Kyle Lecture Asthmatic/cardiac

Question 1

Describe ion flow during ventricular action potential

Answer 1

Question 2

3 Phases of SA node action potential

Answer 2

4-leaky Na channels, slight upslope
0-Na Ca influx
3-K efflux

Question 3

Primary effect on action potential
Na channels blockade

Answer 3

Slows depolarization of fast AP cells

Question 4

Primary effect on action potential
Beta blockade

Answer 4

Slows depolarization in slow AP cells

Question 5

Primary effect on action potential
K channels blockade

Answer 5

Prolongs action potential

Question 6

Primary effect on action potential
CA channel blockade

Answer 6

Slows depolarization in slow AP cells

Question 7

Fast AP cells types

Answer 7

Atria, ventricle, HIS/purkinje

Question 8

Slow AP cells

Answer 8

Sinus and AV nodes

Question 9

Primary effect on EKG
Na channel block

Answer 9

Widens QRS complex

Question 10

Primary effect on EKG
Beta blockade

Answer 10

Slows sinus rate and prolongs PR interval

Question 11

Primary effect on EKG
K channel block

Answer 11

QT prolongation

Question 12

Primary effect on EKG
Ca channel block

Answer 12

Slows sinus rate and prolongs PR
-same as beta

Question 13

Differentiate strength of sodium channel blockade and primary impact on action potential

Answer 13

1a- moderate, increases AP -procainamide

1b- weak, decreases AP- lidocaine

1c- strong, no effect on APD but strong right shift on upstroke

Question 14

Rate control in WPW/afib

Answer 14

Procainamide

Question 15

Pill in the pocket, outpatient afib conversion

Answer 15

Flecainide

Question 16

1a class specific side effects

Answer 16

Prolong QT, negative inotropy

Question 17

Metoprolol indications

Answer 17

Rate control afib
Suppress PAC/PVC
Suppression of VT

Question 18

Beta blockers with ISA

Answer 18

Pindolol
Acebutolol

Question 19

What don’t you give to an asthmatic?

Answer 19

Beta blockers

Question 20

Side effects of amiodarone

Answer 20

Pulmonary fibrosis
thyroid dysregulation
Elevated LFTs
Visual changes
Neurological symptoms
Hypotension

All K channel blockers prolong the QT!!!

Question 21

Which calcium channel blockers decrease inotropy and give two examples

Answer 21

Non-dihydropyridines

Diltiazem and verapamil

Question 22

Why does digoxin slow the heart?

Answer 22

Vagolytic effect

Question 23

Digoxin mechanism

Answer 23

Inhibits Na/K pump

Which increases intracellular Na the cell can use to exchange for calcium

Question 24

Classes of antiarrhythmics that cause torsades

Answer 24

1a

III

Anything that prolongs repolarization

Question 25

What do we hold before surgery?

Answer 25

ACE inhibitors

Question 26

Considerations for poorly controlled asthma perioperatively

Answer 26

Using rescue inhaler more than 1-2 a week

High risk bronchospasm

Anticholinergic/b2 agonist (duoneb)

Avoid desflurane

Question 27

How do we treat intraoperative bronchospasm?

Answer 27

100% O2-take off vent
Deepen anesthetic
B2 agonist

Low dose epi if unresponsive 5 mcg

Question 28

Isoproterenol expected reactions

Answer 28

Palpitations/flushing

Hypotension/tachycardia