Arrhythmias Flashcards
PR interval
(0.12-0.2 sec)
QRS complex
(0.04 – 0.14 sec)
QT interval
( < 0.42 sec)
What can we stop if we see a phase 4 slope (no meds)
Double quarter pound lettuce mayo fries please
Class 1A - Disopyramide, Quinidine, Procainamide
Class 1B - Lidocaine, Mexilitine
Class 1C - Flecainide, Propafenone
Disopyramide dose
Disopyramide SV, AV, or both
Both
Disopyramide 4 AD
THE BIGGEST ANTICHOLINERGIC AND PROLONGED QTC
HF
hypotension
Tdp
Quinidine dose
Quinidine SV, AV, or both
Both
Quinidine AD
BIGGEST cinchonism[ diarrhea,nausea,
tinnitus, visual changes, dizziness, headache]
thrombocytopenia
diarrhea
hypotension
Tdp
Procainamide Dose
Only IV
Procainamide Lab monitoring
PA 4-8 mcg/mL
NAPA 4-10 mcg/mL
one of the drugs we can monitor
Procainamide SV, AV, or both
Both
Procainamide AD
BIGGEST - LUPUS-LIKE SYNDROME (oral long-term use)
Hypotension with IV
Tdp
LESS QTC prolonged than quinidine
Procainamide what is special about this class 1A drug
It a negative inotrope
worsens heart failure
Procainamide elimination
Renal and hepatic
pot k and mg levles
4 and 2
what 3 questions should I ask before using Arrhythmias drugs
should we treat
do they have symptoms
need pros and cons of drugs
What drugs are the best at post MI patients
2 A
lidocaine and mexiletine
Lidocaine dose
Lidocaine SV, AV, or both
ventricular but only 20% effective need combo
What 2 disease affect Lidocaine?
liver disease
heart failure
Lidocaine Lab monitoring
1.5 - 5 mcg/mL
Lidocaine AD
A lot of CNS
Mexiletine dose
good for long term use bc analog of lidocaine
Mexiletine SV, AV, or both
ventricular but only 20% effective need combo
Mexiletine AD
CNS
GI upset
Flecainide dose
Flecainide SV, AV, or both
both but used for only Ventricular
Flecainide AD
proarrhythmic
exacerbate heartfailure
heartblock
what is unique about flecainide and propafenone
can use as a single dose of a drug in the pocket
Propafenone dose
Propafenone SV, AV, or both
both but usually supraventricular
Propafenone elminiation
hepatic and renal
What class A drugs do we see in practice
Diosprimide and Flecainide
Propafenone AD
pro-arrhythmia
worsening CHF
bronchospasm
CNSeffects
What are the class II drugs
Esmolol
Esmolol dose
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
Esmolol SV, AV, or both
why is Esmolol good in the ICU
bc low half-life that makes adjusting everything easy
Esmolol AD
What does ADiDas mean
Class III
Amiodarone, Dronedarone, Ibutilide, Dofetilide, and Sotalol
Amiodarone dose
Amiodarone SV, AV, or both
Both
Amiodarone AD
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
what drug causes smurf syndrome?
Amiodarone
What baseline labs do we monitor for Amiodarone?
thyroid and liver
What do we do for Amiodarone AD
What drug can not be given if I have Iodine allergies?
Amiodarone
Why is Amiodarone given to almost every patient
highly effective
less Tdp than sotalol
CAN BE USED IN MI and CHF w/ low EF
What is one anti-arrhythmias drug that can be used in both CHF and MI
Amiodarone
Dronedarone dose
What is the benefit of Drodedarone
can be used in Iodine allergy and less side effects
Cons of Drodedarone?
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
Patient comes in with heart failure <30 days ago can i use Dronedarone
No
Dronedarone SV, AV, or both
Dronedarone AD
Ibutilide dose
Dose for <60-kg: 0.01mg/kg IV over 10minutes
Dose for ≥60-kg: 1mgIV over 10 minutes
Stop once the arrhythmia is terminated.
Pro of Ibutilide
Ibutilide SV, AV, or both
niche drug
Ibutilide AD
AV and bundle branch blocks
every kind of arrhythmia
HA
hypotension
nausea/vomiting
Cons of ibutilide
Dofetilide dose
500 mcg
Dofetilide SV, AV, or both
what is the issue of Dofetilide
Renal clearance
requires 3 day hospital
When do we usually use Dofetilide
works well in patients with structural heart disease
What happens if they are on a renal cation drug for Dofetilide and what are the drugs
must stop dofetilide
verapamil, cimetidine, trimethoprim, ketoconazole, prochlorperazine, megestrol
Dofetilide AD
Big - QTC prolongation
Sotalol dose
Sotalol SV, AV, or both
both
Sotalol AD
Bradycardia, fatigue, depression, bronchospasm, impotenceincreased QT interval, Tdp
What is the range to be concerned on QTC
450ms
What limits Sotalol QTC or renal?
QTC, but renal adjustment is a good starting point
What 2 drugs that are unclassified
Adenosine and Digoxin
Class IV drugs
Diltiazem and Verapamil
Diltiazem and Verapamil use in arrhythmia
Adenosine dose
Adenosine SV, AV, or both
Adenosine AD
flushing, dyspnea, chest pain, asystole but short HL so not a big worry, bronchospasms, abdominal discomfort
Adenosine patient education
going to feel really bad but will go away
stop AV node signals so can tell the difference
What is the on issue of Adenosine?
the short half-life and the dosing
How do we administer Adenosine
Digoxin Dose
Digoxin SV, AV, or both
Digoxin AD
What reduces the effectiveness of Digoxin
high resting heartrate
What are the DDI with Digoxin
p-glycoprotein pump
What labs do we monitor for Digoxin
0.5-0.9 ng/mL (heart failure)
– 0.5-1.2 ng/mL (rate control – atrial fib/flutter)
What do we use to reverse Digoxin
Managing toxicity could include atropine (minor toxicity), magnesium, and/0r digoxin immune fab (ovine)