Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Flecanide and propafenone contraindication

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Chief concern for Dofetilide and sotalol

A

Torsades de pointes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When can we proceed with dofetilide initiation

A

Only if QTC<440

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

when to dx dofetilide

A

if QTc>500 after 2nd dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

difference in ECG initiation between dofetilide and sotalol

A

Dofetilide- <440 ms
Sotalol<450

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When to discontinue sotalol

A

If QTc is greater than 500 ms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When are catheter ablations 1st line therapies

A

In younger patients with fewer comorbidities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the supraventricular arrythmias

A

Sinus bradycardia
AV block
Sinus tachycardia
A fib
Supraventricular tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

rhythm of supraventricular tachycardia (SVT)

A

regular rhythm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

QRS complexes on supraventricular tachycardia (SVT)

A

Narrow QRS complexes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Supraventricular tachycardia HR (SVT)

A

HR 110-250 BPM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

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

A

spontaneous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is paroxysmal SVT

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Most common cause of SVT

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

how many potential conduction pathways in AV node? How many of the normally active unde normal circumstances

A

2 potential pathways
only 1 active under normal circumstances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

SVT etiologies and risk factors

A

women have 2x higher risk than men
age>65
occurs in ppl with no unerlying CVD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Sx associated with SVT

A

Neck pounding
palpitations
dizziness
weakness
lightheadedness\
near syncope/syncope
polyuria

28
Q

Does SVT cause stroke?

A

No

29
Q

is SVT associated with the same morbidity/mortality of A fib

A

no

30
Q

to eliminate SVT we want drugs that do what? What are the drugs

A

inhibit conduction to AV node

Adenosine
BB (only IV)
diltiazem
verapamil

31
Q

treatment of hemodynamically unstable A fib or SVT

A

DCC

32
Q

Dosing of adenosine

A

6-12-12
6 mg IV bolus, if no response in 1-2 mins 12 mg IV bolus, repeat 12 mg

33
Q

adverse effects of adenosine

A

chest pain
Sinus pause (FLAT LINE) for 3 seconds

34
Q

algorithim for hemodynamically stable SVT

A

Vagal maneuvers and or IV adenosine

if in effective

IV BB
IV diltiazem
IV verapamil

if ineffective
synchronized DCC

35
Q

Algorithim for prevention of recurrence of asymptomatic SVT

A

clinical follow up without tx

36
Q

Algorithim for prevention of recurrence of symptomatic SVT

A

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
Q

what are the two pathways for treatment forsymptomatic SVT pts that do not want catheter ablation

A

HFrEF
no HFrEF

38
Q

treatment of HFrEF pt with symptomatic SVT that does not want catheter ablation

A

Amiodarone
Digoxin
Dofetillide
Sotalol

39
Q

treatment of no HFrEF pt with symptomatic SVT that does not want catheter ablation

A

BB
diltiazem
verapamil

if not effective

flecanide
propafenone

40
Q

Flecanide and propafenone CI in pts with

A

CAD

41
Q

What are the 3 ventricular arrhythmias

A

premature ventricular complexes (PVC)
ventricular tachycardia
Ventricular fibrillation

42
Q

QRS complex of premature ventricular complexes

A

Wide QRS complexes

43
Q

types of PVC (premature ventricular complexes)

A

simple
frequent/repetitive forms

44
Q

What is a simple PVC

A

isolated single PVC

45
Q

What are the different types of frequent/repetitive forms of PVC

A

Pairs (couplets)
every 2nd beat (bigeminy)
every 3rd beat (trigeminy)
every 4th beat (quadrigeminy)

46
Q

criteria to become a frequent OVC

A

Atleast 1 PVC on ECG
30 PVC per hour

47
Q

mechanism of PVC

A

increased automaticity of ventricular muscle cells/purkinje fibers

48
Q

symptoms of PVC

A

asymptomatic
palpitations
dizziness
lightheadedness

49
Q

prognostic implications of PVC

A

<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
Q

treatment of asymptomatic PVC

A

Asymptomatic PVC- no treatment

51
Q

Treatment of symptomatic PVC in pts who do not have CAD or HF

A

BB
Diltiazem
verapamil

if unresponsive- antiarrythmic meds

52
Q

tx of frequent symptomatic PVC (>15% of beats)

A

BB
CCB
antirrythmics

53
Q

tx of frequency symptomatic PVC unresponsive to BB, CCB and antiarythmic drugs

A

catheter ablation

54
Q

tx of symptomatic PVC in pt who have CAD

A

BB, diltiazem or verapamil
if unresponsive- antiarythmic drugs

55
Q

tx of symptomatic PVC who have HF

A

BB

56
Q

What are the 3 ventricular arrythmias

A

PVC
ventricular tachycardia
ventricular fibrilation

57
Q

Rhythm of ventricular tachycardia

A

regular

58
Q

QRS complex of ventricular tachycardia

A

Wide QRS complexes

59
Q

Define ventricular tachycardia

A

Defined as 3 or more consecutive VPD at ?100 BPM

60
Q

P wave in ventricular tachycardia

A

No p wave

61
Q

What are the types of ventricular tachycardia

A

non sustained
sustained
sustained monomorphic VT in ptswith no structural heart disease (idiopathic)

62
Q

describe non sustained ventricular tachycardia

A

3 or more consecutive VPDs

63
Q

describe sustained ventricular tachycardia

A

VT lasting 30 seconds or more

or

require termination b/c of hemodynamic instability in <30 seconds

64
Q

What are the two types of sustained monomorphic VT (idiopathic VT)

A

verapamil sensitive VT and outflow tract VT

65
Q
A

Therapeutics (38 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions