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therapeutics 3 - exam 2 > arrhythmias pt 3 > Flashcards

arrhythmias pt 3 Flashcards

tisdale pg 23 - 31

1
Q

if a person is administered to the emergency room with AF needing acute ventricular rate control, what is the first question you would ask?

A

are they hemodynamically stable?

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2
Q

if a person is admitted for acute ventricular rate control and hemodynamically UNstable, what would you do?

A

direct current (electrical) cardioversion
cannot wait for the drugs to take effect

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3
Q

if a person is admitted for acute ventricular rate control and hemodynamically stable, what would you do?

A

see if they have decompensated HF

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4
Q

if a person is admitted for acute ventricular rate control, is hemodynamically stable, and has decompensated HF, how would you treat them?

A

IV amiodarone

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5
Q

if a person is admitted for acute ventricular rate control, is hemodynamically stable, and does not have decompensated HF, how would you treat them?

A

BB, diltiazem, or verapamil as first line
then digoxin
then amiodarone
all IV

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6
Q

for a patient being admitted for acute ventricular rate control, what type of dosage form for drugs is needed?

A

IV
needs a response fast

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7
Q

with each therapy change, what should be monitored when admitted for acute ventricular rate control?

A

assess HR
goal of under 100-110 bpm and asymptomatic

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8
Q

if a person is admitted for long-term ventricular rate control, what type of drugs is necessary?

A

oral

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9
Q

if a person is seeking therapy for long-term ventricular rate control, what is the first thing you should assess?

A

their LVEF

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10
Q

if a person is needing long-term ventricular rate control and has HFrEF, how should they be treated?

A

BB
then digoxin

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11
Q

if a person is needing long-term ventricular rate control and has a LVEF over 40%, what should they be treated

A

first line of BB, diltiazem, or verapamil
then digoxin

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12
Q

why is it important to not administer diltiazem or verapamil with HFrEF pts?

A

negative inotropes and could make things worse

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13
Q

if a person is hemodynamically unstable but needs to be converted to sinus rhythm, how should they be treated?

A

always use emergent DCC

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14
Q

if a person is hemodynamically stable AF for under 48 hours, can they be converted to normal sinus rhythm?

A

yes considered safe

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15
Q

if a person has hemodynamically stable AF for over 48 hours, can they be converted to normal sinus rhythm?

A

no, not until pt has been anticoagulated for over 3 weeks or until a TEE has been performed to rule out clot in atrium

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16
Q

what are the different treatment options for conversion to sinus rhythm?

A

synchronized DCC
amiodarone
ibutilide
procainamide
flecainide
propafenone

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17
Q

what is the MOA of synchronized DCC?

A

simultaneously depolarizes all myocardial cells, allowing the sinus node to take over as pacemaker

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18
Q

what are AE of synchronized DCC?

A

risk of general anesthesia (needs to be sedated if possible) –> aspiration, allergic rxn to anesthetics

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19
Q

when used to tx sinus rhythm conversion, what are the AE of amiodarone?

A

hypotension
bradycardia
QT prolongation

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20
Q

when used to tx sinus rhythm conversion, what are the drug interactions of amiodarone?

A

inhibits elimination of digoxin, warfarin, and statins

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21
Q

what is the AE of ibutilide?

A

torsades de pointes

22
Q

when used to tx sinus rhythm conversion, what are the MOA of amiodarone?

A

class I-IV

23
Q

when used to tx sinus rhythm conversion, what are the MOA of ibutilide?

24
Q

when used to tx sinus rhythm conversion, what are the MOA of procainamide?

25
Q

when used to tx sinus rhythm conversion, what are the AE of procainamide?

A

QT prolongation
TdP
hypotension
HFrEF exacerbation
agranulocytosis
neutropenia

26
Q

when used to tx sinus rhythm conversion, what are the AE of flecainide and propafenone?

