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PHRM3011 > Antiarrhythmic drugs > Flashcards

Antiarrhythmic drugs Flashcards

1
Q

Principal site of action

AV NODE- which drugs?

A

A- adenosine
B - BB
C - CCB (verapamil, diltiazem)
D - digoxin

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2
Q

Principal site of action

Ventricles - which drugs?

A

lignocaine (LA)

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3
Q

Principal site of action

Atria, ventricles, accessory pathways (throughout the heart)

A

A - amiodarone
D - disopyramide
D - dronedarone
F - flecainide

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4
Q

Antiarrhythemic drugs are negative inotropes, therefore we need to avoid using these in which condition?

A

HF

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5
Q

Which of the antiarrythmic drugs can we use in HF as an exceptions?

A

digoxin and amiodarone

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6
Q

What drugs can we use for bradyarrhythmia?

A

ST: atropine injuection (vagus nerve blocker), isoprenaline infusion (BB of heart)
pacemaker

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7
Q

What drugs can we use for tachyarrhythmia? (either SVA or VA)

A

DC shock, ablation (tissue destroying), drugs, implantable defibrillator

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8
Q

In which tachyarrhythmia do drugs work better?

A

SVA

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9
Q

In which tachyarrhythmia do implantable defibrillator work better?

A

VA

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10
Q

Antiarrhythmic drugs are proarrhythmic. what does this mean?

A

AA can cause another arrhythmia and prolong QT interval

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11
Q

What happens in QT interval?

A

R wave might run into T wave (depol and repol simultaenously –> ventricular fibrillation)

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12
Q

What happens to the rates in ventricles and atria in AF?

A

Rapid atrial rate at 400bpm
slower in ventricles
(AF: irregular - 160-180bpm,
Atrial flutter: regular - 150bpm)

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13
Q

In rate control of AF? which rate is controlled?

A

the ventricular rate

NOT the atria rate

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14
Q

Is the resting heart rate slower in HF?

A

yes

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15
Q

When is rhythm control preferred over rate control?

A

for 1st presentation,
if pt is less than 65 years old,
if symptomatic with AF

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16
Q

If before 48 hours since AF, it means

A

less chance of atria stunning (less chance of blood clots in the heart)

17
Q

If after 48 hours since AF, it means we need…

A

pharmacological tx or DC shock

18
Q

Before pharmacological tx or DC shock, you need to give them anticoagulants for how long?

A

for 3 weeks
up to 6 weeks
e.g. warfarin, dabigatran, rivaroxaban, apixaban

19
Q

what do we use for maintenance of sinus rhythm after cardioversion?

A

sotalol
flecainide
amiodarone
but only 50% stay in sinus rhythm

20
Q

Drugs that block the AV node for rate control are…

A

1st line: CCB (v/d), BB (metoprolol, atenolol)

2nd: digoxin (in elderly)
3rd: amiodarone, sotalol, flecainide

21
Q

What are the ADE of D/V?

A

Constipation (a lot in verapamil)

bradycardia, heart block

22
Q

What are the ADE of digoxin?

A

nausea vomiting anorexia, confusion in elderly

23
Q

What are the ADE of amiodarone?

A

nausea vomiting in the beginning,
nightmares, neurotoxicity, photosensitivity, thyroid dysfunction, skin pigmentation, taste disturbances, poor vision at night

24
Q

What pre-tx is needed for amiodarone?

A

TFT, LFT, electrolytes (esp potassium)

25
Q

Explain the complex dosing regimen for amiodarone

A
  1. 200mg TDS 7 days
  2. 200mg BD 7 days
  3. 200mg OD
26
Q

AF significantly increases the risk of stroke.

What are the two antithrombotic groups?

A

anticoagulants

antiplatelets

27
Q

What does warfarin do?
What are issues with warfarin?
What are the DI of warfarin?

A

it thins your blood
it has narrow therapeutic range and you need to individualise the doses and monitor INR all the time and take the doses at the same time each day (for all anticoagulants)
Food, alcohol and affect warfarin

28
Q

What are the NOACS?

A

Dabigatran (150mg BD)
Rivaroxaban (20mg OD)
Apixaban (5mg BD)

29
Q

When should you reduce the dose of the NOACs?

A

low CrCl (80yr

30
Q

What are the antiplatelet examples?

A

aspirin, clopidogrel (or together)

31
Q

When do they use antiplaelets in AF?

A

in people who do not want to take oral anticoagulants

32
Q

Who do we use the ChA2DS2VASc score on?

A

for people with AF

33
Q

At which HAS-BLED score is the patient rated at high risk of bleeding?

A

3 or higher

34
Q

When first starting warfarin, taking drug that increase warfarin effect will require

A

reduced dose of warfarin

35
Q

taking drug that decrease warfarin effect will require

A

usual starting dose and CAREFUL MONITORING

36
Q

Where is NOAC contraindicated?

A

in renal impairment (severe)

37
Q

Which criteria is included in the Cardiac risk chart?

A

Age, BP, gender, diabetes, cholesterol ratio

38
Q

Verapamil interacts with which drugs?

A

BB, digoxin, AA (dabigatran), carbamazepine

PHRM3011 (12 decks)

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