Cardiovascular Conditions: Arrythmias

Question 1

Arrhythmia is,,,

Answer 1

an abnormal heart rhythm, causing heart to beat too slow or too fast

Question 2

Which node is the hearts pacemaker?

Answer 2

SA node

Question 3

When is QTc considered prolonged?

Answer 3

> 440ms, but usually > 500ms is worrying

Question 4

QT prolongation risk factors

Answer 4

Higher doses
Multiple QT prolonging drugs
Reduced drug clearance
Low potassium, mag, calcium
Other cardiac conditions
Female gender

Question 5

Class I anti arrhythmic drugs mechanism

Answer 5

Na-channel blockers

Reduces speed of ion conduction through sodium channels

Question 6

Class Ia, Ib, Ic

Answer 6

Double Quarter Pounder, Lettuce, Mayo, Fries, Please

Ia = DQP
Ib = LM
Ic = FP

D = disopyramide
Q = Quinidine
P = Procainamide
L = Lidocaine
M = Mexiletine
F = Flecainide
P = Propafenone

Question 7

Class II anti arrhythmic drugs

Answer 7

Beta blockers

Question 8

Class III anti arrhythmic drugs

Answer 8

K- channel blockers

D = Dronedarone
D = Dofetilide
S = Sotalol
I = Ibutilide
A = amiodarone

Question 9

Class IV anti arrhythmic drugs

Answer 9

non-DHP CA blockers

Diltiazem
Verapamil

**Dont use in HF and HFrEF **

Question 10

Paroxysmal AF

Answer 10

terminates spontaneously or with intervention within 7 days of onset

Question 11

Persistent AF

Answer 11

continuous AF > 7 days

Question 12

Long-standing Persistent AF

Answer 12

continuous AF > 12 months

Question 13

Permanent AF

Answer 13

clinician/patient cease further attempt to restore/maintain normal sinus rhythm

Question 14

Valvular AF

Answer 14

AF w/ moderate-severe mitral stenosis or with mech heart valve, long term warfarin anticoag indicated

Question 15

Non-valvular AF

Answer 15

AF w/o moderate-severe mitral stenosis or mech heart valve

Question 16

Rate control goals

Answer 16

resting HR < 80 BPM in symptomatic patients
resting HR < 110 BPM in asymptomatic w/ preserved left ventricular function

Question 17

Preferred rate control treatment?

Answer 17

BB
non-DHP (dont use in HFrEF)

Question 18

Rhythm control - Cardioaversion

Answer 18

High risk of thromboembolsim, zap the heart

pt should start anticoagulant 3 weeks before, and continue 4 weeks after
INR 2-3 if on warfarin

Question 19

Rhythm control - pharmacologic cardio aversion

Answer 19

amiodarone
dofetilide
flecainide
ibutilide
propafenone

Question 20

Amiodarone Boxed warning

Answer 20

Pulmonary toxicity
Hepatotoxicity

Question 21

Amiodarone Contraindications

Answer 21

Iodine hypersensitivity

Question 22

Amiodarone Warnings

Answer 22

Hyper/Hypothyroidism (hypo is common)
optic neuropathy
photosensitivity (slate-blue skin discoloration)

Question 23

Amiodarone Side effects

Answer 23

hypotension
bradycardia
corneal microdeposits
photosensitivity

Question 24

Amiodarone monitoring

Answer 24

ECG
BP
HR
Electrolytes
LFTs Q 6 months
Thyroid function

Question 25

Amiodarone 1/2 life

Answer 25

40 - 60 days

Question 26

Common drug interactions amiodarone

Answer 26

digoxin = decrease digoxin by 50%
warfarin = decrease warfarin by 30-50%
no more than 20mg/day simvastatin
no more than 40mg/day lovastatin

Dont sue with sofosbuvir, can increase bradycardic effect

Question 27

Digoxin contraindications

Answer 27

V. Fib

Question 28

Digoxin monitoring

Answer 28

Digoxin lvls, 12-24hrs after dose

Question 29

Digoxin toxicity

Answer 29

N/V
loss of appetite
blurred/double vision
greenish-yellow halos
bradycardia
life threatening arrhythmias

low potassium, mag, calcium inc risk of digoxin toxicity

Question 30

Digoxin antidote

Answer 30

DigiFab

Question 31

Disopyramide warnings and Side effects

Answer 31

Warnings: pro arrhythmic

SE: anticholinergic effects

Question 32

Quinidine take with or without food?

Answer 32

With food or milk to decease stomach upset

Question 33

Quinidine warnings and Side Effects

Answer 33

Warnings: Proarrhythic, hemolysis risk (dont use in G6PD deficiency), can cause positive Coombs test

SE: DILE, diarrhea, stomach ache
Cinchonism (Quinidine OD) = tinnitus, hearing loss, blurred vision, headache, delirium

Question 34

Procainamide boxed warnings

Answer 34

potentially fatal agranulocytosis
monitor first 3 months

long-term use leads to + ANA in 50% pts, can result in DILE (20-30% pts)

Question 35

Procainamide Slow acetlyators

Answer 35

at risk for drug accumulation and toxicity

fast acetylators can have subthereapeutic drug conc

Question 36

Drug used for refractory VT and cardiac arrest?

Answer 36

Lidocaine injection

Question 37

Propafenone Side effects

Answer 37

metallic taste

Question 38

Dronedarone Boxed warnings

Answer 38

inc risk of death/stroke in HF pts or permanent AF

Question 39

Dronedarone CI

Answer 39

concurrent use strong CYP3A4 inhib and QT prolonging drugs

Question 40

Dronedarone warnings

Answer 40

Hepatic failure (esp first 6 months)
pulmonary disease

Question 41

Dronedarone SE

Answer 41

QT prolongation
diarrhea

Question 42

Sotalol dosing adjustments

Answer 42

CrCL < 60 = decrease frequency
CrCl < 40 = depends on formulation

Question 43

Ibutilide notes

Answer 43

correct hypokalemia and hypomagnesemia before use and throughout treatment with medication

Question 44

Dofetilide boxed warning

Answer 44

initiated in setting of continuous ECG monitoring, assess CrCl for min 3 days, QT prolongation

Question 45

Dofetilide CrCl adjustments

Answer 45

CrCl < 60 = decrease dose
CrCl < 20 = contraindicated

Question 46

Dofetilide is the anti arrhythmic drug of choice in

Answer 46

Heart failure