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Pharmacology > Week 2: Arrythmias > Flashcards

Week 2: Arrythmias Flashcards

1
Q

What is the classification of anti arrhythmic drugs called?

A

Vaughan Williams

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2
Q

What are the class I drugs MOA?

A

block sodium channels

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3
Q

What are the Ia drugs of class I?

A

quinidine
procainamide
disopyramide
increase AP

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4
Q

What are the Ib medications?

A

lidocaine
mexiletine
decrease AP

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5
Q

What are Ic medications?

A

flecainide, propafenone

slows conduction velocity

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6
Q

What are the class II drugs?

A

beta-adrenoceptor antagonists

atenolol, sotalol

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7
Q

What are the class III drugs?

A

prolong action potential and prolong refractory period(suppress re-entrant rhythms)
amiodarone sotalol dofetiliden ibutilide

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8
Q

What are the class IV medications?

A

calcium channel antagonists
impair impulse propagation in SA & AV nodes
verapamil, diltiazem

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9
Q

What are the major problems with afib? (3)

A 
atrial thrombi
right atrium (pulmonary emboli)
left atrium (cerebral emboli & stroke)
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10
Q

What is the stroke risk of patients with a fib compared to those without?

A

2x greater than in patients without a fib

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11
Q

What percentage of patients that would benefit from prophylactic anticoagulation therapy receive treatment?

A

only 15-44%

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12
Q

What should be done if a pt is not compromised and greater than 48 hours or do not know how long pt has been in a fib?

A

rate control and anticoagulation

conversion to SR might dislodge a thrombus

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13
Q

What is the safest of all the antiarrythmics?

A

amiodarone (Cordarone)

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14
Q

What is the loading dose of amiodarone (Cordarone)

A

150mg IV loading dose

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15
Q

Can you give amiodarone if the pt has an iodine allergy?

A

yes

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16
Q

What are the side effects of amiodarone?

A 
hypothyroid
hyperthyroid
pulmonary fibrosis
lenticular opacities
blue skin discoloration
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17
Q

What is the rate of conversion of amiodarone?

A

about 60%

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18
Q

When is dronedarone (Maltaq) used?

A

for a fib/flutter who have converted

NO iodine to limit toxicity

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19
Q

What medication is contraindicated in NYHA class IV HF or NYHA class II-III with recent decompensation (increased HF deaths in clinical trials)?

A

dronedarone (Maltaq)

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20
Q

What is the MOA of sotalol (Betapace)?

A

blockers beta 1 and beta 2 receptors

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21
Q

When is sotalol (beta pace) mainly given?

A

usually used to maintain SR after conversion

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22
Q

When is sotalol contraindicated?

A

for a fib for CrCl <40mL/min

need to adjustment dose for impairment

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23
Q

When should sotalol dose be individualized?

A

In ventricular arrhythmias with CrCl <10

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24
Q

What is propafenone (Rhythmol) indicated for?

A

atrial fibrillation/flutter

25
Q

How is diltiazem (cardizem) given?

A

IV and PO

26
Q

What is the MOA of diltiazem (cardizem)?

A

calcium channel blocker

27
Q

What form of diltiazem should be given PO?

A

use only the CD form

cardizem CD

28
Q

What are the beta blockers that control rate?

A

metoprolol (lopressor)

carvedilol (coreg)

29
Q

What is significant about Digoxin? (3)

A

works better in patients with an EF <40%
also in patients with a low BP
positive inotrope (increases force of myocardial contraction)

30
Q

What is digoxin dosed?

A

in micrograms (mcg)

31
Q

What is the half life of digoxin?

A

long (adults 36-48 hours)

32
Q

What is the digoxin loading dose for a fib? (IVP)

A

500 mcg IVP x1; then 250mcg every 6 hours x 2 doses

33
Q

What is the digoxin loading dose for a fib? (PO)

A

0.5mg once daily x 2 days

34
Q

What is the Total Dizitizing Dose (TDD) of digoxin for supra ventricular tachycardia?

A

10-15mcg/kg

35
Q

What are the risk factors listed on the CHADS2 index?

A 
CHF, recent
HTN
AGE >75
DM
Stroke (h/o TIA) 2 points
36
Q

What should be considered a primary approach for patients with atrial fibrillation and CHF?

A

rate control

37
Q

What eliminated the need for repeated cardio version and reduced rates of hospitalization?

A

rate-control strategy

38
Q

___ control provided no advantage in mortality.

A

Rhythm

39
Q

Avoidance of ______ drugs is desirable.

A

anti arrhythmic

40
Q

When can rhythm control be abandoned?

A

can be abandoned early if not fully satisfactory

41
Q

What is significant about pharmacological conversion of AF? (4)

A

simpler but less efficacious
major risk is toxicity of anti arrhythmic drugs
most effective if performed less than 7 days of developing AF
much less effective if AF onset greater than 7 days

42
Q

When does Electrical vs drug conversion both carry a similar risk of thromboembolism ?

A

if AF greater than 48 hours

43
Q

What are the drugs for AF conversion (less than 7 days) that have proven efficacy? (3)

A

Amiodarone (iv/po)
ibutilide (iv only)
Dofetilide (po only)

44
Q

What are the drugs for AF conversion (greater than 7 days) that have proven efficacy? (3)

A

amiodarone (IV/po)
ibutilide (iv only)
Dofetilide (po only)

45
Q

What is the most prevalent cardiac arrhythmia?

A

atrial fib

46
Q

A fib is associated with ______ increase in stroke.

A

> 5 times increase

47
Q

Anticoagulation with ____ has consistency been shown to reduce ischemic stroke risk compared with placebo.

A

warfarin

48
Q

Intracranial hemorrhage risk is dependent on what? (2)

A

age

INR dependent

49
Q

What is ventricular tachycardia (VT) often precipitated by?

A

electrolyte disturbances (esp severe hypokalemia)
hypoxemia
digitalis toxicity
during acute MI or ischemia (most common)

50
Q

What is the drug of choice for ventricular arrhythmias?

A

amiodarone 300mg IV load

51
Q

What is a complication of the other antiarrythmics used to treat v-tach?

A

all cause ventricular arrhythmias

all are potentially dangerous to use

52
Q

What anti arrhythmic; diagnostic agent has a very short half life- seconds?

A

adenosine (adenocard)

53
Q

What is the MOA of adenosine (adenocard)?

A

slows conduction thru AV node, interrupting re-entrant pathways, restoring sinus rhythm (SR)

54
Q

What are possible complications of adenosine (adenocard)?

A

may cause prolonged sinus pauses

rarely prolonged systole (very rarely death)

55
Q

When is adenosine (adenocard) used?

A

IT DOES NOT convert AF/flutter to SR, but used diagnostically if underlying rhythm is not apparent

56
Q

How is adenosine (adenocard) given?

A

IVP over 1-2 seconds via a peripheral line
each bolus followed with 20mL NS
administer as close to the trunk as possible

57
Q

Where SHOULDN’T adenosine (adenocard) be given?

A

do not use hand or lower arm or lower extremity

58
Q

When is adenosine (adenocard) contraindicated?

A 
2nd or 3rd degree heart block
sick sinus syndrome
symptomatic bradycardia (except with functioning PM)
AF/flutter with underlying WPW syndrome
asthma

Pharmacology (17 decks)

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