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Naplex 2025 > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

What is an Arrhythmia?

A
  • Abnormal heart rhythem; too fast [tachycardia] & too slow [bradycardia]
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2
Q

What is the Cardiac Conduction Pathway?

A
  1. Impluse starts at SA Node
  2. Travels to Right/Left Atria [Contracts]
  3. Passes through AV Node
  4. Into bundle of His
    5 & 6. Bundle of His splits into Right and Left
  5. Lastly going through Purkinje Fibers [Contracts]
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3
Q

What is the Cardiac Action Potential?

A
  • Movement on ions through Myocytes that cause electrical impluses [powering cardiac system]
  • SN Node can start it on its own [only one too do this]
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4
Q

What are the 4 phases of the Cardiac Action Potential?

A

Phase 0: Rapid Depolarization due to influx of Na = contractions (QRS Wave)
Phase 1: Early Repolarizaton [Na channel closed]
Phase 2: Influx of Ca & Efflux of K
Phase 3: Ventricular Repolarization [Efflux of K] (T Wave)
Phase 4: Rest (P Wave)

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5
Q

What are some of the common causes of Arrhythmias?

A
  • Myocardial Ischemia OR
  • INfarctions
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6
Q

What are some of the non-cardiac conditions that can cause Arrhythmias?

A
  • Electrolye Imbances [K, Mg, Ca, Na]
  • Elevated Sympathetic States [Hyperthyroidism, Infections]
  • Drugs [legal or those that prolong QT]
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7
Q

What are the 2 types of Arrhythmias?

A
  • Supraventricular [Sinus Tachy, A. Fib, A. Flutter, A. Tachy, PSVT]
  • Ventricular [Premature Ventricular Contractions (PVC), V. Tachy, V. FIb]
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8
Q

What is important to know about the Premature Ventricular Contractions [PVCs]?

-

A
  • “Skipped Heartbeats”
  • A series with HR > 100 is V. Tach [Pulseless V. Tach is a medical emergency]
  • V. Tach –> V. Fib = medical emergency
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9
Q

When is it considered that your QT Interval is Prolonged?

A
  • > 440 - 460 milliseconds
  • > 500 is very bad
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10
Q

What are some of the risk factors that may increase QT interval?

A
  • Higher Doses
  • On mulitple QT proloning drug
  • Reduce drug Clearance [do to renal clearance]
  • Low K or Mg
  • Female
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11
Q

What are some of the drugs that could increase or prolong the QT Interval?

A
  • Class Ia, Ic, III antiarrhythmics
  • Antimalarials, Macrolides, Quinolones
  • SSRIs [Citalopram/Escitalopram], TCAs, Mirtazipine, Trazodone, Velafazine
  • Ondansetron, Droperidol, Metoclopramide, Promethazine
  • Haloperidol, Chlorproazine, Ziprasidone
  • TKIs, Leuprolide
  • ETC
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12
Q

What is one thing that needs to be done before starting on an antiarrhythmic drug?

A
  • Eletrolyte and toxicology screening
  • all antiarrhythmics can cause new or worse the ones already present
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13
Q

What are the Class Ia Antiarrhythmic Drugs?

Sodium Channel Blockers?

A
  • Disopyramide
  • Quinidine
  • Procainamide
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14
Q

What are the Class Ib Antiarrhythmic Drugs?

A
  • Lidocaine
  • Mexiletine
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15
Q

What are the Class Ic Antiarrhythmic Drugs?

A
  • Flecainide
  • Propafenone
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16
Q

What are the Class II Antiarrhythmic Drugs?

A
  • Beta-Blockers
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17
Q

What are the Class III Antiarrhythmic Drugs?

Potassium Channel Blockers?

A
  • Dronedatone
  • Dofetilide
  • Sotalol
  • Ibutilide
  • Amiodarone
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18
Q

What are the Class IV Antiarrhythmic Drugs?

Non-DHP CCBs?

A
  • Verapimil
  • Diltiazem
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19
Q

What is the way to remember all the Vaughan Williams Classificaitons?

A
  • Double Quarter Pounder, Lettuce, Mayo, Fries Please! Because Dieting During Stress Is Always Very Difficult
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20
Q

What is the way that Amiodarone works in the body?

A
  • K Channel Blocker but it also blocks Na and Ca channels

Half Life of 40 - 60 days

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21
Q

What is the BOXED WARNING for Amiodarone?

A
  • Pulmonary Toxicity
  • Heptatotoxicity
  • For Life-Threatening Arrhythmias ONLY [Proarrhythmic]
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22
Q

What is the contraindicatoins for Amiodarone?

-

A
  • Iodine Hypersensitivity
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23
Q

What is the Warnings for Amiodarone?

A
  • Hyper- and Hypothyroidism [Hypo more common]
  • Optic Neuropathy
  • Corneal Micodeposits
  • Photosensitivity [Blue-Gray Skin Coloration]
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24
Q

What is the side effects for Amiodarone?

