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Flashcards in Arrhythmias Deck (50):
1

How are ectopic beats treated

rarely need treatment but could use beta blocker

2

if patient presents with arrythmia had less than 48 hours is rate or rhythm preferred?

rhythm control
-over 48 hours rate control

3

2 treatments for urgent rate control

beta blocker or verapamil IV

4

2 drugs for pharmacogolical cardioversion

flecinade
amiodarone (preferred when there is structural heart disease)

5

Is pharmacological or electrical cardioversion preferred

electrical if arrhythmia present for over 48 hours - pt must be anticoagulated

6

Rate or rhythm control is first line

Rate (unless less than 48 hours or arrhythmia)

7

What beta blocker is not suitable for rate control

sotolol

8

what are two rate limiting CCBs?

verapamil and diltiazem

9

what are the two drug classed that are used for rate control

beta blocker
rate limiting CCB

10

does digioxin control rate or rhythm
when is it suitable and why

rate
predominately sedentary patients as it only controls rate at rest

(also used when there is AF and CHF)

11

what is first
second
third line for AF

first - rate monotherapy
second - two rate controlling medications
third - rhythm control

12

rhythm control options: (6)

betablocker or
anti-arrhythmic drugs:
-sotolol
-flecinade
-propanfenone
-amiodarone
-dronedarone

13

what is used for pil in the pocket (2)

flecinade
propafenone

14

chads vasc parameters:

Congestive heart failure/Left ventricular dysfunction (1)
Hypertension (1)
A2 - Age≥75 (2)
Diabetes mellitus (1)
S2 - Stroke/TIA/TE (thromboembolism) (2)
Vascular disease — coronary artery disease (CAD), myocardial infarction (heart attack), peripheral artery disease (PAD), or aortic plaque (1)
Age 65-74 (1)
Sc - Sex category — Female gender (1)

15

hasbled parameters

Hypertension (1)
Abnormal liver/renal (1 or 2)
Stroke (1)
Bleeding (1)
Labile INR (1)
Elderly (1)
Drugs/alchohol (1)

16

Is aspirin a suitable alternative to anticoagulation in AF

no - ther risk of bleeding outweighs the modest benifit

17

what is a labile INR

in range less than 60% of the time

18

What systolic BP is considered hypertension in the HASBLED

> 160

19

How do you assess the need for anticoagulation in atrial flutter?

Using HASBLED and CHADSVASC just like AF

20

what would be the treatment for bradycardia post MI (2)

atropine IV
or adrenaline

21

what electrolyte imbalance can contribute to long QT syndrome?

hypokalaemia

22

what is dysopyramide used for? what is a caution with this drug?

control arrhythmias after MI
but has anticholinergic effects therefore caution in BPH and closed angle glaucoma

23

caution of flecainide

can precipitate serious ventricular arrhythmias in patients with otherwise normal hearts in a small minority of patients

24

What is the loading dose for amiodarone

200mg tds - one week
200mg bd - one week
200mg od - from then on

25

how long can drug interactions happen after treatment with amiodarone

weeks or even months after stopping treatment

26

How does amiodarone affect the QT interval

prolongation - caution with loads of drugs

27

what color can amiodarone discolour skin?

slate grey

28

what is the problem with amiodarone and driving at night?
is this reversible?
is this side-effect a reason to withdraw treatment?

microdiposits in the cornea - causing night glare (being dazzled when driving and night)
(reversible)
this does not usually impair vision however if vision is impaired treatment must be withdrawn to prevent bliness as this could be optic neuropathy

29

why would you be concerned about a patient on amiodarone with increasing SOB or cough

pulmonary toxicity - pneumonitis and fibrosis of the lungs

30

what blood tests should we be doing routinely with amiodarone treatment

TSH/T4
LFTs
every 6 months

31

what is the affect of amiodarone on the thyroid and why?

should amiodarone be withdrawn?

hyper or hypothyroidism can occur
contains iodine

withdraw at least temporarily to achieve control but can continue amiodarone while controlling if necessary

32

what is the effect of amiodarone on the liver

may effect LFTs but also may cause hepatotoxity
if tests severely deranged or symptomatic withdraw amiodoarone

33

what electrolyte should be monitored before amiodarone treatment

Potassium (there is no reason for this stated in the BNF but potassium is all about hearts so just remember that)

34

what advice would you give an amiodarone patient going on holiday to spain

PHOTOTOXICITY - SHIELD YOURSELF FROM THE SUNNNNNNNN!!!!!

35

can amiodarone tabs be crushed?

yes

36

what is the effect of amiodarone on the peripharies

may cans peripheral neuropathy

37

What two electrolyte imbalances MUST be corrected before treatment and why?
(this is a BNF warning box)

hypomagnesaemia
hypokalaemia
- because sotolol prolongs the QT interval and occationally may cause life threatening ventricular arrhythmias

38

for the management of AF digioxin should be taylored to pulse rate, but what pulse is too low

pulse should not be allowed to fall below 60bpm

39

what demographic is particularly suceptable to digioxin toxicity?

the elderly

40

What electrolyte disturbance predisposes a patient to digoxin toxicity?
how do we manage this?

hypokalaemia

- manages using K sparing diuretics or in necessary K supplementation

41

how does the dose of digioxin need to be changes when switching from IV to oral

20-33% increase to maintain same plasma conc

42

id monitoring plasma digoxin levels when would you take the blood?

6 hours post dose

43

plasma digoxin concentration alone dose not reliably indicate toxicity BUT liklihood of toxicity increases progressively through the range of ............. to ..............

1.5-3 MICROgrams/litre

44

what is the maintinance dose range of dig and how do you decide what to give?

125-250 micrograms OD - according to renal function

45

name some significant interactions with digoxin and how to manage

amiodarone increases plasma digoxin
(half the digoxin dose)

46

name some significant interactions with amiodarone

inhibitor of CYP therefore all of those interactions

47

what is the effect of amiodarone on warfarin

enhanced anticoagulant effect (by inhibiting the metabolism of warfarin)

48

is there an interaction between amiodarone and statins?

amiodarone increase risk of myopathy with simvastatin

49

is there an interaction with amiodarone and lithium

yes - both these drugs seem to interact with erverything so look out chaps

50

what CCBs can interact with beta blockers

diltizem and verapamil - AV block, bradycardia, HF