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Cardiovascular system SA > Arrhythmias treatment > Flashcards

Arrhythmias treatment Flashcards

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1
Q

What is Vaughan-Williams classification of drugs used to treat arrhythmias

A 
Class 1
-Class Ia
-Class Ib
-Class Ic
Class II
Class III
Class IV
Other
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2
Q

What is the electrophysiologic property of class IA

A

Fast* sodium-channel blockade

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3
Q

What is the electrophysiologic property of class IB

A

Intermediate* sodium-channel blockade

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4
Q

What is the electrophysiologic property of class IC

A

Slow* sodium-channel blockade

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5
Q

What is the electrophysiologic property of class II

A

Β-Adrenergic receptor antagonism

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6
Q

What is the electrophysiologic property of class III

A

Prolong refractoriness

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7
Q

What is the electrophysiologic property of class IV

A

Calcium channel blockade

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8
Q

What are class I drugs, and what do they all do

A

Membrane-stabilizing agents

- sodium channel blockers

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9
Q

What is examples of class Ia

A

quinidine, procainamide, disopyramide

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10
Q

How do class Ia drugs block sodium channels

A

Delay repolarization

Increase the action potential duration

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11
Q

What are class Ia drugs used for

A

Used for atrial fibrillation, premature atrial contractions, premature ventricular contractions, ventricular tachycardia, Wolff-Parkinson-White syndrome

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12
Q

What is examples of class Ib drugs

A

tocainide, mexiletine, phenytoin, lidocaine

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13
Q

How does class Ib drugs block sodium channels

A

Accelerate repolarization

Decrease the action potential duration

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14
Q

What are class Ib drugs used for

A

ventricular dysrhythmias only (premature ventricular contractions, ventricular tachycardia, ventricular fibrillation)

Digoxin toxicity

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15
Q

What is examples Ic drugs

A

encainide, flecainide, propafenone

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16
Q

What is Ic drugs affect onaction potential duration or repolarization

A

Little effect

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17
Q

What class 1 drug is the stronger sodium channel blocker

A

class Ic

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18
Q

What is class Ic drug used for

A

Used for severe ventricular dysrhythmias

May be used in atrial fibrillation/flutter

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19
Q

What are class II drugs, and how do they work

A

Beta blockers

Reduce or block sympathetic nervous system stimulation, thus reducing transmission of phase 4 depolarisation of impulses in the heart’s conduction system

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20
Q

What is examples of class II drugs

A

atenolol, bisoprolol, propranolol

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21
Q

What is the use of class 11 drugs

A

General myocardial depressants for both supraventricular and ventricular dysrhythmias

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22
Q

What is first line use for atrial fibrillation

A

Class II - bisoprolol

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23
Q

How does class III prolong refractoriness

A

Increase action potential duration by prolonging repolarization in phase 3
Slowing the rate pottasium coming out the cell

