > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

PR interval

A

(0.12-0.2 sec)

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2
Q

QRS complex

A

(0.04 – 0.14 sec)

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3
Q

QT interval

A

( < 0.42 sec)

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4
Q

What can we stop if we see a phase 4 slope (no meds)

A
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5
Q

Double quarter pound lettuce mayo fries please

A

Class 1A - Disopyramide, Quinidine, Procainamide
Class 1B - Lidocaine, Mexilitine
Class 1C - Flecainide, Propafenone

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6
Q

Disopyramide dose

A
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7
Q

Disopyramide SV, AV, or both

A

Both

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8
Q

Disopyramide 4 AD

A

THE BIGGEST ANTICHOLINERGIC AND PROLONGED QTC
HF

hypotension
Tdp

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9
Q

Quinidine dose

A
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10
Q

Quinidine SV, AV, or both

A

Both

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11
Q

Quinidine AD

A

BIGGEST cinchonism[ diarrhea,nausea,
tinnitus, visual changes, dizziness, headache]

thrombocytopenia
diarrhea

hypotension
Tdp

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12
Q

Procainamide Dose

A

Only IV

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13
Q

Procainamide Lab monitoring

A

PA 4-8 mcg/mL
NAPA 4-10 mcg/mL
one of the drugs we can monitor

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14
Q

Procainamide SV, AV, or both

A

Both

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15
Q

Procainamide AD

A

BIGGEST - LUPUS-LIKE SYNDROME (oral long-term use)

Hypotension with IV
Tdp
LESS QTC prolonged than quinidine

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16
Q

Procainamide what is special about this class 1A drug

A

It a negative inotrope
worsens heart failure

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17
Q

Procainamide elimination

A

Renal and hepatic

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18
Q

pot k and mg levles

A

4 and 2

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19
Q

what 3 questions should I ask before using Arrhythmias drugs

A

should we treat
do they have symptoms
need pros and cons of drugs

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20
Q

What drugs are the best at post MI patients

A

2 A
lidocaine and mexiletine

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21
Q

Lidocaine dose

A
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22
Q

Lidocaine SV, AV, or both

A

ventricular but only 20% effective need combo

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23
Q

What 2 disease affect Lidocaine?

A

liver disease
heart failure

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24
Q

Lidocaine Lab monitoring

A

1.5 - 5 mcg/mL

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25
Q

Lidocaine AD

A

A lot of CNS

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26
Q

Mexiletine dose

A

good for long term use bc analog of lidocaine

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27
Q

Mexiletine SV, AV, or both

A

ventricular but only 20% effective need combo

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28
Q

Mexiletine AD

A

CNS
GI upset

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29
Q

Flecainide dose

A
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30
Q

Flecainide SV, AV, or both

A

both but used for only Ventricular

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31
Q

Flecainide AD

A

proarrhythmic
exacerbate heartfailure
heartblock

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32
Q

what is unique about flecainide and propafenone

A

can use as a single dose of a drug in the pocket

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33
Q

Propafenone dose

A
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34
Q

Propafenone SV, AV, or both

A

both but usually supraventricular

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35
Q

Propafenone elminiation

A

hepatic and renal

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36
Q

What class A drugs do we see in practice

A

Diosprimide and Flecainide

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37
Q

Propafenone AD

A

pro-arrhythmia
worsening CHF
bronchospasm
CNSeffects

38
Q

What are the class II drugs

A

Esmolol

39
Q

Esmolol dose

A

loading: dose 500mcg/kgIV over 1minute
maintenance: dose50mcg/kg/min to start and may increase by 50 mcg/kg/min every 4 minutes until a maximum of 300 mcg/kg/min
may rebolus w/500mcg/kg before each dose increase

40
Q

Esmolol SV, AV, or both

A
41
Q

why is Esmolol good in the ICU

A

bc low half-life that makes adjusting everything easy

42
Q

Esmolol AD

A
43
Q

What does ADiDas mean

A

Class III
Amiodarone, Dronedarone, Ibutilide, Dofetilide, and Sotalol

44
Q

Amiodarone dose

A
45
Q

Amiodarone SV, AV, or both

A

Both

46
Q

Amiodarone AD

A

Slow onset
Large loading dose
iodine allergy
pulmonary fibrosis - over 400mg daily for the long term WATCH OUT
hypotension
bradycardia
eye floaters
Photosensitivity
SMURF SYNDROME

47
Q

what drug causes smurf syndrome?

