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PHRM 845 > Tisdale > Flashcards

Tisdale Flashcards

1
Q

P-R interval represents

A

conduction time through AV node

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2
Q

P wave represents

A

atrial depolarization

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3
Q

QT interval represents

A

ventricular repolarization

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4
Q

QRS represents

A

ventricular depolarization

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5
Q

how to calculate HR from ecg

A

300/number large big squares in R-R interval

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6
Q

big box is how long

A

0.2 sec

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7
Q

little box is how long

A

0.04 seconds

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8
Q

QTC interval higher in what gender

A

women

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9
Q

if QTC higher than what, risk of Torsad

A

500 ms or 0.5 sec

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10
Q

what is torsades de pointes

A

causes sudden cardiac death
ECG up and down like crazy
(twisting of the points)

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11
Q

drug classes that may cause torsades

A

antiarryhtmic
anti microbials (macrolides and fluroquinolones, -cin)
antidepressants (citaloprams, pramines, lithium, mirtazapine, venlafaxine
antipsychotics (peridol, idone, azapine)
anticancer (nibs)
methadone

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12
Q

types of supraventricular arrythmias

A

sinus bradycardia
sinus tachycardia
atrial fibrillation
AV block
supraventricular tachycardia

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13
Q

types of ventricular arrythmias

A

ventricular fibrillation
ventricular tachycardia
prematrue ventricular complexes (PVCs)

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14
Q

what is sinus bradycardia and where does it occur?

A

HR < 60 bpm, impulses from SA node

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15
Q

sinus bradycardia MOA

A

decreased automaticity of SA node

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16
Q

risk factors sinus bradycardia

A

prior MI/ischemia
abnormal sympathetic/parasympathetic tone
hyperkalemia or hypermagnesia

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17
Q

drugs that could cause sinus bradycardia

A

beta blockers
verap and dilt
digoxin
amiodarone!!!
dronedarone
ivabradine

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18
Q

symptoms of sinus bradycardia

A

hypotension
dizzy/faint

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19
Q

treatment for sinus bradycardia

A

only if symptomatic
atropine 0.5-1 mg IV every 5 mins max: 3 mg

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20
Q

second line sinus bradycardia

A

transcutaneous pacing
dopamine
epinephrine
isoproterenol

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21
Q

adverse effects of atropine

A

tachycardia, urinary retention, blurred vision, dry mouth, mydriasis

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22
Q

how to treat bradycardia following a heart transplant or spinal cord injury?

A

theophylline, aminophylline

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23
Q

long term treatment sinus bradycardia

A

permanent pacemaker
theophylline

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24
Q

afib atrial activity

A

chaotic and disorganized

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25
Q

ventricular rate afib

A

120-180 bpm

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26
Q

egc rhythm afib

A

irregularly irregular
no p waves

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27
Q

stage 1 afib

A

modifiable and non-modifyable risk factors

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28
Q

stage 2 afib

A

pre-afib
- atrial flutter
- atrial enlargement
- atrial premature beats

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29
Q

stage 3 afib

A

A: paroxysmal: lasts 7 or fewer days
B: persistent: lasts more than 7 days
C: long standing persistent: lasts more than 12 months
D: permanent: no further attempts at controlling

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30
Q

afib automaticity and mechanism

A

abnormal atrial and pulmonary vein automaticity
atrial re-entry

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31
Q

reversible afib etiologies

A

hyperthyroidism
sepsis
thoracic surgeries

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32
Q

increased morbidity and mortality conditions in pts with afib (4)

A

mortality
stroke / systemic embolism - huge risk
dementia
heart failure

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33
Q

afib treatment goals

A

prevent embolism
slow vent response ( ventricular rate control)
return to sinus rhythm
maintain sinus rhythm

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34
Q

CHADSVASC score

A

C - congestive HF
H - HTN
A - age 75+ (2)
D - diabetes
S - stroke/TIA (2)
V - vasc disease (PAD, MI hx, aortic plaque)
A - age 65-74
S - female

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35
Q

what CHADSVASC score should we give anticoags to for males and females?

A

1 in males
2 in females

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36
Q

when is warfarin preferred, and goal INRs

A

mechanical heart valve (2.5-3.5)
mitral valve stenosis (2-3)

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37
Q

warfarin or apixaban is preferred in who?

