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PHRM 845 Therapeutics > Exam 2 - Arrhythmias Tisdale > Flashcards

Exam 2 - Arrhythmias Tisdale Flashcards

1
Q

PR interval range

A

0.12-0.20 seconds

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2
Q

QRS duration

A

0.08-0.12 seconds

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3
Q

QT and QTc interval range

A

QT: 0.38-0.46 seconds
QTc: 0.36-0.45 seconds for men;
0.36-0.46 seconds for women

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4
Q

does the QT interval get shorter or longer as heart rate increases?

A

QT interval gets shorter

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5
Q

Torsade de pointes occurs when QTc interval is _____ ms or more

A

500 ms or more

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6
Q

5 types of supraventricular arrhythmias

A

-sinus bradycardia
-AV block
-sinus tachycardia
-A fib
-supraventricular tachycardia

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7
Q

3 types of ventricular arrhythmias

A

-premature ventricular complexes (PVCs)
-ventricular tachycardia
-ventricular fibrillation

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8
Q

sinus bradycardia is HR < ___ beats per minute

A

< 60

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9
Q

mechanism of sinus bradycardia

A

decreased automaticity of the SA node

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10
Q

main treatment for sinus bradycardia

A

atropine 0.5-1 mg IV, repeat every 5 min

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11
Q

what are the 3 alternative drugs to atropine for sinus bradycardia?

A

-dopamine
-epinephrine
-isoproterenol

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12
Q

2 drugs for treatment of sinus bradycardia after heart transplant or spinal cord injury

A

-aminophylline 6 mg/kg IV over 20-30 min
-theophylline

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13
Q

long term tx for pts unwilling to get a permanent pacemaker

A

theophylline oral 5-10 mg/kg/day titrated to effect

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14
Q

which of the following is false about A fib?

a. no atrial depolarizations
b. 120-180 bpm
c. irregularly regular rhythm
d. absent P waves

A

c. irregularly regular rhythm (it is irregularly irregular)

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15
Q

what is paroxysmal A Fib?

A

AF that is intermittent and terminates within 7 days of onset

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16
Q

what is persistent A Fib?

A

AF that is continuous and sustains for > 7 days and requires intervention

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17
Q

what is long-standing persistent A Fib?

A

AF that is continuous for > 12 months in duration

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18
Q

what is successful AF ablation?

A

freedom from AF after percutaneous or surgical intervention to eliminate AF

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19
Q

2 mechanisms of A Fib

A

-abnormal atrial/pulmonary vein automaticity
-atrial reentry

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20
Q

hyperthyroidism and thoracic surgery are etiologies of _____ _____ _____

A

reversible atrial fibrillation

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21
Q

4 goals of therapy for treating A fib

A

-prevent stroke/systemic embolism
-slow ventricular response by inhibiting conduction of impulses to ventricles
-convert A fib to normal sinus rhythm
-maintain sinus rhythm (reduce freq of episodes)

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22
Q

what CHADsVASc score for men and women are oral anticoagulants REASONABLE in A Fib?

A

men - 1 or more
women - 2 or more

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23
Q

warfarin is preferred over DOACs in which two pts with A Fib?

A

-pts with mechanical heart valves (INR 2.5-3.5)
-pts with moderate-to-severe mitral valve stenosis (INR 2.0-3.0)

24
Q

warfarin or apixaban are preferred in which 2 pts with A Fib?

A

-pts with CrCl < 15 mL/min (End-stage CKD)
-pts on hemodialysis

25
Q

true or false: DOACs are preferred over warfarin for MOST pts with A Fib

A

true

26
Q

reversal agent for rivaroxaban, apixaban, and edoxaban

A

andexanet alfa

27
Q

reversal agent for dabigatran

A

idarucizumab

28
Q

which DOAC is not recommended in CrCl > 95 mL/min?

a. dabigatran
b. rivaroxaban
c. apixaban
d. edoxaban

A

d. edoxaban

29
Q

what drugs/drug classes can be used for ventricular rate control?

A

non-DHP CCBs, beta blockers, digoxin, amiodarone

30
Q

how often should INR be measured for pt on warfarin with A Fib?

A

measure weekly at initiation, the monthly after INR is stable

31
Q

what are the four conditions for hemodynamic unstability?

