ANGINA AND ARRHYTHMIAS - PHARM EXAM 2| TOP
SCORES MADE SIMPLE | TRUSTED TEST SOLUTIONS!
what causes abnormal heart beats Answer: electrical imbalances (K+)
drugs
injury (heart attack, ischemia)
abnormal pacemaker cells
paroxsymal A fib Answer: A fib terminates spontaneously or with intervention within 7
days of onset
episodes may recur w variable frequency
persistent A fib Answer: continuous AF that is sustained >7 d
longstanding persistent A fib Answer: continous A fib of >12 months duration
permanent A fib Answer: term used when there has been a joint decision by the patient
and clinician to cease further attempts to restore and/or maintain sinus rhythm
acceptance of A fib represents a therapeutic attitude on the part of the patient clinician
rather than an inherent pathophysiological attribute of the A fib
acceptance of A fib may change as symptoms, the efficacy of therapeutic interventions,
and patient and clinician preferences evolve
how do we treat a fib (general)? Answer: drugs, cardioversion, remove the source
(drug, diet), ablation
2 paths to treating A fib Answer: rate or rhythm control
rate control is generally used in patients who are older or those who have failed rhythm
control
rhythm control is generally used in patients who are younger and likely to be able to be
converted back to NSR or those who do/would not tolerate rate control
rate control drugs, use, goal Answer: BB or CCB (diltiazem/verapamil)
used in paroxysmal, persistent, permanent A fib
goal to have resting HR <80; lenient rate control goal <110 may be used in pts who are
asymptomatic and who retain LV function
1
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, diltiazem MOA Answer: inhibits Ca ions from entering into certain channels on vascular
smooth muscle or myocardium during depolarization
diltiazem SE Answer: bradycardia, headache, dizziness, fatigue
diltiazem contraindications Answer: reduced EF heart failure
verapamil MOA Answer: slows automaticity and conduction of AV node by blocking Ca
channels
verapamil SE Answer: headache, fatigue, dizziness
constipation, gingival hyperplasia (verapamil)
verapamil contraindications Answer: reduced EF heart failure
rhythm control guidelines and drugs Answer: should only be used in paroxysmal or
persistent A fib
the following drugs are recommended to maintain sinus rhythm - amiodarone, dofetilide,
drondaron, flecainide, propafenone, sotalol
vaughn williams classification Answer: IA - Na channel blocker, slows phase 0
IB - Na channel blocker, shortens phase 3
IC - Na channel blocker, slows phase 0
II - BB, inhibits phase 4 in nodes
III - K channel blocker, prolongs phase 3 repolarization
IV - Ca channel blocker, inhibits action potential in nodes
rhythm control strategies in patients with paroxysmal and persistent A fib Answer: see
slides for algorithm
AP of cardiac muscles Answer: phase 0 - rapid Na+ influx through open fast Na+
channels
phase 1 - transient K+ channels open, K+ efflux
phase 2 - influx of Ca through Ca channels is electrically balanced by K efflux through
delayed K channels
phase 3 - Ca channels close but delayed K+ channels remain open and return
membrane potential to -90
phase 4 - Na, Ca channels closed, open K channels keep membrane potential at K
Class 1A antiarrhythmics drugs Answer: quinidine, procainamide, disopyramide
2
APPHIA - Crafted with Care and Precision for Academic Excellence.
SCORES MADE SIMPLE | TRUSTED TEST SOLUTIONS!
what causes abnormal heart beats Answer: electrical imbalances (K+)
drugs
injury (heart attack, ischemia)
abnormal pacemaker cells
paroxsymal A fib Answer: A fib terminates spontaneously or with intervention within 7
days of onset
episodes may recur w variable frequency
persistent A fib Answer: continuous AF that is sustained >7 d
longstanding persistent A fib Answer: continous A fib of >12 months duration
permanent A fib Answer: term used when there has been a joint decision by the patient
and clinician to cease further attempts to restore and/or maintain sinus rhythm
acceptance of A fib represents a therapeutic attitude on the part of the patient clinician
rather than an inherent pathophysiological attribute of the A fib
acceptance of A fib may change as symptoms, the efficacy of therapeutic interventions,
and patient and clinician preferences evolve
how do we treat a fib (general)? Answer: drugs, cardioversion, remove the source
(drug, diet), ablation
2 paths to treating A fib Answer: rate or rhythm control
rate control is generally used in patients who are older or those who have failed rhythm
control
rhythm control is generally used in patients who are younger and likely to be able to be
converted back to NSR or those who do/would not tolerate rate control
rate control drugs, use, goal Answer: BB or CCB (diltiazem/verapamil)
used in paroxysmal, persistent, permanent A fib
goal to have resting HR <80; lenient rate control goal <110 may be used in pts who are
asymptomatic and who retain LV function
1
APPHIA - Crafted with Care and Precision for Academic Excellence.
, diltiazem MOA Answer: inhibits Ca ions from entering into certain channels on vascular
smooth muscle or myocardium during depolarization
diltiazem SE Answer: bradycardia, headache, dizziness, fatigue
diltiazem contraindications Answer: reduced EF heart failure
verapamil MOA Answer: slows automaticity and conduction of AV node by blocking Ca
channels
verapamil SE Answer: headache, fatigue, dizziness
constipation, gingival hyperplasia (verapamil)
verapamil contraindications Answer: reduced EF heart failure
rhythm control guidelines and drugs Answer: should only be used in paroxysmal or
persistent A fib
the following drugs are recommended to maintain sinus rhythm - amiodarone, dofetilide,
drondaron, flecainide, propafenone, sotalol
vaughn williams classification Answer: IA - Na channel blocker, slows phase 0
IB - Na channel blocker, shortens phase 3
IC - Na channel blocker, slows phase 0
II - BB, inhibits phase 4 in nodes
III - K channel blocker, prolongs phase 3 repolarization
IV - Ca channel blocker, inhibits action potential in nodes
rhythm control strategies in patients with paroxysmal and persistent A fib Answer: see
slides for algorithm
AP of cardiac muscles Answer: phase 0 - rapid Na+ influx through open fast Na+
channels
phase 1 - transient K+ channels open, K+ efflux
phase 2 - influx of Ca through Ca channels is electrically balanced by K efflux through
delayed K channels
phase 3 - Ca channels close but delayed K+ channels remain open and return
membrane potential to -90
phase 4 - Na, Ca channels closed, open K channels keep membrane potential at K
Class 1A antiarrhythmics drugs Answer: quinidine, procainamide, disopyramide
2
APPHIA - Crafted with Care and Precision for Academic Excellence.
