HF & Arrythmia exam Flashcards

1
Q

What are the class 1a antiarrhythmics?

A

mixed block of Na & K channels —> prolongs QT
-Quinidine, procainamide

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

What are the class 1b antiarrhythmics?

A

weak Na channel block —> no significant effect on ECG
-Lidocaine, mexiletine, phenytoin

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

What are the class 1c antiarrhythmics?

A

strong Na channel block —> widens QRS complex
-Flecainide

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

What are the class 3 antiarrythymics?

A

K+ channel blockers; agents that prolong refractory period and QT interval
-Amiodarone, dronedarone, sotalol, Ibutilide, Dofetilide

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

What are the class 2 antiarrythmics?

A

Beta adrenergic blockers
-Esmolol (cardioselective), acebutolol (cardioselective), propanolol (nonselective)
-slows pacemaker cells and Ca2 currents; increase PR interval

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

What are the class 4 antiarrythmics?

A

Ca+2 channel blockers
-Verapamil, Diltiazem
-frequency dependent block of Cav1.2 channels; blockade accumulates in rapidly depolarizing tissue (tachycardia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What phase does the class 1 (Na channel blockers) work in?

A

-phase 0

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

What phase does the class 2 (Beta-blockers) work in?

A

-phase 4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What phase does the class 3 (K channel blocker) work in?

A

-phase 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What phase does the class 4 (Ca channel blocker) work in?

A

-phase 2

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

What drugs increase PR interval?

A

beta-blockers (Esmolol, acebutolol, propranolol)
Ca Channel blockers (verapamil, diltiazem)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What drugs widens QRS complex?

A

Class 1c drugs (Flecainide, propafenone)

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

What drugs lengthen QT?

A

Class 1a drugs (Quinidine, procainamide, disopyramide)
Class 3 drugs (amiodarone, dronedarone, sotalol, Ibutlilide)

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

What drugs have no ECG changes?

A

Class 1b drugs (Lidocaine, Mexiletine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What type of fibrillation has no P waves?

A

atrial fibrillation
-irregularly irregular rhythm
-abnormal pulmonary vein automaticity & mult. re-entry circuits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the chads-vasc score?

A

Congestive heart failure, Hypertension, Age > 75 years (2 pts), Diabetes, Stroke/TIA/TE history (2 pts), Vascular disease, Age 65-74 years, Sex (female)

17
Q

When is Warfarin indicated over DOACs for afib?

A

-if pt has mechanical heart valves (target INR 2.5-3.5)
-if pt has heart valve disease (moderate/severe mitral valve stenosis) (target INR 2-3)

18
Q

What anticoagulation medication for afib is indicated in ESRD?

19
Q

What drugs are indicated for acute ventricular rate control in afib if patient is hemodynamically stable + decompensated HF?

A

-amiodarone

20
Q

What drugs are indicated for acute ventricular rate control in afib if patient is hemodynamically unstable?

A

DCC (direct current cardioversion)

21
Q

What drugs are indicated for acute ventricular rate control in afib if patient is hemodynamically stable + no decompensated HF?

A

B-blockers, diltiazem, Verapamil
2nd line: digoxin
3rd line: amiodarone

22
Q

What drugs are indicated for long-term ventricular rate control in afib + HFrEF?

A

B-Blockers, 2nd line: digoxin

23
Q

What drugs are indicated for long-term ventricular rate control in afib (no HFrEF) ?

A

B-Blockers, Diltiazem, verapamil 2nd line: digoxin
-interaction between digoxin and verapamil

24
Q

What drugs are indicated for converting AF to SR (hemodynamically stable) ?

A

IV amiodarone, Ibutilide, procainamide (faster acting, higher risk of torsades des pointes)
-procainamide cannot be be administered with amiodarone or Ibutilide

25
What drugs are indicated for converting AF to SR if pt has HFrEF?
IV amiodarone
26
What is the dosing for dofetilide?
-monitor in hospital -d/c if QTc > 500 ms or increases by > 15% 500 mcg BID = CrCl > 60 mL/min 250 mcg BID = CrCl 40-60 mL/min 125 mcg BID = CrCl 20-39 mL/min
27
What are the adverse effects and monitoring parameters of amiodarone?
AE's: blue-grey discoloration, photosensitivity, corneal microdeposits, pulmonary fibrosis, hepatoxicity, bradycardia, hypo/hyperthyroidism Monitoring: TSH, LFTs, ECG, chest X-ray for pulmonary fibrosis (once when starting then if symptoms)
28
What drugs are indicated for maintenance of SR following conversion for afib with normal LV function, no prior MI or significant structural heart disease?
Dofetilide, dronedarone, Flecainide, Propafenone 2nd line: Amiodarone 3rd line: Sotalol
29
What drugs are indicated for maintenance of SR following conversion for afib with prior MI or significant structural heart disease, inlcuding HFrEF?
amiodarone, dofetilide, dronedarone 2nd line: Sotalol -if pt is NYHA class III or IV then dronedarone is CI
30
How do you administer Adenosine?
dose is 6 mg IV, then 12 mg IV then a second dose of 12 mg IV again
31
How do you treat symptomatic PVCs and have no CAD or HF?
B-Blockers, diltiazem, verapamil 2nd line: antiarrythmic medication; catheter ablation
32
How do you treat symptomatic PVCs w/HF?
B-Blockers
33
How do you treat symptomatic PVCs w/CAD?
B-Blockers, diltiazem, or verapamil 2nd line: antiarrythmic medication
34
What is the algorithm for termination of stable VT and structural heart disease?
DCC 2nd line: IV procainamide 3rd line: IV amiodarone or IV Sotalol
35
What is the algorithm for termination of stable VT if no structural heart disease?
if Verapamil-sensitive VT then treat with Verapamil If outflow tract VT then B-Blocker if fails, then DCC
36
What is indicated for ventricular fibrillation treatment?
Defibrillation -use Epinephrine 1 mg IV then 2 does of Amiodarone 300 mg IV/Lidocaine 1-1.5 mg/kg IV (1/2 dose second time)