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Pre Reg > Cardiovascukar System > Flashcards

Cardiovascukar System Flashcards

(58 cards)

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1
Q

Class I anti-arrthymic drugs

A

Membrane stabilising drugs ; Na+ blockers
Disopyramide
Lidocaine
Flecainide/ propafenone

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2
Q

When are flecainide/propafenone contraindicated

A

Asthma
Severe COPD
Avoid in structural/ ischaemic heart disease

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3
Q

Class II anti arrthymic drugs

A

Beta blockers
Propranolol
Esmolol
-olol

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4
Q

Class III anti arrthymic drugs

A

K+ channel blockers
Amiodarone
Sotalol
Dronedarone

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5
Q

Amiodarone dose after electrical cardioversion

A

4 weeks before and 12 months after to increase success

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6
Q

Dronedarone side effects

A

Hepatotoxicity and HF side effect

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7
Q

Class IV anti arrthymic drugs

A

Calcium channel blockers (rate limiting)
Verapamil
Diltiazem

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8
Q

Diltiazem is it a licensed or unlicensed CCB

A

Unlicensed

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9
Q

Other anti arrthymic drugs

A

Adenosine
Digoxin

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10
Q

Advantage of digoxin

A

Effective in sedentary patients with non - paroxysmal AF and in patients with associative congestive HF

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11
Q

What is atrial fibrillation

A

Abnormal, disorganised electrical signals fired cause the atrial to quiver or fibrilate = rapid and irregular heartbeat

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12
Q

Symptoms of atrial fibrillation

A

Heart palpitations = pounding/fluttering
Dizziness, SOB, tiredness

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13
Q

Complications of atrial fibrillation

A

Stroke and heart failure

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14
Q

Type of atrial fibrillation

A

Paroxysmal - episode stop within 48hrs without treatment
Persistent - episode more than 7 days
Permanent - present all the time

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15
Q

Two types of treatment

A

Rate control - control ventricular rate
Rhythm control - restores and maintains sinus rhythm

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16
Q

What are the two types of cardioversion

A

Cardioversion is type of rhythm control
1. Electrical - direct current
2. Pharmacological - anti arrthymic

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17
Q

When is rhythm control not suitable

A

If symptoms more than 48 hours and increases risk of stroke

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18
Q

When is electrical cardioversion preferred

A

If more than 48 hours
Must wait until fully anticoagulated for 3 weeks before cardioversion and continue four weeks after

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19
Q

What type of cardioversion if haemodynamically unstable

A

Electrical - give parental anticoagulant and rule out left atrial thrombus immediately before procedure

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20
Q

Treatment for acute new onset of AF

A

Life threatening haemodynamic instability - electrical cardioversion
Without life threatening haemodynamic instability - < 48 hours = rate or rhythm control (electrical or Amiodarone/flecainide
>48 hours = rate control (verapamil, beta blocker)

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21
Q

Maintenance treatment for atrial fibrillation

A

First line: rate control
Beta blockers (not sotalol) , rate limiting CCB, digoxin
Mono therapy —-> dual therapy —-> rhythm control

Second line; beta blockers or oral anti arrthymic drug
Ie. Sotalol, Amiodarone, flecainide, propafenone, Dronedarone

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22
Q

Paroxysmal and symptomatic AF treatment

A

Ventricular or rhythm control = standard BB or oral anti arrthymic drug
Pill in pocket if infrequent episodes - self treatment = flecainide or propafenone restores sinus rhythm if episode occurs

