Chapter 20: Treatment of Arrhythmia
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Questions and Answers

Which class of drugs is primarily used to slow conduction velocity in arrhythmias?

  • Angiotensin-converting enzyme inhibitors (ACEIs)
  • Angiotensin II type 1 receptor blockers (ARBs)
  • Beta-blockers
  • Cardioglycoside (digoxin) (correct)

What effect do ACEIs and ARBs have on the refractory period and conduction time?

  • No effect on refractory period or conduction time
  • Shorten refractory period and lengthen conduction time
  • Increase dilation of coronary arteries
  • Lengthen refractory period and shorten conduction time (correct)

What is a significant risk factor for the development of Atrial Fibrillation?

  • Hypertension (correct)
  • Healthy diet
  • Low cholesterol
  • Regular exercise

Which of the following drugs is associated with the prevention of stroke in patients with Atrial Fibrillation?

<p>Anticoagulants (C)</p> Signup and view all the answers

Which of these drug pairs are considered look-alike/sound-alike drugs?

<p>Procardia and Provera (A), Amiodarone and Amantadine (C)</p> Signup and view all the answers

What is the primary mechanism through which ARBs reduce the risk of arrhythmias?

<p>They reduce inflammation and structural changes in atria. (D)</p> Signup and view all the answers

Which of the following is NOT commonly used to treat hypertension-related arrhythmias?

<p>Antidepressants (B)</p> Signup and view all the answers

Which of the following treatment options lengthens the refractory period?

<p>Digoxin (D)</p> Signup and view all the answers

What is a common side effect of Class I antiarrhythmics?

<p>Dizziness or drowsiness (D)</p> Signup and view all the answers

Which of the following should be avoided when taking quinidine?

<p>Grapefruit juice (A)</p> Signup and view all the answers

What special instruction should be followed when administering esmolol?

<p>Dilute before use (A)</p> Signup and view all the answers

Which Class III antiarrhythmic should specifically be avoided during pregnancy?

<p>Ibutilide (B)</p> Signup and view all the answers

What is a characteristic feature of atrial flutter?

<p>Usually occurs in the right atrium (B)</p> Signup and view all the answers

What precaution should be taken with sotalol?

<p>Avoid salt substitutes (C)</p> Signup and view all the answers

Which statement regarding Class IV antiarrhythmics is true?

<p>They must be swallowed whole and not crushed or chewed. (A)</p> Signup and view all the answers

Which of the following statements is true about ventricular fibrillation?

<p>The ventricles cannot effectively fill with blood (A)</p> Signup and view all the answers

What is a necessary storage condition for Ia antiarrhythmics?

<p>Do not freeze (A)</p> Signup and view all the answers

What distinguishes supraventricular tachycardia from other arrhythmias?

<p>It originates in regions above the ventricles (A)</p> Signup and view all the answers

Which of the following increases the risk of dizziness while on antiarrhythmics?

<p>Exceeding the prescribed dose (C)</p> Signup and view all the answers

Which arrhythmia is the most common and usually not life-threatening?

<p>Atrial fibrillation (B)</p> Signup and view all the answers

What should patients do to protect themselves when taking amiodarone?

<p>Avoid prolonged sun exposure (A)</p> Signup and view all the answers

What can cause ventricular tachycardia to occur?

<p>Short-circuiting across scar tissue from a heart attack (A)</p> Signup and view all the answers

How should extended-release antiarrhythmics be taken?

<p>Swallowed whole without chewing (D)</p> Signup and view all the answers

Which of the following is a nonmodifiable risk factor for arrhythmias?

<p>Age (B)</p> Signup and view all the answers

Which antiarrhythmic drug class is known to block Na+ channels?

<p>Class I (C)</p> Signup and view all the answers

What is the primary mechanism of action for Class II antiarrhythmic drugs?

<p>Block stimulation of the AV and SA nodes (D)</p> Signup and view all the answers

Which disease is considered a risk factor for arrhythmias?

<p>Obstructive sleep apnea (A)</p> Signup and view all the answers

What is a common adverse effect of antiarrhythmic medications?

<p>Bradycardia (D)</p> Signup and view all the answers

Which antiarrhythmic drug class is primarily used to treat atrial fibrillation?

<p>Class IV (B)</p> Signup and view all the answers

Class III antiarrhythmic drugs are known to prolong which aspect of the heart's electrical activity?

<p>Depolarization and refractory period (A)</p> Signup and view all the answers

What lifestyle factor is considered modifiable and can affect the risk of arrhythmias?

