1Arrhythmias that originate in the SA node, atrial myocardium, or AV node is called?
supraventricular arrhythmias
2What are the 4 tachyarrhythmias?
supraventricular
Afib
A flutter
Sinus tachycardia
3What are the 4 ventricular arryhthymias?
premature ventricular beats
ventricular tachycardia
torsade de pointe
ventricular fibrillation
4What is the most common sustained arrhythmia?
atrial fibrillation
5Which five medications are used for rate control for A-fib?
Beta blockers
Nondihydropyridine CCB
amiodorone
digoxin
antiarryhthmics
6What are the two first line therapies for A-fib?
beta blockers
nondihydropyridine CCB
7When should you avoid beta blockers patients with Afib?
if they have COPD?
8When should you avoid nondihydropyridine CCB in patients with afib?
patients with decompensated heart failure
9What is the second line treatment for A-fib? When is it preffered?
Digoxin for patients with decompensated HF and beta blockers are contraindicated
10What is third line treatment for Afib?
amiodorone
11What are the indicators for AV node ablation and implantation of a permanent ventricular pacemaker?
recurrent Afib
Afib refractory to medical rate control
patient does not tolerate pharmacological options
12Aside from rate control what else are you looking to managed in patients with Afib?
anticoagulation
13What is the MOA for digoxin?
it inhibits Na+/K+-ATPase, increasing cardiac contractility and decreasing AV conduction and HR
14How is digoxin eliminated?
through the kidneys
15What are the indications for digoxin?
Congestive HF
Afib
SVT
16What are some AE for digoxin?
N/V/D
visual distubances- xanthopsia, photophobia, blurry vision with a yellow tin and halos
17What are some CIs for digoxin?
ventricular fibrillation, pregnancy
18What are some DDIs for digoxin?
K+ depleteing diuretics - lead to arrhythmias
verapamil/diltiazem, amiodorone, quinidine-possible overdose
19What is the primary MOA for amiodarone?
bloackage of voltage gateed potassium channels--> prolonged repolarization of the cardiac action potential
20What is the secondary MOA for amiodorone?
inhibits beta receptors, sodium and calcium channels --> decreases conduction through the AV and sinus node
21Arrhythmias that originate in the SA node, atrial myocardium, or AV node is called?
supraventricular arrhythmias
22Acute treatment is administered via ____
IV
23What is acute amiodorone used to treat?
persistent Vtach after defibrillation
pulseless ventricular fibrillation
SVT in patients with cardiac failure
second line for patients with vtach who are hemodynamically stable
24Amiodorone can accumulate in the ___
thyroid
lungs
nerves
skin
eyes
heart
25What are some CI of amiodorone?
sinus node dysfunction
2nd/3rd degree heart block
preexisting lungdx
hypo/hyperthyroidism
26What drugs are used to manage SVT?
adenosine
diltiazem
verapamil
BB
amiodarone
27Type of SVT resulting in AVRT, characterized by "pre-excitation over the accessory pathway competes with conduction through the AV node
Wolff-Parkinson-White
28What drugs should be avoided with WPW?
adenosine, BB, diltiazem, verapamil, digoxin and amiodorone
29What is the long term management for WPW?
catheter ablation
30What drugs are preffered with WPW?
IV procainamide or ibutilide
31What are some AE or amiodarone?
AV block
blue-grey skin discoloration
bradycardia
corneal microdeposits
hepatotoxicity
hyper/hypothyroidism
photosensitivity
pulmonary fibrosis
32What should be monitored with amiodorone?
LFTs
TFTs
SCR and electrolytes
chest x ray
ECG
ophthalmologic exam
PFTs (baseline and only for unexplained dyspnea)
33What are some AE of dofetilide?
QT interval prolongation
Torsades de pointes
34What should be monitored with dofetilide?
continuous ECG monitoring during the 1st 3 days of dosing while hospitalized
ECG
SCr
35What are some DDIs with dofetilide?
cimetidine
HCTZ
ketoconazole
megestrol
trimethoprim
verapamil
36What are some AEs of dronedarone?
bradycardia
diarrhea
nausea
hepatotoxicity
pulmonary fibrosis
worsening HF
37What should be monitored with dronedarone?
LFTs
ECG
SCr
38What are some AEs of sotalol?
beta blocking effects
QT interval prolongation
torsades de pointes
39What is recommended to be monitored with sotalol?
continuous ECG monitoring during 1st 3 days of dosing
ECG
SCr
40Which two mediations need to be monitored with ECG for the first 3 days of dosing?
sotalol
dofetilide
41When are class 1C antiarrhythmics CI?
after MI
42Propafenone DDI?
digoxin- increases concentrations
43What are the AE associated with Flecainide?
blurred vision
dizziness
HF excacerbation
QRS prolongation
ventricular arrythmias
44What is a DDI with flecainide?
amiodorone
45What are the antiarrhythmic drugs?
Class 1A
Class 1B
Class II
Class III
Class IV
46What is the MOA for Class 1A antiarrhythmic drugs?
moderate blockage of Na+ channels causing a prolong action potential and prolonged refractory period in ventricular APs
47What are some examples of Class 1A antiarrhythmics?
quinidine
procainamide
disopyramide
48What are class 1A antiarrhythmics used for?
PSVT
Ectopic SVTs
Ventricular arrhythmias
Antidromic AVRT and WPW
atrial fibrillation and atrial flutter
49What are some AE for Class 1A antiarrhythmics?
torsade de points
h/a
hearing/vision loss
tinnitus
psychosis and cognitive impairment
thrombocytopenia
50What are some AE associated with procainamide?
drug induced lupus erythematous
drug fever
51What are some AE associated with disopyramide?
HF
anticholinergic effects
52What is the MOA for Class 1B antiarrhythmics?
weak blockage of sodium channels causing:
shorten AP duration
slow conduction velocity
no effect or slight prolongation of ERP
53What are some examples of class 1B antiarrhythmics?
lidocaine
mexiletine
54What are class 1B antiarrhythmics used for?
ventricular arrhythmias
digitalis-induced cardiac arrhythmias
55Where is the class 1Bs strongest effect
ischemic or depolarized cardiac purkinje cells and ventricular myocardiam
56What are some AE of class 1B antiarrhythmics?
CNS: possible depression or excitation
dizziness
nausea
seizures
AV conduction block
ventricular extrasystoles
57What is the MOA of class 1C antiarrhythmics?
Strong blockage of sodium channels causes:
QRS prolongation
no/minimal effect on AP duration
slow conduction velocity
extended duration of effective refractory period in both AV node and accessory tracts
58What are some examples of class 1C antiarrhythmics?
flecainide
propafenone
59What are some uses for class 1C antiarrhythmics?
PSVT
AFib
Atrial flutter
last resort in refractory VT
60What are some AE of class 1C antiarrhythmics?
proarrhythmogenic
possible QT prolongation
61When are class 1C antiarrhythmics CI?
after MI