Cardio 1 Flashcards
1
Q
What is systole?
A
contraction (pumping)
2
Q
What is diastole?
A
relaxation
3
Q
Does systole change with heart rate?
A
no
4
Q
Does diastole change with heart rate?
A
yes
5
Q
What are normal heart sounds? (s1/s2/s3/s4)
A
s1 and s2
6
Q
What heart sounds are heard in heart failure? (s1/s2/s3/s4)
A
s3
7
Q
What heart sounds are heard in hypertrophied/stiff hearts? (s1/s2/s3/s4)
A
s4
8
Q
S3 heart sounds are due to __
A
increased ventricular filling/dilation
9
Q
S4 heart sounds are due to __
A
increased pressure
10
Q
A ventricular gallop (S3) is correlated with __
A
Ken Tuc KY
early diastole
11
Q
An atrial gallop (S4) is correlated with __
A
TE Nuh See
Late diastole
12
Q
Arteries are __ vessels
A
conduit
13
Q
Arterioles are __ vessels
A
resistance
14
Q
Capillaries are __ vessels
A
exchange
15
Q
Venules/Veins are __ vessels
A
capacitance
16
Q
What are examples of organs that recondition blood?
A
Lungs
Kidneys
Skin
17
Q
What are examples of organs that are supplied only for metabolic needs?
A
Brain
Heart
Skeletal muscle
18
Q
Flow only occurs when there is a __
A
pressure difference
19
Q
Heart need to keep pressure __>__ to maintain flow
A
arteries>veins
20
Q
What is stroke volume?
A
fraction of blood that is pumped from the left ventricle during ventricular systole
21
Q
What is stroke volume used for?
A
to calculate ejection fraction
22
Q
What is left ventricular end diastolic volume (LVEDV)?
A
total amount of volume in the left ventricle at the end of diastole (before it is ejected
23
Q
What is systemic vascular resistance (SVR)?
A
resistance exerted by the vascular bed impeding blood flow
24
Q
What is low/narrow pulse pressure usually due to?
A
low stroke volume
(heart failure, trauma/blood loss, aortic stenosis)
25
What is high/wide pulse pressure usually due to?
increase in stroke volume/decrease in SVR
(temporary due to exercise)
(chronic due to anemia, atherosclerosis, aortic regurgitation)
26
Contraction is triggered by an __
action potential
27
Rate of change of transmembrane voltage IS/IS NOT proportional to the net current across membranes
IS
28
Current is influenced by movement of __
ions
29
What are three ions for cardiac transmembrane potentials?
NA, Ca, K
30
In order for effective pumping, what must be true? (5)
not arrhythmic
not stenotic
not regurgitant
not weak
not stiff
31
B1 receptors are in the __
heart
32
B2 receptors are in the __
lungs
33
M1,35 are excitatory/inhibitory
excitatory
increase heart rate/constriction
34
M2,4 are excitatory/inhibitory
inhibitory
decrease heart rate, produces vasodilation
35
nicotinic receptors are excitatory/inhibitory
can be either
several subsets
36
What does a cardio exam consist of?
jugular venous pressure
waveform
blood pressure
arterial pulse
palpitation of the heart
cardiac auscultation
37
jugular venous pressure (JVP) is an __
estimation of volume status
38
Central venous pressure is estimated by measuring __
the vertical distance from the top of the jugular venous pulsation to the sternal inflection point or clavicle
39
Elevated JVP is suggestive of __
right-sided heart failure
constructive pericarditis
pericardial effusion
40
What is an A wave?
right Atrial contraction
41
What is a C wave?
beginning of right ventricular Contraction as the triCuspid Closes, interrupts the x descent
42
What is the x descent?
fall in right atrial pressure (relaXation)
43
What is a V wave?
atrial diastole (Venous filling) and Ventricular Contraction
44
What is the Y descent?
emptYing of atrium into ventricle (ventricular diastole, tricuspid open)
45
What is the waveform abnormality in atrial fibrillation?
no a wave present
46
What is the waveform abnormality in pulmonary hypertension?
large a wave
47
What is the waveform abnormality in heart block/ventricular arrhythmias?
cannon a wave
48
What is the waveform abnormality in tricuspid regurgitation?
large v wave
49
What is the waveform abnormality in pericardial tamponade/tricuspid stenosis?
prolonged or blunted y descent
50
Too small of a cuff can result in an over/under estimation of BP
over
51
Too large of a cuff can result in an over/under estimation of BP
under
52
Measurement differences >10mmHg in arms may suggest __
atherosclerosis
aortic dissection
subclavian artery disease
53
Large leg-arm differences are seen in __
PAD
severe AR
54
Very low DBP may suggest __
severe AR
large AV fistula
55
Visible left anterior chest heave indicates __
enlarge RV
56
Visible right upper parasternal pulsation indicates __
aortic disease
57
A sternal lift indicates __
volume overload
58
Leftward/downward displacement of apex beat indicates __
enlarged LV
59
What is thrill and what is it from?
vibratory sensation felt over skin
due to a murmur
60
A systolic click indicates __
mitral valve prolapse
61
Friction rub is due to __
pericarditis
62
What is bruit and what is it from?
murmur
due to blood flow through vascular abnormality (narrowing)
63
Class I agents block __ channels, inhibit phase __ of action potential, and __ rate of depolarization WITH/WITHOUT changing the resting potential
sodium
0
decrease
without
64
Class I agents can interact with Na channels via what 3 routes?
-external hydrophilic route
-internal hydrophobic-hydrophilic route
-direct membrane spanning route
65
To cross the membrane and reach the sodium channels, the drugs must be in the __ form
neutral (uncharged)
66
Quinidine has which two rings?
quinoline
quinuclidine
67
Quinidine is BASIC/ACIDIC at physiological pH
basic
68
Quinidine IS/IS NOT protonated at physiological pH.
is protonated
69
Procainamide is a bio-iostere of __. The ester group was replaced with an __. This makes it more resistant to __, less __, and fewer __ effects.
procaine
amide
hydrolysis
lipophilic
CNS
70
The acetylated metabolite of procainamide IS/IS NOT active as an anti arrhythmic.
