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Pharm II > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

What are the common SEs of anti-arrhythmics?

A 
Pro-arrhythmic
-Ventricular arrhythmias
-Torsades de Pointes
Exacerbate HF
Drug interactions: Any other agents that increase QT interval= increased TdP risk
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2
Q

What are the lowest risk agents for Torsades de Pointes?

A

Amiodarone and dronedarone

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3
Q

What are safe agents for HF?

A

Dofetilide and amiodarone

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4
Q

When is sotalol safe to use?

A

Hx of MI

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5
Q

When is sotalol unsafe to use?

A

HF

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6
Q

What are the class Ia drugs?

A

Quinidine, procainamide, disopyramide

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7
Q

Quinidine dosing considerations

A

PO (q6h, q8h,

q12h)

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8
Q

What do class Ia meds treat?

A

Supraventricular and ventricular arrhythmias

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9
Q

SEs of quinidine

A

cinchonism
GI disturbances
Hypotension
Thrombocytopenia

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10
Q

Monitoring for quinidine

A

CBC
BMP
LFTs

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11
Q

BBW for quinidine

A

Increased mortality

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12
Q

Dosing considerations for procainamide

A

IV bolus followed by infusion

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13
Q

Dose adjustment for quinidine

A

Hepatic

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14
Q

Dose adjustment for procainamide

A

Hepatic

Renal

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15
Q

SEs of procainamide

A

Hypotension
Drug induced lupus (BW)
Agranulocytosis (BW)

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16
Q

Dosing considerations for disopyramide

A

PO (IR-q6h, SR BID)

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17
Q

Dose adjustment for disopyramide

A

Hepatic, renal

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18
Q

SEs of disopyramide

A

Anticholinergic sx (xerostomia), nausea, anorexia, constipation

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19
Q

Monitoring for disopyramide

A

Urinary retention
Anticholinergic sx
BP

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20
Q

What are the class Ib meds?

A

Lidocaine

Mexiletine

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21
Q

Dosing considerations lidocaine

A

IV push: continuous infusion

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22
Q

Dose adjustment in lidocaine

A

Liver dz

HF

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23
Q

Indication for lidocaine

A

Vfib

Vtach

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24
Q

SEs of lidocaine

A

Neurotoxicity: psychosis, seizures, paresthesia, confusion

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25
Q

Monitoring for lidocaine

A

Drug levels >24h

EKG

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26
Q

Dosing considerations for mexiletine

A

200-300 mg PO q8h

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27
Q

Dose adjustment for mexiletine

A

Hepatic dysfunction (esp if HF as well)

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28
Q

Indication for mexiletine

A

Ventricular arrhythmias

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29
Q

SEs of mexiletine

A 
Dizziness
Sedation
Paresthesia
Seizure
Confusion
N/V
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30
Q

Monitoring for mexiletine

A

LFTs

ECG

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31
Q

Considerations for mexiletine

A

Hepatotoxicity (BW)

32
Q

What are class Ic meds?

A

Flecainide

Propafenone

33
Q

Dosing considerations flecainide

A

50-200 mg q12h

34
Q

Dose adjustment for flecainide

A

Hepatic and renal

35
Q

Indications for flecainide

A

Atrial and ventricular arrhythmias

36
Q

SEs of flecainide

A

Dizziness
Blurred vision
HF exacerbation
Dyspnea

37
Q

Monitoring for flecainide

A

Measure trough levels
Renal/hepatic impairment
Pediatric: use with amiodarone

38
Q

Considerations for flecainide

A

Pill in the pocket: 300 mg PO x 1

39
Q

Dosing considerations propafenone

A

150-300 mg q8h

225-425 mg q12h

40
Q

Dosing adjustments for propafenone

A

Hepatic

41
Q

Indication for propafenone

A

Atrial arrhythmias

42
Q

SEs of propafenone

A 
Dizziness
Blurred vision
Bronchospasm
Taste disturbance
HF exacerbation
43
Q

Monitoring for propafenone

A

Pulse (at beginning of therapy)

44
Q

Considerations for propafenone

A

Pill in the pocket: 450 mg PO x 1

45
Q

What are the class III meds?

