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Pre-reg > Cardiac - Arrhythmias > Flashcards

Cardiac - Arrhythmias Flashcards

1
Q

what are the class I anti-arrhythmic drugs and give 4 examples.

A
  • membrane stabilising drugs; Na+ blockers
  • lidocaine
  • Disopyramide
  • Flecainide/Porpafenone
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2
Q

what are the contraindications for flecainide/propafenone? (class I)

A

asthma / severe COPD
avoid in heart disease

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3
Q

what class of drugs belong to the class II anti arrhythmics?

A

beta blockers e.g., propranolol

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4
Q

what type of drugs are class III anti arrhythmics?
give some examples

A

K+ channel blockers
e.g., amiodarone
sotalol
dreonedrone

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5
Q

how many months before and after cardioversion should amidoarone be given to increase success.

A

4 weeks before and 12 months after

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6
Q

what class III anti arrythmic has SE of hepatotoxicity and heart failure SE?

A

dronedarone

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7
Q

what class of drugs belong to the class IV anti arrythmics?
give 2 examples
which one is unlicensed use?

A

rate limiting calcium channel blockers
e.g., verapamil, diltiazem
diltiazem is unlicensed

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8
Q

what other anti arrythmic drugs are there that don’t belong to a class?

A

adenosine and digoxin

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9
Q

in what type of patient is digoxin most effective in?

A

sedentary patients with non-paroxysmal AF and in patients with associated congestive heart failure

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10
Q

what are the 2 main complications of AF?

A

stroke and heart failure

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11
Q

whats the differernce between paroxysmal AF, persistent AF and permanent AF?

A
  • paroxysmal: episodes stop within 48hrs without treatment
  • persistnet AF: episode lasts >7 days
  • Permanent AF: present all the time
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12
Q

what are the 2 focuses of treatment in AF?

A
  1. rate control
  2. sinus rhythm control
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13
Q

what does cardioversion mean and what are the 2 ways this can be achieved?

A
  • means to restore sinus rhythm
  • either electrical (give direct current) or pharmacological by giving anti-arrhythmic
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14
Q

why can’t you give management for cardioversion if symptoms >48 hours?
what is the preferred method if it has been >48hrs

A

due to increased risk of stroke
electrical is preferred if >48hrs

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15
Q

how long must someone be anticoaglated for before cardioversion?
how long must this continue post cardioversion?

A

need to be fully anticoagulated for 3 weeks before and continue 4 weeks after

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16
Q

what type of cardioverson can you give if the patient is haemodynamically unstable?

A

electrical - give parenteral anticoagulant and rule out left atrial thrombus

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17
Q

if a patient presents with new onset AF - what are the differences in management it they have life threatening haemodynamic instability and do not have life threatening haemodynamic instability?

A

If life-threatening = electrical cardioversion
without = <48hrs = rate or rhytham control (electrical or amiodarone/flecainide)
>48hrs = rate control (verapamil, beta blocker)

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18
Q

what are the first line options for maintence therapy in AF?

A

1st line = rate control
betablockers, rate limiting CCB, digoxin

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19
Q

what beta blocker can you not use for rate control in AF?

A

sotalol

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20
Q

what is the 2nd line in maintance therapy for AF?

A

2nd line = rhythm control
e.g., amiodarone, flecainide

21
Q

what is the management for paroxysmal and symptomatic AF?

A
  1. ventricular or rhythm control = standard beta blocker or antiarrhythmic
  2. ‘pill in pocket’ if infreqeunt episodes = flecainide or propafenone to restore sinus rhythm
22
Q

what must a persons CHADSVASC score be to qualify for anticoagulant?

A

2
not needed if low risk (male = 0 and females = 1)

23
Q

what are the risk factors contributing to a raised CHADSVASC score?

A
  • 75yrs +
  • HF
  • HTN
  • diabetes
  • previous stroke or TIA
24
Q

what are ventricular arrhythmias?

A

when the heart beats too fast

25
Q

what are the 4 different types of ventricular arrhythmias?

A
  1. pulseless or fibrilation
  2. unstable
  3. stable
  4. non-sustained
26
Q

what is the management for pulseless arrhythmias?

A

immediate defibrilation and CPR
IV amiodarone is given refractory to defibrilation

27
Q

whats the management for unstable ventricular tachycardia?

A

direct current cardioversion. If this fails give IV amiodarone

28
Q

whats the management for stable ventricualr tachycardia?

