Treatment of Arrhythmias II- CardioRush

False (depends on the arrhythmia, the patient, etc)
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K channel blockers, anti fibrillatory drugs, prolong AP durationWhat are class III antiarrhythmics?Ca channel blockers for nodal tissuesWhat are class IV antiarrhythmic drugs?DigoxinWhat antiarrhythmic doesn't fit into the traditional 4 group classification scheme?1a, 1b, 1cWhat are the 3 groups of class I antiarrhythmic drugs?Prolong AP duration and absolute refractory periodWhat is the action of class 1a antiarrhythmics?Procainamide, quinidineWhat are 2 examples of class 1a antiarrhythmics?Shorten AP duration and absolute refractory period, works specifically on diseased tissueWhat is the action of class 1b antiarrhythmics?Lidocaine, mexiletineWhat are 2 examples of class 1b antiarrhythmics?Marked depression of phase 0 upstroke, no effect on AP duration or refractory periodWhat is the action of class 1c antiarrhythmics?Convert a fib in horsesWhat is the main use of Quinidine clinically?Vagolytic effect of quinidine may increase HR, worsen existing tachWhy should you give digoxin before quinidine in horses with a fib and tachycardia?Ventricular and SV arrhythmias, second line drug for V tachWhat are the uses for procainamide?False (it will not)True or false: procainamide will significantly depress ventricular functionProarrhythmia, colic, hypersensitivity rxn, urticaria, sweating, tachycardia, GI signs, skin rash, hypotension, CV collapseWhat are the possible side effects of quinidine in horses?Sympatholytic leading to hypotension, proarrhythmia, AV block, GI upset, lupus like effects, coat color changesWhat are the possible side effects of procainamide?Calculate max dose, give in small amounts up to that dose to check for conversion or adverse rxns, monitor with continuous ECGHow can we administer quinidine in horses to minimize side effects?False (cannot be used, will make AV block worse by slowing HR)True or false: Procainamide can be used to treat second degree AV blockPromote conduction block, depress automaticity, suppress afterdepolarizationsWhat is the action of class 1b antiarrhythmics on diseased or ischemic myocardium?TrueTrue or false: class 1b antiarrhythmics work to decrease arrhythmias through all 3 mechanisms of arrhythmogenesisLidocaineWhat is the first line emergency drug for treatment of v tach?V tach, sometimes SV arrhythmiasWhat type of arrhythmias can lidocaine be used to treat?Extensive hepatic first pass metabolismWhy can't lidocaine be given orally?HypokalemiaWhat electrolyte deficiency must be corrected before use of lidocaine to get maximum efficacy?MexiletineWhat is the lidocaine-like oral drug that can be used long term for arrhythmia treatment?Ventricular arrhythmiasWhat type of arrhythmias is mexiletine used to treat?Class II or III drugsWhat is mexiletine often combined with for treatment of arrhythmias, especially Boxer ARVC?Vomiting, seizures, ataxia, CNS depression, increased defibrillation threshold, suppression of escape rhythmsWhat are the side effects of class 1b drugs?Cats, horsesWhat species are side effects from class 1b antiarrhythmics more common in?Reduce dose by 50%What should be done in cats and horses to decrease the risk of side effects from class 1b antiarrhythmics?False (Not safe, lidocaine suppresses escape rhythms, which are required for ventricular contraction in AV block)True or false: it is safe to treat a patient with 3rd degree AV block with lidocaine for ventricular arrhythmias before placing a pacemakerAtenolol, carvedilol, esmolol, propranololWhat are examples of class II antiarrhythmics (beta blockers)?Ultrashort acting IV formulation, good for emergency, eliminated quickly if patient reacts poorlyWhat is the benefit of using esmolol?False (it is not commonly used in vet med)True or false: Propranolol is a mainstay of treatment for conditions that require beta blockersVentricular or SV arrhythmias, CM if CHF is absent or well controlled, subaortic stenosis, pulmonic stenosis, LVOTO, hyperthyroidism, intoxication with some compounds that cause tachycardiaWhat are some clinical situations in which we would use class II antiarrhythmics?Decrease HR, lower COWhy are beta blockers contraindicated in CHF?TrueTrue or false: beta blockers are the mainstay of treatment for cats with hypertrophic obstructive cardiomyopathy with dynamic LVOTONegative chronotropism leads to bradycardia or AV block, negative inotropism can cause CHF or weakness, hypotension, bronchospasm, hypoglycemiaWhat are some side effects of class II antiarrhythmics?False (use caution, beta blockers have been associated with bronchospasm and hypoglycemia, so a different med should be used instead to minimize risk)True or false: Beta blockers are completely safe to use in