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1- Foundation year Cardiovascular > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

What are the 5 classes of anti-arrhythmic drugs?

A

~class I- Membrane stabilising drugs
~class II- beta-blocker
~class III- K+ channel blockers
~class IV- calcium channel blockers (rate limiting)
~others

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2
Q

What are the class I anti-arrhythmic drugs known as membrane stabilising drugs? 4 main drugs

A

disopyramide
lidocaine
flecainide/propafenone (contraindicated in asthma/severe COPD avoid in structural /ischeamic heart disease)

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3
Q

What are the class II anti-arrhythmic drugs known as beta-blockers?

A

propranolol, esmolol

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4
Q

What are the class III anti-arrhythmic drugs known as K+ channel blockers?

A

-amiodarone (4 weeks before &12 months after electrical cardioversion to increase success)
-sotalol
-dronedarone

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5
Q

What are the class IV anti-arrhythmic drugs known as CCB (rate limiting)?

A

-verapamil
-diltiazem (unlicensed)

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6
Q

What other anti-arrhythmic drugs are there?

A

-adenosine
-digoxin (effective in sedentary patients with non-paroxysmal AF and in patients with associative congestive HR)

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7
Q

What is atrial fibrillation?

A

abnormal, disorganised electrical signals fired cause the atria to quiver or fibrillate= rapid and irregular heart beat

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8
Q

what are some symptoms for AF?

A

-heart palpation’s
-dizziness
-shortness of breath
-tiredness

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9
Q

what can be some complications (other diseases-related) for AF?

A

stroke and heart failure

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10
Q

what the different types of AF? 3 types

A

-paroxysmal AF: EPISODES STOP WITHIN 48 HOURS WITHOUT TREATMENT
-persistent AF: episodes last >7 days
-permanent AF: present all the time

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11
Q

what are the 2 first steps for treatment in AF?

A

1) RATE CONTROL
2) RHYTHM CONTROL

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12
Q

what is reason for rate control in AF treatment?

A

controls ventricular rate

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13
Q

what is reason for rhythm control in AF treatment?

A

restore and maintain sinus rhythm

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14
Q

what is the treatment for rhythm control in AF?

A
  • electrical cardioversion or with pharmacological treatment (amiodarone/ flecainide
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15
Q

what is the preferred treatment for rhythm control and what are the additional notes for the use of a cardioversion?

A

-electrical preferred if >48 hours.
` due to risk of clotting have to wait until fully anticoagulated for 3 weeks before cardioversion and continue 4 weeks after
-if hemodynamically unstable =electrical cardioversion; give parenteral anticoagulant and rule out left atrial thrombus immediately before procedure

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16
Q

what drugs can be used as rhythm control after cardioversion if needed?

A

standard beta blocker
or
Sotalol, propafenone, amiodarone (can be started 4 weeks before and continued for 12 months after procedure to help success rate) of flecainide SPAF

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17
Q

What is THE TREATMENT FOR acute new-onset presentations for AF treatment in life threatening and non-life threatening scenarios?

A

-life threatening haemodynamic instability: electrical conversion
-without life threatening haemodynamic instability: <48 hours= rate and rhythm control (electrical or amiodarone/flecainide)
>48 hours=rate control (verapamil, betablocker)

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18
Q

what are the maintenance drugs treatment for AF?

A

first line= RATE CONTROL
-betablocker (not sotalol), rate limiting CCB, digoxin

second line=RHYTHM CONTROL
-beta-blocker or oral anti-arrhythmic drug (sotalol, amiodarone, flecainide, propafenone, dronedarone) (also given if rhythm control is still required post-cardioversion)

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19
Q

what is the treatment for paroxysmal and symptomatic AF? or they persist

A

-ventricular or rhythm control= standard beta blocker or oral anti-arrthmic drug
-if symptoms persist: SPAF drugs
-“PILL IN POCKET” if infrequent episodes- self treatment= flecainide or propafenone

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20
Q

What is the treatment for atrial flutter?

A

Similar treatment as AF

first line= RATE CONTROL
-betablocker (not sotalol), rate limiting CCB, digoxin

second line=RHYTHM CONTROL
-beta-blocker or oral anti-arrhythmic drug (sotalol, amiodarone, flecainide, propafenone, dronedarone) (also given if rhythm control is still required post-cardioversion)

BUT ABLATION MORE SUITABLE

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21
Q

What is the scoring system used for stroke prevention?

A

CHA2DS2VASC

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22
Q

what does CHA2DS2VASC stand for?

A

Congestive heart failure or Left ventricular dysfunction hypertension
age 75+ diabetes
stroke/TIA/venous thromboembolism history vascular disease
65-74 years sex category

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23
Q

when do you give anticoagulation when using CHA2DS2VASC score?

A

give anticoagulation if score is 2 or more

24
Q

what treatment can be given for diagnosed AF?

A

WARFARIN OR noac

25
What are the different types of ventricular tachycardia?
-pulseless -unstable -stable -non-sustained
26
what is the treatment for pulseless?
immediate defibrillation + CPR; iv AMIODARONE IS GIVEN REFRACTORY TO DEFIBRILLATION
27
what is the treatment for an unstable person in ventricular tachycardia?
direct current cardioversion. If this fails give IV amiodarone and repeat direct current
28
what is the treatment for a stable person in ventricular tachycardia?
IV anti-arrhythmic drugs (amiodarone preferred)
29
what is the treatment for a non-sustained ventricular tachycardia?
beta-blocker
30
what is maintenance treatment for people at high risk of cardiac arrest?
-most patients= cardioverter defibrillator implant -some patients also require a drug= sotalol, beta-blocker alone or beta-blocker with amiodarone
31
what is the treatment for prolonged QT interval?
magnesium sulphate
32
what can cause a prolonged QT interval?
sotalol, amiodarone, macrolides, haloperidol, SSRIs, TCAs, antifungals and drugs that cause hypOKalaemia and bradycardia SAMSTAH=QT prolongation
33
how do paroxysmal supraventricular tachycardia stop?
spontaneously or with reflex vagal nerve (immerse face in cold water, carotid sinus massage) stimulation
34
what drugs can help treat paroxysmal supraventricular tachycardia stop? cases for haemodynamically unstable or recurrent episodes?
IV adenosine (contraindicated in COPD/asthma) therefore IV verapamil would work too - unstable= direct current cardioversion -recurrent episodes=catheter ablation OR drugs (verapamil, diltiaazem, beta-blocker
35
what is amiodarone and the standard loading dosing for it?
-200mg TDS of 7 days -200mg BD for 7 days and then -200mg OD as maintenance
36
when should amiodarone be avoided in?
bradycardia and heart block as it slows heart rate
37
what is amiodarone common eye side effects for it?
-corneal micro-deposits= can be reversed when stopped -optic neuropathy/neuritis (blindness)
38
what is the counselling points for corneal micro-deposits and optic neuropathy/neuritis?
-corneal micro-deposits= night-time glares when driving -optic neuropathy /neuritis= stop if impaired vision
39
what is amiodarone common skin side effects for it?
-phototoxicity (burning, erythema) -slate-grey skin on light-exposed areas
40
what is the counselling points for phytotoxicity and slat-grey skin?
shield skin from light during treatment. Use wide-spectrum, high SPF sunscreen for months after stopping due to long half life
41
what other upper body condition can amiodarone cause?
thyroid issues- can cause hypo or hyper due to iodine content
42
what is amiodarone common nerve side effects?
peripheral neuropathy
43
what is the counselling points for peripheral neuropathy?
be aware of numbness, tingling hands and feet and tremors
44
what is amiodarone common lungs side effects?
pneumonitis, pulmonary fibrosis
45
what is the counselling points for lung side effects?
be aware of shortness, dry cough
46
what is amiodarone common liver side effects?
hepatotoxicity
47
what is the counselling points for liver side effects?
jaundice, nausea, vomiting, malaise, itching, dark urine bruising, abdominal pain, 3x liver transaminase
48
what is amiodarone common thyroid dysfunction side effects?
-hyperthyroidism (weight loss, heat intolerance, tachycardia) =give carbimazole if necessary withdraw amiodarone -hypothyroidism (weight gain, cold intolerance, bradycardia) =start levothyroxine withdrawing amiodarone if essential
49
what are some monitoring needed for amiodarone?
-annual eye test: annually -chest x ray before treatment -LFT every 6 months -blood pressure and ECG -serum potassium: before treatment -thyroid function test: 6 monthly -ECG and live transaminase if using IV
50
what are some interactions with amiodarone?
-it has a extremely long T1/2- 50 days. there can be a danger of interactions several months after stopping -increased plasma amiodarone conc=grapefruit -amiodarone is an enzyme inhibitor= would interact with warfarin, phenytoin digoxin( so use half dose of digoxin) as they are CYP450 enzyme substrates -drugs that cause hypokalemia -increased risk of myopathy=statins -bradycardia, AV block and myocardial depression=beta-blocker, rate limiting CCBs -qt prolongation, increased risk of ventricular arrhythmia= quinolones, macrocodes, TCAS,SSRIs, lithium quinine, hydroxchlotoquine, anti-malarias, antipsychotics -its a
51
what is the therapeutic levels of digoxin? when to measure levels? toxicity levels increase from when?
0.7-2ng/ml (check conc 6-12 hours after dose) regular monitoring is not required during maintenance treatment unless toxicity suspected OR in renal impairment (really cleared) -toxicity levels increase from 1.5-3ng/ml
52
what is the doses for digoxin?
-loading doses required due to long T1/2 -maintenance once daily: =atrial flutter and non-paroxysmal AF in sedentary patients 125-250mcg =worsening or severe HF (in sinus rhythm) 62.5-125mcg -different dosage frommes have different bioavailabilities Elixir=75% tablets=90% IV 100%
53
what are some of the signs of toxicity in digoxin?
-bradycardia/heart block -nausea, vomiting and diarrhoea, abdominal pain -blurred or yellow vision -confusion, delirium -rash -depression
54
what is treatment for signs of toxicity for digoxin?
withdrawal- correct electrolyte imbalances Digoxin-specific antibody for life-threatening ventricular arrhythmias unresponsive to atropine
55
what are some interactions for digoxin?
-hypOKalaemia predisposes to digoxin toxicity= diuretics (loop/thiazide), B2 agonist, steroids, theophylline (if K+ <4.5mmol/l give K+ supplements OR K+ sparing diuretics -increased plasma digoxin conc when using with CYP450 ENZYME INHIBITORS means toxicity= amiodarone (half digoxin dose), rate limiting CCB, macrocodes, cyclosporin (enzyme inhibitors) -decreased plasma digoxin conc using with CYP450 ENZYME inducers means sub-therapeutic= st johns wort, rifampicin -Reduced renal excretion meaning toxicity= NSAIDs, ACE inhibitors/ARBs -TCAs- can induce arrhythmias -beta blockers-increase risk of AV block and increase plasma conc
56
what is the acronyms for remembering the digoxin interactions?
CRASED -CCB -RIFAMPICIN -AMIODARONE -ST JOHNS WORT -ERYTHOMYCIN -DIURETICS

1- Foundation year Cardiovascular (7 decks)

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