A

end stage CKD (CrCl < 15)
dialysis pts

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38
Q

which anticoag not reccomended for CrCl > 95

A

edoxaban

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39
Q

antidote for dabigatran

A

idaricizumab

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40
Q

antidote for apixaban, rivaroxaban, and edoxaban

A

andexanent alpha

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41
Q

apixaban special considerations

A

2.5 mg daily if:
SCr > 1.5
80+ years old
<60 kgs

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42
Q

apixaban and rivaroxaban are contraindicated with what drugs

A

strong CYPs: rifampin and phenytoin

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43
Q

drugs for ventricular rate control

A

verapamil
diltiazem
beta blockers: esmolol, propranolol, metoprolol
digoxin
amiodarone

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44
Q

amiodarone side effects

A

blue gray skin
photosensitivity
corneal microdeposits
pulmonary fibrosis
hepatotox
thyroid
hypotension
bradycardia

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45
Q

acute ventricular rate control afib treatment

A

if hemo unstable: DCC
if decomp HF: amiodarone
if stable and no decomp HF: beta, verap, dilt then dig then amio

46
Q

hemodynamically unstable

A

SBP 90 or less
HR 150 or higher
lost conscious
ischemic chest pain

47
Q

goal HR for pts after drug

A

<100-110 bpm and asymptomatic

48
Q

patients with decompensated HF should not get

A

verapamil or diltiazem

49
Q

long term ventricular rate control afib treatment

A

HFrEF (<=40%): beta blockers then dig
no HFrEF (>40%): verap, dilt, beta then dig

50
Q

pts with HFrEF should not get

A

verapamil or diltiazem

51
Q

when can we convert to sinus rhythm for afib?

A

if hemodynamically stable
- afib 48 hours or less
-afib greater than 48 hours need anticoag x 3 weeks or TEE to rule out a clot in atrium

52
Q

drugs for conversion to sinus rhythm afib

A

DCC
amiodarone
ibutilide
procainamide
flecainide
propafenone

53
Q

conversion to sinus rhythm afib drugs with risk of torsades de pointes

A

amiodarone (QT)
ibutilide
procainamide (QT)

54
Q

which drugs to not use together, conversion to sinus rhythm afib

A

amiodarone and ibutilitde should not be used with procainamide

55
Q

conversion to sinus rhythm afib treatment

A

must be hemodynamically stable
normal LV function: IV amio or ibutilide, or procainamide
HFrEF: IV amiodarone
not in hospital: flecainide or propafenone

56
Q

drugs for maintenance of sinus rhythm afrib

A

amiodarone
dofetilide
dronedarone
flecainide
propafenone

57
Q

what drugs is dofetilide contraindicated with?

A

verapamil, cimetidine, thiazide diuretics, ketoconazole, trimethoprim

58
Q

dronedarone side effects

A

diarrhea
nausea
rash
NO THYROID/PULM FIBROSIS

59
Q

dofetilide renal dosing

A

CrCl > 60: 500 mcg BID
CrCl 40-60: 250 mcg BID
CrCl 20-39: 125 mcg BID
CrCl < 20: contraindicated

60
Q

amiodarone monitoring

A

thyroid tests every 6 months
LFTs every 6 months
ECG annually
chest x ray for pulm fibrosis
derm
eye doc

61
Q

continuation of sinus rhythm afib treatments

A

normal LV function: dofetilide, dronedarone, flecainide, propafenone THEN amiodarone THEN sotalol
prior MI, HFrEF, struct disease: dofetilide, dronedarone, amiodarone THEN sotalol
- if decomp HF recently or NY III: no dronedarone

62
Q

patients with history MI, structural heart disease, or HFrEF should not get what drug for afib maintain sinus rhythm

A

flecainide or propofenone

63
Q

patients with NYHA III or decomp HF recently should not get what drug in afib

A

dronedarone

64
Q

patients starting dofetilide or sotalol must do what

A

be in hospital for 3 days during initiation for continuous ECG monitoring

65
Q

what to do after dofetilide first dose

A

after 2-3 hours post dose, check QTC interval
- if 15% increase or less keep dose
- if > 15% increase or 500 ms half dose

