Anti-arrythmics

Question 1

What would you use to treat SVT without underlying cause?

Answer 1

metoprolol/ atenolol/ verapamil

Question 2

What would be your medical management of AF

Answer 2

Rate control= 1. beta blockers + digoxin OR 2. centrally acting Ca2+ blockers
Rhythm control= sotalol and amiodarone
Anticoagulation= warfarin or other oral anticoagulant

Question 3

how would you treat paroxysmal supra ventricular tachycardias with narrow QRS complex?

Answer 3

Narrow complex paroxysmal supraventricular tachycardia (PSVT) may be converted to sinus rhythm by manoeuvres that enhance vagal tone.
-Valsalva manoeuvre and carotid sinus massage; caution with the latter is required in the elderly.
OR
1. adenosine OR 2. verapamil
Both adenosine and verapamil restore sinus rhythm in most patients. If PSVT persists, intravenous amiodarone, direct current (DC) cardioversion or overdrive pacing may be required.

Question 4

Class 1 anti arrhythmic agents?

Answer 4

Sodium channel blockers like lignocaine and flecanide

Question 5

Class 2 anti-arrhythmic agents?

Answer 5

Beta blockers

Question 6

Class 3 anti arrhythmic agent?

Answer 6

Potassium channel blocker like amiodarone and sotalol

Question 7

Class 4 anti arrhythmic agent?

Answer 7

calcium channel blocker like verapamil

Question 8

what does isoprenaline do?

Answer 8

Improves conduction through AV node

Question 9

what does adenosine do?

Answer 9

Adenosine slows conduction time through the A-V node, can interrupt the reentry pathways through the AV node, and can restore normal sinus rhythm in patients with paroxysmal supraventricular tachycardia (PSVT), including PSVT associated with Wolff- Parkinson-White Syndrome.

Question 10

what does digoxin do?

Answer 10

Suppresses the AV node by Increasing vagal Stimulation

Question 11

what is required for the use of flecanide?

Answer 11

requires a structurally stable heart

Question 12

how does flecanide work?

Answer 12

Slows cardiac conduction and to a lesser extent, increases refractory period in all myocardial tissues (including bypass tracts) but particularly in the His-Purkinje (ventricular conduction) system. Also has negative inotropic activity

Question 13

what is sotalol mostly used for?

Answer 13

rhythm control

Question 14

what are some side effects of amiodarone?

Answer 14

Causes hyper and hypo thyroid problems

Can cause permanent skin discolouration

Question 15

what cardiac drugs can cause hyperkalemia?

Answer 15

ACE inhibitors (e.g. Lisinopril)
Angiotensin Receptor Blockers (e.g. Losartan)
Potassium sparing diuretics – (e.g. Spironolactone / Amiloride)
NSAIDS / COX 2 inhibitors
Beta blockers
Heparin

Question 16

how do we treat hyperkalemia?

Answer 16

1. Beta agonist like salbutamol
2. insulin
3. Resonium

Question 17

what you do in a MET call for a patient who has just gone suddenly into rapid AF? Would you give digoxin or amiodarone?

Answer 17

Would give amiodarone initially because it can take at least a day to load someone with digoxin whereas amiodarone is ready to go in half an hour

Question 18

half life of adenosine?

Answer 18

10 secs

Question 19

acute management of VT?

Answer 19

amiodarone then procainamide

Question 20

management of complete heart block?

Answer 20

atropine + fluids
isoprenaline
pacing

Question 21

how do we treat toussades VT?

Answer 21

magnesium

Question 22

how does amiodarone work?

Answer 22

Decreases sinus node and junctional automaticity, slows atrioventricular (AV) and bypass tract conduction and prolongs refractory period of myocardial tissues (atria, ventricles, AV node and bypass tract); also has weak beta-blocker activity.