A

dizziness
blurred vision
HFEF exacerbation

27
Q

when used to tx sinus rhythm conversion, what are the MOA of flecainide/propafenone?

28
Q

what drugs are considered pill in the pocket and why?

A

flecainide and propafenone because people will keep it in their pocket and sometimes go months between episodes of taking it to relieve symptoms

29
Q

if a person has hemodynamically stable AF and needs to convert to sinus rhythm, what is the first thing that needs to be assessed?

A

what their LV function is

30
Q

for pts wanting to convert from hemodynamically stable AF to sinus rhythm and have normal LV function, how should they be treated?

A

with IV amiodarone or ibutilide
if for some reason those cannot be used, then procainamide

31
Q

for pts wanting to convert from hemodynamically stable AF to sinus rhythm, but has HFrEF, how should they be treated?

A

IV amiodarone

32
Q

for pts wanting to convert from hemodynamically stable AF to sinus rhythm but is occurring outside of the hospital and has normal LV function, how should they be treated?

A

with pill in the pocket
flecainide/propafenone

33
Q

why should procainamide not be used if a pt already received amiodarone or ibutilide?

A

risk of excessive QT interval prolongation and TdP

34
Q

what drugs are used for maintenance therapy of sinus rhythm?

A

amiodarone
dofetilide
dronedarone
sotalol
propafenone
flecainide

35
Q

if a person is on digoxin and starts amiodarone, what should happen to their doses?

A

reduce dig dose by half

36
Q

what are the important drug-drug interactions of dofetilide?

A

cimetidine
thiazide diuretics
KTZ
trimethoprim
verapamil
megestrol

37
Q

what is the AE of dofetilide?

38
Q

what classes/MOA are dofetilide, dronedarone, and sotalol are?

A

all Class III, but sotalol is also class II

39
Q

what are the AE of dronedarone?

A

bradycardia
ND
asthenia
rash

40
Q

what are the important drug-drug interactions of dronedarone?

A

inhibits elimination of digoxin, statins, verapamil, diltiazem, and dabigatran
metabolism is inhibited by KTZ, ITZ, ribavirin, grapefruit juice

41
Q

how does dronedarone differ from amiodarone?

A

no interaction with warfarin
not as effective
cYP3A4 reactions
no thyroid and no pulmonary fibrosis

42
Q

how does CrCl affect sotalol dose?

A

over 60 –> 80 to 160 mg BID
40-60 –> 80 to 160 mg QD
under 40 –> CI

43
Q

what are the AE of sotalol?

A

B-blockade
TdP

44
Q

how does CrCl affect dofetilide dosing?

A

over 60 –> 500 mcg BID
40-60 –> 250 mcg BID
20-39 –> 125 mcg BID
under 20 –> CI

45
Q

while taking amiodarone, when and why should a TSH test be taken?

A

at baseline, 3-6 months, and then every 6 months due to AE of hypo OR hyper thyroidism

46
Q

while taking amiodarone, when and why should a liver function test be taken?

A

at baseline, every 3-6 months, every 6 months due to AE of hepatotoxicity
ALT, AST

47
Q

while taking amiodarone, when and why should an ECG be taken?

A

at baseline then annually due to AE of QT interval prolongation

48
Q

while taking amiodarone, when and why should a chest x-ray be taken?

A

at baseline and if a pt develops unexplained cough/dyspnea/other symptoms suggestive of lung disease due to AE of pulmonary fibrosis
pt will usually start corticosteroid and it goes away

49
Q

if a pt is taking amiodarone, when and why should a pt have an ophthalmologic exam?

A

only recommended if pt develops visual abnormalities due to AE of corneal microdeposits

50
Q

if a pt is taking amiodarone, when and why should a physical exam be taken?

A

annual and if development of skin discoloration/photosensitivity due to AE of dermatologic conditions like blue-grey skin discoloration and photosensitivity

therapeutics 3 - exam 2 (13 decks)

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