<p>Excessive alcohol consumption (D)</p> Signup and view all the answers

Which antiarrhythmic class is characterized by its ability to suppress both supraventricular and ventricular arrhythmias?

<p>Class III (C)</p> Signup and view all the answers

Atrial fibrillation primarily leads to which of the following outcomes?

<p>Irregular heart rhythms (C)</p> Signup and view all the answers

Which of the following is NOT a symptom of arrhythmia?

<p>Increased appetite (B)</p> Signup and view all the answers

What characterizes atrial fibrillation?

<p>Disorganized electrical signals causing the atria to quiver (A)</p> Signup and view all the answers

Which risk factor is associated with supraventricular tachycardia?

<p>Alcohol consumption (A)</p> Signup and view all the answers

Ventricular fibrillation is primarily treated by which method?

<p>Electrical cardioversion (A)</p> Signup and view all the answers

What is a common risk factor for developing ventricular tachycardia?

<p>Family history of arrhythmias (C)</p> Signup and view all the answers

Which class of drugs is commonly used to treat arrhythmias?

<p>Antiarrythmics (B)</p> Signup and view all the answers

Which of the following can lead to arrhythmia formation?

<p>Improper cardiac ion exchange (C)</p> Signup and view all the answers

What is the significance of the refractory period in arrhythmias?

<p>It prevents further depolarization during recovery (D)</p> Signup and view all the answers

Which of the following is NOT a potential symptom of ventricular fibrillation?

<p>Increased energy levels (C)</p> Signup and view all the answers

The primary treatment for atrial fibrillation often includes which of the following?

<p>Use of anticoagulants to prevent stroke (C)</p> Signup and view all the answers

Flashcards

Digoxin's Effect on Conduction

Digoxin slows conduction velocity and increases the time it takes for electrical signals to travel through the heart.

ACEIs and ARBs' Effect on Arrhythmias

ACE inhibitors (ACEIs) and Angiotensin II receptor blockers (ARBs) lengthen the refractory period and shorten conduction time in the heart.

Arrhythmia Risk Factor - Hypertension

High blood pressure (hypertension) significantly increases the likelihood of developing Atrial Fibrillation (A-Fib).

Stroke Prevention in Atrial Fibrillation

Anticoagulants are medications used to prevent stroke in individuals with Atrial Fibrillation or A-fib.

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Look-Alike/Sound-Alike Drugs

Several drugs have similar names, potentially leading to medication errors.

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Cardioglycoside Mechanism

Cardioglycosides like digoxin slow down electrical conduction and lengthen the time between heartbeats.

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Drug Classes for Arrhythmia

Medications categorized as ACEIs and ARBs are used for treating arrhythmia alongside hypertension.

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Atrial Fibrillation Risk for Stroke

Atrial Fibrillation (A-Fib) is a significant risk factor for stroke.

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Modifiable Risk Factors for Heart Disease

Factors that can be changed to reduce the risk of heart disease, such as obesity, smoking, excessive alcohol consumption, and stimulant use.

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Nonmodifiable Risk Factors for Heart Disease

Factors that cannot be changed, such as age, gender, and low heart rate.

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Antiarrhythmic Drugs

Drugs used to treat irregular heart rhythms and rate.

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Class I Antiarrhythmics

Antiarrhythmics that block sodium channels, slowing depolarization.

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Class II Antiarrhythmics

Antiarrhythmics that block beta-adrenergic receptors, slowing heart rate and preventing abnormal rhythms.

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Class I Antiarrhythmics Warning

May cause dizziness/drowsiness; swallow whole; take on empty stomach; avoid grapefruit juice; refrigerate (some); take with food (some); don't skip or exceed dose (some); wear sunglasses (some).

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Class III Antiarrhythmics

Antiarrhythmics that block potassium channels, prolonging heart cell depolarization, suppressing arrhythmias.

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Class IV Antiarrhythmics

Antiarrhythmics that block calcium channels, reducing heart rate and controlling supraventricular arrhythmias.

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Class II Antiarrhythmics Warning

May cause dizziness/drowsiness; must be diluted (esmolol); swallow whole (extended release); don't skip doses.

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Adverse Effects of Antiarrhythmics

Side effects of antiarrhythmic drugs, including bradycardia, hypotension, dizziness, nausea, vomiting, diarrhea and constipation.

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Class III Antiarrhythmics Warning

Avoid prolonged sun exposure (amiodarone); may cause dizziness/drowsiness; avoid grapefruit juice (amiodarone, dofetilide); shouldn't be taken during pregnancy (ibutilide); avoid salt substitutes (sotalol); take on an empty stomach (sotalol); protect from moisture (dofetilide).