IS active
71
Disopyramide is a unique molecule with a chiral carbon directly linked to __
a pyridine ring, a phenyl ring, an amide, and an alkyl diisopropyl amine (tertiary amine)
72
Disopyramide's tertiary amine is converted into salts such as phosphate to improve __
water solubility
73
Lidocaine is used for __ arrhythmias
ventricular
74
Lidocaine has a __ amine and is weakly BASIC/ACIDIC
tertiary
basic
75
Lidocaine has a RAPID/SLOW onset with administered parenterally
rapid
76
The amide bond of lidocaine is replaced with an ether to make __ more resistant to __
Mexiletine
hydrolysis
77
Mexiletine is weakly BASIC/ACIDIC
basic
78
Mexiletine primarily exits in the __ form in the stomach and in ___ form in the intestine
ionized (hydrophilic)
unionized (lipophilic)
79
Mexiletine undergoes EXTENSIVE/MINIMAL first pass metabolism
minimal
80
Mexiletine is used to slow down rapid __ rates on IV administration
ventricular (V-FIB)
81
Flecainide is a __ derivative and sold as an __ salt
bis-trifluoroethoxy benzamide
acetate
82
Flecainide is used to slow down rapid __ rates on IV administration
ventricular (V-FIB)
(after MI)
83
Propafenone has a __ and is sold as a __
chiral center
racemic mixture
84
The __ isomer of propafenone is mainly responsible for Beta1 blocking properties
S-(+)
85
Propafenone has a __ group and contains a weakly __ secondary amine group
phenyloxypropanolamine
basic
86
Beta2 agonists are used in the treatment of __
asthma and COPD
87
Beta1 antagonists are in the treatment of __
cardiovascular disorders
88
Beta-blockers INCREASE/DECREASE sympathetic stimulation of adrenergic receptors in both peripheral and central nervous system by __
decrease
norepinephrine
89
First generation beta blockers are __
nonselective
90
Second generation beta blockers are __
more selective for Beta1
91
Beta agonists have an __ structure, while beta antagonists have an __ structure
arylethanolamine
aryloxypropanolamine
92
Beta selectivity INCREASES/DECREASES with size of R group
increases
93
What are examples of first generation beta blockers?
propranolol
carteolol
nadolol
penbutolol
S-timolol
94
What are examples of second generation beta blockers?
atenolol
metoprolol
acebutolol
betaxolol
bisoprolol
95
Esmolol has a very SHORT/LONG half life
short
96
What beta blocker has intrinsic sympathomimetic activity?
acebutolol
97
Beta blockers that prevent norepinephrine from binding to the receptor are __
antagonists
98
Beta blockers with intrinsic sympathomimetic activity stimulate the Beta receptors and are __
partial agonists
99
Stimulation of beta receptors by norepinephrine is responsible for increased __ and __
heart contraction
heart rate
100
Propranolol:
has a __ group
LIKELY/NOT LIKELY to pass the BBB
hydrocarbon naphthyl
likely
101
Atenolol:
has a __ group
LIKELY/NOT LIKELY to pass the BBB
a lower dose may be required in patients with __ impairment
polar acetamide
not likely
renal
102
Metoprolol:
is more HYDROPHILIC/LIPOPHILIC
a lower dose may be required in patients with __ impairment
lipophilic
hepatic
103
Class III agents block __ channels
Phase __ of action potential
INCREASE/DECREASE duration of action potential
potassium
3
increase
104
Amiodarone:
a __ derivative
highly HYRDOPHILIC/LIPOPHILIC
weakly BASIC/ACIDIC
diionated benzofuran
lipophilic
basic
105
Dronedarone:
a __ analogue of amiodarone
lack of __ and addition of __ group makes it more hydrophilic
Decreases risk of __
Reduced __ side effects
SHORTENS/LENGTHENS half-life
non-iodine containing benzofuran
iodine
methanesulfonyl
neurotoxicity
non-cardiovascular
shortens
106
Ibutilide:
Structurally similar to __
Contains __ and __ side chains
Has good __ solubility
Sold as a __
Sotalol
hydroxybutyl
heptyl
water
racemic mixture
A methanesulfonamide
107
Dofetilide:
Highly selective ___ blocker compared to amiodarone
POORLY/WELL absorbed
potassium channel
well
a bis-methanesulfonamide
108
What are Class I anti-arrhythmic agents?
Na channel blockers
109
What are Class II anti-arrhythmic agents?
beta-adrenergic blockers
110
What are Class III anti-arrhythmic agents?
K channel blockers
111
What are Class IV anti-arrhythmic agents?
Ca channel blockers
112
What are misc anti-arrhythmic agents?
Digoxin
Adenosine
113
What is the MOA of Class IV anti-arrhythmic agents?
inhibit SA nidal firing and decrease AV conduction because Ca involved in depolarization of nodal cells
114
What medications are Class IV anti-arrhythmic agents?
Verapamil
Diltiazem
115
What is the MOA of Digoxin?
Inhibits the Na/K ATPase which in turn serves to increase the calcium concentration inside heart cells
Increases the force of contraction
116
If adenosine is given IV It causes __
transient heart block in the AV node
117
What is the MOA of adenosine?
Binds to A1 receptor in cardiac tissue
inhibits adenylate cyclase, decreased cAMP, increased outward K flux, hyperpolarization
118
What are the 3 main components of adenosine's SAR?
N at 3 and 7 position required
Ribose required for agonist activity
Substitution at N6 increases affinity for A1
119
Cardiac glycosides inhibit the __
Na/K ATPase pump
120
Positive intropic agents are used for __
heart failure
121
Negative chronotropic agents are used for __
arrhythmia
122
Cardiac glycosides are found in __ and __
plants
poisonous frogs
123
Glycosides contain both a __ and a __
sugar part
non-sugar part
124
The R group on the steroid ring of the glycoside differs depending on __
the origin of the glycoside
125
Aglycone:
CIS or TRANS fused?
-A/B
-C/D
-B/C
Has a characteristic __ shape
-Cis
-Cis
-Trans
U shape
126
R group at C-17 in aglycone is an __
lactone ring
127
The sugar part of cardiac glycosides are mono or polysaccharides with __ linkages and can be __
beta-1,4-glycosidic
acetylated
128
Lipophilicity of cardiac glycosides depends on __ and __
the number of sugar molecules
the number of -OH groups on aglycone
129
C/D trans fusion leads to __ aglycone
inactive
130
A/B trans leads to __ aglycone
decreased activity
131
What is the sugar attachment point on the cardiac glycoside?
C3-OH
132
The __ is important for receptor binding and __ is very important. (Cardiac glycosides)
lactone ring
C=C
133
If __ or __ are OH the duration of action of the cardiac glycoside is effected.
C12
C16
134
Which drug has a longer half-life: Digoxin or Digitoxin?
