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Pre-reg Exam 2021 > Arrhythmias > Flashcards

Arrhythmias Flashcards

(55 cards)

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1
Q

What are the Class I anti arrhythmias?

A

Na+ blockers

Disopyramide
Lidocaine
Flecainide/propafenone

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2
Q

When is flecainide contraindicated?

A

Asthma

Severe COPD

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3
Q

When should you avoid propafenone?

A

In structural/ischaemic heart disease

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4
Q

What are class II anti arrhythmics?

A

Beta blockers

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5
Q

What are Class III antiarrhythmics?

A

K+ channel blockers

Amiodarone
Sotalol
Dronedarone

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6
Q

When should amiodarone be used in order to increase the chances of success?

A

4 weeks before and 12 weeks after electrical cardioversion

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7
Q

What are the main side effects of dronedarone?

A

Hepatotoxicity

Heart failure

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8
Q

What are the class IV antiarrhythmics?

A

Rate limiting CCBs

Verapamil
Diltiazem

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9
Q

When is digoxin used in arrhythmias?

A

For sedentary patients with non-paroxysmal atrial fibrillation

Associative congestive heart failure

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10
Q

What is atrial fibrillation?

A

Rapid and irregular heartbeat

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11
Q

What are the symptoms of atrial fibrillation?

A

Heart palpitations
Dizziness
SOB
Tiredness

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12
Q

What are the complications of atrial fibrillation?

A

Stroke

Heart failure

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13
Q

What is paroxysmal atrial fibrillation?

A

Episodes stop within 48 hours without treatment

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14
Q

What is persistent atrial fibrillation?

A

Episodes last > 7 days

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15
Q

What is permanent AF?

A

Episodes present all the time

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16
Q

What is rate control?

A

Controls ventricular rate

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17
Q

What is rhythm control?

A

Restores and maintains sinus rhythm

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18
Q

What is cardioversion?

A

Type of rhythm control

  1. Electrical
  2. Pharmacological
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19
Q

Which of the following is most appropriate when there is acute new-onset presentation of atrial fibrillation and life threatening haemodynamic instability?

A) electrical cardioversion 
B) flecainide
C) verapamil
D) digoxin
E) sotalol
A

A) electrical cardioversion

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20
Q

Which of the following is most appropriate when there is acute new-onset presentation of atrial fibrillation without life threatening haemodynamic instability and it is less than 48 hours since onset of presentation

A) electrical cardioversion 
B) bisoprolol 
C) verapamil
D) digoxin
E) sotalol
A

A) electrical cardioversion

Or amiodarone/flecainide

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21
Q

Which of the following is most appropriate when there is acute new-onset presentation of atrial fibrillation without life threatening haemodynamic instability and it is more than 48 hours since onset of presentation

A) electrical cardioversion 
B) Amiodarone
C) verapamil
D) digoxin
E) Flecainide
A

C) Verapamil

Or beta blocker

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22
Q

What is the first line treatment for atrial fibrillation?

A
  1. Rate control - B-blockers (not sotalol), rate limiting CCB, digoxin. Monotherapy - dual therapy - rhythm control
  2. Rhythm control - beta blockers/amiodarone/flecainide/propafenone/dronedarone
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23
Q

What are the treatments for paroxysmal and symptomatic atrial fibrillation?

Study These Flashcards
A

Ventricular or rhythm control - beta blocker or oral antiarrhythmic

Pill in pocket - flecainide or propafenone

24
Q

What tool is used to calculate bleeding risk in atrial fibrillation?