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23
Q

Atrial flutter treatment

A

Similar to AF but catheter ablation more suitable

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24
Q

When to give Anticoagulant in stroke prevention

Study These Flashcards
A

If risk of thromboembolic stroke > the risk of bleed HAS-BLED

25
Risk of stroke tool and meaning
CHA2DS2VASC TOOL C - chronic heart failure or left ventricular dysfunction H- hypertension A2- age ur+ D- diabetes mellitus S2- stroke/TIA/VTE history V- vascular disease A- 65-74 years Sc- sex category ie. Female
26
What score on CHA2DS2VASC to give anticoagulant
If 2 or more No anticoagulant if male =0 or female = 1
27
New onset of AF treatment
Parenteral anticoagulant
28
Diagnosed AF treatment
Warfarin or NOAC
29
What is NOAC
Novel oral anticoagulant in non valvular AF with >= 1 risk factor ( 75+, heart failure, htn, dm, previous stroke or TIA
30
What is the different types of ventricular tachycardia and the treatment
Pulseless or fibrillation - immediate defibrillation and CPR, IV Amiodarone is given refractory to defib Unstable sustained VT - direct current cardioversion, if this fails give IV Amiodarone and repeat direct current Stable sustained VT - IV anti arrthymic drug (Amiodarone preferred) Non sustained VT- beta blocker
31
Maintenance of ventricular tachycardia treatment
For high risk of cardiac arrest- Most patients = cardioverter defibrillator implant Some pt also require drug ; Sotalol, bb alone or bb with Amiodarone
32
What is torsade de pointes
Prolonged QT interval
33
Treatment and cause of prolonged QT interval
Treat - magnesium sulphate Causes -Sotalol and other drugs that prolong QT interval, hypokalaemia and bradycardia
34
Paroxysmal supraventricular tachycardia
Terminates spontaneously or with reflex vagal nerve stimulation or. Valsalva manoeuvre, carotid sinus massage or immersing face in ice cold water— > IV adenosine (CI- COPD/ASTHMA)— ->IV verapamil
35
Treatment of haemodynamically unstable paroxysmal supraventricular tachycardia (PST)
Direct current cardioversion
36
Treatment of recurrent paroxysmal supraventricular tachycardia
Catheter ablation OR drugs (verapamil, Diltiazem, BB, flecainide, propafenone
37
Amiodarone
Class III anti arrthymic used in supraventricular and ventricular arrhythmia
38
Amiodarone dose
Loading dose 200mg TDS for 7 days 200mg BD FOR 7 days and then 200mg OD as maintenance
39
Amiodarone side effects -eyes
Corneal micro deposits Pt counselling ; night time glares when driving Optic neuropathy/neuritis (blindness) Pt counselling : STOPif impaired vision
40
Amiodarone side effects ; skin
Phototoxicity (burning, erythema) Slate grey skin on light exposed areas Pt counselling; shield skin from light during treatment, use wide spectrum, high spf for months after stopping
41
Amiodarone side effects ;nerves
Peripheral neuropathy Pt counselling; numbness, tingling in hands and feet, tremors
42
Amiodarone side effects ;lungs
Pneumotitis, pulmonary fibrosis Pt counselling: SOB, dry cough
43
Amiodarone side effects: liver
Helatotoxicity Pt counselling ; report jaundice, nausea, vomiting, malaise, itching, bruising, abdominal pain - due to 3x raised liver transaminases)
44
Amiodarone side effects; thyroid dysfunction (Amiodarone contains iodine)
Hyperthyroidism (eg. Weight loss, heat intolerance, tachycardia) - give carbimazole if necessary and withdraw Amiodarone Hypothyroidism (weight gain, cold intolerance, bradycardia) -Start levothyroxine without withdrawing Amiodarone
45
Amiodarone monitoring
Annual eye test Chest c ray before treatment Liver function tests every 6 months Monitor TSH, T3,T4 before treatment and every six months Blood pressure and ECG (can cause hypotension and bradycardia) Serum potassium (causes hypokalaemia, enhances arrthymogenjc effect of Amiodarone)
46
Amiodarone interactions
Has a long half life ~ 50days Danger of interactions for several months after stopping - increased plasma Amiodarone concentrations = grapefruit juice (enzyme inhibitor) -Amiodarone is an enzyme inhibitor * warfarin, phenytoin, digoxin (half dose) -increased risk of myopathy = statins - bradycardia, AV block and myocardial depression = beta blockers, rate limiting CCB ie. Verapamil and Diltiazem - QT prolongation = increased risk of ventricular arrthymia = quinolones, macrolides, TCAs, SSRIs, lithium, quinine, hydroxychloroquine, anti-malarial (chloroquines, mefloquine), antipyschotics(esp. sulpride, pimozide, amisulpride)
47
Digoxin class and moa
Cardiac glycoside 1-2mcg /L High risk drug Increases force of myocardial contraction (positive into rope) Reduces conductivity in the AVnode (negative chronotrope)
48
Therapeutic level of digoxin
1-2mcg/L (desired plasma concentration 6 hours after dose) Regular monitoring is not required during maintenance treatment unless toxicity suspected OR in renal impairment (Renally cleared)
49
Digoxin dose
Loading doses required due to long half life Maintenance OD : atrial flutter and non - paroxysmal AF in sedentary patients ; 125-250mcg Worsening or severe heart failure (in sinus rhythm); 62.5-125mcg
50
Different bioavailability’s of different formulation for digoxin
Elixir = 75% Tablet = 90% IV =100%
51
Risk and Signs of digoxin toxicity
Risk of toxicity in hypokalemia, hypomagnesaemia, hypercalcemia, hypoxia and renal impairment Symptoms ; bradycardia/heart locks -nausea , vomiting and diarrhoea, abdominal pain - blurred or yellow vision - Confusion, delirium - Rash
52
Treatment for digoxin toxicity
Withdraw and correct electrolyte imbalance Digoxin specific antibody ; for life threatening ventricular arrhythmias unresponsive to atropine
53
Digoxin interactions
Ihypokalaemia predisposes digoxin toxicity - diuretic (loop/thiazide), B2 agonist, steroid, theophylline (if potassium levels < 4.5mmol/L; give potassium supplements or potassium sparing diuretics (preferred) Increased plasma digoxin concentration = toxicity - Amiodarone (half digoxin dose), rate limiting CCB, macrolides, ccilosporin (enzyme inhibitors) Decreased plasma digoxin concentration = sub therapeutic = St John’s wort, rifampicin ( enzyme inducers) Reduced renal excretion = toxicity (digoxin renally excreted) - NSAIDs, ACEi/ARBs
54
Digoxin interaction pneumonic
CRASED C - CCB (VERAPAMIL) R - RIFAMPICIN A - AMIODARONE E- ERYTHROMYCIN ( macrolide) D- DIURETIC
55
Two types of venous thromboembolism (VTE)
Venous thromboembolism 1. Deep vein thrombosis (DVT) 2. Pulmonary Embolism (PE)
56
What is DVT
A blood clot occurs in a deep vein, usually in calf of one leg
57
What is pulmonary embolism
Detachment of blood clot which travels to lungs and blocks the pulmonary artery
58
VTE risk assessment
For all pt admitted to hospital - immobility - obesity BMI> 30 - malignant disease - 60+ years - personal history of VTE = thrombophyllic disease, 1st degree of relative with VTE - HRT / Combined contraception = varicose veins with phlebitis - pregnancy = critical care, significant co - morbidities.

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