A 
Amiodarone
Dronedarone
Sotalol
Ibutilide
Dofetilide
46
Q

Indication for amiodarone

A

Ventricular and atrial arrhythmias

47
Q

Warfarin + amiodarone

A

Decrease warfarin dose by 30% on a pt already on warfarin

48
Q

Digoxin + amiodarone

A

Reduce digoxin dose empircally by 50%

49
Q

SEs of amiodarone

A 
Severe bradycardia/heart block
Hyper and hypothyroidism
Peripheral neuropathy
GI discomfort
Photosensitivity
Blue-gray skin discoloration
Fluminant hepatitis
Pulmonary fibrosis
Optic neuropathy/neuritis (blindness)
Corneal microdeposits
50
Q

Monitoring and management of severe bradycardia/heart block in amiodarone

A

Monitor: ECG baseline and every 3-6 mos
Management: Lower dose or d/c if severe

51
Q

Monitoring and management of hyper and hypothyroidism in amiodarone

A

Monitor: TSH/T4 baseline and every 6 mos
Manage: Medication therapy- levothyroxine/methimazole

52
Q

Monitoring and management of peripheral neuropathy in amiodarone

A

Monitor: PE at each office visit
Manage: Lower dose or d/c if severe

53
Q

Monitoring and management of photosensitivity in amiodarone

A

Monitor: PE at each office visit
Manage: Lower dose or d/c if severe

54
Q

Monitoring and management of blue-gray skin discoloration in amiodarone

A

Monitor: PE at each office visit
Manage: Lower dose or d/c if severe

55
Q

Monitoring and management of fulminant hepatitis in amiodarone

A

Monitor: LFTs baseline and every 6 mos
Manage: Lower dose or d/c (if LFTs>3x ULN)

56
Q

Monitoring and management of pulmonary fibrosis in amiodarone

A

Monitor: CXR baseline and every 12 mos
PFTs (if sx)
Manage: D/c amiodarone immed.
Start cortiocosteroid

57
Q

Monitoring and management of optic neuropathy/neuritis in amiodarone

A

Monitor: Ophthalmologic exam baseline and if sx
Manage: D/c amiodarone immediately

58
Q

Monitoring for corneal microdeposits in amiodarone

A

Slit-lamp exam

59
Q

When should you avoid dronedarone?

A

With potent CYP3A4 inhibitors/inducers

60
Q

Dose of dronedarone

A

400 mg PO BID with food

61
Q

MOA of dronedarone

A

PGP inhibitor
Increased digoxin levels
Reduce digoxin by 50%

62
Q

Pros of dronedarone

A

Shorter half life (no LD, quicker recovery from adverse effects)
No significant pulmonary, hepatic, or thyroid toxicity
Fewer DIs

63
Q

Cons of dronedarone

A 
BBW in decompensated HF
Similar to amiodarone with bradycardia, QT prolongation
Mild increase in creatinine
Less effective than amiodarone
Cost
64
Q

Dosing of dofetilide

A

CrCL >60 mL/min: 500 mcg PO BID

65
Q

Monitoring for dofetilide

A

Should be initiated in the hospital bc risk of QT prolongation causing TdP is very high
ECG after each dose and dose reduction if QT prolonged >15%
Monitor K with loop diuretics
Do not use in noncompliant pts

66
Q

SEs of dofetilide

A

HA
Dizziness
TdP

67
Q

Sotalol dosing

A

80-160 mg PO BID

CrCl<50 mL/min: increase frequency to once daily

68
Q

Monitoring for sotalol

A

Should be initiated in the hospital bc risk of QT prolongation causing TdP is very high
Monitor telemetry for ~5 doses

69
Q

Adverse effects of sotalol

A 
Bradycardia
AV block
TdP
Fatigue
Bronchospasm
70
Q

Ibutilide dosing

A

1 mg IV x 1 dose, may repeat one time if unsuccessful

May administer Mg prophylactically to minimize QT prolongation

71
Q

Indication for ibutilide

A

Pharmacological cardioversion (direct current cardioversion still preferred)

72
Q

Adverse effects of ibutilide

A

HA
TdP
Hypotension

73
Q

How to treat sinus brady in hemodynamically unstable pts

A

Atropine 0.5 mg IV q3-5 mins (max total dose= 3 mg)

74
Q

How to treat sinus brady in refractory pts

A

Dopamine IV infusion
Epinephrine IV infusion
Isoproterenol IV infusion

75
Q

Tx of AV nodal block

A

Same as sinus brady

No isoproterenol

Pharm II (8 decks)

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