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Anti-Arrhythmic Drugs Flashcards

1
Q

what does class 1 control?

A

rhythm

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2
Q

what is the mechanism of action of class 1?

A

sodium channel antagonists

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3
Q

what are the names of class 1 drugs?

A

lidocaine

flecanide

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4
Q

what does class 2 control?

A

rate

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5
Q

what is the mechanism of action of class 2?

A

beta blockers

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6
Q

what are the names of class 2 drugs?

A

atenolol

bisoprolol

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7
Q

what does class 3 control?

A

rhythm

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8
Q

what is the mechanism of action of class 3?

A

potassium channel antagonists

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9
Q

what are the names of class 3 drugs?

A

amiodarone

sotolol

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10
Q

what does class 4 control?

A

rate

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11
Q

what is the mechanism of action of class 4?

A

calcium channel antagonists

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12
Q

what are the names of class 4 drugs?

A

diltiazem

verapamil

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13
Q

what are the names of class 5 drugs?

A

digoxin
adenosine
magnesium sulphate

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14
Q

name types of narrow complex tachycardias

A

sinus tachycardia
supraventricular tachycardia
Atrial fibrillation/atrial flutter
Wolf Parkinson white syndrome

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15
Q

name types of broad complex tachycardias

A

ventricular tachycardia
ventricular fibrillation
SVT/AF with BBB

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16
Q

what is the initial general management for all tachycardias?

A

ABCDE + access patient for haem instability

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17
Q

if the patient is found to be unstable, what is the general management for tachycardias?

A

1st line: DC cardioversion up to 3 times

2nd line: IV amiodarone 300mg ove 10-20 mins

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18
Q

what is the management for stable narrow complex tachycardias?

A

access ECG and found to be regular:
1st line - vagal manoeuvres (carotid massage, vavalsalva)
2nd line - IV adenosine
(if not responding consider atrial flutter and treat with beta blockers to control rate)

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19
Q

what is the management for irregular narrow complex tachycardias?

A

access ECG and found to be irregular –> AF
if symptoms <48 hours consider chemical/electrical cardioversion
beta blockers/digoxin to control rate plus anti-coagulation

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20
Q

what is the treatment for stable broad complex tachycardias?

A

if VT/unknown rhythm:
loading dose of amiodarone followed by 24 hour infusion
(correct K/Mg)

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21
Q

what is the treatment for irregular broad complex tachycardias?

A

presumed AF with BBB:
treat as irregular narrow complex

if polymorphic VT (torsades des pointes):
IV mag sulf

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22
Q

where does supra ventricular tachycardia originate?

A

in or above the AV node

associated with reentrant current

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23
Q

what does SVT ECG look like?

A

no clear P waves
regular, narrow complexes
rate divisible (100, 150, 300)

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24
Q

what prevention can be used for SVT?