A

Amiodarone

48
Q

What baseline labs do we monitor for Amiodarone?

A

thyroid and liver

49
Q

What do we do for Amiodarone AD

A
50
Q

What drug can not be given if I have Iodine allergies?

A

Amiodarone

51
Q

Why is Amiodarone given to almost every patient

A

highly effective
less Tdp than sotalol
CAN BE USED IN MI and CHF w/ low EF

52
Q

What is one anti-arrhythmias drug that can be used in both CHF and MI

A

Amiodarone

53
Q

Dronedarone dose

A
54
Q

What is the benefit of Drodedarone

A

can be used in Iodine allergy and less side effects

55
Q

Cons of Drodedarone?

A

Not a great and effective drug
cant be used in afib or aflutter
no bradycardic patietns
No HF
cant be used in 30 days of heartfailure

56
Q

Patient comes in with heart failure <30 days ago can i use Dronedarone

A

No

57
Q

Dronedarone SV, AV, or both

A
58
Q

Dronedarone AD

A
59
Q

Ibutilide dose

A

Dose for <60-kg: 0.01mg/kg IV over 10minutes
Dose for ≥60-kg: 1mgIV over 10 minutes
Stop once the arrhythmia is terminated.

60
Q

Pro of Ibutilide

A
61
Q

Ibutilide SV, AV, or both

A

niche drug

62
Q

Ibutilide AD

A

AV and bundle branch blocks
every kind of arrhythmia
HA
hypotension
nausea/vomiting

63
Q

Cons of ibutilide

A
64
Q

Dofetilide dose

A

500 mcg

65
Q

Dofetilide SV, AV, or both

A
66
Q

what is the issue of Dofetilide

A

Renal clearance
requires 3 day hospital

67
Q

When do we usually use Dofetilide

A

works well in patients with structural heart disease

68
Q

What happens if they are on a renal cation drug for Dofetilide and what are the drugs

A

must stop dofetilide
verapamil, cimetidine, trimethoprim, ketoconazole, prochlorperazine, megestrol

69
Q

Dofetilide AD

A

Big - QTC prolongation

70
Q

Sotalol dose

A
71
Q

Sotalol SV, AV, or both

A

both

72
Q

Sotalol AD

A

Bradycardia, fatigue, depression, bronchospasm, impotenceincreased QT interval, Tdp

73
Q

What is the range to be concerned on QTC

A

450ms

74
Q

What limits Sotalol QTC or renal?

A

QTC, but renal adjustment is a good starting point

75
Q

What 2 drugs that are unclassified

A

Adenosine and Digoxin

76
Q

Class IV drugs

A

Diltiazem and Verapamil

77
Q

Diltiazem and Verapamil use in arrhythmia

A
78
Q

Adenosine dose

A
79
Q

Adenosine SV, AV, or both

A
80
Q

Adenosine AD

A

flushing, dyspnea, chest pain, asystole but short HL so not a big worry, bronchospasms, abdominal discomfort

81
Q

Adenosine patient education

A

going to feel really bad but will go away

82
Q
A

stop AV node signals so can tell the difference

83
Q

What is the on issue of Adenosine?

A

the short half-life and the dosing

84
Q

How do we administer Adenosine

A
85
Q

Digoxin Dose

A
86
Q

Digoxin SV, AV, or both

A
87
Q

Digoxin AD

A
88
Q

What reduces the effectiveness of Digoxin

A

high resting heartrate

89
Q

What are the DDI with Digoxin

A

p-glycoprotein pump

90
Q

What labs do we monitor for Digoxin

A

0.5-0.9 ng/mL (heart failure)
– 0.5-1.2 ng/mL (rate control – atrial fib/flutter)

91
Q

What do we use to reverse Digoxin

A

Managing toxicity could include atropine (minor toxicity), magnesium, and/0r digoxin immune fab (ovine)

92
Q
A

Theraputics Winter (15 decks)

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