Duke PA pharm antiarrhythmics
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| Amiodarone (Pacerone, Cordarone) | Considered class III but has properties of all three classes
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| Digoxin (Lanoxin) | Inhibits the sodium potassium ATPase pump
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| A system of classifying antiarrhythmic medications based on simplified electrophysiologic actions | Vaughan-Williams
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| Procainamide (Procan SR, Procanabid) | Type IA
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| Modulation/blockade of sodium channels | Type I antiarrhythmics
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| The class that exhibits slow conduction velocity and prolongs action potential duration | Type IA
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| Quinidine (Quinidex) | Type IA
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| Disopyramide (Norpace) | Type IA
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| Lidocaine (Xylocaine) | Type IB
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| Mexiletine | Type IB
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| Class that has no effect on conduction velocity, May shorten action potential duration | Type IB
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| Flecainide (Tambocor) | Type IC
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| Propafenone (Rhythmol) | Type IC
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| Moricizine | Type IC
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| Slows coduction velocity and may prolong action potential duration (mildly) | Type IC
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| Mexiletine | Oral analog of Lidocaine
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| Lidocaine | unlike other class I antiarrhytmics it can be used in patients with active ischemia
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| Beta blockers | Type II
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| Beta blockers | Inhibit phase IV (depolarizing current) and prolong repolarization
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| Beta blockers | decrease sympathetic stimulation of myocardium
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| Beta blockers | slow the sinus rate
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| Amiodarone (Pacerone, Cordarone) | Type III
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| Sotalol (Betapace) | Type III
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| Dofetilide (Iikosyn) | Type III
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| Ibutilide | Type III
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| Blockade of potassium channel | Type III
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| Prolongation of action potential plateau, repolarization, and refractor period | Type III
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| Verapamil | Type IV
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| Diltiazem | Type IV
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| Calcium channel blockers | Type IV
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| Blockade of calcium channel | Type IV
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| slows conduction velocity through AV node and prolongs refractory period | Type IV
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| Sets of the initial depolarization | Phase IV
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| Does not increase mortality in high risk patients-has a higer safety level than the other classes | Type III
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| Ibutilide | IV administration only -one time use for conversion-no long term treatment
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| Anticipated ECG change for this type is prolongation of the QT interval | Type IA
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| Usually no ECG changes in therapeutic doses | Type IB
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| Anticipated ECG changes for this type is prolongation of the PR and QRS intervals | Type IC
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| Anticipated ECG change for this type is prolongation of the QT interval | Type III
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| This type is used for atrial and ventricular tachyarrhythmias | Type IA
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| This type is used for ventricular arrhythmias | Type IB
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| This type is used for atrial and ventricular arrhythmias | Type IC
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| Procainamide (Procan SR, Procanabid) | Used for WPW
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| This type is used for atrial and ventricular arrhythmias | Type II
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| This type is used for atrial and ventricular arrhythmias | Type III
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| This type is used for atrial arrhthmias | Type IV
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| Procainamide (Procan SR, Procanabid) | SE-lupus like syndrome, torsades
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| Disopyramide (Norpace) | SE-anticholinergic symptoms, heart failure, torsades (QT prolongation)
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| Lidocaine (Xylocaine) | SE-seizures, CNS
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| Amiodarone (Pacerone, Cordarone) | SE-many toxic side effects (Pulmonary fibrosis, hypo/hyperthyroidism, photophobia, liver toxicity, blue staining of skin.
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| Amiodarone (Pacerone, Cordarone) | Has a very large volume of distribution
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| Amiodarone (Pacerone, Cordarone) | Has a half life of 15-180 days
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| Amiodarone (Pacerone, Cordarone) | If patient is on Warfarin at the time of prescription, cut the Warfarin dose by 30-50%
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| Procainamide (Procan SR, Procanabid) | Used for hemodynamically stable VT
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| Procainamide (Procan SR, Procanabid) | Limited role in a-fib/a-flutter
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| Quinidine (Quinidex) | SE-include chinchonism, hypotension, torsades, hemolytic anemia
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| Quinidine (Quinidex) | Use with digoxin leads to increased digoxin concentration
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| Disopyramide (Norpace) | Indicated for conversion/maintenance of sinus rhythm in patients with a-fib/a-flutter
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| Lidocaine (Xylocaine) | Used for management of VT or pulseless VT/Vfib
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| Lidocaine (Xylocaine) | Dose determined by liver function
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| Flecainide (Tambocor) | used in a-fib/a-flutter for maintenance of sinus rhythm
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| Flecainide (Tambocor) | Avoid in patients with structural heart disease or history of CAD
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| Propafenone (Rhythmol) | Indicated for conversion/maintenance of sinus rhythm in patients with a-fib/a-flutter
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| Dofetilide (Tikosyn) | Indicated for conversion/maintenance of sinus rhythm in patients with a-fib/a-flutter
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| Dofetilide (Tikosyn) | Starting dose based on estimated creatinine clearance. Contraindicated in patients with CrCl <20 ml/min.
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| Sotalol (Betapace) | used in a-fib/a-flutter for maintenance of sinus rhythm
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| Stroke risk index based on a point system, integrating risk based on various co-morbidities | CHADS2
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| The C in CHADS2 stands for | Cardiac failure (one point)
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| The H in CHADS2 stands for | Hypertension (one point)
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| The A in CHADS2 stands for | Age >75 years (one point)
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| The D in CHADS2 stands for | Diabetes (one point)
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| The S2 in CHADS2 stands for | Sroke or TIA (you get 2 points for this one)
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| CHADS2 score of 0-1 | Low risk-treat with full dose asa
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| CHADS2 score of 2 and above | High risk-treat with Warfarin
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| Most common arrhythmia | A-fib
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| Characterized by rapid and disorganized atrial activation with ventricular responses of 120-180 bpm | A-fib
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| A-fib management in the hemodynamically stable patient | Ventricular rate control with beta blocker, calcium channel blocker, or digoxin
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| A-fib management in the hemodynamically stable patient | Anticoagulation therapy
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| A-fib management in the hemodynamically unstable patient | Cardioversion
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| When a-fib is symptomatic, recurrent and failed response of greater than or equal to 1 AAD plus rate contrel | consider ablation
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| Beta blockers | safe and effective treatment for Ventricular Premature Beat suppression
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| Lidocaine (Xylocaine) | Sustained monomorphic V-tach with LVEF <40% and expected ischemia/MI
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