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Therapeutics > Exam 2 lecture 8 > Flashcards

Exam 2 lecture 8 Flashcards

1
Q

Difference between intermittent vs paroxysmal AF

A

Intermittent AF starts spontaneously and lasts for several minutes/hours and stops suddenly

Paroxysmal- Can have sx couple times per week or month

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2
Q

Algorithim for maintenance of Sinus rhythm (SR) following conversion to SR in A fib pts or for paroxysmal AF

A
  1. If pt has normal LV function, no prior MI or no significant heart disease

Dofetilide
Dronedarone In no particular order
Flecanide
Propafenone

Amiodarone

Sotalol

  1. If pt has prior MI significant structural heart disease and HFrEF (LVEF<40%)

a) Amiodarone
Dofetilide

   Sotalol

b) Does pt have NYHA III or IV or recent decompensated HF
i) if no- Dronedarone
II) If yes- dronedarone contraindicated

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3
Q

How to maintain sinus rhythm (SR) following conversion to SR in A fib pts or paroxysmal AF pts if pt has normal LV function, no prior MI or no significant heart disease

A

Dofetalide
Dronedarone
Flecanide
Propafenone

Amiodarone

Sotalol

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4
Q

How to maintain sinus rhythm (SR) following conversion to SR in A fib pts or paroxysmal AF in patients that have prior MI, significant structural heart disease, and HFrEF (LVEF<40)

A
  1. Amiodarone
    Dofetilide
    sotalol
  2. NYHA III or IV or recent decompensated HF
    if no- dronedarone
    If yes- dronedarone contraindicated
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5
Q

Flecanide and propafenone contraindication

A

Pts with prior MI, significant structural heart disease and/or HFrEF

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6
Q

Chief concern for Dofetilide and sotalol

A

Torsades de pointes

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7
Q

Algorithim for in patient initiation of dofetilide

A

Place patient on continous ECG, proceed only if QTC<440 ms

CrCl>60- 500 mcg BID
CrCl- 40-60- 250 mcg BID
CrCl- 20-39- 125 mcg BID

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8
Q

When can we proceed with dofetilide initiation

A

Only if QTC<440

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9
Q

Post dose adjustment of Dofetilide after 1st dose

A

check QTc interval after 1st dose
If QTC incrases less than 15% continue current dose
If QTc increases more than 15% or to 500 ms lower dose

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10
Q

If QTc increases more than 15% after 1st dose or to 500 ms what should we do

A

500 BID to 250 BID
250 BID to 125 BID
125 BID to QD

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11
Q

when to dx dofetilide

A

if QTc>500 after 2nd dose

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12
Q

algorithim for in patient initiation of sotalol

A

Place pt on continous ECG monitoring, proceed only if QTc <450ms

CrCl>60- 80 mg BID
CrCl 40-60- 80 mg QD

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13
Q

difference in ECG initiation between dofetilide and sotalol

A

Dofetilide- <440 ms
Sotalol<450

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14
Q

When to discontinue sotalol

A

If QTc is greater than 500 ms

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15
Q

What to do if QTC<500 ms after giving sotalol

A

after 3 days of BID dosing or 5 days of QD dosing if still <500 either discharge OR increase dose to 120 BID and pt can be followed for 3 days

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16
Q

What is catheter ablation

A

Is a device used for rhythm control to improve symptoms in pts who anti arrythmic drugs have been ineffective or contraindicated in

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17
Q

When are catheter ablations 1st line therapies

A

In younger patients with fewer comorbidities

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18
Q

What are the supraventricular arrythmias

A

Sinus bradycardia
AV block
Sinus tachycardia
A fib
Supraventricular tachycardia

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19
Q

rhythm of supraventricular tachycardia (SVT)

A

regular rhythm

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20
Q

QRS complexes on supraventricular tachycardia (SVT)

A

Narrow QRS complexes

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21
Q

Supraventricular tachycardia HR (SVT)

A

HR 110-250 BPM

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22
Q

are initiation and termination of supraventricular tachycardia (SVT) spontaneous and not

