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