arrhythmia-therapies

Question 1

give 2 examples of supraventricular arrhythmias?

Answer 1

atrial fibrillation

SVT (junctional)

Question 2

give 2 ventricular arrhythmias?

Answer 2

ventricular tachycardia

ventricular fibrillation

Question 3

describe the appearnance of ventricular fibrillation on an ECG

Answer 3

HR-300-600
rhythm- extremely irregular
p wave- absent

Question 4

what is the action of class IA Vaughn-Williams anti-arrythmia drugs?

Answer 4

fast sodium-channel blockade to delay repolarization and increase AP duration

Question 5

what is the action of class IB Vaughn-Williams anti-arrythmia drugs?

Answer 5

intermediate sodium channel blockade so accelerate reploarization and decrease the action potential duration

Question 6

what is the action of class IC Vaughn-Williams anti-arrythmia drugs?

Answer 6

slow sodium channel blockade

Question 7

what is the action of class II Vaughn-Williams anti-arrythmia drugs?

Answer 7

B-adrenergic receptor antagonism

Question 8

what is the action of class III Vaughn-Williams anti-arrythmia drugs?

Answer 8

prolong refractriness by potassium channel blockade

Question 9

what is the action of class IV Vaughn-Williams anti-arrythmia drugs?

Answer 9

calcium channel blockade

Question 10

what are the Vaughn-WIlliams class IA drugs for arrythmias?

Answer 10

Quinidine. Procainamide, dispyramide

Question 11

what are the Vaughn-WIlliams class IB drugs for arrythmias?

Answer 11

Lidocaine, mexiletine, tocainide

Question 12

what are the Vaughn-WIlliams class IC drugs for arrythmias?

Answer 12

Flecainide, propafenone

Question 13

what are the Vaughn-WIlliams class II drugs for arrythmias?

Answer 13

Atenolol, bisoprolol

Question 14

what are the Vaughn-WIlliams class III drugs for arrythmias?

Answer 14

Amiodarone, bretylium, sotalol

Question 15

what are the Vaughn-WIlliams class IV drugs for arrythmias?

Answer 15

Diltiazem, verapamil

Question 16

what are class Ia anti-arrhythmia drugs used for?

Answer 16

atrial fibrillation, premature atrial contractions, premature ventricular contractions, ventricular tachycardia, Wolff-Parkinson-White syndrome

Question 17

what are class Ib anti-arrhythmia drugs used to treat?

Answer 17

ventricular dysrhythmias only (premature ventricular contractions, ventricular tachycardia, ventricular fibrillation

Question 18

what are class Ic anti-arrhythmia drugs used to treat?

Answer 18

severe ventricular dysrythmias

atrial fibrillation/flutter

Question 19

what are class II antiarrhythmic drugs used to treat?

Answer 19

first line for atrial fibrillation (bisoprolol)

general myocardial depressants for supraventricular and ventricular dysrythmias

Question 20

what are class III antiarrythmia drugs used to treat?

Answer 20

dysrhythmias that are difficult to treat:
Life-threatening ventricular tachycardia or fibrillation, atrial fibrillation or flutter—resistant to other drugs
Sustained ventricular tachycardia

Question 21

what are class IV anitarrhythmia drugs used to treat?

Answer 21

paroxysmal supraventricular tachycardia

rate control for atrial fibrillation and flutter

Question 22

what ais the action of digoxin?

Answer 22

inhibits sodium -potassium pump so is a positive ionotrope

Question 23

what is digoxin used to treat?

Answer 23

heart failure

atrial dysrythmias

Question 24

what mjust be monitored when a patient is on digoxin?

Answer 24

potassium levels
drug levels
toxicity

Question 25

what are the side effects of digoxin (digocin toxicity)?

Answer 25

nausea and vomiting xanthopsia-yellow haze round objects tachycardia arrhythmias: VT and VF

Question 26

what is the treatment of digoxin toxicity?

Answer 26

stop digoxin | has long half life though and at high levels has a risk of significant arrythmias so use digibind to inactivate.

Question 27

when is digoxin toxicity more serious?

Answer 27

when potassium levels are low

Question 28

what is the classic scenario where digoxin poisoning occurs?

Answer 28

elderly on drug for rate control and had impaired renal function so levels of drug build

Question 29

what is amiodarone used for?

Answer 29

ventricular tachycardia | occasionally in supreventricular tachycardia

Question 30

what are the side effects of amiodarone?

Answer 30

``` Thyroid (hypo or hyperthyroidism) Pulmonary fibrosis Slate – grey pigmentation Corneal deposits LFT abnormalities ```

Question 31

what does amiodarone interact with?

Answer 31

many drugs, including digoxin

Question 32

what is the action of adenosine?

Answer 32

slows conduction through AV node

Question 33

what is adenosine used to treat?

Answer 33

paroxysmal supraventricular tachy cardia, converts it to sinus rhythm

Question 34

how is adenosise administered?

Answer 34

IV push

Question 35

what are the side effects of adenosine?

Answer 35

asystole for a few seconds

Question 36

which drugs are used to treat sinus tachycardia?

Answer 36

class II and IV

Question 37

which drugs are used to treat atrial fibrillation/flutter?

Answer 37

``` class Ia, Ic, II, III, IV, digoxin anticoagulation ```

Question 38

which drugs are used to treat paroxysmal supreventricular tachycardia?

Answer 38

class Ia, Ic, II, III, IV, adenosine

Question 39

which drugs are used to treat AV block?

Answer 39

atropine

Question 40

which drugs are used to treat ventricular tachycardia?

Answer 40

class I, II, III

Question 41

which drugs are used to treat premature ventricular complexes?

Answer 41

``` class II, IV, magnesium sulfate can be benign and not drugs not required ```

Question 42

what are the drugs used to treat digitalis toxicity?

Answer 42

class Ib magnesium sulfate digibind

Question 43

what are the indications for anticoagulation?

Answer 43

atrial fibrillation DVT/PE after surgery immobilisation- prophylaxis is those at high risk of DVT

Question 44

which anticoagulants are given in AF patients?

Answer 44

``` warfarin direct oral anticoagulants -Dabigatran -Rivaroxaban -Apixaban -(Edoxaban) ```

Question 45

what conditions are arterial thrombi associated with?

Answer 45

MI. strokes, ischaemia

Question 46

what are conditions are venous thrombi associated with?

Answer 46

congestive heart failure, cancer, surgery

Question 47

which drugs interact with warfarin, incvreasing warfarin activity?

Answer 47

aspirin, sulfonamides cimetidine, disulfiram oral antibiotics

Question 48

which drugs interact with warfarin, promoting bleeding?

Answer 48

aspirin | heparin and antimetabolites

Question 49

which drugs interact with warfarin, decreasing warfarin's activity?

Answer 49

barbiturates phenytoin vitamin K cholestyramine

Question 50

how is warfarin therapy monitored?

Answer 50

international normalised ratio (INR)- the number of times longer blood takes to clot when on warfarin. Should be 2.5-4.0

Question 51

what are the adverese affects of warfarin?

Answer 51

``` bleeding teratogenic (so avoid 1st and 3rd trimester causes retro placental and fetal intracerebral bleeding ```

Question 52

what are the CHADS2 score?

Answer 52

``` used for warfarin bleeding risk: congestive heart failure 1 hypertsension 1 age >/= 75 years 1 diabetes mellitis 1 stroke or TIA 2 ```

Question 53

what are the characterstics for an ideal anticoagulant?

Answer 53

``` oral no need for monitoring no interaction with food or drugs given once or twice a day/fixed dose irrespective of body weight/age as affective as warfarin safer than warfarin ```