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CDM 2 Exam 1 > Lecture 8 - Arrhythmias 2 > Flashcards

Lecture 8 - Arrhythmias 2 Flashcards

1
Q

goals of anti arrhythmic therapy

A
  1. Dec or inc conduction velocity
  2. alter excitability of cardiac cells by changing the duration of the effective refractory period
  3. Suppress abnormal automaticity
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2
Q

Vaughan-williams Classification

A

Class 1- 1A, 1B, 1C
Class 2
Class 3
Class 4

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3
Q

Class 1A drugs

A

Moderate Na+ blockers = fast fibers

Drugs: Quinidine, Procainamide, Disopyramide

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4
Q

What do Class 1A drugs do?

A

Dec conduction velocity
Inc refractory period
Dec automaticity

Prolongs QT

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5
Q

What are Class 1A drug used for?

A

useful for Supraventricular and ventricular dysrhythmias

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6
Q

Class 1B drugs

A

Weak Na+ blockers = fast fibers

Drugs: Lidocaine, Mexilitine, Phenytoin

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7
Q

What do Class 1B drugs do?

A

No effect on conduction velocity
Dec refractory period
Dec automaticity

** More effect on Fast HR, no real effect on slow **

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8
Q

Class 1B used for?

A

Ventricular dysrhythmias only

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9
Q

Class 1C drugs?

A

Strong Na+ blockers = fast fibers

Drugs: Flecainide, Propafenone

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10
Q

What do Class 1C drugs do?

A

Profoundly dec conduction velocity
No sig effect on refractory period
Dec automaticity

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11
Q

What are Class 1C drugs used for?

A

effective in both supraventricular and ventricular dysrhythmias

** don’t use in pts w/ CVD secondary to pro arrhythmia and mortality **

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12
Q

Class 2 Drugs

A

Work at SA/AV nodal tissue

Drugs: Beta-blockers

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13
Q

What do Class 2 Drugs do?

A

Block catecholamines
Dec conduction velocity
Inc refractory period (nodal tissue)
Dec automaticity

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14
Q

What are Class 2 drugs used for?

A

slowing ventricular response to supraventricular tachycardias (A-Fib)

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15
Q

Class 3 Drugs

A

K+ blockers = fast fibers

Drugs: Amiodarone, Dofetilide, Dronedarone, Ibutilide, Sotalol

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16
Q

What do Class 3 Drugs do?

A

don’t effect conduction velocity (except amiodarone/dronedarone)

profound inc in refractory period

no effect of automaticity (except amiodarone/dronedarone/sotalol)

**prolongs QT (rare with amiodarone)

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17
Q

What are Class 3 drugs used for?

A

both supraventricular and ventricular dysrhythmias

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18
Q

Class 4 drugs

A

Blocks Ca Channel

Drugs: Diltiazem, Verapamil

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19
Q

What do Class 4 drugs do?

A

Dec conduction velocity
Inc refractory period (nodal tissue)
Dec automaticity

20
Q

What are Class 4 drugs used for?

A

slowing ventricular response to supraventricualr tachycardias (A-Fib)

21
Q

Class I mortality info

A

Avoid in pts for short or long-term use

Ok in pt without CAD or CHF (studies show inc morality)

22
Q

Class 3 mortality info

A

class of choice for pt with CAD and CHF

Avoid Sotalol and Dronedarone in pt w/ CHF

Amiodarone may have mortality benefit

23
Q

Amiodarone MOA

A
  1. Prolongs repolarization, lengthen refractoriness, slows AV conduction, inhibits automaticity, and has nonspecific B-blocking properties
  2. QT prolongation is minimal
24
Q

Amiodarone Uses

A
  1. Ventricular and atrial arrhythmias
  2. considered most effective anti arrhythmic available
  3. Can be used in pts w/ CVD and decompensated HF
25
Q

Amiodarone Dosing IV (Supraventricular arrhythmias)

A

150 mg over 10-30 min, followed by 1mg/min X 6hrs, then 0.5mg/min X 18hrs, then 400 mg PO BID-TID until 10 grams total….then maintenance therapy with 200-400 mg/day

26
Q

Amiodarone Dosing Oral (Supraventricular arrhythmias)

A

1.2-1.8 g/day in divided doses until 10g total, then 200-400 mg/day

27
Q

Amiodarone Toxicity: CVD

A

Hypotension
AV block
Bradycardia
V-tach

** careful in elderly**

28
Q

Amiodarone Toxicity: Endocrine

A

Hypo-/Hyperthyroidism (Hypo most common)

29
Q

Amiodarone Toxicity: Dermatological

A

Photosensitivity
Bluish-slate gray discoloration of skin
Phlebitis (if using IV)

30
Q

Amiodarone Toxicity: Opthalmologic

A

Visual disturbances
Halo vision
Corneal microdeposits
Optic neuritis (rare)

31
Q

Amiodarone Toxicity: Pulmonary

A

Pulmonary pneumonitis

Risk factors: >400mg/day, COPD+Asthma, Elderly, Smoking

32
Q

Two types of Pulmonary pneumonitis

A 
Hypersensitivity pneumonitis (ARDS) (within weeks)
Interstitial pneumonitis ( ~ about a month)
33
Q

Amiodarone Toxicity: Neurologic

A 
Abnormal gait/ataxia
Dizziness
Fatigue
insomnia
poor coordination
peripheral neuropathy
Tremor
34
Q

Amiodarone Toxicity: Hepatic

A

AST or ALT > 2x ULN, hepatitis or cirrhosis

35
Q

Amiodarone Toxicity: GI

A

N,V, anorexia
Constipation, abdominal pain
abnormal salivation and taste

36
Q

Amiodarone Drug Interactions

A

Inc lvls of…

CSA, digoxin, flecainide, statins, warfarin, many more

37
Q

Dofetilide MOA

A

Blocks K+ channels and profoundly inc refractory period but doesn’t alter conduction velocity or automaticity

Strong QT-prolonging agent

No negative inotropic effects and no significant effects on HR or BP

38
Q

Dofetilide Uses

A

A-fib/A-flutter (not for ventricular arrhythmias)

Can be used in pts w/ CVD and decompensated HF

39
Q

Dofetilide Dosing

A

500mcg PO BID

Dosing dependent on QTc + Renal function

QTc must be determined prior to 1st dose

1st time starters must stay in hospital for min of 3 days

40
Q

Dofetilide CI

A
  1. Weak substrate of CYP3A4

2. Avoid drugs that strongly inhibit CYP3A4 or prolong QT interval

41
Q

Absolute CI for Dofetilide

A
  1. Long QT Syndromes
  2. Baseline QTc > 440 msec
  3. CrCl < 20ml/min (known how to calc)
42
Q

which drugs cant you use with Dofetilide

A 
Cimetidine
Dolutegravir
HCTZ
itraconazole
Ketoconazole
megestrol
proclorperazine 
trimethoprim
verapamil
43
Q

Chest X-Ray & Opthalmologic eval timeframe (amiodarone)

A

BL, Q12 months

44
Q

Pulmonary function test & ScCR/Electrolytes, Neurologic/GI/Derm eval time (amiodarone)

A

BL, PRN

45
Q

Thyroid & Liver function Test Eval time (amiodarone)

A

BL, Q6 months

46
Q

ECG eval time (amiodarone)

A

BL, q3-6 months

CDM 2 Exam 1 (12 decks)

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