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FINALS > Anti-Arrhythmic Drugs > Flashcards

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
Q

what is wolf Parkinson white syndrome?

A

congenital accessory pathway exists between atria and ventricles leading to atrioventricular reentry tachycardia

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26
Q

what does wolf Parkinson white syndrome look like on ECG?

A

short PR interval
slurred upstroke R wave - delta wave
left acid deviation if right sided pathway - main one

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27
Q

what is the management for wolf Parkinson white syndrome?

A

avoid AV node drugs - BB, digoxin, verapamil
medical - amiodarone, flecainide, sotalol
surgical - radio frequency ablation of the pathway –> definitive management

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28
Q

what are the 3 classifications of AF?

A

paroxysmal
persistent
permanent

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29
Q

what is paroxysmal AF?

A

episodes (>2) lasting less than 48 hours than may spontaneously resolve to sinus rhythm

30
Q

what is persistent AF?

A

AF lasting >7 days with little chance of spontaneous resolution of rhythm

31
Q

what is permanent AF?

A

AF that is unresponsive to cardioversion therapy with the aim to control the HR and anti-coagulate

32
Q

what is the management for unstable acute AF?

A

emergency cardioversion

33
Q

what is the management for stable acute AF?

A

rate control
1st line: BB or CCB (diltiazem preferred over verapalim)
2nd line: digoxin
if HF use digoxin

34
Q

when would rhythm control be used to treat AF?

A 
CCF
symptomatic 
younger 
first presentation with just AF 
reversible cause
35
Q

what are the two options for rate control?

A

chemical or electrical cardioversion

36
Q

what is the rhythm control management for AF?

A

1st line: chemical cardioversion
- amiodarone (if structural heart problems)
- flecanide (no structural heart problems) (avoid if IHD)
2nd line: DC cardio version

37
Q

what should be given prior to DC cardioversion and why?

A

anti-platelet drug

risk of clots being pushed through heart

38
Q

what must happen if the patient has been experiencing AF for >48 hours prior to cardioversoin?

A

heparinised for 3 weeks prior

39
Q

what must happen post cardioversion?

A

anti-coagulation for at least 4 weeks

40
Q

what is used to determine anti-coagulation cover?

A

CHADVASC score

41
Q

what drug is used prior to risk assessment for AF being carried out?

A

heparin

42
Q

what is the treatment for chronic AF?

A

rate control
1st line: BB or CCB
2nd line: + digoxin (only used in mono therapy if sedentary life)

43
Q

what is the CHADVASC score?

A 
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
Q

what are the CHADVASC score categories?

A

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
Q

what is used to anti-coagulate AF patients?

A

either warfarin or NOAC (abans)

46
Q

what does atrial flutter look like on ECG?

A

300 BMP and sawtooth appearance

47
Q

what is the long term management of atrial flutter?

A

rate control with BB

48
Q

what are the causes of VT?

A 
IHD
trauma
hypoxia
acidosis 
long QT syndrome 
electrolyte imbalance - low K and Mg
49
Q

what is pulseless VT?

A

cardiac arrest

50
Q

what its he most common cause of death post MI?

A

ventricular fibrillation

51
Q

what is the presentation of VF?

A

LOC
pulseless
cardiac arrest

52
Q

what does VF look like on ECG?

A

irregular random baseline

53
Q

what is the management of unstable bradyarrhythmias?

A

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
Q

what are causes of sinus bradycardia?

A

hypothyroidism

cushing’s reflex

55
Q

what is sick sinus syndrome?

A

SA node dysfunction that causes tachy-brady syndrome

periods of bradycardia +/- arrest/asystole with periods of SVT

56
Q

where is the dysfunction in heart block?

A

AV node

57
Q

what is first degree heart block?

A

PR interval >0.2 seconds (should be 0.12 to 0.20)

58
Q

what is second degree heart block mobitz type 1?

A

progressive lengthening of PR interval before dropped beat

59
Q

what is second degree heart block mobitz type 2?

A

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
Q

what is the treatment for mobitz type 2? why?

A

ventricular pacemaker

can progress into complete heart block or asystole

61
Q

what is third degree heart block?

A

full heart block

no correlation between the atria and ventricles

62
Q

what is the management for third degree heart block?

A

ventricular pacemaker

63
Q

what can cause prolonged QT syndrome?

A 
severe bradycardia
ischaemic heart disease
electrolyte disturbance - low K, Mg, Ca
drugs 
genetics
64
Q

what drug classes can cause prolonged QT syndrome?

A

anti-arrhythmics, antibiotics, anti fungal, anti-psychotics, anti-depressants, anti-histamines, anti-sickness

65
Q

what anti-arrhythmics cause prolonged QT syndrome?

A

BB –>sotalol, CCB, digoxin, amiodarone

66
Q

what antibiotics cause prolonged QT syndrome?

A

erythromycin, clarithromycin, levofloxacin

67
Q

what anti-psychotics and anti-depressants cause prolonged QT syndrome?

A

first and second generation

TCA and SSRIs (citalopram)

68
Q

what other drugs cause prolonged QT syndrome?

A

ketoconazole (anti-fungal)
loratadine (anti-histamine)
ondanestrone (anti-sickness)
haloperidol

69
Q

in genetic prolonged QT syndrome what situations can cause prolongation?

A

stress
sudden auditory stimulus
swimming

70
Q

what is considered prolonged QT in men and women?

A

men >450 ms (normal <430 ms)

woman >470 ms (normal <450 ms)

71
Q

what is the management for prolonged QT syndrome?

A 
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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