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Advanced Pharm 2 For NA > Nagelhout - Antiarrhythmics - Exam 2 > Flashcards

Nagelhout - Antiarrhythmics - Exam 2 Flashcards

1
Q

In general, drugs that _ the heart are anti-arrhythmic

A

depress

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2
Q

T/F People experience arrhythmias more under GA than awake

A

false.
less under anesthesia than awake

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3
Q

A drug that _ the heart is typically arrhythmogenic

A

stimulates

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4
Q

Most successful way to treat arrhythmias:

A

ablations

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5
Q

Class I Antiarrhythmics

A

Na Channel blockers!! -slow phase 0 depolarization, acts mainly on ventricles

IA-after-prolong AP
-procainamide, quinidine, disopyramide
IB-before-shorten AP repolarization
-lidocaine, mexilitine, phenytoin
IC-depression
-flecainide, propafenide

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6
Q

Class II Antiarrhythmics

A

Beta Blockers! - inhibit phase 4 depolarization

-esmolol, propranolol, metoprolol, timolol, atenolol, nadolo, carvedilol

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7
Q

Class III Antiarrhythmics

A

K Channel blockers! - prolongs repolarization

-AMIO, sotalol, ibutilide, dofetilide

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8
Q

Class IV Antiarrhythmics

A

Ca Channel Blockers! - acts mainly on Atria/ SA/AV node

-Verapamil, Diltiazem

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9
Q

Class Other/V Antiarrhythmics

A

-Adenosine, Digoxin, Atropine

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10
Q

In the heart, Ca++ channels leak in which areas mainly:

A

atria, SA + AV node

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11
Q

In the heart, Na+ channels leak in which areas mainly:

A

ventricles

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12
Q

Which class of antiarrhythmics have a LA effect on heart?

A

Class I -Na channel blockers

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13
Q

Which antiarrhtyhmic class is preferrable for Afib normally

A

Class IV, CCB

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14
Q

Most common cause of arrhythmias during anesthesia:

A

pt not deep enough

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15
Q

Arrhythmias
-general factors

A

-age
-LA enlargement
-high adrenergic state
-hypoxia
-hypovolemia
-reperfusion arrhythmia
-HTN
-pulm disease
-beta blocker withdraw

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16
Q

Arrhythmias
-structural factros

A

-CAD
-MI
-valve/congenital heart disease
-cardiomyopathy
-SSS or long QT syndrome
-WPW
-secondary heart disease
-brady
-AV HB

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17
Q

Arrhythmia
-transient imbalances/factors

A

-lytes
-stress
-laryngoscopy, hypoxia, hypoxemia
-device malfunctions
-diagnostic interventions (interrogations)
-surgical stim
-central venous caths

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18
Q

4 main cardiac risk factors:

A

-Unstable coronary syndrome
-Decomp. HF
-Significant Arrhythmias
-Severe valve disease

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19
Q

Major cardiac risks
-Unstable Coronary Syndrome

A

-acute or recent (<6mo) MI
-severe/unstable angina

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20
Q

Major cardiac risks:
-Decomp HF

A

-NYHA Class IV, new-onset or worsening

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21
Q

Major cardiac risks:
-Significant Arrhythmias

A

-high grade AV blk
-2’2 blk
-3’ AV Blk
-symptomatic vent. arrhythmias
-supraventricular arrhythmias (afib w uncontrolled rate>100)
-symptomatic brady
-newly recognized VT

22
Q

Major cardiac risks:
-Severe Valve Disease

A

-Severe AS w/ mean pressure grad >40mmHg, aortic valve area<1cm^2, or symptomatic
-symptomatic Mitral stenosis, exertional presyncope, dyspnea on exertion, HF

23
Q

Scariest cardiac risk factor to be on edge about:

A

HF
-#1 risk for mortality/morbidity for anesthesia

24
Q

Intermediate cardiac risk factors

A

-mild angina
-previous MI or pathologic Q waves, but doing ok
-compensated/previous HF
-IDDM
-renal insufficiency

