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PHRM 845 > Pathophysiology and Pharmacotherapy of Cardiac Arrhythmias > Flashcards

Pathophysiology and Pharmacotherapy of Cardiac Arrhythmias Flashcards

1
Q

Which antiarrhythmic agents could cause torsades de pointes?

A

Procainamide, flecainide, ibutilide, dofetilide, sotalol, amiodarone, dronedarone

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2
Q

Which antimicrobials could cause torsades de pointes?

A
  • Macrolides (azithromycin, clarithomycin, erthromycin)
  • Fluoroquinolones (levofloxacin, moxifloxacin, ciprofloxacin)
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3
Q

Which antidepressants could cause torsades de pointes?

A

Citalopram, escitalopram, clomipramine, desipramine, lithium, mirtazapine, venlafaxine

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4
Q

Which antipsychotics could cause torsades de pointes?

A

Chlorpromazine, haloperidol, pimozide, thioridazine, aripiprazole, clozapine, iloperidone, olanzapine, paloperidone, quetiapine, risperidone, sertindole, ziprasidone

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5
Q

Which anticancer drugs could cause torsades de pointes?

A

Arsenic trioxide, eribulin, vandetanib (and most drugs ending in -nib)

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6
Q

Which opioid could cause torsades de pointes?

A

Methadone

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7
Q

What are the types of supraventricular arrhythmias?

A
  • Sinus bradycardia
  • AV block
  • Sinus tachycardia
  • Afib
  • Supraventricular tachycardia
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8
Q

What are the types of ventricular arrhythmias?

A
  • Premature ventricular complexes (PVCs)
  • Ventricular tachycardia
  • Ventricular fibrillation
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9
Q

What is the general HR of sinus bradycardia?

A

<60 bpm

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10
Q

Where does sinus bradycardia impulses originate from?

A

SA node

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11
Q

What is the mechanism of sinus bradycardia?

A

Decreased automaticity of SA node

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12
Q

What are the risk factors of sinus bradycardia?

A
  • MI or ischemia
  • Abnormal sympathetic or parasympathetic tone
  • Idiopathic
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13
Q

What are the electrolyte abnormalities that are risk factors for sinus bradycardia?

A
  • Hyperkalemia
  • Hypermagnesemia
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14
Q

What are the drugs that are risk factors for sinus bradycardia?

A
  • Dig
  • BBs
  • Non-DHP CCBs
  • Amiodarone
  • Dronedarone
  • Ivabradine
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15
Q

What are the sxs of sinus bradycardia?

A
  • Hypotension
  • Dizziness
  • Syncope
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16
Q

What can happen if you go above max of 3 mg for atropine?

A

Could cause paradoxical response or tachycardia

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17
Q

What are the AEs of atropine?

A
  • Tachycardia
  • Urinary retention
  • Blurred vision
  • Dry mouth
  • Mydriasis
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18
Q

What are features ONLY of afib?

A
  • Rhythm is irregularly irregular
  • P waves are absent
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19
Q

What does irregularly irregular mean?

A

Interval between R waves are irregular and there are no distinct pattern in the irregularity

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20
Q

What is stage 1 afib?

A

Presence of modifiable and nonmodifiable risk factors associated w afib

21
Q

What is stage 2 afib?

A

Pre-atrial fibrillation
- Evidence of structural or electrical findings further predisposing a pt to afib (atrial enlargement, frequent atrial premature beats, atrial flutter)

22
Q

What is stage 3A afib?

A

Paroxysmal Afib
- Afib that is intermittent and terminates within <= 7 days of onset

23
Q

What is stage 3B afib?

A

Persistent afib
- Afib that is continuous and sustains >7 days and requires intervention

24
Q

What is stage 3C afib?

A

Long standing persistent afib
- Afib that is continuous for >12 months in duration

25
Q

What is stage 3D afib?

A

Successful afib ablation
- Freedom from afib after percutaneous or surgical intervention to eliminate afib

26
Q

What is stage 4 afib?

A

No further attempts at rhythm control after discussion between pt and clinician

27
Q

What is the mechanisms behind afib?

A
  • Abnormal atrial/ pulmonary vein automaticity
  • Atrial reentry
28
Q

What is the only social determinants of health for afib?

A

Socioeconomic status

29
Q

What are the etiologies of reversible afib?

A
  • Hyperthyroidism
  • Sepsis
  • Thoracic surgery (CAGB, lung resection, esophagectomy, valve replacement surgery)
30
Q

What is the tx plan if pt has reversible afib due to hyperthyroidism?

A

Don’t need to tx afib, tx hyperthyroidism and afib resolves on its own

31
Q

How much increase in risk is there for stroke/systemic embolism in pts w afib?

A

risk increased 5 fold

32
Q

How much increase in risk is there for heart failure in pts w afib?

A

risk increased 3 fold

33
Q

How much increase in risk is there for dementia in pts w afib?

A

risk increased 2 fold

34
Q

How much increase in risk is there for mortality in pts w afib?

A

risk increased 2 fold

35
Q

What are the goals of afib drug therapy?

A
  • Prevent thrombosis and embolism leading to stroke and systemic embolism
  • slow ventricular response by inhibiting conduction of impulses to ventricles
  • Convert afib to NSR
  • Maintain NSR
36
Q

What is the antidote for dabigatran?

A

Idarucizumab

37
Q

What is the antidote for rivaroxaban, apixaban, and edoxaban?

A

Andexanet alfa

38
Q

Are the DOACs all p-glycoprotein subrates?

A

Yes

39
Q

What are AEs of diltiazem?

A

Hypotension, bradycardia, HF exacerbation, AV block

40
Q

What are AEs of verapamil?

A

Hypotension, HF exacerbation, bradycardia, AV block, constipation (oral)

41
Q

What are AEs of BBs used in afib ventricular control?

A

Hypotension, bradycardia, AV block, HF exacerbation

42
Q

What are the AEs of digoxin?

A

Nausea, vomiting, anorexia, ventricular arrhythmias

43
Q

What are the AEs of amiodarone?

A

Hypotension (IV), bradycardia, blue grey skin, photosensitivity, corneal microdeposits, PULMONARY FIBROSIS, hepatotoxicity, hypo- or hyperthyroidism

44
Q

What is the dose of flecainide if <70 kg?

A

200 mg single oral dose

45
Q

What is the dose of flecainide if >70 kg?

A

300 mg single oral dose

46
Q

What is the dose of propafenone if <70 kg?

A

450 mg single oral dose

47
Q

What is the dose of propafenone if >70 kg?

A

600 mg single oral dose

48
Q
A

PHRM 845 (48 decks)

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