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PHRM 845 Exam 2 > Arrythmias > Flashcards

Arrythmias Flashcards

1
Q

Sinus bradycardia

A

ONLY TREAT IF SYMPTOMATIC
HR < 60
Impulses in the SA node

Decrease automaticity in the SA node

Hypotension, dizziness, fainting

Atropine 0.5-1 mg every 5 minutes, max of 3 mg if symptomatic

SE of atropine: tachycardia, constipation, dry mouth, blurred vision, urinary retention

OR: dopamine, epinephrine, isoproterenol

PACEMAKER if unwilling for pacemaker then theophylline

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2
Q

Atrial fibrillation

A

chest pains, palpitations, dizziness, light headedness, SOB, hypotension, angina, fatigue, HF exacerbation

Goal #1 is to prevent thrombosis leading to a stroke: anticoagulants

Goal #2 is to control ventricular rate: Non-DHP CCB, BB, Digoxin, Amiodarone

Goal #3 convert to NSR: ibutilite, amiodarone, procainamide, flecainide, propafenone, DCC

Goal #4 is to maintain NSR and to prevent recurrent episodes: dronedarone, dofetilide, flecainide, propafenone , amiodarone, sotalol

Ventricular rate: 120-180 bpm

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3
Q

Supraventricular tachycardia (SVT)

A

Types: paroxysmal SVT

Features: regular rhythm
HR: 110-250 bpm
Narrow QRS complexes

Single re-entry circuit in the AV node moving in a circular motion depolarizing ventricles but travelling back up to repolarize atria

Can also occur in the AV pathway, atria, and SA node

Neck pounding, palpitations, dizziness, lightheadedness, polyuria, syncope

Goal #1 Terminate SVT

Adenosine: 6-12-12
Diltiazem
Verapamil
BB

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4
Q

Premature ventricular complexes (PVC)

A

Widened QRS complex

NSR with occasional abnormal beats

Types:
Simple: isolated single PVC
Frequent: at least 1 PVC on a 12-lead ECG or > 30 PVCs/hour

Risk factors: ischemic heart disease, MI, anemia, hypoxia, cardiac surgery

Usually asymptomatic, palpitations, dizziness, lightheadedness

Treatment:
asymptomatic PVC should not be treated
BB, verapamil, diltiazem, cardiac ablation

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5
Q

Ventricular tachycardia

A

MONOMORPHIC TACHYCARDIA

Regular Rhythm
Wide QRS complex
HR: 100-250
Series of > 3 consecutive PVC’s at a rate > 100 bpm

Types: non-sustained, sustained, sustained + no structural heart disease

Mechanism: increase automaticity, re-entry within the ventricles

Risk factors: MI, CAD, HFrEF, electrolyte imbalance, drugs such as flecainide, propafenone, digoxin

Symptoms: asymptomatic (nonsustained VT), palpitations, dizziness, lightheadedness, angina, syncope, hypotension

Goal 1: Terminate VT, restore NSR
DCC is preferred, then procainamide, then IV Amiodarone or sotalol

verapamil and BB is for no structural heart disease

Goal 2: prevent recurrence and sudden cardiac death
- Implantable cardiac defibrillator (ICD)

outflow tract VT: BB

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6
Q

Ventricular fibrillation

A

Irregular, disorganized, chaotic electrical activity
No recognizable QRS complexes

Risk factors: MI, HFrEF, CAD

Symptoms: syndrome of sudden cardiac death

Goal: Terminate VF, restore NSR

The only effective treatment is defibrillation

Drugs are used to facilitate defibrillation

Drugs alone with not terminate VF

Defibrillation, Epinephrine, Amiodarone, Lidocaine

Defibrillation, CPR, DRUG–> repeat

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7
Q

How to read an ECG

A

P wave: atrial depolarization

QRS complex: ventricular depolarization, atrial repolarization is buried

T wave: ventricular reploarization

PR interval: conduction time of AV node

QT interval: repolarization

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8
Q

How to determine NSR

A

Is there a p wave in front of every QRS complex?
Is there a QRS complex after every p wave?
Is the interval between the R waves equal?
Is there HR between 60-100 bpm?

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9
Q

Normal ECG values

A

PR interval: 0.12-0.20 seconds (120-200 ms)
QRS duration: 0.08-0.12 seconds (80-120 ms)
QT interval: 0.38-0.46 seconds (380-460 ms)
QTc interval: 0.36-0.45 seconds (360-450 ms) – Men
QTc interval: 0.36-0.46 seconds (360-460 ms) - Women

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10
Q

Torsades de pointes

A

POLYMORPHIC TACHYCARDIA

When QTc > 0.5 seconds–> increased risk of drug-induced arrhythmia

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11
Q

What does QTc interval mean?