Digitoxin
135
Calculate the cardiac output for a 46 year old male with a heart rate of 78 beats per minute and a stroke volume of 70 mL.
a. 5.5 L/min
b. 5,460 L/min
c. 1.1 L/min
d. 897 L/min
5.5 L/min
136
Activation of the sympathetic nervous system would cause:
a. Decrease in heart rate
b. Increase in heart rate
c. Decrease in norepinephrine
d. Increase in acetylcholine
Increase in heart rate
137
During atrial systole, what is occurring?
a. The atria are contracting and allowing blood movement into the lungs and systemic circulation
b. The atria are relaxing and allowing blood to fill within each atria
c. Blood is moving from the atria to the ventricles via the pulmonary and aortic valves
d. Blood is moving from the atria to the ventricles via the tricuspid and mitral valves
Blood is moving from the atria to the ventricles via the tricuspid and mitral valves
138
Which of the following accurately describes phase 0 of the action potential?
a. depolarization due to a rapid influx of Na
b. repolarization due to a rapid efflux of K
c. depolarization due to a rapid efflux of Na
d. repolarization due to a rapid influx of K
depolarization due to a rapid influx of Na
139
Which of the following anchors actin to myosin and allows for contraction of the myofibril?
a. Troponin T
b. Troponin I
c. Troponin A
d. Troponin C
Troponin I
140
Which valve allows blood to move from the left atrium to the left ventricle?
a. mitral valve
b. aortic valve
c. tricuspid valve
d. pulmonary valve
mitral valve
141
Which of the following would cause an increase in blood pressure?
a. decrease in heart rate
b. increase in LVEDV
c. decrease in stroke volume
d. increase in systemic vascular resistance
increase in systemic vascular resistance
142
What is occurring in the heart during S1?
a. Tricuspid and mitral valve closes, ventricular systole
b. Aortic and pulmonic valves open, ventricular diastole
c. Aortic and pulmonic valves close, ventricular systole
d. Tricuspid and mitral valves close, ventricular diastole
Tricuspid and mitral valve closes, ventricular systole
143
Cardiac index corrects the cardiac output based on:
a. heart rate
b. body surface area
c. weight
d. blood pressure
body surface area
144
What purpose does the pericardial fluid within the pericardium serve?
a. Speeds up the action potential to allow for increased conduction
b. The fluid does not have a specific purpose but increases the risk of pericardial effusion
c. Serves as a barrier to protect the heart from trauma
d. Acts as a lubricant to allow the heart to move freely during contraction and relaxation
Acts as a lubricant to allow the heart to move freely during contraction and relaxation
145
What three factors determine O2 delivery to tissues?
a. body surface area
b. ejection fraction
c. weight
d. oxygen saturation
e. hemoglobin
f. cardiac output
d. oxygen saturation
e. hemoglobin
f. cardiac output
146
Which of the following is a normal ejection fraction?
a. 20-25%
b. 90-95%
c. 60-65%
d. 40-45%
60-65%
147
The influx of which cation into the myocardium is most critical in inducing myocardial contraction?
a. Mg
b. K
c. Na
d. Ca
Ca
148
Which of the following is the primary neurotransmitter of the parasympathetic nervous system?
a. vasopressin
b. acetylcholine
c. epinephrine
d. norepinephrine
acetylcholine
149
What vessel supplies blood to the LAD and Circumflex?
a. Diagnol artery
b. Right coronary artery
c. Left main artery
d. Aorta
Left main artery
150
As an antiarrhythmic agent, procainamide has fewer CNS side effects than procaine because:
a. Procainamide has a greater ability to cross cell membranes compared to procaine
b. Procainamide is more susceptible to metabolic hydrolysis than procaine
c. Conversion of the ester to an amide makes the molecule less lipophilic
d. The metabolic hydrolysis of procainamide gives p-aminobenzoic acid
Conversion of the ester to an amide makes the molecule less lipophilic
151
The most basic nitrogen atom in the following molecule is:
a. 3
b. 4
c. 2
d. 1
4
152
Which two of the following statements best describe why Mexiletine can be taken orally whereas Lidocaine is administered IV?
a. Mexiletine has a chiral center but not lidocaine
b. Conversion of the amide function of lidocaine to an ether function in mexiletine makes it metabolically more stable
c. Being more lipophilic mexiletine is almost completely absorbed with a bioavailability of 80-90%
d. Mexiletine is a primary amine whereas lidocaine is a tertiary amine
b. Conversion of the amide function of lidocaine to an ether function in mexiletine makes it metabolically more stable
c. Being more lipophilic mexiletine is almost completely absorbed with a bioavailability of 80-90%
153
The absence of the two iodine atoms and the introduction of a methane sulfonamide group in dronedarone compared to amiodarone result in:
Select ALL that apply.
a. An increase in the ability to cross cell membranes
b. Reduction in the ability to form salts with acids
c. A decrease in the lipophilicity of the molecule
d. A decrease in neurotoxicity
c. A decrease in the lipophilicity of the molecule
d. A decrease in neurotoxicity
154
Which of the following molecules is likely to be the most selective b1 antagonist with shortest duration of action?
a. A
b. B
c. C
d. D
e. E
D
155
What happens in phase 4?
resting membran potential
156
What happens in phase 0?
opening of fast Na channels
rapid influx of Na
157
What happens in phase 1?
Opening of transient K channels
K efflux
158
What happens in phase 2?
Plateau is a phase of maintained depolarization
Ca enters the cell by opening L-type Ca channels
K leaves cell by opening transient K channels
159
What happens in phase 3?
opening of K channels
K efflux
160
Antiarrhythmic drugs suppress arrhythmias by blocking flow through __ or by __
specific ion channels
altering autonomic function
161
Antiarrhythmic drugs can cause __
arrhythmias
162
What medications are Class 1A anti arrhythmic drugs?
Disopyramide
Procainamide
Quinidine
163
What medications are Class 1B anti arrhythmic drugs?
Lidocaine
Mexiletine
Phenytoin
164
What medications are Class 1C anti arrhythmic drugs?
Flecainide
Propafenone
165
Class 1 anti- arrhythmic drugs have no effect in __ cells
pacemaker
166
What is the mechanism of action of class 1 anti arrhythmic agents?
Blockage of fast sodium channels
Decrease phase 4 diastolic Na currents
Increase threshold
167
For blockers, most useful drugs bind readily to RESTING/ACTIVE/INACTIVE channels
active or inactive
168
Dissociation occurs during the RESTING/ACTIVE/INACTIVE stage.
resting
169
Recovery time from Na block is expressed as __
Recovery Time Constant (Trec)
170
If there is a rapid binding/dissociation Trec is SMALL/LARGE
small
171
If there is a slow binding/dissociation Trec is SMALL/LARGE
large
172
Drugs with a SLOW/FAST recovery rate have a greater effect
slow
173
Class 1A anti arrhythmic drugs have a greater affinity for the OPEN/INACTIVE state and have a SLOW/INTERMEDIATE/FAST recovery
open
intermediate
174
Class 1B anti arrhythmic drugs have a greater affinity for the OPEN/INACTIVE state and have a SLOW/INTERMEDIATE/FAST recovery
inactive
fast
175
Class 1C anti arrhythmic drugs have a greater affinity for the OPEN/INACTIVE state and have a SLOW/INTERMEDIATE/FAST recovery
open
slow
176
There are fast and slow acetylators of __
prcainamide
177
What are adverse effects of Disopiramide?
Anticholinergic activity
(dry mouth, constipation, urinary retention)
178
Lidocaine is not effective for __ arrhythmias
atrial
179
Which class 1 subclass is associated with Torsades de pointes?
Class 1A
180
What are some common ADRs for Procainamide?
GI problems
hypotension
fatal bone marrow aplasia
lupus syndrome
risk of Torsades
181
What are some common ADRs for Quinidine?
GI irritating
Cinchonism
Thrombocytopenia
Risk of Torsades
182
What are some common ADRs for Lidocaine?
