Atrial & Ventricular Arrhythmias

Question 1

Class I Vaugn Williams Classification of Antiarrhyhmic drugs

Answer 1

block sodium channels

Question 2

class II Vaugn Williams Classification of Antiarrhyhmic drugs

Answer 2

B adrenoreceptor antagonists

Question 3

class III Vaugn Williams Classification of Antiarrhyhmic drugs

Answer 3

prolonging action potential and prolong refractory period

Question 4

Class IV Vaugn Williams Classification of Antiarrhyhmic drugs

Answer 4

Calcium channel antagonists

Question 5

major problems with a fib

Answer 5

atrial thrombi
right atrium (PE)
left atrium (cerebral emboli -- stroke)

Question 6

stroke risk in a fib is ___ greater than in patients w/o a fib

Answer 6

2x

Question 7

only ___% o f patients who would benefit from prophylactic anticoagulant therapy receive treatment

Answer 7

15-44%

Question 8

if patient is not compromised and > 48 hours or do not know how long the patient has been in a fib give:

Answer 8

rate control and anticoagulation

conversion to SR may dislodge a thrombus!

Question 9

the safest of all the antiarrythmics are ___

Answer 9

amiodarone (cordarone)

Question 10

use a ___ dose of amiodarone given over 1- minutes during a fib

Answer 10

150mg IV loading dose

Question 11

can you give amiodarone if I have an iodine allergy?

Answer 11

yes

Question 12

side effects of amiodarone

Answer 12

hypothyroid
hyperthyroid
pulmonary fibrosis
lenticular opacities
blue skin discoloration

Question 13

the rate of conversion of amiodarone is about ___

Answer 13

60%

Question 14

use dronedarone for a fib/flutter who have ___

Answer 14

converted

Question 15

no iodine to limit __ in dronedarone

Answer 15

toxicity

Question 16

black box warning of dronedarone

Answer 16

c/I in NYHA class IV HF or NYHA class II-III HF with recent decompensation (increased HF deaths in clinical trials)

Question 17

sotalol blocks ____

Answer 17

B1 and B2 receptors

Question 18

sotalol is usually used to maintain ____

Answer 18

SR after conversion

Question 19

sotalol is ___ eliminated

Answer 19

renally; dose adjustment for impairment

Question 20

sotalol is c/I for a fib for CrCl ___

Answer 20

<40mL/min

Question 21

sotalol c/I for vent arrhythmias for CrCl ___

Answer 21

<10 – individualize dose.

Question 22

propafenone is indicated for ____

Answer 22

a fib/flutter

Question 23

Rate controllers:

Answer 23

diltiazem
beta blockers
digoxin

Question 24

administration of diltiazem

Answer 24

IV and PO (PO is Cardizem CD)

Question 25

class of Diltiazem

Answer 25

CCB

Question 26

when using diltazem PO, use only the ____ form

Answer 26

CD

Question 27

Beta blockers

Answer 27

metaprolol | carvedilol

Question 28

digoxin works better in patients with ___

Answer 28

EF <40%, low BP

Question 29

digoxin has a positive ___

Answer 29

inotrope (increases force of myocardial contraction)

Question 30

digoxin is dosed in ___

Answer 30

micrograms

Question 31

digoxin halflife

Answer 31

long (adults 36-48 hrs)

Question 32

loading dose of digoxin for a fib

Answer 32

500mcg IVP x 1; then 250 mcg q6h x 2 doses | oral: 0.5mg once a day x 2 days

Question 33

total digitizing dose of digoxin

Answer 33

10-15mcg/kg

Question 34

CHADs index

Answer 34

``` CHF HTN Age >75 DM Stroke (or hx of TIA) ```

Question 35

stroke risk with nonvalvular AF

Answer 35

CHADS2 index

Question 36

the rate-control strategy eliminated the need for ___

Answer 36

repeated cardio version and reduced rates of hospitilization

Question 37

___ should be considered the primary approach for patients with a fib and CHF

Answer 37

rate control

Question 38

avoidance of _____ is desirable

Answer 38

anti arrhythmic (most are pro-arrhythmic, especially long-term)

Question 39

___ provided no advantage in mortality

Answer 39

rhythm control

Question 40

rate control can now be considered the ___

Answer 40

primary approach

Question 41

rhythm control can now be ____

Answer 41

abandoned early if not fully satisfactory

Question 42

pharmacological conversion of AF

Answer 42

simpler but less efficacious major risk is toxicity of anti arrhythmic drugs most effective if performed <7 days of developing AF much less effective if AF onset >7 days

Question 43

electrical and drug conversion fo AF carry risk of

Answer 43

thromboembolism if AF >48h

Question 44

electrical and drug conversion cary similar

Answer 44

thromboembolism risk

Question 45

drugs for AF conversion <7d ays

Answer 45

amiodarone ibutilide dofetilide

Question 46

drugs for AF conversion >7 d ays

Answer 46

amiodarone ibutilide dofetilide

Question 47

the most prevalent cardiac arrhythmia

Answer 47

a fib

Question 48

a fib is assoc w/ ____

Answer 48

>5x increase in stroke

Question 49

anticoagulation with warfarin has been shown to ___

Answer 49

reduce the ischemic stroke risk compared with placebo

Question 50

ICH risk is both ___ and ___ dependent

Answer 50

age and INR

Question 51

ventricular tachycardia is often precipitated by

Answer 51

electrolyte disturbances (esp severe hypokalemia) hypoxemia digitalis toxicity during acute MI or ischemia

Question 52

most common precipitating factor of VT

Answer 52

during acute MI or ischemia

Question 53

drug of choice for ventricular arrhythmias

Answer 53

amiodarone

Question 54

dose of amiodarone for ventricular arrhythmias

Answer 54

300mg IV load

Question 55

all antiarrythmics used for v tach cause

Answer 55

ventricular arryhtmias

Question 56

all antiarrythmics used for v tach are potentially

Answer 56

dangerous to use

Question 57

anti arrhythmic; diagnostic agent

Answer 57

adenosine

Question 58

half life of adenosine

Answer 58

very short; seconds

Question 59

Moa of adenosine

Answer 59

slows conduction through AV node, interrupting reentrant pathways, restoring SR

Question 60

adenosine may cause prolonged ___

Answer 60

sinus pauses

Question 61

adenosine rarely ___

Answer 61

prolonged asystole

Question 62

adenosine does NOT convert ___

Answer 62

a fib/flutter to SR< but used diagnostically if underlying rhythm is not apparent.

Question 63

adenosine administration

Answer 63

given over 1-2 sec via peripheral line

Question 64

follow each bolus of adenosine with ___

Answer 64

20mL NS

Question 65

administer adenosine as close to ___ as possible

Answer 65

trunk

Question 66

when giving adenosine, do nOT

Answer 66

use hand or lower arm or lower extremity

Question 67

adenosine is c/I in

Answer 67

``` 2nd or 3rd degree HB sick sinus syndrome symptomatic bradycardia (except with functioning PM) a fib/flutter w/ underlying WBW syndrome asthma ```