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Cardio 4 > Arrhythmai therapies and drugs > Flashcards

Arrhythmai therapies and drugs Flashcards

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1
Q

What is the Vaughan-Willians classifications of anti-arrhythmic drugs?

A

C;lasses antiarrythmic drups 1-5 in relation to the receptor they work on

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2
Q

Why are anticoagulants important in cardiac arrythmias?

A
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3
Q

What is sinus arrythmia?

A

It is the natural increase and decrease ib heart rate, especially in younger people when they breathe in and out (increased HR on inhalation, and decreased HR on exhalation)

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4
Q

Supraventricular arrhythmias eg and ecg

A

AF, SVT (junctional)

Narrow QRS complex, genararlly more irregular (esp tchycardias)

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5
Q

ventricular arrythmias eg and ecg

A

Ventricular tachycardia, Ventricular fibrillation

ecg = broad complex, more radid regular (esp tachycardias)

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6
Q

What is bradycardia (pathologies)

A

30-40bpm

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7
Q

resting pot. of heart?

A

-90mV

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8
Q

What do class 1 anytiarrythmias work on?

A

Sodium channels (blockers), therefore reducing the size of action potential (amplitude), also reduces the velocity of conduction and excitability.

Split into
Ia moderate
Ib weak
Ic - strong eg flecainide

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9
Q

Class 2 are? Act on?

A

Betablockers, act on B1 receptors on the heart, blocking sypathetic stimulisation:

  • prolongs depolarisation (reduces SA node and AV conduction, reduces excitability in non nodal cardiac tissue)
  • weaker contractions as shortens phase 2
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10
Q

Class 3?

A

Potassium channel blockers
Blocks K+ channels so delays repolarisation, increasing AP duration

Used fro hard to treat dysrhythmias

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11
Q

Class 4?

A

Ca+ (L type) channel blockers

depresses depolarisation and so slows heart rate in all heart, reduces contractility.

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12
Q

Class 5?

A

Other

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13
Q

What type of drug s Flecainide?

A

A strong Na+ channel blocker, class 1

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14
Q

What type of drug is Atenolol?

A

Beta blocker - used more for bp, class 2

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15
Q

What type of drug is Bisoprolol?

A

Beta blocker - used more for rate control class 2

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16
Q

What type of drug is Amiodarone?

A

K+ channel blockers, class 3

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17
Q

What type of drug is Diltiazem?

A

Ca2+ L type channel blockers, class 4

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18
Q

What type of drug is Verapamil?

A

Ca2+ L type channel blockers, class 4

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19
Q

What type of drug is Digoxin?

A

“Other” class 5

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20
Q

How do class I drug works?

A

Block Na+ channels and therefore decrease the rate and strength of action potential. Repolarising remains unaffected and occurs at the same time and rate as normal.

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21
Q

How does Flecainide affect the depolarisation and repolarisation of cardiac cycle?

A

Flecainide is a class Ic, so a strong Na+ channel blocker, therefore depolarisation is much slower and not as strong. The repolarising phase is pretty much unaffected.

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22
Q

How do class II work?

A

Beta blockers, block B1 receptors on heart so block the affects of the sympathetic stimulation of the heart.

Leads to longer depolarisation and shorter contraction

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23
Q

What is first line control of AF?

24
Q

How do class III work?

Study These Flashcards
A

Block K+ channels and so prolong repolarisation and increase AP duration. Alos prolongs ERP.

