Konorev Anti-arrhythmic drugs part 2 Flashcards
What is a proarrhythmia?
Drug induced significant new arrhythmia or worsening of an existing arrhythmia
What are nonpharmacological treatments of arrhythmias?
- Catheter ablation
- Implantable cardioverter defibrillator
- Artificial cardiac pacemaker
- Direct current cardioversion
What drug classes trigger an excessive slowing of repolarization leading to torsades de pointes?
- Class 1A
- Na channel blockers
- Class 3
- K channel blockers
What class of drugs triggers excessive slowing of conduction leading to persistent ventricular tachycardias?
- Class 1A
- Quinidine
- Procainamide
- Disopyramide
- Class 1C
- Flecainide
- Propafenone
- Both classes are Na channel blockers
What is the most common arrhythmia? How does it present?
- A. fib
- Fatigue, weakness, decreased exercise tolerance
- Hypotension
- Pulmonary congestion
- Exacerbation HF
What is the mechanism behind A. fib?
- Reentry circuits
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what are the two approaches to treat A.fib?
- Rhythm control
- Rate control
Describe rhythm control approach to A. fib?
- Direct current cardioversion
- Chemical cardioversion using Class 1C (Na blocker) or class 3 (K channel blocker)
Which drugs will be effective in interrupting reentry currents in A fib?
- Esmolol & Quinidine
- Mexiletine & Lidocaine
- Verapamil & adenosine
- Sotalol & Flecainide
- Propafenone & diltiazem
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Sotalol & Flecainide
- sotalol is Class 3 K blocker
- Flecainide is 1C
- Esmolol is class 2 Beta blocker
- Quinidine is class 1A Na channel block
- Mexiletine and Lidocaine are class 1B Na channel
- Verapamil & Diltiazem are Ca channel block
- Propafenone class 1C Na channel
How do you maintain sinus rhythm in AF patients with minimal heart disease?
- Catheter ablation
- Flecainide
- 1C
- Propafenone
- 1C
- Sotalol
- class 3
- Amiodarone
- class 3
- Dofetilide
- class 3
In patients with structural disease what class of drugs are contraindicaated?
Class 1C
In order to maintain sinus rhythm in A fib patients with structural disease what is done/used?
- Catheter ablation
- Sotalol
- Class 3
- Amiodarone
- Class 3
- Dofetilide
- Class 3
What is the CHADS VASc tool?
Helps identify if patients need to be on antithrombotic therapy
- Congestive HF
- Htn
- Age >75
- DM
- Stroke
- Vascular dz
- Age 65-74
- Sex
What agents are used for stroke prevention in most patients with AF?
- Dabigatran
- Rivaroxaban
- Edoxaban
- Apixaban
- Warfarin
- Konorev not testing, but Wolff will later on
What is Paroxysmal supraventricular tachycardia? Most common type?
- Abrupt onset and termination of tachycardia
- Most common is AV nodal reentrant tachycardia
Patient symptoms with PSVT?
- abrupt onset palpitations
- dizzy
- lightheaded
- dyspnea
- chest pain
How does PSVT present on ECG?
- Narrow QRS complex tachycardia
- P wave usually inverted or not seen
An effective approach to terminating PSVT is to slow down conduction via AV node in order to interrupt reentry circuit within the node. Which of the following drug classes will do this?
- 1B and 2
- 1B and 4
- 1C and 3
- 1A and 2
- 4 and adenosine
Class 4 and adenosine
- classes 2 and 4 slow down AV conduction and prolong nodal refractory period
- Adenosine inhibits AV conduction and increases AV nodal refractory period
How do we prevent PSVT epidoes?
- Catheter ablation
- Verapamil
- Ca channel block
- Diltiazem
- Ca channel block
- Metoprolol
- Atenolol
- Propranolol
- “olol” Beta blockers
What is Torsade De Pointes?
- Rapid form of polymorphic VT that occurs in setting of prolonged QT
- ECG shows twisting QRS complexes
Clinical manifestations of Torsade De Pointes?
- HR 160-250
- Palpitations
- Dizzy/light headed
- Hypotension
- Hemodynamic collapse and syncope
- Sudden cardiac death