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Class IV Antiarrhythmics Warning

Take with food; swallow whole (extended release); don't crush or chew (extended release).

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Arrhythmias as Risk Factors

Conditions such as hypertension, heart failure, stroke, and infection that increase the risk of arrhythmias.

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Heart Diseases as Risk Factors

Conditions like hypertension, heart failure, CHD, stroke, diabetes, and thyroid disease are possible heart disease risk factors.

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Antiarrhythmic Drug Interactions

Certain antiarrhythmic drugs have specific interactions, such as with grapefruit juice, and may need to be taken with specific conditions for food or other factors.

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Class I Drug Timing

Some Class I antiarrhythmics should be taken on an empty stomach, while others should be taken with food.

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Esmolol Dilution

Esmolol, a Class II antiarrhythmic, needs to be diluted.

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Extended Release Swallowing

Extended-release medications should be swallowed whole in order to maintain the correct dosage release rate.

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Sunlight Exposure Warning

Certain antiarrhythmics, specifically amiodarone, require precautions regarding prolonged sun exposure.

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Pregnancy Use Restrictions

Specific antiarrhythmics, such as ibutilide, are not recommended for use during pregnancy.

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What is a normal heart rate?

A normal heart rate is between 60 and 100 beats per minute.

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What is an arrhythmia?

An arrhythmia is an irregular heartbeat or a heart rate that is too fast or too slow.

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What is depolarization?

Depolarization is when sodium and calcium enter the heart, causing the cells to fire and contract.

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Repolarization

Repolarization is the process where heart cells return to their resting state after a contraction.

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What is the refractory period?

The refractory period is the time after repolarization, when a heart cell can't contract again.

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How are arrhythmias formed?

Arrhythmias occur when the heart's ion exchange channels malfunction, causing problems with electrical impulses.

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Can arrhythmias lead to more arrhythmias?

Yes, sometimes arrhythmias can trigger more arrhythmias, making the problem worse.

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What are symptoms of arrhythmia?

Symptoms can include palpitations, rapid heartbeat, sweating, nausea, chest pain, shortness of breath, dizziness, and fainting.

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What are palpitations?

Palpitations are a feeling of fluttering or pounding in the chest caused by an irregular heartbeat.

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Why are arrhythmias important to treat?

Arrhythmias can lead to serious complications like stroke, heart failure, and even death.

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Atrial Flutter

A heart rhythm where the atria contract rapidly (160-350 bpm), but the ventricles don't keep up. This usually occurs in the right atrium.

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Atrial Fibrillation

A common arrhythmia where the atria beat chaotically (300-400 bpm), making the heart less effective at pumping blood.

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Supraventricular Tachycardia (SVT)

A fast heart rhythm (up to 200 bpm) originating in the upper chambers (atria or AV node). It can be intermittent or constant.

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Ventricular Tachycardia (VT)

A dangerous rapid heartbeat (over 200 bpm) originating in the ventricles, often caused by scar tissue from a heart attack.

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Ventricular Fibrillation (VF)

A life-threatening arrhythmia where the ventricles quiver chaotically (over 600 bpm), preventing proper blood pumping. It requires an electrical shock to correct.

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Study Notes

Chapter 20: Treatment of Arrhythmia

  • Arrhythmia is an irregular heartbeat, either too fast or too slow.
  • Normal heart rate is between 60-100 beats per minute (approximately 100,000 beats per day).
  • Blood is pumped throughout the body, delivering oxygen and nutrients to cells and organs, including the heart.
  • Arrhythmias can exceed 600 beats/minute.

Lesson 20.1: Treatment of Arrhythmia

  • The goal of this lesson is to learn about the terminology, risk factors, types, and treatments for arrhythmias.
  • Learning objectives include learning terminology, listing risk factors, describing types, listing and categorizing medications, describing drug mechanisms of action, identifying look-alike/sound-alike drug issues, and identifying warning labels/precautionary messages.

Key Terms

  • Review of key terms related to the treatment of arrhythmia is necessary.

Arrhythmia

  • Depolarization: Sodium and Calcium enter the heart, causing cell firing and contraction.
  • Repolarization: Cells return to resting state.
  • Refractory period: Time for repolarization, after which depolarization occurs.
  • Cardiac ion exchange channels function improperly.
    • Excessive firing
    • Extra currents in the refractory period.
    • Establishment of sinus rhythm by non-pacemaker cells.
    • Arrhythmias can trigger more arrhythmias.