25
Class III used for what?
Hard to treat dysrhythmias. | Ventricular tachycardia or fibrilation, AF or atrial flutter
26
WHat do you do to verapamil/digoxin if startingf Amioadrone?
Half the dose as they compete with Amiodrone for albumin binding
27
What abnormalities can Amidraonone toxcitiy cause?
Iodine - thyroid issues Lung fibrosis Sun damage leads to permanent slate grey pigmentation Eye deposits
28
How do class 4 work?
Block type L Calcium channels, so slows th edepolarisation meaning reduced heart rate and also strength of contraction. Used for paroxysmal supraventricular tachycardia, rate control of AF and atrial flutter
29
What type is adenosine?
An "other" drug, type 5
30
What does Digoxin do?
Inhibits sodium-potassium ATPase pump. ``` Slows HR (decreases vagal tone) Reduces refractory period Increases intracellular Ca ```
31
Digoxin indications
Atrial dysrhythmias eg AF, Atrial Flutter, (SVT) | Heart failure
32
Digoxin half life and factors affecting, and symptoms
Long! 36-48h! Kidney function affects half live and also digoxin affects kidney life! Monitor for toxicity Nausea and vommiting, yellow haze around everything (Xanthopsia), brady and tachycardia, VT and VF arrhythmias
33
How to reduce digoxin levels if become toxic?
Digibind, forms an immune complex , that is more easily secreted.
34
How does Adenosine work and use?
Blocks/slows conduction through AV node. Converts paroxysmal supraventricular tachycardia to sinus rhythm.
35
Adenosine short/long half life? Symptoms?
Short half life, minimal side effects- can cause arrhythmias.
36
AF has what significant srisks?
Stroke
37
Why AF cause thrombosis?
The disarray of atrial contraction can lead to stasis, particularly in the left atrial appendage. Also due to increase in size of the atrium.
38
Prevelance of AF?
Increases with age, 10-20% 8th decade have some af
39
2 other important risk factors
Other medical contitions, BP and diabetes
40
CHADSVascS score means what ?
``` C - congestive heart failure (1) H - Hypertension (1) A - Age (65-74 =1, 75+ = 2) D - Diabetes S - Stroke/Tia/thromboembolism (prev) - (2) Vasc - Vascular disease (1) Sex - femaie (1) ``` Increase in score means higher risk of stroke. ``` 2+ = moderate -high risk, consider anticoagulant. 1= think about ```
41
What makes an anticoagulant good?
``` Minimal interactions with other drugs/food No need for monitoring As effective and safer than warfrin Oral Given once or twice a day, fixed dose ```
42
What 3 groups of anticoagulants ?
Vit K antagonists (warfrin) Direct Thrombin Inhibitor (prevents fibrinogen to fibrin) eg Dabigatran Direct Xa inhibitors , prevents prothrombin to thrombin) (Rivaraxaban,Apixaban, Edoxaban) All work on the cascade of events leading to thrombin production, just at different sages.
43
What type of anticoagulant is Warfrin?
Vitamin K inhibitor, Vit K is important in the production in clotting factors 2,7,9,10.
44
What type of anticoagulant is Dabigatran?
Direct thrombin inhibitor
45
What kind of anticoagulants are Rivaroxaban,Apixaban,Edoxaban?
Direct Xa inhibitors (prevents prothrombin to thrombin)
46
What are the issues of warfrin?
Narrow therapeutic index. No standard dose, depends on no. factros of patient so needs lots of monitoring. Bleeding, and interacts cytochrome P450
47
What is INR? What is it used to monitor?
International normalised ratio: Actual PROTHROMBIN time/Standard PROTHROMBIN time Normal is 1, therapeutic range for INR is 2.5-4 depending on clinical indication
48
What anticoagulant used in pregnancy?
Heparin (sub cutaneous or IV)
49
What is used to calculate risk of bleeding?
HAS-BLED Score ``` Hypertension (1) Abnormal kidney(1), liver(1) Stroke (1) Bleeding(1) Labile (easily changed) INRs(1) Elderly (65+ = 1) Drugs/Alcohol (1) ```
50
Are falls in the elderly a contraindication for anticoafulanet?
Not usually , studies have shown that you'd have to be falling several times/day to sustain a major complication
51
What drugs can increase warfrin activity?
Any drug displacing it from albumin binding site (Asprin (300mg+), sulfonamides) Drugs inhibiting degradation - Cytochrome P450 inhibitors (cimetidine,erthyromycin) Drugs decreasing synthesis of clotting factors (antibiotics - oral)
52
What other drugs would also promote bleeding?
Asprin (inhibits platelets), Heparin/antimetabolites (inhibits clotting factors)
53
What other drugs decrease warfrin activity?
Any cytochrome P450 induces (increases the removal of and excretion of warfrin) eg barbiturates,phenytoin Drugs promoting clotting factor synthesis (eg Vit K) Drugs with reduced absorption (eg Cholestyramine)
54
Cytochrome P450 Inhibitors
Decrease the metabolism of warfrin therefore increasing its effects. ``` Omeprazole Disulfiram Erythromycin, clairithromycin Valproate Isoniazid Ciprofloxacin and Cimetidine Ethanol (acutely) Sulphonamides ```
55
Cytochrome P450 inducers
ABC PRS ``` Alcohol (chronic use) Barbiturates Carbamazepine Phenytoin Rifampicin Sulphonylureas ```
56
Metallic heart valves, what anticoagulant?
Warfrin
57
DVT/PE put on anticoagulant?
yes

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