Pathophysiology and Pharmacotherapy of Cardiac Arrhythmias Flashcards
Which antiarrhythmic agents could cause torsades de pointes?
Procainamide, flecainide, ibutilide, dofetilide, sotalol, amiodarone, dronedarone
Which antimicrobials could cause torsades de pointes?
- Macrolides (azithromycin, clarithomycin, erthromycin)
- Fluoroquinolones (levofloxacin, moxifloxacin, ciprofloxacin)
Which antidepressants could cause torsades de pointes?
Citalopram, escitalopram, clomipramine, desipramine, lithium, mirtazapine, venlafaxine
Which antipsychotics could cause torsades de pointes?
Chlorpromazine, haloperidol, pimozide, thioridazine, aripiprazole, clozapine, iloperidone, olanzapine, paloperidone, quetiapine, risperidone, sertindole, ziprasidone
Which anticancer drugs could cause torsades de pointes?
Arsenic trioxide, eribulin, vandetanib (and most drugs ending in -nib)
Which opioid could cause torsades de pointes?
Methadone
What are the types of supraventricular arrhythmias?
- Sinus bradycardia
- AV block
- Sinus tachycardia
- Afib
- Supraventricular tachycardia
What are the types of ventricular arrhythmias?
- Premature ventricular complexes (PVCs)
- Ventricular tachycardia
- Ventricular fibrillation
What is the general HR of sinus bradycardia?
<60 bpm
Where does sinus bradycardia impulses originate from?
SA node
What is the mechanism of sinus bradycardia?
Decreased automaticity of SA node
What are the risk factors of sinus bradycardia?
- MI or ischemia
- Abnormal sympathetic or parasympathetic tone
- Idiopathic
What are the electrolyte abnormalities that are risk factors for sinus bradycardia?
- Hyperkalemia
- Hypermagnesemia
What are the drugs that are risk factors for sinus bradycardia?
- Dig
- BBs
- Non-DHP CCBs
- Amiodarone
- Dronedarone
- Ivabradine
What are the sxs of sinus bradycardia?
- Hypotension
- Dizziness
- Syncope
What can happen if you go above max of 3 mg for atropine?
Could cause paradoxical response or tachycardia
What are the AEs of atropine?
- Tachycardia
- Urinary retention
- Blurred vision
- Dry mouth
- Mydriasis
What are features ONLY of afib?
- Rhythm is irregularly irregular
- P waves are absent
What does irregularly irregular mean?
Interval between R waves are irregular and there are no distinct pattern in the irregularity
What is stage 1 afib?
Presence of modifiable and nonmodifiable risk factors associated w afib
What is stage 2 afib?
Pre-atrial fibrillation
- Evidence of structural or electrical findings further predisposing a pt to afib (atrial enlargement, frequent atrial premature beats, atrial flutter)
What is stage 3A afib?
Paroxysmal Afib
- Afib that is intermittent and terminates within <= 7 days of onset
What is stage 3B afib?
Persistent afib
- Afib that is continuous and sustains >7 days and requires intervention
What is stage 3C afib?
Long standing persistent afib
- Afib that is continuous for >12 months in duration
What is stage 3D afib?
Successful afib ablation
- Freedom from afib after percutaneous or surgical intervention to eliminate afib
What is stage 4 afib?
No further attempts at rhythm control after discussion between pt and clinician
What is the mechanisms behind afib?
- Abnormal atrial/ pulmonary vein automaticity
- Atrial reentry
What is the only social determinants of health for afib?
Socioeconomic status
What are the etiologies of reversible afib?
- Hyperthyroidism
- Sepsis
- Thoracic surgery (CAGB, lung resection, esophagectomy, valve replacement surgery)
What is the tx plan if pt has reversible afib due to hyperthyroidism?
Don’t need to tx afib, tx hyperthyroidism and afib resolves on its own
How much increase in risk is there for stroke/systemic embolism in pts w afib?
risk increased 5 fold
How much increase in risk is there for heart failure in pts w afib?
risk increased 3 fold
How much increase in risk is there for dementia in pts w afib?
risk increased 2 fold
How much increase in risk is there for mortality in pts w afib?
risk increased 2 fold
What are the goals of afib drug therapy?
- 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
What is the antidote for dabigatran?
Idarucizumab
What is the antidote for rivaroxaban, apixaban, and edoxaban?
Andexanet alfa
Are the DOACs all p-glycoprotein subrates?
Yes
What are AEs of diltiazem?
Hypotension, bradycardia, HF exacerbation, AV block
What are AEs of verapamil?
Hypotension, HF exacerbation, bradycardia, AV block, constipation (oral)
What are AEs of BBs used in afib ventricular control?
Hypotension, bradycardia, AV block, HF exacerbation
What are the AEs of digoxin?
Nausea, vomiting, anorexia, ventricular arrhythmias
What are the AEs of amiodarone?
Hypotension (IV), bradycardia, blue grey skin, photosensitivity, corneal microdeposits, PULMONARY FIBROSIS, hepatotoxicity, hypo- or hyperthyroidism
What is the dose of flecainide if <70 kg?
200 mg single oral dose
What is the dose of flecainide if >70 kg?
300 mg single oral dose
What is the dose of propafenone if <70 kg?
450 mg single oral dose
What is the dose of propafenone if >70 kg?
600 mg single oral dose