66
Q

what to do dofetilide second dose

A

check qtc and if over 500 we stop

67
Q

what qtc interval must patient have to start dofetilide

A

440 ms or less

68
Q

what qtc interval must patient have to start sotalol

A

450 ms or less

69
Q

sotalol dosing renal

A

CrCl > 60 : 80 mg BID
CrCl 40-60: 80 mg daily
CrCl < 40: CI

70
Q

supraventricular tachycardia rhythm and HR

A

regular rhythm
110-250 bpm

71
Q

paroxysmal SVT

A

intermittent episodes, lasts minutes to hours

72
Q

supraventricular tachycardia mechanism

A

re-entry through AV node

73
Q

risk factors supraventricular tachycardia

A

women
older
no history cardiovascular cond

74
Q

key symptom supraventricular tachycardia

A

neck pounding

75
Q

drugs for supraventricular tachycardia

A

adenosine
beta blockers: esmolol, propranolol, metoprolol
verapamil
diltiazem

76
Q

adenosine dosing

A

6 mg IV, 1-2 mins later 12 mg, then 12 mg

77
Q

which drugs for supraventricular tachycardia should not be used for pts with heart failure

A

verapamil or diltiazem

78
Q

supraventricular tachycardia termination of SVT treatment

A

IV adenosine
then beta block, verap, or dilt
then DCC

79
Q

SVT treatment for prevention

A

only if symptomatic
1st - catheter ablation
no HFrEF: beta block, verap, dilt THEN flecainide or propafenone
HFrEF: amiodarone, dofetilide, digoxin, sotalol
(no flec or prop with CAD)

80
Q

which drugs for SVT are contraindicated in CAD

A

flecainide and propafenone

81
Q

PVC on ECG characteristic

A

wide QRS, upside down
normal sinus rhythm

82
Q

bigeminy
trigeminy

A

every 2nd or 3rd beat is a PVC

83
Q

frequent PVCs defined as

A

> 30 per hour
one on a 12 lead ECG

84
Q

mechanism of PVCs

A

increased automaticity of ventricular muscle cells/Purkinje fibers

85
Q

is there re-entry in PVCs

86
Q

symptoms of PVCs

A

usually asymptomatic
-palpatations
-dizziness
-light headedness

87
Q

very frequent PVC definition and risk

A

> 10,000 per day
risk cardiomyopathy

88
Q

PVCs associated with increased mortality in what disease group

89
Q

PVCs associated with sudden cardiac death risk for who

A

MI hx, frequent PVCs

90
Q

treatment of PVCs

A

asymptomatic = none
no HF = beta block, dilt, verap
HF = beta block
unresponsive = antiarrhythmic or catheter ablation

91
Q

ventricular tachycardia rhythm

A

regular (100-250 bpm)

92
Q

ventricular tachycardia ECG pattern

A

wide QRS, >3 consecutive PVCs at rate of >100 bpm

93
Q

nonsustained vent tachycardia def

A

three or more consecutive PVCs that terminate spontaneously

94
Q

sustained VT definition

A

VT lasting greater than 30 seconds or requiring termination because of hemodynamic stability < 30 seconds

95
Q

sustained monomorphic VT

A

idiopathic ventricular tachycardia, verapamily sensistive, pts with no structural heart disease

96
Q

mechanism of ventricular tachycardia

A

increased automaticity in ventricular tissue

97
Q

is there re-entry in ventricular tachycardia

A

yes, in ventricles

98
Q

drugs that could cause v tach

A

digoxin
flecainide
propofenone

99
Q

which two antiarrythmics should not be given to pts with CAD history

A

flecainide and propofenone

100
Q

electrolyte risk factors for getting v tach

A

hypokalemia and hypomagnesia

101
Q

what is outflow track VT

A

VT occurring in the right or left ventricle outflow tract

102
Q

ventricular tachycardia drugs for termination of VT

A

procainamide
amiodarone
sotalol
verapamil
beta blockers

103
Q

treatment for termination of hemodynamically stable VT

A

structural heart disease: DCC, IV procainamide, IV amiodarone or sotalol
no structual heart disease: verapamil or beta blocker (outflow = beta)

104
Q

if med given for VT and didn’t work what should we do

105
Q

what is an ICD

A

implantable cardioverter defibrillator

106
Q

drugs / prevention of recurring VT or sudden cardiac death

A

ICD
amiodarone
sotalol
catheter ablation

107
Q

what does ventricular fibrillation look like

A

irregular disorganized chaotic electrical activity
no QRS complexes

108
Q

ventricullar fibrillation treatment

A

CPR
defib shock
epinephrine 1 mg
defib shock
amiodarone 300 mg / lidocaine 1-1.5 mg/kg
defib shock
epi
defib shock

109
Q

epinephrine given every ____ in v fib

PHRM 845 (38 decks)

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