Arrhythmias

Question 1

rate and rhythm of the heartbeat is set by the rapidly firing cells in the?

Answer 1

sinoatrial node

Question 2

NSR originates in the?

Answer 2

SA node

Question 3

what causes the atrium to contract

Answer 3

SA node

Question 4

what causes the ventricles to contract

Answer 4

purkinje fibers

Question 5

define supraventricular arrhythmia

Answer 5

originating above the AV node

Question 6

define ventricular arrhythmia

Answer 6

originating below the AV node

Question 7

define ventricular tachycardia

Answer 7

series of PVCs in a row resulting in a heart rate >100

also absence of peripheral pulse

Question 8

which antiarrhythmics prolong the QT interval

Answer 8

Class 1-especially 1a
class 3

Question 9

common drugs that prolong QT interval (7)

Answer 9

quinolones
macrolides
azoles
TCAs
SSRIs
5-HT3 receptor antagnoists
antipsychotics

Question 10

when is a QTc considered prolonged

Answer 10

> 440 msec

Question 11

How to remeber vaughan williams drug classes

Answer 11

Double Quarter Pounder, Lettuce, Mayo, Fries Please!

Because Dieting During Stress Is Always Very Difficult

Question 12

Class 1a Vaughan williams

Answer 12

Disopyramide
Quinidine
Procainamide

Question 13

Class 1b Vaughan Williams

Answer 13

Lidocaine

Mexiletine

Question 14

Class 1c Vaughan Williams

Answer 14

Flecainide

Propafenone

Question 15

Class 2 Vaughan Williams

Answer 15

Beta-blockers

Question 16

Class 3 Vaughan Williams

Answer 16

Dronedarone
Dofetilide
Sotalol
Ibutilide
Amiodarone

Question 17

Class 4 Vaughan Williams

Answer 17

Verapamil

Diltiazem

Question 18

Rate control for Afib

Answer 18

Beta blockers
Non-DHP
digoxin

Question 19

Rhythm control for Afib

Answer 19

Class 1a, 1c, or 3 antiarrhythmics

Question 20

Goal HR in symptomatic Afib

Answer 20

< 80

Question 21

Goal HR in asymptomatic Afib

Answer 21

<110

Question 22

Afib with HFrEF should not recieve

Answer 22

non-DHP

Question 23

Define paroxysmal Afib

Answer 23

terminates spontaneously or within 7 days of onset

Question 24

Define persistant afib

Answer 24

sustained > 7 days

Question 25

Define long-standing persistent afib

Answer 25

continuous > 12 months

Question 26

Define permanent afib

Answer 26

joint decision has been made to cease further attempts to restore or maintain NSR

Question 27

Define valvular afib

Answer 27

moderate to severe mitral stenosis or with a mechanical heart valve; long-term anticoagulation with warfarin is indicated

Question 28

Define non-valvular afib

Answer 28

without moderate to severe mitral stenosis or a mechanical heart valve

Question 29

Cardioversion and thromboembolism prophylaxis

Answer 29

started 3 weeks prior | continued for at least 4 weeks

Question 30

MOA of class 1 VW class

Answer 30

Na-channel blocker

Question 31

MOA of class 2 VW class

Answer 31

beta-blocker

Question 32

MOA of class 3 VW class

Answer 32

K-channel blocker

Question 33

MOA of class 4 VW class

Answer 33

CCB-non-DHP

Question 34

MOA of digoxin

Answer 34

Na-K-ATPase blocker

Question 35

MOA of adenosine

Answer 35

activates adenosine receptors to decrease AV node conduction

Question 36

What is the preferred antiarrhythmic used in HF

Answer 36

amiodarone

Question 37

What is the indication for adenosine

Answer 37

paroxysmal supraentricular tachyarrthmias (PSVTs)

Question 38

warning for amiodarone (6)

Answer 38

``` pulmonary toxicity hepatoxicity proarrhythmic hyper/hypothyroidism (hypo more common) optic neuropathy photosensitivity ```

Question 39

contraindication for amiodarone

Answer 39

iodine hypersensitivity

Question 40

Amiodarone and digoxin dosing

Answer 40

decrease digoxin by 50%

Question 41

Amiodarone and warfarin dosing

Answer 41

decrease warfarin by 30-50%

Question 42

Amiodarone and simvastatin and lovastatin dosing

Answer 42

simvastatin max 20 mg/day | lovastatin max 40 mg/day

Question 43

therapeutic range of digoxin with Afib

Answer 43

0.8-2 ng/mL

Question 44

which electrolytes levels can cause increased risk of digoxin toxicity

Answer 44

low K, Mg | High Ca

Question 45

Major SE for disopyramide

Answer 45

Anticholinergic effects

Question 46

Warning for quinidine

Answer 46

``` hemolysis risk (avoid in G6PD deficiency) Drug-induced lupus erthematosus ```

Question 47

Boxed warning for procainamide

Answer 47

agranulocytosis | drug-induced lupus erhtematosus

Question 48

Class 1b is used in what only

Answer 48

ventricular arrhythmias | no efficacy in afib

Question 49

Dronedarone boxed warning

Answer 49

increased risk of death, stroke, HF in pateints with decompensated HF or permanent Afib