Rhythm Control

Question 1

Amiodarone dosage

Answer 1

AKA Cordarone

600-1200 mg QD for 1-2 wks, then taper to lowest possible dosage

200 mg QD for maintenance dosage

Question 2

Disopyramide dosage

Answer 2

AKA Norpace

400-800 mg per day in divided doses

Question 3

Dofetilide dosage

Answer 3

AKA Tikosyn

500 mcg PO q12 hrs at initiation of therapy, titrate downward based on QT response

Question 4

Flecainide dosage

Answer 4

AKA Tambocor

100-150 mg taken at onset of a fib

May also be taken BID for prevention of a fib

Question 5

Ibutilide

Answer 5

AKA Corvert

A one-time 1 mg dosage, may repeat once after 10 minutes if no response

Question 6

Procainamide

Answer 6

Up to 50 mg per kg per day in divided doses

Question 7

Propafenone

Answer 7

AKA Rythmol

225-425 mg PO q12 hours

Question 8

Quinidine

Answer 8

324-648 mg

1-2 tablets every 8-12 hrs

Question 9

Sotalol

Answer 9

AKA Betaspace

80-160 mg BID

Question 10

AE Cordarone

Answer 10

AKA Amiodarone

abnormal cardiac conduction, anaphylaxis, HF, pulmonary toxicity, ocular toxicity, thyroid abnormalities, hypersensitivity rxn, liver failure, lupus, thyromocytopenia, Stevens-Johnson Syndrome

Question 11

AE Norpace

Answer 11

AKA Disopyramide

torsades de pointes (uncommon and distinctive form of polymorphic ventricular tachycardia characterized by a gradual change in the amplitude and twisting of the QRS complexes around the isoelectric line), drug induced lupus, hepatotoxicity, hypoglycemia, HF

Question 12

AE Tikosyn

Answer 12

AKA Dofetilide

Prolonged QT interval and various proarrhythmias

Use is restricted to trained prescribers and facilities

In-hospital ECG monitoring required for at least 3 days

Question 13

AE Tambocor

Answer 13

AKA Flecainide

Various proarrhythmias, torsades de points

NOT recommended for pts with chronic a fib

Question 14

AE Corvert

Answer 14

AKA Ibutilide

Polymorphic ventricular tachycardia, hypotension, HA

Caution is needed in pots with QT elongation, hypokalemia, hypomagnesemia, bradycardia

Continuous ECG monitoring required for 4 hrs after last dosage

Question 15

AE Procainamide

Answer 15

Procainamide

agranulocytosis, aplastic anemia, coag disorder, arrhythmia, hepatotoxicity, drug-induced lupus

Question 16

AE Rythmol

Answer 16

AKA Propatenone

agranulocytosis, angina, chest pain, HF, atrioventricular shock, bradyarrhythmias, hypotension, palpitations, sinus arrest, drug-indced lupus, bronchospasm

Question 17

AE Quinidine

Answer 17

Quinidine

various proarrhythmias, tornadoes de pointes, hepatotoxicity, kidney dz, myelosuppression (bone marrow suppression), drug-induced lupus

Question 18

AE Betaspace

Answer 18

AKA Sotalol

torsades de pointes, various proarrhythmias, HF, bradycardia, heart block, asthma

Continuous ECG monitoring required for 3 days after initiation of therapy

Avoid in renal insufficient pts

Question 19

What anti-arrhythmic medications are preferred in pts with minimal or no heart disease and preserved LV systolic fxn?

Answer 19

Flecainide and propafenone

Question 20

What anti-arrhythmic medications are preferred in pts with HF?

Answer 20

Amiodarone and foretilide

Question 21

What pts use “pill-in-the-pocket” method and what meds are used for this?

Answer 21

Paroxysmal a fib

Flecainide or propafenone

Question 22

Guidelines for anticoag in cardioversion

Answer 22

3 weeks before and 4 weeks after cardioversion because thrombi may form as soon as 48 hrs after the onset of a fib