CNS effects
Convulsions
Nystagmus
183
What are some common ADRs for Mexiletine?
Very GI irritating
CNS effects
184
What are some common ADRs for Flecainide?
GI problems
Blurred vision
185
What drugs elevate concentrations of Procainamide?
Amiodarone
Cimetidine
186
Quinidine elevates concentrations of what drugs?
Digoxin
Warfarin
187
Quinidine decreases metabolism of __ into __
codeine into morphine
188
What drug elevates concentrations of quinidine?
amiodarone
189
What drugs decrease lidocaine metabolism?
beta blockers
cimetidine
190
Melixetine reduce clearance of what medication?
theophylline
191
What increases concentrations of Flecainide?
amiodarone
192
Class 1A anti arrhythmic are indicated for __
atrial and ventricular arrhythmias
193
Class 1B anti arrhythmic are indicated for __
local anesthesia
ventricular arrhythmias
194
Class 1C anti arrhythmic are indicated for __
atrial and ventricular arrhythmias
195
Class 1C anti arrhythmic drugs have a high risk of __ in patients with CHF and CAD
proarrhythmias
196
What drug specifically inhibits slow Na channels in pacemaker cells?
Ivabradine (Corlanor)
197
Ivabradine is FDA approved for and used off label for __ and __
CHF (increased ejection fraction)
angina
tachycardia
198
What are adverse effects caused by ivabradine?
Bradycardia
risk of increased QT
AV block
vision changes
199
Beta blockers are used to treat __
hypertension
ischemic heart disease
heart failure
arrhythmias cause by increased sympathetic tone
200
Which beta blockers are nonselective?
nanodol
propranolol
timolol
sotalol
201
Which beta blockers are selective?
acebutolol
atenolol
esmolol
metoprolol
pindolol
penbutolol
202
Which beta blockers have vasodilation effects?
carvedilol
betaxolol
203
What is the primary effect of beta blockers?
in the pacemaker cells:
decreases automaticity in SA node
decrease slope of phase 4
Decrease heart rate
Decrease Na and Ca currents
204
What is a secondary effect of beta blockers?
in Cardiomyocytes:
Decrease heart rate
decrease force of contraction
decrease activity of Ca channels
205
What are therapeutic uses for beta blockers?
SA node increase automaticity
Supraventricular tachycardia
DADs and EADs
To terminate AV and AV nodal reentry or to prevent such arrhythmias
Controlling ventricular response in AF or Aflutter
Physical or emotional stress induced-arryhtmias
Prophylaxis for post MI arrhythmias
Cocaine induced arrhythmias
Angina, HF, HTN
206
What are non-cardiovascular uses for beta blockers?
thyrotoxicosis
anxiety
essential tremors
207
What are common adverse effects of beta blockers?
hypotension
bradycardia
dizziness
fatigue
lethargy
208
What are severe ADRs of beta blockers?
heart block
Aggravation of heart failure in susceptible individuals
Bronchosonstriction (nonselective)
Can induce DAD and EAD mediated arrhythmias
209
What are drugs that enhance AV nodal inhibition of beta blockers?
amidoarone
clonidine
digoxin
diltiazem
dronedarone
verapamil
210
Beta blockers may mask the symptoms of __
hypoglycemia
211
What are contraindications for beta blockers?
sinus bradycardia
cariogenic shock
second or third degree heart block
212
What are typical class III anti arrhythmic drugs?
Dofetilide (Tikosyn)
Ibuteilide (Corvert) (IV)
213
What are drugs that are mainly class II anti arrhythmic but also part of other classes?
Amiodarone (Cordarone, Pacerone)
Dronedarone (Multaq)
Sotalol (Betapace)
214
What are common uses of K channel blockers?
Atrial fibrillation/flutter
Anatomic reentry
DAD-mediated VT
215
Class II anti arryhtmics delay rectifier ___ in phase __ in __
K channels
phase 3
cardiomyocytes
216
K channel blocker have no effect on K channels in phase __ or __ transient K channels
phase 4
T1
217
What are effects of K channel blockers?
prolonged or increased action potential duration (Increased QT)
Increased refractory period
218
What are adverse effects of K channel blockers?
Increased risk of EAD
Increased risk of Tornadoes de pointes
219
What is an oral class III anti arrhythmic?
dofetilide
220
What is an IV class III anti arrhythmic?
Ibutilide
221
What are common adverse effects of dofetilide?
CNS
GI problems
Bradycardia
Torsades
222
What are rare adverse effects of dofetilide?
hepatotoxicity
angioedema
AV block
223
What are rare adverse effects of Dofetilide?
hepatotoxicity
angioedema
AV block
224
What are common adverse effects of ibutilide?
Headache
Nausea
Bradycardia
Torsades
225
What are contraindications of dofetilide?
Increased baseline QT
hypersensitivity
Hepatic or renal impairment
Hypokalemia
226
What are contraindications of ibutilide?
Increased baseline QT
Hypersensitivity
227
What medications increase Dofetilide effects?
loop and thiazide diuretics
228
What medications increase Dofetilide concentrations?
Cimetidine
Verapamil
Antifungals
229
Ibutilide may increase concentrations of __
lidocaine
230
__ may increase the arrhythmogenic effect of ibutilide
propafenone
231
Amiodarone has a SHORT/LONG half-life
long
35-110 days
232
What is the mechanism of action of amiodarone?
Blocks inactivated Na channels
Blocks K channels
Blocks Ca channels
Blocks beta receptors
Blockas alpha1 receptors
233
What are the effects of amiodarone?
Impairs SA nodal function
Modifies automaticity
Decrease AV conduction
Increase refractoriness
Increase APD
234
What is the mechanism of action of sotalol?
Blockes adrenergic receptor
Blocks K channels
235
What are the effects of sotalol?
Effects of beta blockers
Effects of K channel blockers
Increase action potential duration
Increase refractory period
Decrease adrenergic response
Decrease SA pacemaker rate
Decrease AV conduction rate
236
What are common adverse effects of amiodarone?
hypothyroidism
hyperthyroidism
hypotension
CNS
GI disturbances
Eye problems
Blue-gray pigmentation
Bradycardia
Torsades
237
What are effects that happen at toxic rates of amiodarone?
pulmonary toxicity
hepatotoxicity
238
What are adverse effects of dronedarone?
GI distubrances
Skin rash
Muscle weakness
Torsades
Hepatotoxicity
Renal and lung toxicity
239
What are contraindications of amiodarone?
Increased QT interval
iodine hypersensitivity
AV block
Thyroid disease
240
What are contraindications of dronederone?
Increased baseline QT
Heart failure
241
What are common adverse effects of sotalol?
CNS
bradycardia
dyspnea
242
What are less common adverse effects of sotalol?
bronchospasm
hypotension
Torsades
243
What are contraindications of sotalol?