A
  • Hypotension
  • Bradycardia [may need to lower infusion rate]
  • Photosensitivity
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25
What are some things to **Monitor** for **Amiodarone**?
- ECG, HR, BP, Electrolytes - LFTs, Thyroid Functions
26
What is the **Warnings** for **Disopyramide**?
- **Proarrhythmic**, Hypotension, Exacerbate HF - Myasthenia Gravis [Anticholinergic Effects]
27
What is the **side effects** for **Disopyramide**?
- Anticholinergic Effects [Dry Mouth, Dry Eyes, Constipation, Urinary Retention]
28
29
What is the **side effects** for **Quinidine**?
- Drug-Induced Lupus, Diarrhea, Stomach Cramping - Cinchonism [toxicity] = Tinnitus, Hearing Loss, Blurred Vision, Headache, Delirium
30
What is the **BOXED WARnING** for **Procainamide**?
- Agranulocytosis [potentially fatal] - Long term use leads to Antinuclear antibody [ANA] = DILE
31
What is the **Warnings** for **Procainamide**?
- Proarrhythmic
32
What are some **additional notes** for **procainamide**?
- NAPA is the active metabolite --> so slow acetylators have increase toxicity risk
33
What are some **additional notes** for **Lidocaine & Mexiletine**?
- Lidocaine is an injection used for refractory VT/Cardiac arrest - Mexiletine: Life-threatening Arrhythmias only
34
What is the **BOXED WARNING** for **Flecainide**?
- Proarrhythmic [do NOT use in A. Fib]
35
What is the **contraindications** for **Flecainide**?
- Structural Heart Disease [Heart Failure, MI]
36
What is the **Contraindications** for **Propafenone**?
- Structural Heart Disease [Heart Failure, MI]
37
What is the **warnings** for **Propafenone**?
- Proarrhythmic
38
What is the **side effects** for **Propafenone**?
- Metallic Taste
39
What is the **BOXED WARNINGS** for **Dronedarone**?
- **contraindicated** in decompensated HF or permanent AFib due to increased risk of death, stroke, and HF
40
What is the **Contraindications** for **Dronedarone**?
- 3A4 inhibitors - QT Prolonging Agents
41
What is the **Warnings** for **Dronedarone**?
- Hepatic Failure - Pulmonary
42
What is the **side effects** for **Dronedarone**?
- Proarrhythmic
43
What are some **additional notes** for **Dronedarone**?
- DOES NOT contain iodine = no effect on thyroid [opposite of Amio] - AVOID: strong inhibitors/inducers of 3A4 and QT prolonging agetns
44
What is the **BOXED WARNING** for **Dofetilide**?
- Initiated with continuous ECG - Having ability to assess CrCl for a minimum 3 days - Proarrhythmic
45
What are some **additional notes** for **Dofetilide**?
- Preferred in HF
46
What is the **BOXED WARNING** for **Sotalol**?
- Adjust dosing interval based on CrCl to decrease proarrhythmic risk - QTc Prolongation is related to the Concentration
47
What is the **warning** for **sotalol**?
- Proarrhythmic - Can worse HF & cause Bronchodilation
48
What are some **additional notes** for **Adenosine**?
- Half-Life < 10 secs - Only for supraventricular re-entrant tachycardia
49
What is **A. Fib**
- Mulitple wave of electrial impluses that are an **irregular ventricular response** = decreased cardiac output [heart cant fill up]
50
What are the **four stages** of A. Fib?
- Stage 1 [At risk of A. Fib] - Stage 2 [Pre-A. Fib] - Stage 3 [A. Fib] - Stage 4 [Premanent A. Fib]
51
What is **Stage 1 A. Fib [At risk of A. Fib]**
- Presence of modifiable [obesity] and non-modifiable [Male sex] risk factors
52
What is **Stage 2 [Pre-A. Fib]**
- Evidence of structural or electrical finding of A. Fib
53
What are the **four parts** of **Stage 3 [A. Fib]**
- Paroxysmal [terminates within 7 days] - Persistent [sustained for > 7 day] - Long-standing Persistant [susntained for > 12 day] - Successful Ablation [NO A. Fib b/c surgery]
54
What is **Stage 4 [Permanent A. Fib]**? | -
- NO more rhythm control attmepts
55
What is the **Resting Rate Control Goal** for someone with **A. Fib**
- < 80 BPM (< 110 BPM might be more lenient]
56
What **Medications** are best to help with **Rate Control** in **A. Fib**
- Beta Blockers & Non-DHP CCBs ## Footnote Patients with HFrEF and A. Fib should NOT get a non-DHP CCB
57
What is the **Stroke prophylaxis** for someone with **A. Fib**
- Clots can form easily with A. Fib - DOACs or Warfarin [based on CHA2DS2-VASc]
58
59
What is the **monitoring** for **Digoxin**?
- Electrolytes - Renal Function - HR
60
What is the **toxicity** for **Digoxin**?
- N/V; Decreased Appetite - Blurred/Double Vision; Greenish-Yellow Halos - Increased risk of Hyopkalemia, Hypomagnesemia, Hypercalcemia
61

Naplex 2025 (49 decks)

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