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Pharmacy Exam 2021 > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

Class I Anti-Arrhythmics

A

Na Blockers - disopyramide, lidocaine, flecainide

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2
Q

Class I Anti-Arrhythmics CI/warnings

A

CI- severe asthma/COPD

warning: structural/ ischeamic HD

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3
Q

Class II Anti-Arrhythmics

A

B blockers

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4
Q

Class III Anti-Arrhythmics

A

K Blockers - amiodarone, sotalol, dronedarone

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5
Q

Dronedarone ADRs

A

Hepatotox and HF

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6
Q

Class IV Anti-Arrhythmics

A

Rate lim. CCBs (Dil & Ver)

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7
Q

Other Anti-Arrhythmics

A

Digoxin (sedentary non-pAF, cong HF), adenosine

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8
Q

Electro or Pharmo Cardioversion

A

Pharmo must be w/i 48h of symptoms or inc risk of stroke. Electro preferred if >48hrs post symptoms (wait 3 wks post anticoag, wait 4 wks post cardioversion before stopping anticoag.) If heamodynamically unstable, electocardioversion (give parenteral antiocoag & rule out atrial thrombus before procedure)

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9
Q

AF Maintenance

A

1st line rate (B blocker, rate lim CCB, digoxin)
Monotherapy-> dual therapy -> rhythm control
Rhythm control- B blockers, antiarythmics
Pill in pocket (anti-arryhthmics eg flecanide) for infrequent episodes of pAF.

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10
Q

New onset AF

A

W/ life threatening heamodynamic instability- electrocarioversion
W/o life threatening heamodynamic instability:
<48hrs - rate/rhythm control (electrical or amiodarone/flec)
>48hrs - rate control only (verapamil or B blocker)

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11
Q

AF stroke prevention

A

anticoag if stroke risk (CHA2DS2VASc) >bleed risk (HAS-BLED)

give anticoag if score 2 or more on chadsvasc, no anticoag req if man=0 or woman=1

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12
Q

CHA2DS2VASc

A 
C- chronic HF/LVD
H- hypertension
A2- Age 75+
D- diabetes
S- stroke/tia/VTE history
V- vascular disease
A- age 65-74
Sc - Sex category
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13
Q

Ventricular tachycardias immediate treatment

A

Pulseless/fib - immediate defib and CPR
unstable sustained: direct current cardioversion (repeat w/ amiodarone if unsuccessful)
Stable sustained : IV amiodarone
Unsustained : B blocker

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14
Q

Ventricular tachycardias maintenance

A

High risk of cardiac arrest
Most patients require defib implant
some also require drugs - sotalol, B-Blocker (w/ or w/o amiodarone)

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15
Q

Torsades de Pointes (QT prolongation)

A

Treatment: Magnesium sulphate
Causes: Sotalol and other QT prolongers, hypokal, bradycardia.

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16
Q

Amiodarone ADRs: skin

A

slate grey skin, phytotoxicity (counsel to cover skin and use sun cream for months after finishing amiodarone)

17
Q

Amiodarone ADRs: eyes

A

Corneal deposits (counsel- night time glare whilst driving), optic neuropathy leading to blindness (couple to stop if any vision disturbances/loss)

18
Q

Amiodarone ADRs: nerves

A

Peripheral neuropathy (counsel- may feel tingling etc in extremities)

19
Q

Amiodarone ADRs: lungs

A

pneumonitis, pulmonary fibrosis (counsel- look for SOB, dry cough)

20
Q

Amiodarone ADRs: liver

A

hepatotoxicity (counsel- signs of hepatotox, inc. itching, jaundice, signs of bleeding, etc)

21
Q

Amiodarone ADRs: Thyroid

A

Hyper (weight loss, heat intolerance, tachycardia), start carbimazole, stop amiodarone
Hypo (weight gain, cold intolerance, bradycardia), starts levothyroxine if necessary, w/o w/d amiodarone

22
Q

Amiodarone monitoring

A

annual eye test, chest X-ray before starting, LFTs 6/12, TFTs 6/12, BP, ECG, U&Es (K+).

23
Q

amiodarone interactions

A

enzyme inhibitor, so reduced doses may be required for warfarin, phenytoin, digoxin required half m=normal dose
Inc risk of myopathy with statins
Bradycardia, AV block, myocardial depression with B blockers, and Rate lim CCBs
QT prolongation- other drugs include quinolones, macrolides, TCAs, (es)citalopram, quinine and analogues, antipsychotics, fluconazole

24
Q

Digoxin MOA

A

Increases myocardial force of contraction (+ inotrope), reduces AVN conduction (- chronotrope)

25
Q

Digoxin Therapeutic levels &monitoring

A

1-2mcg/l (6h after dose). Monitoring only required with signs of toxicity and renal impairment

26
Q

Amiodarone loading dose

A

200mg TDS 7/7 then BD 7/7 then OD

27
Q

Digoxin maintenance dose

A

AF 125-250mcg, worsening/sever HF (in sinus) 62.5-125mcg

28
Q

Digoxin signs of toxicity

A 
Slow and sick 
Bradycardia/heart block
Nausea, V&D
Abdo pain
Yellow/blurred vision
confusion, delirium,
rash
29
Q

Digoxin toxicity risk

A

low K, Mg, high Ca, hypoxia, renal impairment

30
Q

Digoxin toxicity treatment

A

Withdraw dig, treat electrolyte imbalances, digital for life threatening vent. arrhythmia if atropine not successful

31
Q

Digoxin interactions

A

Drugs causing hypokalaemia (inc risk of toxicity) eg thiazide/loop diuretics, b agonists, steroids, theophylline.
Enzyme inhibitors (inc risk of toxicity): eg amiodarone, fluconazole, SSRIs
Enzyme inhibitors (sub therapeutic): eg SJW, rifampicin
Nephrotoxics (reduce digoxin clearance) eg NSAID, ACE?ARBs

Pharmacy Exam 2021 (16 decks)

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