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24
Q

What is examples of class III drugs

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A

amiodarone, bretylium, sotalol,

25
When is class III drugs used
Used for dysrhythmias that are difficult to treat Life-threatening ventricular tachycardia or fibrillation, atrial fibrillation or flutter—resistant to other drugs Sustained ventricular tachycardia
26
How does class IV drugs acts as calcium channel blockers
By depressing phase 4 depolarization
27
What is examples of class IV drugs
verapamil, diltiazem
28
What are class IV drugs used for
paroxysmal supraventricular tachycardia; rate control for atrial fibrillation and flutter
29
What is examples of antidysrhythmics
Digoxin | adenosine
30
What kind of drug is digoxin and whats it affect on the heart
Cardiac glycoside Positive ionotrope Improves strength of cardiac contraction
31
How does digoxin affect the hearts contractility
Inhibits the sodium-potassium ATPase pump Allows more calcium to be available for contraction
32
What is digoxin used for
Used for heart failure and atrial dysrhythmias
33
What is the disadvantages of digoxin used
Low therapeutic jinxed therefore drug levels must be monitored for toxicity
34
What patient in digoxin commonly used in and why
Commonly used in elderly, as digoxin has a reduced globular filtration rate, therefore as elderly more likely to have renal impairment its more beneficial
35
What is the side affect of digoxin toxicity
``` Nausea and vomiting Xanthopsia Bradycardia Tachycardia Arrhythmias: VT and VF ```
36
What is the problem in treating digoxin toxicity
Long half life not effectively removed by dialysis Half life increased in renal impairment
37
What is the treatment plan in digoxin toxicity, and what is the further treatment plan if levels are high with a risk of arrhythmia
Stop digoxin Give digibind -Digoxin immune antibody Binds with digoxin, forming complex molecules Excreted in urine
38
When are digoxin toxicity more serious
if potassium levels are low risk of developing arrhythmia
39
What is the side effect of the drug interaction between digoxin and amiodarone (class II drug)
``` Thyroid (hypo or hyperthyroidism) Pulmonary fibrosis Slate – grey pigmentation Corneal deposits LFT abnormalities ```
40
How does the antidysrhythmics adenosine affect the heart rate
Slows conduction through the AV node
41
What is adenosine used for
to convert paroxysmal supraventricular tachycardia to sinus rhythm
42
How is adenosine administrated
administered as fast IV push
43
What is the side effect of adenosine
May cause asystole for a few seconds, other side effects minimum (very short half life)
44
Whats is one of the main side effects of antiarrhythmics
arrhythmias
45
What is the treatment for sinus tachycarida
Class II - beta blockers | Class IV - calcium channel blockers
46
what is the treatment for atrial fibrillation/flutter
Class IA, IC, -sodium channel blockers Class II - Beta blocker Class III - prolong refractoriness Class IV - calcium channel blockers Anticoagulation
47
What is the treatment for Paroxysmal supraventricular tachycardia
Class IA/ IC, - sodium channel blockers II, Class III, prolong refractoriness Class IV, - calcium channel blockers adenosine - decreases HR
48
What is the treatment for AV block
atropine
49
What is the treatment for ventricular tachycardia
Class I - sodium channel blockers Class II - Beta blcokers Class III - prolong refractoriness
50
Why it is wise to give anticoagulation with atrial fibrillation
As increase risk of stroke and peripheral emboli
51
What is examples of anticoagulation drugs
Warfarin - Structurally related to vitamin K therefore Inhibits production of active clotting factors Dabigatran/Apixaban - direct thrombin inhibitor Rivaroxaban - Factor Xa inhibitor Preventing the formation of thrombin
52
What is the indications of anticoagulation therapy
Atrial fibrillation - reduce stroke risk by 80% DVT/PE After surgery Immobilisation: those at high risk of DVT
53
What are the drugs that interact with warfarin and increase activity and how
Aspirin, Sulfonamides - decrease binding to albumin Cimetidine, Disulfiram - inhibit degradation Antibiotics (oral) - decrease synthesis of clotting factors
54
What are the drugs that interact with warfarin and promote bleeding
Aspirin - Inhibition of platelets antimetabolites + heparin - Inhibition of clotting factors
55
What are drugs that interact with warfarin and decrease activity
Barbiturates + pheytoin = Induction of metabolizing Enzymes (cytochrome P450) Vitamin K - promote clotting factor synthesis Cholestyramine - reduced absorption
56
Where is warfarin metabolised and how is the therapy monitored
In the liver by the cytochrome P450 system International normalised ratio (INR) =Standard thromboplastin time Normal INR = 1 educate patients watch alcohol intake
57
What do you give first in the indication of DVT
Heparin
58
What is the disadvantages to warfarin therapy
Can promote Bleeding Is a tetraogenic - chondrodysplasia - malformation of cartilage
59
Wha conditions increases you risk of bleeding on warfarin
``` C - congestive heart failure H - hypertension A - age > 75 years D - diabetes mellitus S - stroke (or TIA) ``` CHADS2

Cardiovascular system SA (43 decks)

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