Increased baseline QT
heart block
heart failure
bronchial asthma
244
Amiodarone increases the level of which drugs?
statins
warfarin
digoxin
quinidine
procainamide
phenytoin
flecainide
cyclosporine
245
What drug decreases amiodarone metabolism?
cimetidine
246
What medication decreases amiodarone concentration?
rifampicin
247
What medications reduce absorption of sotalol?
antacids
248
What medications increase bradycardia effect of sotalol?
Ca channel blockers
249
Sotalol in combination with __ increase risk of heart block
digoxin
250
What are effects of calcium channel blockers on the heart?
Increase vasodilation
decrease contractility
Decrease heart rate
decrease SA conduction
decrease AV conduction
251
What are the major effects on pacemaker cells that calcium channel blockers do?
Increase the threshold and slow depolarization
Block Ca channels in later phase 4 and in phase 0 - decrease heart rate
Decrease SA rate
Decrease AV conduction - increase refractory period
Decrease reentrant arrhythmias involving AV node
252
What are common adverse effects of calcium channel blockers?
bradycardia
GI irritating
Constipation
Dizziness/lightheadedness
Headache
Hypotension
Peripheral edema
253
What are rare/severe adverse effects of calcium channels blockers?
Worsening of heart failure
AV block
Increase hepatic enzymes
254
What are contraindications of calcium channel blockers?
Heart failure
Cardiogenic shocl
Second or third degree AV block
255
What are calcium channel blockers used for?
reentrant arrhythmias involving AV node
PSVT, Afib, Aflutter
Ventricular rate control
256
What drugs increase the risk of bradycardia if taken with verapamil?
amiodarone
beta blcokers
257
What drug increases the effects of verapamil?
fluconazole
258
Verapamil increase concentrations of what drugs?
statins
digoxin
dofetilide
theophilline
cyclosporine
259
What drugs increase effects of diltiazem?
CYP3A4 inhibitors
260
What drugs increase hypotensive effects of diltiazem?
sildenafil
azole antifungals
antihypertensive drugs
261
What drugs decrease hypotensive effects of diltiazem?
Rifampin
erythromycin
262
If diltiazem is taken with which drugs it can increase risk of bradycardia?
amiodarone
beta blockers
263
What is the mechanism of action of adenosine?
G protein-coupled adenosine receptors
Activates ACh-sensitive K channels-hyperpolarization
Decrease Ca current
264
What is adensoine used for?
PSVT
Inhibition of DADs elicited by sympathetic stimualtion
265
What are adverse effects of adenosine?
short lived
flushing
chest tightness
dizziness
syncope
transient SA/AV block
transient asystole
266
What drugs potentiate the effects of adenosine?
carbamazepine
dipyridamole
267
What medication diminishes the effects of adenosine?
theophylline
268
Digoxin has a LOW/HIGH therapeutic index
low
269
Andmistration of __ increases risk of toxicity of dogoxin
antibiotics that destroy intestinal microflora
270
What is the site of action for digoxin?
Atrium SA and AV nodes for arrhythmias
271
What is the mechanism of action for arrhythmias of digoxin?
Increases vagal tone - activation of ACh sensitive K channels in atrium - shortening APD
Decrease Ca currents in AV node - suppresses the AV node
272
What is digoxin used for?
terminating re-entrant arrhythmias involving atrium and AV node
Controlling ventricular rate response in afib
273
What are common ADRs of digoxin?
GI
Dizziness
headache
blurred or yellow vision
274
What are less common ADRs of digoxin?
atrial tachycardia
AV block
ventricular arryhtmias
hyperkalemia
275
What is an antidote for Digoxin toxicity?
Digibind
276
What disease states can enhance digoxin toxicity?
hypothyroidism
hypokalemia
hypomagnesemia
hypercalcemia
277
What is the potential mechanism of action of magnesium sulfate for arryhtmias?
Competes with Ca at ion channel transport site
278
What is Magnesium Sulfate used for?
Prevention/treatment of Torsades
Arryhtmias due to digoxin/digitalis toxicity
279
What are adverse effects of magnesium sulfate?
hypotension
breathing difficulties
280
You are developing a drug that will affect phase 4 in SA node cells. Which main characteristic should the drug have to produce a specific effect only in these cells?
a. It should inhibit rectifier potassium channels
b. It should inhibit L-type calcium channels
c. It should inhibit T-type potassium channels
d. It should inhibit slow sodium channels
It should inhibit slow sodium channels
281
Which drug can cause arrhythmias by affecting K+ channels?
a. Dofetilide
b. Atenolol
c. Flecainide
d. Lidocaine
Dofetilide
282
Beta blockers are used to treat arrhythmias because________.
a. They decrease the AV refractory period
b. They increase automaticity
c. They increase AV conduction time
d. They increase phase 4
They increase AV conduction time
283
In a patient diagnosed with arrhythmia caused by an AV reentry mechanism, you most likely use ________because it________?
a. Flecainade; blocks sodium channels
b. Verapamil; blocks calcium channels
c. Quinidine; blocks potassium channels
d. Lidocaine; blocks sodium channels
Verapamil; blocks calcium channels
284
__________ is used in a patient with a ventricular tachycardia produced by an ectopic focus because it inhibits________ and __________.
a. Procanamide; fast sodium channels; reduces phase 4
b. Adenosine; ACh-sensitive K+ channels; hyperpolarizes cardiomyocytes
c. Propanolol; beta receptors; increases calcium current
d. Phenytoin; slow sodium channels; increases APD
Procanamide; fast sodium channels; reduces phase 4
285
Which class I drug has significant cholinergic adverse effects producing dry mouth and constipation?
a. Disopyramide (norpace)
b. Lidocaine (xylocaine)
c. Flecainide (tambocor)
d. Procainamide (procan SR)
Disopyramide (norpace)
286
Which drug classes cause both effects: a reduction in the heart contraction force, and a slowing of the AV node conduction?
a. Class I and Class II
b. Class I and Class III
c. Class II and Class III
d. Class II and Class IV
e. Class III and Class IV
Class II and Class IV
287
Which of the following electrolyte abnormalities is assocaited with Tosades de Pointes?
Hyperkalemia
Hyponatremia
Hypercalcemia
Hypermagnesemia
Hyperkalemia
288
RJ's rhythm strip shows 5 large boxes between the top of his QRS complexes. What is RJ's heart rate?
60 beats/min
75 beats/min
90 beats/min
80 beats/min
60 beats/min
289
Identify the abnormal aspect of this EKG:
a. Wide QRS complex
b. Prolonged PR interval
c. Delta wave
d. ST segment depression
Prolonged PR interval
290
Identify the dysrhythmia that is occuring in this EKG:
a. Atrial fibrillation
b. Ventricular tachycardia
c. Atrial flutter
d. Ventricular fibrillation
Atrial fibrillation
291
The rapid influx of sodium in Phase 0 of the action potential correlates to which section of the rhythm strip?
P
S
T
Q
Q
292
Which of the following best describes the path of electricity within the heart?
