37 Questions
Which of the following is the primary focus of the section?
Reducing automaticity of myocardial cells
What is the main purpose of antidysrhythmic drug therapy in the context described?
Altering the cardiac output
What symptoms may result from altered cardiac output as mentioned in the text?
Decreased coronary, cerebral, and/or systemic circulation
What condition may ventricular tachycardia cause according to the text?
Cardiac arrest
What has changed over the years regarding the clinical use of antidysrhythmic drugs for tachydysrhythmias?
The availability of alternative treatments
In which condition is the use of antidysrhythmic drugs commonly indicated?
Reducing ventricular rate
Which class of antidysrhythmic drugs slows the rate of depolarization?
Class I sodium channel blockers
What type of therapy is recommended for most patients with nonvalvular atrial fibrillation to reduce the risk of stroke?
Anticoagulants
Based on which scoring system is stroke risk assessment for atrial fibrillation done?
CHA2DS2-VASC score
What type of drugs are used to prevent or reduce the risk of thrombosis?
Anticoagulants and antiplatelet drugs
What is a possible treatment option for persistent inappropriate sinus tachycardia?
Catheter ablation
What class of drugs reduces automaticity and conduction velocity?
Class II beta-adrenergic blockers
What are the contraindications to atropine use?
Peptic ulcers and urinary retention
What are the adverse effects of atropine?
Increased intraocular pressure and photophobia
What is the purpose of administering adenosine?
To restore normal sinus rhythm in paroxysmal supraventricular tachycardia
What is the action of magnesium sulfate as an antidysrhythmic drug?
It restores normal sinus rhythm
From where is heparin obtained?
Bovine lung or porcine intestinal mucosa
What should be assessed before administering atropine?
Heart rate and blood pressure
What is the primary function of heparin?
Inhibiting platelet aggregation
When is heparin used prophylactically?
For patients at risk of DVT and PE
Why is heparin considered the anticoagulant of choice during pregnancy and lactation?
It does not cross the placental barrier and is not secreted in breast milk
What caution is necessary when administering heparin to children?
Avoid heparin solutions containing benzyl alcohol as a preservative
Why are older adults more likely to experience bleeding and complications when receiving heparin therapy?
Elimination of heparin may be delayed in older adults with renal impairment
What is a potential risk for people with renal or hepatic impairment taking heparin?
Increase in the half-life of the drug
How can patients manage standard heparin at home?
Using LMWHs for home management of venous thrombosis
What is the primary effect of atropine on the cardiovascular system?
Increased heart rate
Which of the following is a contraindication for the use of atropine?
Impaired renal function
What adverse effect of atropine is more likely to be experienced by children?
Facial flushing
What is the main treatment for atropine overdose?
Activated charcoal
Which system is adversely affected by atropine resulting in tachycardia?
Cardiovascular system
What is the antidote for atropine overdose?
Physostigmine salicylate
Which medication may be an option for self-administration at home to manage recurrent atrial fibrillation?
Flecainide
What is a strategy to control atrial fibrillation's ventricular rate?
Manage symptoms with beta-blockers or non-dihydropyridine calcium channel blockers
What is necessary before attempting to restore sinus rhythm if atrial fibrillation has lasted for 48 hours or more?
Transesophageal echocardiography (TEE) for thrombus identification
What significantly reduces the risk of atrial fibrillation after cardiac surgery?
Cholesterol-lowering medications
Which type of medication may be refractory to one or more Class I or III antiarrhythmic medications, making catheter ablation an indicated option for rhythm control?
Paroxysmal atrial fibrillation
What type of medication is used to treat atrial flutter in the same manner as atrial fibrillation?
Direct-acting oral anticoagulants
Study Notes
- Patients requiring immediate anticoagulation may receive IV or low-molecular-weight heparin until warfarin therapy is effective, and INR is within therapeutic range (2.0-3.0).
- Medications for atrial fibrillation depend on stroke and bleeding risks, patient preferences, and values.
- Warfarin therapy necessitates weekly INR testing during initiation and ongoing monitoring.
- Direct-acting oral anticoagulants and Factor Xa inhibitors require baseline assessments of hemoglobin, hematocrit, liver, and renal function.
- Advantages of these medications include fewer drug-drug interactions and dietary limitations, as well as elimination of frequent INR testing.
- A strategy to control atrial fibrillation's ventricular rate is to manage symptoms with medications that lower the heart rate, such as beta-blockers or non-dihydropyridine calcium channel blockers.
- Attempts to restore sinus rhythm should only be made after anticoagulation if atrial fibrillation has lasted for 48 hours or more.
- Thrombus identification via transesophageal echocardiography (TEE) is crucial before cardioversion.
- Flecainide is an option for self-administration at home to manage recurrent atrial fibrillation.
- Preoperative beta-blocker administration significantly reduces the risk of atrial fibrillation after cardiac surgery.
- Cholesterol-lowering medications may be prescribed to prevent new-onset atrial fibrillation following cardiac surgery.
- Paroxysmal atrial fibrillation may be refractory to one or more Class I or III antiarrhythmic medications, making catheter ablation an indicated option for rhythm control.
- Atrial flutter is treated with antithrombotic therapy, rate control, and rhythm control in the same manner as atrial fibrillation.
- Atropine, an anticholinergic drug, increases heart rate by blocking parasympathetic vagal stimulation. Its effects last for about 4 hours, except for ocular effects, which last up to 2 weeks.
- Atropine is well-absorbed and metabolized in the liver, crosses the placenta and breast milk, and enters the CNS where it can produce stimulant or depressant effects.
Learn about the competitive blocking effects of atropine on muscarinic cholinergic receptors and its impact on parasympathetic postganglionic impulses. Understand atropine's role in depressing salivary and bronchial secretions, dilating the bronchi, and relaxing the pupil of the eye.
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