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2 Cardiovascular > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

How are ectopic beats treated

A

rarely need treatment but could use beta blocker

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2
Q

if patient presents with arrythmia had less than 48 hours is rate or rhythm preferred?

A

rhythm control

-over 48 hours rate control

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3
Q

2 treatments for urgent rate control

A

beta blocker or verapamil IV

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4
Q

2 drugs for pharmacogolical cardioversion

A 
flecinade
amiodarone (preferred when there is structural heart disease)
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5
Q

Is pharmacological or electrical cardioversion preferred

A

electrical if arrhythmia present for over 48 hours - pt must be anticoagulated

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6
Q

Rate or rhythm control is first line

A

Rate (unless less than 48 hours or arrhythmia)

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7
Q

What beta blocker is not suitable for rate control

A

sotolol

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8
Q

what are two rate limiting CCBs?

A

verapamil and diltiazem

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9
Q

what are the two drug classed that are used for rate control

A

beta blocker

rate limiting CCB

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10
Q

does digioxin control rate or rhythm

when is it suitable and why

A

rate
predominately sedentary patients as it only controls rate at rest

(also used when there is AF and CHF)

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11
Q

what is first
second
third line for AF

A

first - rate monotherapy
second - two rate controlling medications
third - rhythm control

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12
Q

rhythm control options: (6)

A 
betablocker or
anti-arrhythmic drugs:
-sotolol
-flecinade
-propanfenone
-amiodarone
-dronedarone
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13
Q

what is used for pil in the pocket (2)

A

flecinade

propafenone

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14
Q

chads vasc parameters:

A 
Congestive heart failure/Left ventricular dysfunction (1)
Hypertension (1)
A2 - Age≥75 (2)
Diabetes mellitus (1)
S2 - Stroke/TIA/TE (thromboembolism) (2)
Vascular disease — coronary artery disease (CAD), myocardial infarction (heart attack), peripheral artery disease (PAD), or aortic plaque (1)
Age 65-74 (1)
Sc - Sex category — Female gender (1)
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15
Q

hasbled parameters

A 
Hypertension (1)
Abnormal liver/renal (1 or 2)
Stroke (1)
Bleeding (1)
Labile INR (1)
Elderly (1)
Drugs/alchohol (1)
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16
Q

Is aspirin a suitable alternative to anticoagulation in AF

A

no - ther risk of bleeding outweighs the modest benifit

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17
Q

what is a labile INR

A

in range less than 60% of the time

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18
Q

What systolic BP is considered hypertension in the HASBLED

A

> 160

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19
Q

How do you assess the need for anticoagulation in atrial flutter?

A

Using HASBLED and CHADSVASC just like AF

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20
Q

what would be the treatment for bradycardia post MI (2)

A

atropine IV

or adrenaline

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21
Q

what electrolyte imbalance can contribute to long QT syndrome?

A

hypokalaemia

22
Q

what is dysopyramide used for? what is a caution with this drug?

A

control arrhythmias after MI

but has anticholinergic effects therefore caution in BPH and closed angle glaucoma

23
Q

caution of flecainide

A

can precipitate serious ventricular arrhythmias in patients with otherwise normal hearts in a small minority of patients

24
Q

What is the loading dose for amiodarone

A

200mg tds - one week
200mg bd - one week
200mg od - from then on

25
Q

how long can drug interactions happen after treatment with amiodarone

A

weeks or even months after stopping treatment

26
Q

How does amiodarone affect the QT interval

A

prolongation - caution with loads of drugs

27
Q

what color can amiodarone discolour skin?

A

slate grey

28
Q

what is the problem with amiodarone and driving at night?
is this reversible?
is this side-effect a reason to withdraw treatment?

A

microdiposits in the cornea - causing night glare (being dazzled when driving and night)
(reversible)
this does not usually impair vision however if vision is impaired treatment must be withdrawn to prevent bliness as this could be optic neuropathy

29
Q

why would you be concerned about a patient on amiodarone with increasing SOB or cough

A

pulmonary toxicity - pneumonitis and fibrosis of the lungs

30
Q

what blood tests should we be doing routinely with amiodarone treatment

A

TSH/T4
LFTs
every 6 months

31
Q

what is the affect of amiodarone on the thyroid and why?

should amiodarone be withdrawn?

A

hyper or hypothyroidism can occur
contains iodine

withdraw at least temporarily to achieve control but can continue amiodarone while controlling if necessary

32
Q

what is the effect of amiodarone on the liver

A

may effect LFTs but also may cause hepatotoxity

if tests severely deranged or symptomatic withdraw amiodoarone

33
Q

what electrolyte should be monitored before amiodarone treatment

A

Potassium (there is no reason for this stated in the BNF but potassium is all about hearts so just remember that)

34
Q

what advice would you give an amiodarone patient going on holiday to spain

A

PHOTOTOXICITY - SHIELD YOURSELF FROM THE SUNNNNNNNN!!!!!

35
Q

can amiodarone tabs be crushed?

A

yes

36
Q

what is the effect of amiodarone on the peripharies

A

may cans peripheral neuropathy

37
Q

What two electrolyte imbalances MUST be corrected before treatment and why?
(this is a BNF warning box)

A

hypomagnesaemia
hypokalaemia
- because sotolol prolongs the QT interval and occationally may cause life threatening ventricular arrhythmias

38
Q

for the management of AF digioxin should be taylored to pulse rate, but what pulse is too low

A

pulse should not be allowed to fall below 60bpm

39
Q

what demographic is particularly suceptable to digioxin toxicity?

A

the elderly

40
Q

What electrolyte disturbance predisposes a patient to digoxin toxicity?
how do we manage this?

A

hypokalaemia

  • manages using K sparing diuretics or in necessary K supplementation
41
Q

how does the dose of digioxin need to be changes when switching from IV to oral

A

20-33% increase to maintain same plasma conc

42
Q

id monitoring plasma digoxin levels when would you take the blood?

A

6 hours post dose

43
Q

plasma digoxin concentration alone dose not reliably indicate toxicity BUT liklihood of toxicity increases progressively through the range of …………. to …………..

A

1.5-3 MICROgrams/litre

44
Q

what is the maintinance dose range of dig and how do you decide what to give?

A

125-250 micrograms OD - according to renal function

45
Q

name some significant interactions with digoxin and how to manage

A

amiodarone increases plasma digoxin

half the digoxin dose

46
Q

name some significant interactions with amiodarone

A

inhibitor of CYP therefore all of those interactions

47
Q

what is the effect of amiodarone on warfarin

A

enhanced anticoagulant effect (by inhibiting the metabolism of warfarin)

48
Q

is there an interaction between amiodarone and statins?

A

amiodarone increase risk of myopathy with simvastatin

49
Q

is there an interaction with amiodarone and lithium

A

yes - both these drugs seem to interact with erverything so look out chaps

50
Q

what CCBs can interact with beta blockers

A

diltizem and verapamil - AV block, bradycardia, HF

2 Cardiovascular (14 decks)

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