SA node, AV node, Bundle of His, Purkinje fibers
Purkinje fibers, Bundle of His, AV node, SA node
Bundle of His, SA node, Purkinje fibers, AV node
AV node, Purkinje Fibers, SA node, Bundle of His
SA node, AV node, Bundle of His, Purkinje fibers
293
The characteristic of an EKG that can lead to torsades de pointe is:
a. Widened QRS complex
b. Prolonged QT interval
c. ST segment elevation
d. Prolonged PR interval
Prolonged QT interval
294
Calculate the heart rate of this rhythm on the EKG strip.
a. Less than 60 BPM
b. Within 60-80 BPM
c. Within 80-100 BPM
d. Over 100 BPM
Within 60-80 BPM
295
Which of the following electrolytes is not directly involved with action potential electrophysiology?
Sodium
Potassium
Calcium
Bicarbonate
Bicarbonate
296
Which of the following leads are formed by voltage triangles, otherwise known as Einthoven's triange?
Leads I, II, III
Leads V1, V2, V3
Leads aVR, aVL, aFV
Leads V1, aVR, V3
Leads I, II, III
297
Atrium action potential has a more narrow phase __ and more gradual phase __
phase 2
phase 3
298
What happens during the p wave?
atria contraction
299
What happens during the QRS complex?
ventricle contraction
300
What happens during the t wave?
ventricular repolarization
301
Absolute refractory period is when there is __ to any stimulus, and is in phase(s) __
no reaction from cells
phases 1 and 2
302
Effect refractory period is when there is __ to any stimulus and is in phase(s) __
a lock, weak response
phase 3
303
Relative refractory period is when __ and happens in phase(s) __
large stimulus may propogate a response, but slower than normal
phase 4
304
How many positive electrodes are used for an EKG?
one
305
The EKG tracing is based on the sensing of the __
positive electrode
306
An electrical wavefront approaching a positive electrode causes a __
positive deflection
307
An electrical wavefront moving away from a positive electrode creates a __
negative deflection
308
An electrical wavefront moving perpendicular to a positive electrode causes an __
isoelectric deflection
309
A 12 lead EKG includes:
I, II, III, aVF, aVL, and aVR
310
An average PR interval is __ or __ small squares
0.12-0.2 seconds
<5
311
An average QRS interval is __ or __ small squares
0.008-0.1 seconds
<2.5
312
An average QTc interval is __ for males or __ for females
<0.46 seconds
<0.47 seconds
313
An average ST interval is __ or __ small squares
0.08-0.12 seconds
<3
314
If Q wave is >1 small box or amplitude is 1/3 of the QRS indication of __
past MI
315
Increased PR interval may indicate __
1st degree AV block
316
Prolonged QTc (>0.48s) puts patients at risk of __
Torsades
317
Elevation or depression of ST segment may indicate __
an acute MI
318
QT has to be corrected for heart rate using __
Bazett's formula
319
What information can be obtained from the EKG?
rate
rhythm
axis
hypertrophy
infarction
320
What structure normally starts electric conduction in the heart?
SA node
321
What is the most accurate way to determine rate on an EKG?
60/(# of small boxes x 0.04)
322
What are the steps to determining rhythm on an EKG?
Is there a p wave in front of every QRS complex?
Is there a QRS complex after each p wave?
Is the rhythm regular?
Is the heart rate 60-100bpm?
Is the PR interval prolonged or QRS complex wide?
Is there a delta wave?
323
What is enhanced automaticity?
non-pacemaker myocardial tissue fires on its own instead of waiting to be stimulated by a neighboring cell
324
What are causes of enhanced automaticity?
Ischemia
Electrolyte imbalances
Acidemia
Medications
325
What is the proposed underlying mechanism of triggered activity causing dysrhythmias?
spontaneous depolarization during phases 2-4 of the action potential
leads to sustained triggering of action potentials
326
What is EAD?
early afterdepolarization
during phase 2/3
factors that prolong the QTc or increase intracellular Na
327
What is DAD?
delayed afterdepolarization
during phase 3/4
factors that increase intracellular Ca
328
What are the 3 conduction requirements for re-entry to occur?
At least two pathways for impulse conduction
One area with unidirectional block in one pathway
Slowed conduction in the other pathway
329
Accessory pathways are __ dependent
NA
330
What is a conduction block?
occurs when conduction tissue is unexcitable
Cannot communicate the impulse to the next area
can be permanent or transient?
331
What are causes of conduction block?
ischemia
trauma
scarring
fibrosis
medications
332
Describe Sinus tachycardia
regular rhythm
rate >100 bpm
always has an underlying cause
Most common: overactivation of SNS
Infection/fever, exercise, pain, stress
333
Describe Sinus Bradycardia
regular rhythm
rate <60 bpm
Due to decreased SNS or increased PNS activity
Common causes: hypothyroidism, hypertension, medications, vagal nerve stimulation
334
Describe Premature Ventricular Contractions
Single abnormal beat earlier than expected
originates in the ventricle
QRS is wider, taller, and early
Cause: electrolyte abnormalities, exercise, ischemia, heart failure
335
Describe Ventricular Tachycardia
originates in the ventricles, wide complex
Don't see p wave
>140-260 bpm
Requires at least 3 beats Sustained >30s or requires intervention, Nonsustained <30 seconds
Monomorphic or polymorphic
Common causes are CAD and heart fialure
336
Describe Torsades de Pointes
type of polymorphic VT, but with changes in direction of the complex
If not treated, can lead to vfib quickly
Cause: prolonged QTc, drugs, hypokalemia
337
Describe Ventricular Fibrillation
chaotic electrical discharge that does not effectively depolarize ventricles
Wide QRS complex, usually >300 bpm
Fatal if not rapidly terminated
Causes: AMI, HF, hypokalemia
338
Describe Asystole
total absence of electrical activity
heart is unable to generate a single QRS complex
Myocardium is functionally dead
339
Describe PEA
no pulse, but some electrical activity
heart is unable to generate a single QRS complex
Myocardium is functionally dead
340
Describe Premature Atrial Contractions
premature ectopic beat
still a visible P wave before the PAC
Causes: increased SNS, decreased PNS, stimulants, alcohol
341
Describe Atrial Fibrillation
no organized atrial contraction or normal P waves
Atria beating at 400-600 bpm
Normal contracting ventricles but beating fast >100-200 bpm
Causes: advanced age, valvular heart disease, HF, COPD
342
Describe Atrial Flutter
presence of flutter waves with atrial rate of 200-300 bpm
rhythm is regular
sawtooth appearance
Cause: HF, valvular heart disease, COPD
343
Describe Supraventricular Tachycardia
regular rhythm
rate 160-260 bom
P wave looks different than normal
Cause: increased SNS activation
344
Describe Wolff Parkinson White Syndrome
type of SVT
preexcitation syndrome
accessary pathway leading to tachyarrhythmia
congenital heart defect
delta wave
345
Describe 1st degree AV block
abnormally long delay in transmission of the atrial impulse through the AV node
prolonged PR interval
Causes: medications, sick sinus syndrome
346
Describe 2nd degree AV block Mobitz Type I
Wenckebach
progressive prolonging of PR interval
Suddent QRS drop
Cause: disease of AV node (medications, inferior MI)
347
Describe 2nd degree AV block Mobitz Type II
PR intervals are consistent, sudden drop of QRS complex
Due to disease of the His bundle or Purkinje fibers
Cause: anteroseptal MI, HF, sarcoidosis
348
Describe 3rd degree AV block
No association between P wave and QRS complex due to AV dissociation
Two pacemakers, one in atria and one In ventricles
Length of PR intervals may vary, no pattern
Cause: advanced age, infarction, medications
349
Which of the following cannot be detected from the ECG?