A

spontaneous

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23
Q

what is paroxysmal SVT

A

subset of SVT that has intermittent paroxysms of SVT that last minutes/hours

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24
Q

Most common cause of SVT

A

Re-entry within AV node (60%) most common

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25
how many potential conduction pathways in AV node? How many of the normally active unde normal circumstances
2 potential pathways only 1 active under normal circumstances
26
SVT etiologies and risk factors
women have 2x higher risk than men age>65 occurs in ppl with no unerlying CVD
27
Sx associated with SVT
Neck pounding palpitations dizziness weakness lightheadedness\ near syncope/syncope polyuria
28
Does SVT cause stroke?
No
29
is SVT associated with the same morbidity/mortality of A fib
no
30
to eliminate SVT we want drugs that do what? What are the drugs
inhibit conduction to AV node Adenosine BB (only IV) diltiazem verapamil
31
treatment of hemodynamically unstable A fib or SVT
DCC
32
Dosing of adenosine
6-12-12 6 mg IV bolus, if no response in 1-2 mins 12 mg IV bolus, repeat 12 mg
33
adverse effects of adenosine
chest pain Sinus pause (FLAT LINE) for 3 seconds
34
algorithim for hemodynamically stable SVT
Vagal maneuvers and or IV adenosine if in effective IV BB IV diltiazem IV verapamil if ineffective synchronized DCC
35
Algorithim for prevention of recurrence of asymptomatic SVT
clinical follow up without tx
36
Algorithim for prevention of recurrence of symptomatic SVT
If catheter ablation candidate and pt prefers catheter ablation- do catheter ablation If no- If HFrEF (LVEF<40)- Amiodarone Digoxin Dofetillide Sotalol If no HFrEF- Diltiazem verapamil BB if not effective Flecanide and propafenone
37
what are the two pathways for treatment forsymptomatic SVT pts that do not want catheter ablation
HFrEF no HFrEF
38
treatment of HFrEF pt with symptomatic SVT that does not want catheter ablation
Amiodarone Digoxin Dofetillide Sotalol
39
treatment of no HFrEF pt with symptomatic SVT that does not want catheter ablation
BB diltiazem verapamil if not effective flecanide propafenone
40
Flecanide and propafenone CI in pts with
CAD
41
What are the 3 ventricular arrhythmias
premature ventricular complexes (PVC) ventricular tachycardia Ventricular fibrillation
42
QRS complex of premature ventricular complexes
Wide QRS complexes
43
types of PVC (premature ventricular complexes)
simple frequent/repetitive forms
44
What is a simple PVC
isolated single PVC
45
What are the different types of frequent/repetitive forms of PVC
Pairs (couplets) every 2nd beat (bigeminy) every 3rd beat (trigeminy) every 4th beat (quadrigeminy)
46
criteria to become a frequent OVC
Atleast 1 PVC on ECG 30 PVC per hour
47
mechanism of PVC
increased automaticity of ventricular muscle cells/purkinje fibers
48
symptoms of PVC
asymptomatic palpitations dizziness lightheadedness
49
prognostic implications of PVC
<30- no prognostic sin=gnificance >30- PVC influences long term risk frequent and very frequent PVC are associalted with CVD/mortality and cardiomyopathy respectivelly
50
treatment of asymptomatic PVC
Asymptomatic PVC- no treatment
51
Treatment of symptomatic PVC in pts who do not have CAD or HF
BB Diltiazem verapamil if unresponsive- antiarrythmic meds
52
tx of frequent symptomatic PVC (>15% of beats)
BB CCB antirrythmics
53
tx of frequency symptomatic PVC unresponsive to BB, CCB and antiarythmic drugs
catheter ablation
54
tx of symptomatic PVC in pt who have CAD
BB, diltiazem or verapamil if unresponsive- antiarythmic drugs
55
tx of symptomatic PVC who have HF
BB
56
What are the 3 ventricular arrythmias
PVC ventricular tachycardia ventricular fibrilation
57
Rhythm of ventricular tachycardia
regular
58
QRS complex of ventricular tachycardia
Wide QRS complexes
59
Define ventricular tachycardia
Defined as 3 or more consecutive VPD at ?100 BPM
60
P wave in ventricular tachycardia
No p wave
61
What are the types of ventricular tachycardia
non sustained sustained sustained monomorphic VT in ptswith no structural heart disease (idiopathic)
62
describe non sustained ventricular tachycardia
3 or more consecutive VPDs
63
describe sustained ventricular tachycardia
VT lasting 30 seconds or more or require termination b/c of hemodynamic instability in <30 seconds
64
What are the two types of sustained monomorphic VT (idiopathic VT)
verapamil sensitive VT and outflow tract VT
65

Therapeutics (38 decks)

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