25
Q

Minor cardiac risk factors:

A

-age
-abnormal EKG (LBBB, ST abnormalities, LVH)
-not sinus rhythm -but stable
-low METS
-CVA hx
-uncontrolled systemic HTN

26
Q

Major Surgical Risk for Heart:
->5% risk

A

-major vasc surgery
-emergent major surgery
-long cases with large fluid shifts or blood loss

27
Q

Intermediate Surgical Risks for Heart
-1-5% risk

A

-carotid endarterectomy
-endovasc. AAA repair
-H+N cases
-Intraperitoneal/Intraabdominal cases
-Ortho
-Prostate surgery

28
Q

Minor Surgical Risks for Heart:
-<1%

A

-superficial case
-cataracts
-breast
-ambulatory surgery

29
Q

Effective preventative cardiac measures for surgery:

A

-Beta blockers (debatable)
-Statins
-Alpha2 blockers
-CABG if they desperately need it (4-5x)
-PAC (not common now)
-EPIDURAL ANESTHESIA
-normothermia intraoperatively!

30
Q

Afib/ A Flutter
-acute mgmt

A

-Rate control IV verapamil
-beta blocker or digoxin
-DC cardiovert

OR
-procainamide or amio

31
Q

Afib/ A flutter
-chronic tx

A

rate control
-verapamil
-diltiazem
-Bblocker
-digoxin
-amio
-sotalol

32
Q

Other supraventricular arrhythmia
-acute mgmt

A

-IV adenosine, verapamil, diltiazem
-esmolol, Bblocker, digoxin

-we won’t terminate this rhythm unless its pathway is thru the AV node, adenosine won’t be effective

33
Q

Other supraventricular arrhythmia
-chronic tx

A

Bblocker, verapamil, diltiazem, flecainide, amio, sotalol, dig

34
Q

Typically, for arrhythmia tx
-atria:
-vent:

A

A: CCB
V: Amio

35
Q

If pt develops acute, unexpected arrhythmia during case, what is our goal?

A

-Try to treat but focus on pt stabilization
-get thru case
-get to PACU
-CONSULT CARDS, let the experts handle it

36
Q

PVC or nonsustained VT
-acute mgmt

A

Asymptomatic=nothing

Symptomatic- BBlocker

37
Q

Sustained VT
-acute mgmt

A

Amio
-or procainamide/ Lidocaine

38
Q

Ventricular Fibrillation
-acute mgmt

A

Amio/ Defib
-lidocaine/procainamide
-prevent recurrence

39
Q

Cardiac Glycoside-induced VT (Dig-tox!)
-acute mgmt

A

Digoxin-immune Fab / Digibind

40
Q

Drug-induced Torsades
-acute mgmt

A

IV Mag sulfate
-pacing, isoprel, keep K ~4-5

41
Q

Bradycardia
-acute mgmt

A

Atropine

42
Q

Tachycardia
-acute mgmt

A

BBlocker

43
Q

Ok to give Adenosine during case?

A

No, not safe to “stop” heart
-just give Bblocker or CCB

44
Q

3 (4) pts to avoid BBlockers in:

A

-Diabetics (low BG + masks s/s)
-Asthmatics (bronchoconstriction)
-Claudication
-HB (duh)

45
Q

Why avoid adenosine in asthmatics?

A

in large doses can cause BSpasm

46
Q

Adenosine interact with

A

Methylxanthines (caffeine/ theophylline) - antagonize it

47
Q

Which beta blocker is ideal for asthmatics? (esmolol, labetalol, metoprolol)

A

Metoprolol
-B1 selective!

48
Q

Esmolol is metabolized by :

A

RBCs
-no renal/liver involvement

49
Q

Esmolol CI:

A

HF, severe brady, HB >1’, cardiogenic shock

50
Q

4 main drugs Esmolol interacts with:

A

-Digoxin (increase blood levels)
-Sux (prolongs)
-Warfarin
-Catecholamine depleting drugs

51
Q
A

Advanced Pharm 2 For NA (14 decks)

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