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BNF Chapter 2 - Cardiology > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

Describe the negative inotropic effects of anti-arrhythmic drugs. What extra care is needed due to this feature?

A

They tend to be additive. Care is needed when using two or more, especially if myocardial function is impaired.

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2
Q

Define inotrope.

A

An agent which alters the force or energy of muscle contractions.

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3
Q

Describe the difference between positive and negative inotropes.

A

Positive inotropes increase the strength of muscular contractions whilst negative inotropes decrease the force of muscular contractions.

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4
Q

Which electrolyte imbalance can affect the pro-arrhythmic nature of many drugs?

A

Hypokalaemia.

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5
Q

What treatment should be used for life-threatening, new-onset atrial fibrillation?

A

Emergency electrical cardioversion.

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6
Q

Define electrical cardioversion.

A

The use of electricity to return the heart to a regular rhythm.

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7
Q

If new-onset atrial fibrillation is not life-threatening, what should be used to return the heart rhythm to normal?

A

Pharmacological or electrical cardioversion.

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8
Q

What can be used as monotherapy to control ventricular rate?

A

A standard beta-blocker or a rate limiting calcium-channel blocker (e.g. diltiazem or verapamil).

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9
Q

Which beta-blocker should not be used for the control of ventricular rate?

A

Sotalol.

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10
Q

If monotherapy for ventricular rate control does not achieve the desired result, what can be used as dual therapy?

A

A beta-blocker, digoxin or diltiazem.

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11
Q

Define sinus rhythm.

A

Cardiac rhythm with depolarisation beginning at the sinoatrial node.

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12
Q

How can sinus rhythm be maintained post-cardioversion?

A

With a standard beta-blocker.

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13
Q

If a standard beta-blocker can’t be use to maintain sinus rhythm after cardioversion, what alternatives can be used?

A

Sotalol, flecainide, propafenone or amiodarone.

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14
Q

Verapamil should be avoided in patient’s on beta-blockers. Why?

A

Increased risk of severe hypertension and asystole.

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15
Q

What length of time should atrial fibrillation be present for before electrical cardioversion is preferred?

A

48 hours +.

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16
Q

How long should a patient be fully anticoagulated for before and after electrical cardioversion?

A

At least 3 weeks before and 4 weeks after.

17
Q

What should all patients with atrial fibrillation be assessed for?

A

Their stroke risk and their need for thromboprophylaxis.

18
Q

What does an AF patient’s risk of stroke and need for thromboprophylaxis need balancing with?

A

Their bleeding risks.

19
Q

What score is used to determine the stroke risk of a patient with AF?

A

CHADSVASC.

20
Q

What score is used to determine a patient’s risk of bleeding?

A

HASBLED.

21
Q

What are the risk factors used to determine a patient’s CHADSVASC score?

A

Congestive heart failure, hypertension, age greater than 75 years, age between 65-74, diabetes mellitus, vascular disease, stroke/TIA/thromboembolism, gender (female).

22
Q

What are the risk factors used to determine a patient’s HASBLED score?

A

Hypertension, abnormal liver function, abnormal renal function, alcohol intake over 8u/wk, history of stroke, history of haemorrhage, labile INRs, age over 65 years, drug use (antiplatelets or NSAIDs).

23
Q

What CHADSVASC score constitutes a low risk of stroke, not requiring an antithrombotic for stroke prevention?

A

0 for men and 1 for women.

24
Q

What is amiodarone used for?

A

Used to alter sinus rhythm to restore a normal heart beat.

25
Q

What are some important side effects one should be aware of with amiodarone use?

A

Reversible corneal microdeposits, impaired vision, thyroid function, hepatotoxicity, pulmonary toxicity, neurological effects, phototoxic skin reactions.

26
Q

What monitoring is required before and during amiodarone use?

A

Thyroid function (before and every 6 months), liver function (before and every 6 months), serum potassium (before), chest x-ray (before), ECG with IV use.

27
Q

Why should amiodarone be avoided in pregnancy, unless no alternative is available?

A

Risk of neonatal goitre.

28
Q

Should amiodarone be used in breastfeeding mothers?

A

No, present in milk in significant amounts. Theoretical risk of neonatal hypothyroidism from release of iodine.

29
Q

When may drug interactions with amiodarone be seen and why?

A

Several weeks after treatment cessation due to long half-life.

30
Q

Severe bradycardia and heart block may be seen with the use of amiodarone and which drugs?

A

Sofosbuvir, daclatasvir, ledipasvir and simeprevir.

31
Q

When used with amiodarone, which drugs show an increased plasma concentration?

A

Coumarins, dabigatran, digoxin, flecainide, phenindione, phenytoin.

32
Q

When used with amiodarone, which drugs increase the risk of ventricular arrhythmias?

A

Amisulpride, atomoxetine, chloroquine, citalopram, disopyramide, escitalopram, haloperidol, hydroxychloroquine, levofloxacin, lithium, mizolastine, mefloquine, moxifloxacin, phenothiazines, pimozide, quinine, sulpiride, telithromycin, tolterodine, tricyclics.

33
Q

When given with amiodarone, which drugs increase the risk of bradycardia, AV block and myocardial depression?

A

Beta-blockers, diltiazem, verapamil.

34
Q

When given with amiodarone, what drug increases the risk of myopathy?

A

Simvastatin.

35
Q

What is sotalol used for?

A

To reduce heart rates in arrhythmias.

36
Q

What important safety information should be taken into account when using sotalol?

A

Can prolong the QT interval, occasionally leading to life threatening arrhythmias.

37
Q

What monitoring is required with sotalol use?

A

ECG, corrected QT interval, serum electrolytes (K, Mg, Ca). Correct electrolyte disturbances before use.

BNF Chapter 2 - Cardiology (10 decks)

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