A

-systolic BP less than 90
-HR > 150 bpm
-pt has lost consciousness
-pt experiencing chest pain

32
Q

which two drugs should not be given to pts with decompensated HF?

A

diltiazem, verapamil

33
Q

goal for ventricular rate control

A

100-110 bpm and asymptomatic

34
Q

if pt is hemodynamically unstable with A fib, what is the treatment?

A

DCC (direct current cardioversion)

35
Q

if A Fib has been present for 48 hours or less, can we convert to sinus rhythm?

A

yes

36
Q

if A fib has been present for more than 48 hours, can we convert to sinus rhythm?

A

no (until pt has been anticoagulated for 3 weeks or a TEE has been performed to rule out a clot in the atrium)

37
Q

what drugs are used for conversion to sinus rhythm for A Fib? (5 of them; slide 62)

A

-amiodarone
-ibutilide
-procainamide
-flecainide
-propafenone

38
Q

what are the two “pill in the pocket” drugs we talked about?

A

flecainide and propafenone

39
Q

what drugs are used for maintenance of sinus rhythm for pts with A Fib? (6 of them; slide 67)

A

-amiodarone
-dofetilide
-dronedarone
-sotalol
-propafenone
-flecainide

40
Q

dofetilide is CI in CrCl < ____

A

< 20

41
Q

for inpatient initiation of dofetilide, we only proceed if QTc is less than _____ ms

A

440 ms

42
Q

doses for dofetilide if Cr > 60, 40-60, and 20-39

A

> 60 -> 500 mcg twice daily
40-60 -> 250 mcg twice daily
20-39 -> 125 mcg twice daily

43
Q

after 1st dose of dofetilide in the hospital, when would we decrease the dose?

A

if QTc increases > 15% or > 500 ms after 2-3 hours

44
Q

when would we discontinue dofetilide if we have given at least 2 doses already?

A

if QTc > 500 ms anytime after the 2nd dose

45
Q

for inpatient initiation of sotalol, we only proceed if QTc is ____ or less

A

450 ms

46
Q

what is the dose for inpatient initiation of sotalol if CrCl is > 60, and between 40-60?

A

> 60 -> 80 mg twice daily
40-60 -> 80 mg once daily

47
Q

verapamil inhibits p-glycoprotein, so there is an interaction with what two drugs? (2 of them; slide 54)

A

digoxin, dofetilide (dec doses of these)

48
Q

what are the 3 IV BB’s we use for ventricular rate control for A Fib?

A

esmolol
propranolol
metoprolol

49
Q

what drug should be used in conversion of hemodynamically stable A Fib HFrEF pt (LVEF of 40% or less) to sinus rhythm?

a. IV amiodarone
b. IV ibutilide
c. IV amiodarone
d. flecainide
e. propafenone

A

c. IV amiodarone

50
Q

which works faster for conversion of hemodynamically stable AF to sinus rhythm if pt has normal LV function?

a. IV amiodarone
b. IV ibutilide

A

b. IV ibutilide

51
Q

for conversion of hemodynamically stable AF to sinus rhythm, why do we not administer procainamide if pt has already received amiodarone or ibutilide?

A

risk of excessive QT prolongation and torsades de pointes

52
Q

how often after each dose of sotalol do we check QTc interval? What are we looking for?

A

-check every 2-4 hours
-if QTc < 500 ms after 3 days (or after 5th or 6th dose if once daily), pt can be discharged OR can be inc to 120 mg BID and pt can be followed for 3 days on this dose
-if QTc is 500 ms or greater, d/c sotalol

53
Q

what is the HR range for supraventricular tachycardia?

A

110-250 bpm

54
Q

4 mechanisms for reentry for supraventricular tachycardia

A

-AV node (60%)
-accessory pathway (WPW syndrome; 30%)
-atria (4-8%)
-SA node (4%)

55
Q

what is important about dronedarone that causes less side effects than amiodarone?

A

dronedarone does NOT contain iodine while amiodarone does, so no side effects related to that for dronedarone

56
Q

what is the stepwise therapy for termination of hemodynamically stable SVT (IV drugs)?

A
  1. vagal maneuvers and/or IV adenoside
  2. if not effective, use IV BBs, diltiazem, or verapamil
  3. if not effective, synchronized DCC
57
Q
A

PHRM 845 Therapeutics (34 decks)

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