a. heart rate
b. an abnormal heart rhythm
c. prior MI
d. ejection fraction
ejection fraction
350
A patient presents to ED with a pulse of 30 bpm. You overhear the ED physician reading the ECG and they state there is no association between the P wave and the QRS complex. What kind of arrhythmia is this?
complete heart block
351
What arrhythmia is fatal if not treated immediately?
ventricular fibrillation
352
Name the arrhythmia.
Sinus tachycarida
353
Name the arrhythmia.
Sinus bradycardia
354
Name the arrhythmia.
Premature Ventricular Contractions
355
Name the arrhythmia.
Ventricular tachycardia
356
Name the arrhythmia.
Torsades de Pointes
357
Name the arrhythmia.
Ventricular Fibrillation
358
Name the arrhythmia.
Top Asystole
Bottom PEA
359
Name the arrhythmia.
Premature Atrial COntractions
360
Name the arrhythmia.
Atrial Fibrillation
361
Name the arrhythmia.
Atrial Flutter
362
Name the arrhythmia.
Supraventricular Tachycardias
363
Name the arrhythmia.
Wolff Parkinson White Syndrome
364
Name the arrhythmia.
1st degree AV block
365
Name the arrhythmia.
2nd degree AV block Mobitz Type I
Wenckebach
366
Name the arrhythmia.
2nd degree AV block Mobitz Type II
367
Name the arrhythmia.
3rd degree AV block
368
What is the acronym for antiarrhythmic drugs?
South - Class 1 Na Channel Blockers
Beach - Class 2 Beta Blockers
Pol - Class 3 Potassium blockers
ka - Class 4 calcium channel blockers
369
What is the mechanism of each class of antiarrhythmic drugs?
Class 1: phase 0 (odd)
Class 2: phase 4 (opposite)
Class 3: phase 3 (=)
Class 4: phase 2 (opposite)
370
What is the acronym for class I AADs?
Double Quarter Pounder
(1A: Disopyramide, Quinidine, Procainamide)
Lettuce Mayo
(1B: Lidocaine, Mexiletine)
Fries Please
(1C: Flecainide, Propafenone)
371
Which class 1 subtype has the strongest Na blockade?
Class 1c
372
Which class 1 subtype has the weakest Na blockade?
Class 1b
373
Which class 1 subtype has moderate Na blockade ability?
Class 1a
374
What is the acronym for class 3 AADs?
DAD IS
(Dronedarone, Amiodarone, Dofetilide, Ibutilide, Sotalol))
375
Which of the following best describes the primary ion channel inhibited by sotalol, the corresponding action potential phase affected, and its effects on the ECG?
a. Na, phase 4 causing prolongation of QTc
b. Na, phase 1 causing widening of the QRS
c. K, phase 2 causing a widening of the QRS
d. K, phase 3 causing a prolongation of the QTc
d. K, phase 3 causing a prolongation of the QTc
376
What are examples of atrial arrhythmias?
PACs
SVT
WPWS
Afib
Aflutter
377
What is pharmacological therapy for PAC?
typically do not require medication
if symptomatic or clinically indicated can do low dose metoprolol
378
What is nonpharm treatment for atrial arrhythmias?
minimize alcohol intake
avoid smoking
minimize caffeine intake
stress
379
What are symptoms of SVT?
palpatations
dizziness
syncope
weakness
polyuria
380
Chronic oral anticoagulation IS/IS NOT recommended for SVT
IS NOT
381
If patients present acutely with symptoms or rapid ventricular rate with SVT can medicate with __
Vagal maneuvers
IV adenosine
IV beta blocker
IV non-DHP CCB
IV amiodarone
382
If recurrent/refractory symptoms of SVT can do oral maintenance therapy with __
beta blockers
non-DHP CCB
catheter ablation
383
What is the Valsalva maneuver?
lay patient supine
blow through syringe or obstructed straw for 10-15 seconds
384
What is the diving reflex?
Take multiple deep breaths
hold breath
then immersing face in a basin of water
385
What is bearing down?
bearing down as if making a bowel movement
386
What is a carotid sinus massage?
should be done by a provider
applying pressure with fingertips to carotid sinus areas on face
387
Adenosine administration is useful if patients do not respond to __
vagal maneuvers
388
Can adenosine be repeated?
yes
389
What is the half-life of adenosine?
10 seconds
390
What are contraindications of adenosine therapy?
heart transplant
SVT with an accessory pathway
391
What are types of catheter ablations?
radiofrequency ablations
cryofrequency ablations
AV node ablation
epicardial ablation
maze ablation
392
What are the treatment options for WPWS?
IV procainamide
IV ibutilide
Direct current cardioversion
Catheter ablation *preferred if patients are symptomatic and known accessory pathway*
393
What medications are contraindicated in WPWS?
IV amiodarone
adenosine
digoxin
non-DHP CCBs
lidocaine
use caution with beta blockers
394
Once WPWS accessory pathway has been eliminated do the CI agents still need to be avoided?
no
395
Stop bolus IV Procainamide if __
QRS widens >50% original width
hypotension occurs
or max was given
396
IV procainamide should be reduced by __ in renal/hepatic impairments
50%
397
IV procainamide is contraindicated in patients with __
recent MI (6 days - 2 years)
398
Discontinue IV ibutilide as soon as __
arrhytmia terminates
VT occurs
prolongation of QTc
399
Can IV ibutilide be repeated?
yes
400
When is IV ibutilide contrainidicated?
chronic AF
electrolyte imbalance
requires continuous ECG monitoring
ejection fraction <40% (HF)
401
What are risk factors for AFib?
CAD
heart failure
older age
diabetes mellitus
obesity
obstructive sleep apnea
cardiothoracic surgery
hyperthyroidism
alcohol use
402
What is the most common arrhythmia in clinical practice?
atrial fibrillation
403
What are signs/symptoms of AFib?
fatigue
palpitations
shortness of breath
syncope
angina
404
Afib poses an increased risk of __
SSE
heart failure
dementia
hospitalization
mortality
405
In a patient with Afib and LV dysfunction or HFrEF with medications should be used for rate control?
Beta blockers +/- digoxin
amiodarone
406
In a patient with afib without LV dysfunction or HFrEF which medications should be used for rate control?
beta blockers or non-dhp CCB
amiodarone
407
Which beta blocker are given IV push?