A

Corrected QT interval for HR

Slower HR: Longer QTc
Fater HR: slower QTc

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12
Q

Medications that can cause TdP

A

Antiarrhythmics

Macrolides, fluoroquinolones

Antidepressants, antipsychotics

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12
Q

Amiodarone

A

MOA: all 4 antiarrhythmic mechanisms

Both BB and CCB activity

AE: Hypotension, bradycardia, pulmonary fibrosis, blue/grey skin discoloration, corneal deposits, hepatotoxicity, hypothyroidism, photosensitivity

Drug interactions:
Inhibits Pgp: digoxin
Inhibits CYP: warfarin, statins

Monitoring: Dermatologic, corneal deposits, pulmonary fibrosis, QTC prolongation, hepatotoxicity, hypo,hyperthyroidism

Goal HR < 100-110 bpm and asymptomatic

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12
Q

Hemodynamically unstable criteria

A

SBP < 90
HR > or equal to 150 bpm
Loss of consciousness
Chest pain

ALWAYS USE DCC

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13
Q

Ibutilide

A

Class 3 antiarrhythmic blocking Ikr channel

AE: TdP

DO NOT USE IN HF

NEGATIVE INOTROPE

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14
Q

Procainamide

A

Class 1A blocking both sodium and potassium channels

AE: QTc prolongation, hypotension TdP, HF exacerbation, Agranulocytosis, Neutropenia

Drug interactions: inhibited by cimetidine, ranitidine, trimethoprim

DO NOT GIVE IN HFREF

NEGATIVE INOTROPE

15
Q

Flecainide

A

Class 1C blocking sodium channel

AE: dizziness, blurred vision, HF exacerbation

DO NOT GIVE IN HFREF

NEGATIVE INOTROPES

16
Q

Propafenone

A

class 1C blocking sodium channel

dizziness, blurred vision, HF exacerbation

DO NOT GIVE IN HFREF

NEGATIVE INOTROPES

17
Q

Dronedarone

A

Maintain NSR

Class 3 blocking Ikr channel

T1/2 is 18 hours: remove iodine atoms reducing toxicity, no interaction with warfarin, amiodarone is more effective

AE: bradycardia, nausea, diarrhea, asthma, rash

Drug interactions:
Inhibits elimination of: simvastatin, digoxin, verapamil, diltiazem, dabigatran

inhibited by: ketoconazole, itraconazole, ribavirin, grapefruit juice

18
Q

Dofetilide

A

Must be initiated in hospital for 3 days to undergo ECG monitoring for risk of QT prolongation and TdP

MOA: Class 3 blocking Ikr channel

AE: TdP

Drug interactions: cimetidine, thiazides, trimethoprim, verapamil, ketoconazole

19
Q

Sotalol

A

Must be initiated in hospital for 3 days to undergo ECG monitoring for risk of QT prolongation and TdP

Class 2 and 3

AE: QTc prolongation, TdP, hypotension, bradycardia

20
Q

Catheter ablation

A

Indication: used for patients who did not respond to antiarrhythmic drugs, contraindicated, not tolerated or preferred.

Can be 1st line therapy in younger patients with fewer comorbidities who are experiencing paroxysmal atrial fibrillation

Mapping
Ablation

AE: pulmonary vein stenosis

21
Q

BB

A

Direct AV node inhibitor

Sinus bradycardia, SA/AV node block, sinus arrest, HF exacerbation (low EF)

22
Q

Diltiazem

A

Direct AV node inhibitor

AE: hypotension, lightheadedness, dizziness, bradycardia, SA/AV node block, HF exacerbation

Inhibits CYP3A4: cyclosporine, statins

23
Q

Verapamil

A

Direct AV node inhibitor

AE: hypotension, lightheadedness, dizziness, bradycardia, SA/AV node block, HF exacerbation, constipation

Inhibits CYP3A4: cyclosporine, statins
Inhibits Pgp: digoxin, dofetilide

24
Q

Dofetilide dose

A

Proceed only if QTc < or equal to 440

CrCl > 60: 500 mcg po BID

CrCl 40-60: 250 mcg po BID

CrCl 20-39: 125 mcg po BID

CrCl < 20: contraindicated

25
Q

Sotalol dose

A

Proceed only if QTc < or equal to 450

CrCl > 60: 80 mg po BID

CrCl 40-60: 80 mg po daily

PHRM 845 Exam 2 (3 decks)

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