A

IV anti-arrhythmic = amiodarone

29
Q

whats the management for non-sustained tachycardia?

A

beta blocker

30
Q

whats the treatment for torsade de pointes?

A

magnesium sulphate

31
Q

what is torasde de pointes and what can cause it?

A

prolonged QT
caused by sotalol and other drugs that prolong QT interval, hypOkalaemia, and bradycardia

32
Q

whats the loading dose for amiodarone?

A

200mg TDS 7/7
200mg BD 7/7
200mg OD as maintenance

33
Q

what are the side effects of amiodarone ( N TELLS)

A

N - erves: peripheral neuropathy. Counsel on numbness and tingling hands

T -hyroid dysfunction (contains Iodine)
E - yes corneal micro depsoits, esnure to counsel patients on night time glares when driving
L - iver: cause hepatoxicity. Counsell on symptoms
L - ungs: pneumonitis, pulmonary fibrosis. Counsel on SOB, dry cough
S - kin: phototoxicity, slate grey skin. COunsel on using high SPF sun cream for months after stopping

34
Q

does amiodarone cause hyper or hypo thyroid?
what’s the management?

A

can cause both.
hyper = carbimazole, withdraw amiodarone
hypo = start lebothyroxine, continue amiodarone if essential

35
Q

what are the 6 monitoring requirements for amiodarone?

A
  1. annual eye test
  2. CXR before treatment
  3. LFTS every 6 months
  4. TSH, T3, T4 before treatment and every 6 months
  5. BP and ECG (bradycardia and hypotension)
  6. Serum K+ (causes hypokalaemia; enhances arrhythmogenic effect of amiodarone)
36
Q

whats the half life of amidoarone?

A

50 days = danger of interactions several months after stopping

37
Q

what are 5 interactions with amiodarone?

A
  1. increased plasma amiodarone with grapefruit juice
  2. amiodarone is an enzyme inhibitor = warfarin, phenytoin, digoxin (half dose)
  3. increased risk of myopathy with statins
  4. bradycardia, AV block with beta blockers, rate limiting CCBs
  5. QT prolongation = increased risk of ventricular arrhthmia (quionlones, macrolides, TCAs, SSRIs, lithium, antipsychotics)
38
Q

whats the therapeutic range for digoxin?

A

1 - 2 mcg/l

39
Q

how does digoxin work?

A

increases force of myocardial contraction and reduces conductivity in the AV node

40
Q

how long after PO digoxin has been given can you measure the levels?

A

6 - 8 hours to allow for absorption

41
Q

is regular digoxin monitoring required?

A

no unless suspected toxicity or in renal impairment

42
Q

why does digoxin need a loading dose?

A

becuase it has a long half life

43
Q

whats the maintenance dose for digoxin in non-paroxysmal AF and in severe heart failure?

A

AF = 125mcg - 250mcg
HF = 62.5mcg - 125mcg

44
Q

what are the different bioavailabilities for oral, liquid and IV digoxin?

A

PO = 90%
liquid = 75%
IV = 100%

45
Q

what factors increase the risk of digoxin toxicity?

A

hypO K+, Mg2+
Hyper Ca2+
hypoxia
renal impairment

46
Q

what are the symptoms of digoxin toxicity?

A

“slow and sick”
- bradycardia/heart block
- nausea, vomitting and diarrhoea, abdo pain
- blurred or yellow visions (halos)
- confusion
- rash

47
Q

how do you treat digoxin toxicity?

A
  • withdraw digoxin and correct electrolyte imbalances
  • digoxin-specific antibody for life threatening ventricular arrhythmias unresponsive to atropine
48
Q

what are the main interactions with digoxin and what are the effects? (CRASED)

A
  1. Calcium channel blockers (verampamil) = increased plasma digoxin conc
  2. Rifampicin = decreased digoxin conc, enzyme inducer
  3. Amiodarone = increased plasma digoxin conc, enzyme inhibitor
  4. St Johns Wort = redcued digoxin, enzyme inducer
  5. Erythromycin = increased plasma conc, enzyme inhibitor
  6. Diuretics = hypokalaemia predisposes digoxin toxicicity
49
Q

whats the risk of using digoxin and NSAIDs/ACE/ARBS together?

A

renal impairment = reduced renal excreation = toxicity

Pre-reg (47 decks)

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