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RxPrep
Afib/Arrhythmias (Ch 32)
| Question | Answer |
|---|---|
| What is the mechanism of digoxin? | Inhibits Na-K ATPase → ↑ inotropy and ↑ vagal tone → slows AV node conduction |
| What is digoxin therapeutic range for AF? | 0.8–2 ng/mL |
| When should digoxin level be drawn? | 12–24 hours after dose |
| What electrolyte abnormalities increase digoxin toxicity? | Hypokalemia, hypomagnesemia, hypercalcemia |
| Classic digoxin toxicity visual symptom? | Green-yellow halos |
| Major digoxin drug interaction? | Amiodarone ↑ digoxin levels (reduce dose by 50%) |
| What drugs decrease HR additively with digoxin? | Beta blockers, non-DHP CCBs, amiodarone |
| Digoxin is contraindicated in what arrhythmia? | Ventricular fibrillation |
| Digoxin monitoring parameters? | Electrolytes, renal function, HR, ECG, BP |
| Goal resting HR in symptomatic AF? | < 80 BPM |
| Lenient HR goal in asymptomatic AF? | < 110 BPM |
| First-line rate control drugs for AF? | Beta blockers or non-DHP CCBs |
| When is digoxin used in AF? | Add-on or if hypotension limits BB/CCB |
| Rate control strategy goal? | Stay in AF but control ventricular rate |
| Rhythm control strategy goal? | Restore and maintain NSR |
| Preferred anticoagulants in nonvalvular AF? | DOACs |
| Adenosine mechanism? | Activates adenosine receptors → ↓ AV node conduction |
| Adenosine dose? | 6 mg IV push, then 12 mg if needed |
| Adenosine half-life? | <10 seconds |
| What arrhythmia is adenosine used for? | SVT |
| Adenosine NOT used for? | AF or atrial flutter conversion |
| Adenosine contraindication? | Bronchospastic lung disease |
| Adenosine side effects? | Flushing, chest pressure, hypotension |
| Class IC drugs? | Flecainide, propafenone |
| Flecainide dosing? | 50-100 mg Q12H |
| Flecainide major risk? | Proarrhythmia (1:1 conduction) |
| Flecainide contraindication? | Structural heart disease |
| Propafenone contraindicated in? | Heart failure |
| Class IB drugs? | Lidocaine, mexiletine |
| Lidocaine used for? | Ventricular arrhythmias only |
| Lidocaine infusion rate? | 1–4 mg/min |
| Quinidine toxicity name? | Cinchonism (symptoms include Tinnitus, hearing loss, headache) |
| Quinidine causes what autoimmune issue? | drug-induced lupus |
| Amiodarone boxed warnings? | Pulmonary and hepatic toxicity |
| Amiodarone warnings (non-boxed warnings)? | Hyper or hypothyroidism |
| Amiodarone monitoring? | LFTs, TSH, CXR, ECG, electrolytes |
| Amiodarone ADRs | hypotension, bradycardia |
| Amiodarone contraindications? | Iodine hypersensitivity |
| Can we use amiodarone in pregnancy? | NO, teratogenic |
| Amiodarone drug interactions? | ↑ digoxin, ↑ warfarin |
| Amiodarone reduces digoxin dose by? | 50% |
| Amiodarone reduces warfarin dose by? | 30-50% |
| Which cardiac agent causes skin discoloration? | Amiodarone (can cause blue-grey skin coloration) |
| This cardiac agent is CI in HF patients | Multaq (dronedarone) |
| Advantages of dronedarone over amiodarone? | No iodine, so no hypersensitivity or thyroid effect |
| Which agents are Class 3? | Dronedarone, Dofetilide, Sotolol, Ibutilide, Amiodarone - mainly block potassium channels |
| Which agents are Class 2? | Beta blockers (except sotolol) |
| Which agents are Class 4? | Non-DHPP CCBs |
| Which agents are class 1a? | Disoyramide, Quinidine, Procainamide ("Double Quarter Pounder") |
| Which agents are class 1b? | Lidocaine, Mexiletine ("Lettuce Mayo") |
| When is digoxin used in Afib? | Used as an add-on rate control when BB/CCB insufficient or hypotension limits use |
| Digoxin toxicity symptoms? | N/V, confusion, visual halos, bradycardia |
| When should adenosine NOT be used? | AF or atrial flutter conversion |
| CIs of adenosine | 2nd/3rd degree AV block, sick sinus, bronchospastic disease |
| When is flecainide used? | Rhythm control AF in patients WITHOUT structural heart disease |
| When should flecainide NOT be used? | Structural heart disease, HF, post-MI |
| Should flecainide be used alone? | NO, should use with AV nodal blocker (BB, CCB, digoxin) |
| What organs can amiodarone damage? | Liver, lungs, eyes, thyroid (hypo or hyper), skin. |
| Which antiarrythmics should only be used for arrythmias in an inpatient setting? | Sotolol and dofetilide |
| Which drugs should NOT be used in structural heart disease? | Flecainide, propafenone |
| Which agent would be the safest option for a patient with HF? | Dofetilide |
| Which drug is officially CI'd in HF? | Dronedarone |
| Which drugs cause lupus? | Procainamide and quinidine |
| Which class is only useful for ventricular arrythmias? | Class 1b (lidocaine and mexilitine) |
| Which antiarrythmic drugs are considered safe for HF? | Dofetilide and amiodarone |
Created by:
cdaughtry