A

BB

radio-frequency ablation

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25
what is wolf Parkinson white syndrome?
congenital accessory pathway exists between atria and ventricles leading to atrioventricular reentry tachycardia
26
what does wolf Parkinson white syndrome look like on ECG?
short PR interval slurred upstroke R wave - delta wave left acid deviation if right sided pathway - main one
27
what is the management for wolf Parkinson white syndrome?
avoid AV node drugs - BB, digoxin, verapamil medical - amiodarone, flecainide, sotalol surgical - radio frequency ablation of the pathway --> definitive management
28
what are the 3 classifications of AF?
paroxysmal persistent permanent
29
what is paroxysmal AF?
episodes (>2) lasting less than 48 hours than may spontaneously resolve to sinus rhythm
30
what is persistent AF?
AF lasting >7 days with little chance of spontaneous resolution of rhythm
31
what is permanent AF?
AF that is unresponsive to cardioversion therapy with the aim to control the HR and anti-coagulate
32
what is the management for unstable acute AF?
emergency cardioversion
33
what is the management for stable acute AF?
rate control 1st line: BB or CCB (diltiazem preferred over verapalim) 2nd line: digoxin if HF use digoxin
34
when would rhythm control be used to treat AF?
``` CCF symptomatic younger first presentation with just AF reversible cause ```
35
what are the two options for rate control?
chemical or electrical cardioversion
36
what is the rhythm control management for AF?
1st line: chemical cardioversion - amiodarone (if structural heart problems) - flecanide (no structural heart problems) (avoid if IHD) 2nd line: DC cardio version
37
what should be given prior to DC cardioversion and why?
anti-platelet drug | risk of clots being pushed through heart
38
what must happen if the patient has been experiencing AF for >48 hours prior to cardioversoin?
heparinised for 3 weeks prior
39
what must happen post cardioversion?
anti-coagulation for at least 4 weeks
40
what is used to determine anti-coagulation cover?
CHADVASC score
41
what drug is used prior to risk assessment for AF being carried out?
heparin
42
what is the treatment for chronic AF?
rate control 1st line: BB or CCB 2nd line: + digoxin (only used in mono therapy if sedentary life)
43
what is the CHADVASC score?
``` CCF - 1 hypertension - 1 age >75 - 2 diabetes - 1 previous stroke/TIA/thromboembolism - 2 vascular disease (MI, peripheral, aortic plaque) - 1 age 65 to 74 - 1 female - 1 ```
44
what are the CHADVASC score categories?
score 0 = low risk, don't need to anti-coag score 1 = low to moderate risk, consider anti-coag in males score >2 = high risk, anti-coagulation needed
45
what is used to anti-coagulate AF patients?
either warfarin or NOAC (abans)
46
what does atrial flutter look like on ECG?
300 BMP and sawtooth appearance
47
what is the long term management of atrial flutter?
rate control with BB
48
what are the causes of VT?
``` IHD trauma hypoxia acidosis long QT syndrome electrolyte imbalance - low K and Mg ```
49
what is pulseless VT?
cardiac arrest
50
what its he most common cause of death post MI?
ventricular fibrillation
51
what is the presentation of VF?
LOC pulseless cardiac arrest
52
what does VF look like on ECG?
irregular random baseline
53
what is the management of unstable bradyarrhythmias?
1st line: IV atropine 500mcg (repeat up to 3mg 2-3 minute intervals) if no improvement, get senior help and consider: isoprenaline adrenaline transcutaneous pacing
54
what are causes of sinus bradycardia?
hypothyroidism | cushing's reflex
55
what is sick sinus syndrome?
SA node dysfunction that causes tachy-brady syndrome | periods of bradycardia +/- arrest/asystole with periods of SVT
56
where is the dysfunction in heart block?
AV node
57
what is first degree heart block?
PR interval >0.2 seconds (should be 0.12 to 0.20)
58
what is second degree heart block mobitz type 1?
progressive lengthening of PR interval before dropped beat
59
what is second degree heart block mobitz type 2?
regular PR interval but not every P wave will be followed by a QRS complex usually occurs in regular pattern (2:1, 3:1)
60
what is the treatment for mobitz type 2? why?
ventricular pacemaker | can progress into complete heart block or asystole
61
what is third degree heart block?
full heart block | no correlation between the atria and ventricles
62
what is the management for third degree heart block?
ventricular pacemaker
63
what can cause prolonged QT syndrome?
``` severe bradycardia ischaemic heart disease electrolyte disturbance - low K, Mg, Ca drugs genetics ```
64
what drug classes can cause prolonged QT syndrome?
anti-arrhythmics, antibiotics, anti fungal, anti-psychotics, anti-depressants, anti-histamines, anti-sickness
65
what anti-arrhythmics cause prolonged QT syndrome?
BB -->sotalol, CCB, digoxin, amiodarone
66
what antibiotics cause prolonged QT syndrome?
erythromycin, clarithromycin, levofloxacin
67
what anti-psychotics and anti-depressants cause prolonged QT syndrome?
first and second generation | TCA and SSRIs (citalopram)
68
what other drugs cause prolonged QT syndrome?
ketoconazole (anti-fungal) loratadine (anti-histamine) ondanestrone (anti-sickness) haloperidol
69
in genetic prolonged QT syndrome what situations can cause prolongation?
stress sudden auditory stimulus swimming
70
what is considered prolonged QT in men and women?
men >450 ms (normal <430 ms) | woman >470 ms (normal <450 ms)
71
what is the management for prolonged QT syndrome?
``` treat the cause avoid strenuous exercise and drugs genetics: low risk - lifestyle modification + BB high risk - lifestyle modification + ICD +/- BB ```

FINALS (25 decks)

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