Arrhythmia - therapy

Question 1

What is an arrhythmia?

Answer 1

Any deviation from the normal rhythm of the heart

Question 2

What are the different types of arrhythmias?

Answer 2

Sinus arrhythmia

Supraventricular arrhythmia

Question 3

What causes supraventricular arrhythmia?

Answer 3

Atrial fibrillation

SVT

Question 4

What causes ventricular arrhythmia?

Answer 4

Ventricular tachycardia

Ventricular fibrillation

Question 5

What are class IA, IB and IC drugs?

Answer 5

Fast, intermediate and slow sodium channel blockers

Question 6

Give examples of class IA drugs

Answer 6

Quinidine
Procainamide
Dispyramide

Question 7

Give examples of class IB drugs

Answer 7

Lidocaine
Mexiletine
Tocainide

Question 8

Give examples of class IC drugs

Answer 8

Flecainide

Propafenone

Question 9

Give examples of class II drugs

Answer 9

Atenolol

Bisoprolol

Question 10

Give examples of class III drugs

Answer 10

Amiodarone
Bretylium
Sotalol

Question 11

Give examples of class IV drugs

Answer 11

Diltiazem

Verapamil

Question 12

What are class II drugs?

Answer 12

Beta blockers

Question 13

What are class III drugs?

Answer 13

Prolong refractoriness by reducing or blocking sympathetic nervous system stimulation

Question 14

What are class IV drugs?

Answer 14

Calcium channel blockers

Question 15

What is the first line of medication for Atrial fibrillation?

Answer 15

Class II drugs such as atenolol or bisoprolol

Question 16

Name the antidysrythmics that don’t fit into one class

Answer 16

Digoxin

Adenosine

Question 17

How does Digoxin work?

Answer 17

Inhibits the sodium-potassium ATPase pump so has a positive inotropic effect, improving strength of cardiac contraction

Question 18

What has to be monitored when using Digoxin?

Answer 18

Potassium levels

Drug interactions

Question 19

What are the signs of Digoxin toxicity?

Answer 19

Nausea 
Vomiting 
Xanthopsia 
Bradycardia 
Tachycardia 
Arrhythmia - VT and VF

Question 20

What is the treatment for Digoxin toxicity?

Answer 20

Stop Digoxin

Give Digibind if levels of Digoxin are very high

Question 21

When is Digoxin toxicity most serious?

Answer 21

When Potassium levels are low

Question 22

How does adenosine work?

Answer 22

Slows conduction through the AV node so turns paroxysmal supraventricular tachycardia to sinus rhythm

Question 23

How should adenosine be administered?

Answer 23

Fast IV push

Question 24

What can adenosine cause for a few seconds?

Answer 24

Asystole

Question 25

What can all antiarrhythmics cause?

Answer 25

Arrhythmias

Question 26

Name some anticoagulants

Answer 26

``` Warfarin Dabigatran Rivaroxaban Apixaban Edoxaban ```

Question 27

What are anticoagulants used for?

Answer 27

``` Valvular heart disease Atrial fibrillation Thromboembolism Deep vein thrombosis risk After surgery ```

Question 28

When is atrial fibrillation most common?

Answer 28

After the age of 60

Question 29

How does Warfarin work?

Answer 29

Inhibits production of active clotting factors

Question 30

What drugs promote warfarin activity?

Answer 30

``` Aspirin Sulfonamides Cimetidine Disulfiram Oral antibiotics Heparin antimetabolites ```

Question 31

What drugs decrease warfarin activity?

Answer 31

Barbiturates Phenytoin Vitamin K Cholestyramine

Question 32

What are the adverse effects of warfarin?

Answer 32

Bleeding | Teratogenic

Question 33

When should the use of warfarin be avoided in pregnancy?

Answer 33

First and third trimesters

Question 34

What should be done when monitoring warfarin therapy?

Answer 34

Regular INR Patient education Alcohol intake Watch if altered therapy

Question 35

How is the risk of bleeding assessed with warfarin?

Answer 35

``` CHADS2 score Congestive heart failure Hypertension Age >75 years Diabetes Mellitus Stroke or TIA ```

Question 36

What are class I drugs?

Answer 36

Membrane-stabalizing agents

Question 37

What are class II drugs used for?

Answer 37

General myocardial depressants for both supra ventricular and ventricular dysrhythmias

Question 38

What are class III drugs used for?

Answer 38

Used for difficult dysrhythmias such as: Life threatening ventricular tachycardia or fibrillation Atrial fibrillation or flutter Sustained ventricular tachycardia

Question 39

What are class IV drugs used for?

Answer 39

Paroxysmal supra ventricular tachycardia | Rate control for atrial fibrillation and flutter

Question 40

What is Amiodarone used for?

Answer 40

Ventricular tachycardia | Supra ventricular tachycardia

Question 41

What are the side effects of amiodarone?

Answer 41

``` Thyroid problems Pulmonary fibrosis Slate Corneal deposits LFT abnormalities ```