Metoprolol
propranolol
408
Which beta blockers are given by infusion?
esmolol
409
Non-DHP CCBs are given by IV PUSH/INFUSION
push
410
Which non-dhp CCB is preferred in patients with labile/low BP?
diltiazem
411
Dosing of Digoxin varies based on patient's
weight
renal function
age
medications
heart failure diagnosis
412
Reduce loading dose of digoxin by 50% if __
renal dysfunction
elderly
drug interactions (amidoarone, dronedarone, verapamil)
413
What are signs of toxicity of digoxin?
bidirectional VT
blurred vision
heart block
414
Digoxin is a good option for a patient with afib and __
acute decompensated HF
415
What steady state should be chosen for digoxin dose calculation?
1
416
What CL NR should be used for non-heart failure or for only mild symptoms in digoxin calculations?
40 mL/min
417
What Cl NR should be used for severe heart failure in digoxin calculations?
20 mL/min
418
What is the Afib trough goal for digoxin?
0.8-2 ng/mL
419
What is the heart failure trough goal for digoxin?
0.5-0.9 ng/mL
420
Higher risk of death in trough levels of >__ of digoxin
1.2 ng/mL
421
If loading dose of digoxin is given, check level ___ after loading dose
12-24 hours
422
If no loading dose of digoxin is given, obtain trough __ after therapy
3-5 days
423
If changing maintenance dose of digoxin check trough in __
5-7 days
424
If renal function, check digoxin trough in __
15-20 days
425
1 vial of digoxin immune fab (Digifab) will bind __ digoxin
500mcg
426
In acute digoxin overdose, if dose is unknown, give __
10 vials
may repeat with another 10 vials
427
In acute digoxin overdose, if vial is known give __
number of vials = total body load (0.8*mg digoxin ingested) x2
428
In chronic digoxin toxicity, and serum concentration is unknown give __
6 vials
429
In chronic digoxin toxicity, and serum concentration is known, give __
number of vials = (serum conc (ng/mL) x body weight (kg) / 100
430
After giving Digifab, monitor __ hourly for 4-6 hours and then daily
potassium
431
Should you check digoxin level after giving digifab? why or why not?
no
bound in the blood, will be falsely high
432
Can amiodarone be used in heart failure?
yes
433
For rhythm control of afib first line therapy is __
cardio version
434
For afib rhythm control no HFrEF which medications can be used?
amiodarone
dofetilide
flecainide
ibutilide
propfenone
procainamide
435
For afib rhythm control with HFrEF with medications can be used?
amiodarone
dofetilide
436
What should be done before doing cardioversion?
anticoagulation
ensure no clot
437
Amiodarone has a higher dose for afib for RATE/RHYTHM control
rate
438
What FDA requirements are there for dofetilide?
hospitalization for first 3 days (5 doses)
baseline QTc and 2-3 hours after every dose
If >500 Etc discontinue
439
Monitor __ every 3 months on dofetilide
SCr
K
Mg
QTc
440
What medications CANNOT be taken with dofetilide?
hydrochlorothiazide
prochlorperazine
trimethoprim
verapamil
441
What medications can be taken as needed for afib?
flecainide
propafenone
442
Risk of __ with class 1C antiarrhythmics
1:1 AV node conduction
443
What medicatoin should be given with flecainide or propafenone bc of 1:1 AV node conduction?
beta blocker or non-dhp CCB
444
For afib maintenance therapy with CAD which medications can be used?
dofetilide
dronedarone
sotalol
amiodarone
445
For afib maintenance therapy with HF which medications can be used?
amiodarone
dofetilide
446
For afib maintenance therapy without structural heart disease (CAD/HF) which medications can be used?
dofetilide
dronedarone
flecainide
propafenone
sotalol
amiodarone
447
Dronedarone is contraindicated in patients with __
heart failure
448
Sotalol is contraindicated in CrCl <__, __ HF, EF __
CrCL <40
acute decomponsated HF
EF 450
449
What drugs should have continuous ECG monitoring for 3 days upon initiation/dose adjustments?
Dofetilide
Sotalol
450
Flecainide or Propafenone? Renal dose adjustment
Flecainide
451
Flecainide or Propafenone? Hepatic dose adjustment
Propafenone
452
When is rate control preferred for Afib?
prefers rate control
older
longer history of AF
fewer symptoms
453
When is rhythm control preferred for Afib?
prefers rhythm control
younger (<60yo)
shorter history of AF
more symptoms
454
Most clots in patients with afib originate in the __
left atrial appendage
455
Nonvalvular AF excludes patients with __ or __
moderate/severe mitral stenosis
mechanical heart valves
456
Patients with VALVULAR/NON-VALVULAR Afib should be anticoagulated regardless of score
valvular
457
Patients with valvular afib SHOULD/SHOULD NOT be put on a DOAC
should not
458
What are the components of a CHA2DS-VASc Score?
(Congestive) heart failure
Hypertension
Age >/=75
Diabetes mellitus
Prior Stroke, TIA, or VTE
Vascular disease (prior MI, PAD, aortic plaque)
Age 65-74
Sex category (female)
459
A CHA2DS2-VASc score of __ or higher indicated high risk of thrombosis
2
460
DOACs are indicated in a CHA2DS2-VASc score of __ in men and __ in women
2
3
461
Is aspirin recommended for afib?
no
462
What are the components of a HAS-BLED score?
Hypertension SBP>160
Abnormal renal or hepatic function
History of stroke
History of Bleeding
Labile INRs
Older adults >65
Drugs or alcohol excess
463
What HAS-Bled score warrants more frequent monitoring?
3
464
What is considered abnormal renal function for HAS-BLED score?
chronic dialysis
renal transplant
SCr 2.26 or greater
465
What is considered abnormal liver function for HAS-BLED score?
chronic hepatic disease
bilirubin >2x UNL
Phos >3x UNL
466
Apixaban should be decreased to 2.5mg BID if what is true?
2/3 of the following:
80yo+
SCr 1.5+
60kg or less
467
A 75 YOM presents to the ED with palpatations, dizziness, and lightheadedness. PMH: moderate mitral valve stenosis. Has Afib. BP 110/72 HR 140. What is the most appropriate treatment?
Diltiazem
468
A 68YOF presents with AF. After her HR is controlled with metoprolol, she is asymptomatic. PMH: HTN, T2DM, osteoarthritis, and depression. Meds: metoprolol, lisinopril, tylenol, metformin, citalopram. HR 82 BP 130/88 SCr 0.8 CrCl 60 normal hepatic function. CHA2DS2-VASc and HAS-BLED scores?
4
1
469
What are types of ventricular arrhythmias?
PVC
vtach
vfib
torsades
asystole/PEA
470
If patient presents with PVC, is asymptomatic, but has CAD, what should be considered?
beta blockers
471
If patients presents with symptomatic PVC what should be considered?
beta blockers
non-DHP CCBs
472