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A

ORBIT

Older (75+)
Reduced Hb or history of anaemia
Bleeding history
Insufficient kidney function
Treatment with antiplatelet
25
What is the tool used to determine risk of stroke in atrial fibrillation?
CHA2-DS2-VASc ``` Chronic heart failure Hypertension Age 75+ Diabetes Stroke Vascular disease Age 65-74 Sex female ``` Anticoagulant if 2 or more
26
For new onset atrial fibrillation what anticoagulant would you give for stroke prevention?
Parenteral anticoagulant
27
For diagnosed atrial fibrillation what anticoagulant would you give?
Warfarin or DOAC DOAC in non valvular + 1 or more risk factors
28
How would you treat pulseless v.tach (ventricular tachycardia)?
Immediate defibrillation + CPR Amiodarone refractory to defibrillation
29
How would you treat unstable sustained v.tach?
Direct current cardioversion Failure then IV amiodarone and repeat
30
How would you treat stable sustained v. Tach?
IV anti arrhythmic (amiodarone preferred)
31
How would you treat non-sustained v. Tach?
Beta blocker
32
What is the first line treatment for maintenance after v.tach?
Cardioverter defibrillator implant Some require drug too - sotalol, beta blocker, beta blocker + amiodarone
33
What is the treatment for prolonged QT interval?
Magnesium sulphate
34
What causes prolonged QT interval (torsades de pointes)?
Sotalol Other drugs Hypokalaemia Bradycardia
35
What is the treatment pathway for paroxysmal supraventricular tachycardia?
1. Spontaneously terminates or reflex vagal nerve stimulation 2. IV adenosine 3. IV verapamil
36
What is amiodarone?
Class III anti arrhythmic Used for supraventricular arrhythmias and ventricular arrhythmias
37
What is the dosing schedule for amiodarone?
200mg TDS for 7/7 200mg BD for 7/7 200mg OD maintenance
38
What are the side effects of amiodarone?
``` Corneal microdeposits Optic neuropathy Phototoxicity Slate grey skin Peripheral neuropathy Pneumonitis Pulmonary fibrosis Hepatotoxicity Hyperthyroidism Hypothyroidism ```
39
What are the counselling points for amiodarone?
Night time glares when driving Stop if impaired Shield skin from light during and after stopping Numbness, tingling hands and feet, tremors Shortness of breath, dry cough Jaundice, nausea, vomiting, malaise
40
What would be the action plan for amiodarone induced hyperthyroidism?
Give carbimazole if necessary | Withdraw amiodarone
41
What would be the action plan for hypothyroidism cause by amiodarone?
Start levothyroxine without withdrawing amiodarone if essential
42
What are the monitoring requirements for amiodarone?
``` Annual eye test Chest X-ray before treat,met LFTs every 6 months Thyroid function BP and ECG Serum potassium - causes hypokalaemia ```
43
What are the interactions for amiodarone?
Long T1/2 Grapefruit juice - increases amiodarone concentration Warfarin, phenytoin, digoxin - increases plasma concentration of these drugs Statins - myopathy Beta blockers, rate limiting CCBs - bradycardia Quinolones, macrolides, TCAs, SSRIs, lithium, quinine, hydroxychloroquine, antimalarials, antipsychotics - QT prolongation
44
What is the ideal serum concentration of digoxin?
1-2 mcg/L (Cp 6 hours after dose) Regular monitoring not required unless toxicity suspected or renal impairment
45
What is digoxin?
Cardiac glycosides
46
What is the mechanism of action of digoxin?
Increases force of myocardial contraction Reduces conductivity in the AV node
47
Is a loading dose required for digoxin?
Yes as long half life
48
What is the maintenance dose of digoxin?
Atrial flutter and non paroxysmal AF in sedentary patients - 125-250mcg Worsening or severe heart failure - 62.5-125 mcg
49
What are the signs of digoxin toxicity?
Slow and sick ``` Bradycardia Nausea and vomiting Blurred or yellow vision Confusion Delirium ``` Risk of toxicity in: Hypo K+, Hypo Mg2+, Hyper Ca2+, hypoxia, renal impairment
50
What is the treatment for digoxin toxicity?
Withdraw and correct electrolytes Digoxin specific antibody
51
What are the interactions of digoxin?
CRASED ``` CCB (verapamil) Rifampicin Amiodarone St Johns Wort Erythromycin Diuretics ```
52
Which drugs cause hypokalaemia when given with digoxin?
Diuretics B2 agonists Steroids Theophylline
53
What drugs increase plasma digoxin concentration?
Amiodarone Rate limiting CCB Macrolides Ciclosporin
54
What drugs decrease the plasma digoxin concentrations?
St Johns Wort | Rifampicin
55
What drugs cause reduced renal excretion and lead to digoxin toxicity?
NSAIDS | ACEi

Pre-reg Exam 2021 (79 decks)

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