Symptoms of Arrhythmia

  • Palpitations or fluttering in the chest.
  • Rapid, irregular heart rate.
  • Sweating or nausea.
  • Chest pain.
  • Shortness of breath.
  • Lightheadedness or dizziness.
  • Fainting.

Types of Arrhythmias

  • Atrial flutter: Heart rate of 160-350 beats per minute; more contractions in the atrium than in the ventricle; usually in the right atrium; treated by catheter ablation.
  • Atrial fibrillation: Rapid, uncoordinated contractions of the atria; most common arrhythmia; heart rate of 300 to 400 beats per minute; can be temporary, recurrent, persistent, or permanent.
  • Supraventricular tachycardia: Heart rate up to 200 beats per minute; originates in the regions above the ventricles; can be intermittent (paroxysmal) or frequent.
  • Ventricular tachycardia:Ventricles beat faster than 200 beats per minute; may occur when electrical impulses short-circuit across scar tissue (from a heart attack).
  • Ventricular fibrillation: Ventricles beat faster than 600 beats per minute; life-threatening; ventricles are unable to fill with blood resulting in blood unable to be pumped throughout the body; treated with electrical cardioversion (defibrillator shock).

Overview (1 of 2)

  • Nonmodifiable risk factors: age, gender, low heart rate, emotional stress
  • Modifiable risk factors: obesity, smoking, excessive alcohol consumption, stimulant use

Overview (2 of 2)

  • Diseases as risk factors: hypertension, heart failure, coronary heart disease (CHD), stroke, infections, diabetes, thyroid disease, obstructive sleep apnea

Treatment of Arrhythmias

  • Antiarrhythmic drugs are used to treat irregular heart rhythms; use is declining.
    • Categorized into four classes (I, II, III, and IV) based on mechanisms and structure.
      • Class 1 is further subdivided into 1A, 1B, and 1C.

Mechanism of Action (Drug Classes)

  • Class I: Na+ channel blockers (slow depolarization rate, reduce automaticity, delay conduction, prolong time between contractions)
  • Class II: Beta blockers (block AV and SA node stimulation, increase refractory period, decrease automaticity, slow conduction velocity).
  • Class III: K+ channel blockers (prolong depolarization and refractory period, suppress both supraventricular and ventricular arrhythmias).
  • Class IV: Ca2+ channel blockers (treat supraventricular arrhythmias, atrial fibrillation, atrial flutter).

Summary of Antiarrhythmic Drugs

  • Includes a table summarizing classes, categories, and generic drug names.

Adverse Effects of Antiarrhythmic Agents

  • Bradycardia
  • Hypotension
  • Dizziness
  • Nausea and vomiting
  • Diarrhea or constipation

Additional Treatment Options

  • Cardioglycoside (digoxin)
  • Angiotensin-converting enzyme inhibitors (ACEIs)
  • Angiotensin II type 1 receptor blockers (ARBs)

Mechanism of Action (Additional Treatment Options)

  • Digoxin: Slows conduction velocity, prolongs refractory period.
  • ACEIs/ARBs: Lengthen refractory period, shorten conduction time, decrease dilation of coronary arteries, reduce blood pressure, and reduce inflammation/structural changes in atria (for ARBs).

Look-Alike/Sound-Alike Drugs

  • Procan SR and Proscar
  • Procardia and Provera
  • Quinidine and quinine
  • Acebutolol and albuterol
  • Esmolol and Osmitrol
  • Brevibloc and Brevital
  • Propranolol and Pravachol
  • Inderal, Adderall, Isordil, and Toradol
  • Amiodarone, amantadine, and trazodone
  • Cordarone, Cardura, and Coumadin
  • Betapace AF and Betapace
  • Verapamil and Verelan
  • Calan SR and Calan

Drug Used to Prevent Arrhythmias

  • Angiotensin-converting enzyme inhibitors (ACEIs)
  • Angiotensin II type 1 receptor blockers (ARBs)
  • Drugs used to treat hypertension
    • Hypertension doubles risk of atrial fibrillation.

Prevention of Stroke

  • Atrial fibrillation (Afib) is a risk factor for stroke.
  • Anticoagulants are used to prevent stroke in patients with Afib.

Warning Labels (Classes I, II, III, and IV)

  • Includes specific warning labels and instructions for each class.

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Chapter 20 Treatment of Arrhythmia PDF

Description

This quiz focuses on the treatment of arrhythmias, exploring terminology, risk factors, and types. Learn about various medications and their mechanisms of action as well as crucial safety information. Understanding these concepts is vital for managing heart health effectively.

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