arrythmias Flashcards
1
Q
Sotalol
Indications
A
- Symptomatic ventricular tachycardia
- Atrial tachycardia/fibrillation
- maintenance of sinus rhythm after cardioversion
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2
Q
Sotalol
MOA
A
- Non-selective BB
- Sotalol has both Class II (Beta blocking effect) and Class III (cardiac action potential duration prolongation- lengthens PR, QT and QTc)
- Its B-adrenergic effect causes a reduction in BP, HR and negative inotropic effect which reduces myocardial oxygen consumption and cardiac work
3
Q
Sotalol
Adverse effects
A
- Prolongation of QT can cause life-threatening ventricular arrhythmias- advised to reduce or discontinue if QT >550 msec
- STOPP criteria (Bradycardia, low BP)
- Cold peripheral
- Abdo pain
- ED
- Fatigue
4
Q
Sotalol
Warnings
A
- Contraindications: Asthma, cardiogenic shock, metabolic acidosis, uncontrolled HF
- Hyper/Hypokalaemia (with or without hypomagnesaemia)- due to QT prolongation- should not be given until K imbalance is sorted
- Cautions
- Diabetes (Mask symptoms of hypoglycaemia)
- COPD
- Myasthenia gravis
- Portal HTN (Risk of deterioration of liver function)
- Mask symptoms of thyrotoxicosis
5
Q
Sotalol
Interactions
A
- B-agonists
- Non-dihydropyridine calcium channel blockers (e.g. diltiazem and verapamil)- When used in combination this can cause HF, bradycardia and asystole
6
Q
Sotalol
Monitoring
A
- BP (120+)
- HR (50-90)
- Monitor lung function in patients with a history of obstructive airway disease)
- ECG
- U&E (K, Mg)
7
Q
Flecainide
Common indications
A
- Supraventricular arrhythmias
- Ventricular arrhythmias
- NB- reduce dose by half when concurrent use with amiodarone
8
Q
Flecainide
MOA
A
- Class IC agent- local anaesthetic type
- Characteristics: Marked depression of the fast Na channel in the heart, slow association and dissociation from Na channels, mainly affects Purkinje fibres (as opposed to ventricular muscle)
- These properties leads to depression in conduction velocity with a modest increase in the refractory period
- Flecanide leads to prolongation of PR, QRS duration on ECG
9
Q
Flecainide
Adverse effects
A
- Arrhythmias, dizziness, fever, oedema, visual disturbances
10
Q
flecainide
Warnings
A
- Abnormal LV function
- HF
- Elderly (accumulation can occur)
11
Q
DOAC’s
Indications
A
- Prophylaxis of VTE following Knee and hip replacement
- Prophylaxis (10mg) and Treatment of DVT + PE- 15mg BD for 21 days then 20mg OD maintenance
- Prophylaxis of stroke in patients with AF (With HF, HTN, previous stroke/tia, >75yrs or diabetes)- 20mg
- Prophylaxis of ACS (in combo with antiplatelets)- 2.5mg
12
Q
DOAC’s
Contra-indications
A
- Active bleeding
- Antiphospholipid syndrome
- Oesophageal varices
- GI ulcers
- Intracranial haemorrhage
- Recent brain and ophthalmic surgery
13
Q
DOAC’s
Cautions
A
- Bronchiectasis
- Elderly
- Prosthetic heart valve
- Risk of bleeding
- BW<60kg
14
Q
DOACs
Renal impairment
A
- Rivaroxaban- with 15-49mL- reduce 20mg to 15mg. Avoid <15mL
- Dabigatran- 30-50mL reduce 150mg to 75mg. Avoid if <30mL
- Edoxaban- with 15-50mL reduce 60mg to 30mg. Avoid <15mL
- Apixaban
- Avoid <15mL
- With 15-29mL (AND has Cr=133 or over 80 or <60kg) reduce to 2.5mg BD for stroke
15
Q
DOAC’s
Interactions
A
- CYP3A4 inducers (rifampicin, AEDs)
- Other anti-coagulants + anti-platelets
- Meds that increase risk of bleeding- NSAIDs, SSRI