an asthmatic, diabetic cat with HOCMSotalol, amiodaroneWhat are examples of class III antiarrhythmics?Prolongs AP duration by blocking K channels, some beta blockers effect, depresses AV node conduction, increases atrial refractory period, increases fibrillation thresholdWhat are the overall effects of class III antiarrhythmics?Ventricular and SV arrhythmiasWhat is sotalol commonly used to treat?SotalolWhat drug is especially effective in Boxer ARVC?False (it can be used in cats, may need to compound for appropriate dose)True or false: Sotalol is contraindicated in catsHigh side effect profileWhy is amiodarone not commonly used in vet patients?Malignant or refractory V tach or SVT, sometimes in a fibWhat type of arrhythmias is amiodarone used to treat?MexiletineWhat drug can be combined with sotalol to increase effectiveness of antiarrhythmic?Myocardial failure, CHF, significant beta blocker propertiesWhat conditions should you NOT use sotalol in and why?Risk of anaphylaxis with older formulationWhy should you use caution when giving amiodarone IV?Polysorbate 80What was the ingredient in the older formulation of amiodarone IV that increases risk of anaphylaxis?AmiodaroneIf a patient has both a fib and a ventricular arrhythmia, what is a possible good first choice drug?HepatopathyWhat is the major side effect with amiodarone use?DobermansWhat breed has an increased risk of hepatopathy with amiodarone use?False (usually reversible when drug is discontinued)True or false: hepatopathy with amiodarone use is usually irreversibleThyroid dysfunction, pulmonary fibrosis, blood dyscrasias, neuropathy, anaphylaxis (angioedema, collapse, hypotension)What are some side effects other than hepatopathy that can occur with amiodarone use?Use lowest effective dose, measure serum levels to guide dosing, monitor liver valuesHow can we minimize risk of side effects when using amiodarone?Dihydropyridines, non-dihydropyridinesWhat are the 2 groups within class IV antiarrhythmics?SVT, a fib, systemic hypertension, sometimes HOCMWhat are the clinical uses for class IV antiarrhythmics, depending on the drug?AmlodipineWhat is an example of a dihydropyridine class IV antiarrhythmic?10:1 vascular selectivity, no significant nodal effects, used for systemic hypertensionWhat are the characteristics of dihydropyridine class IV antiarrhythmics?DiltiazemWhat is an example of a non-dihydropyridine class IV antiarrhythmic?Slow nodal conductionWhat is the major effect of diltiazem?Excessive negative chronotropism causes bradycardia or AV block, negative inotropism may precipitate CHF or cause weakness, excessive vasodilation causes hypotensionWhat are the side effects of class IV antiarrhythmics?Potent inhibitor or Na/K ATPase makes it a weak inotrope, Parasympathomimetic, improved baroreceptor functionWhat are the 3 major MOA of digoxin?Decreased SA nodal firing, slowed AV nodal conduction, reduced SNS outputWhat are the effects caused by digoxin as a parasympathomimetic drug?ParasympathomimeticWhat is the main MOA we use digoxin for?A fib, some SVTsWhat are the main arrhythmias digoxin is used to treat?Reduces AV conduction, slows ventricular rateHow does digoxin help in atrial fibrillation?Atrial antiarrhythmic, slows AV conductionHow does digoxin help in SVTs?False (may help due to positive inotropic effects)True or false: digoxin is contraindicated in CHFIncrease CO, ejection fraction, renal flow, diuretic effectWhat are the results of the positive inotropic effects of digoxin?Narrow therapeutic index makes toxicity easyWhy is digoxin difficult to use?TrueTrue or false: Digoxin has a long half life, especially in the cat, so dosing isn't needed every dayFalse (start with half the recommended dose to avoid toxicity, you can always increase if needed)True or false: it is best to start with the dosing recommended in Plumbs or on label for digoxin to avoid toxicityHorses (to control tachycardia before giving quinidine)What is really the only species we use digoxin IV in?High side effect rateWhat is the risk of using digoxin IV?Lethargy, anorexia, vomiting, diarrhea, malaise, any arrhythmia can developWhat are some side effects of digoxin use?Hypokalemia, azotemiaWhat underlying issues will increase risk of side effects with digoxin use?Sinus bradycardia, first or second degree AV block, APCs, VPCs, V tach, AV dissociation, ST segment changeWhat are some examples of arrhythmias that may occur as a result of digoxin use?Renal insufficiency, pre renal azotemia, hypokalemia, low Mg, reduced skeletal mass, advanced age, dosing without considering ascites, some other drugs it interacts withWhat conditions predispose an animal to digoxin toxicity?Quinidine, verapamil, amniodaroneWhat are examples of drugs that digoxin interacts with that predispose an animal to digoxin toxicity?