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BNF Cardiovascular > Arrythmia > Flashcards

Arrythmia Flashcards

1
Q

If etopic beats are troublesome, how can they be treated?

A

Beta blockers

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2
Q

If a patient has AF what 2 assessments can be carried out to assess risk?

A

CHADVASC + HASBLED

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3
Q

At what score on the CHADVASC would you consider treating?

A

more than or equal to 1

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4
Q

If a patient has a HASBLED of <1 can they be treated?

A

Yes. 0-1 can be anticoagulated

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5
Q

What score on the HASBLED tool is anticoagulation not suitable?

A

2

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6
Q

What 2 ways can AF be controlled?

A

Ventricular rate or attempting to restore sinus rhythm

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7
Q

Presentation of AF patient

A

Palpitation, fatigue, SOB, syncope, chest discomfort

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8
Q

What are 2 cardiac assessments to diagnose for AF

A

ECG + ECHO

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9
Q

When must emergency electrical cardioversion be offered?

A

if patient presents with life threatening haemodynamic instability

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10
Q

If a patient presents acutely without life threatening haemodyamic instability what type of treatment should be offered

A

if < 48 hours - Rate / rhythm

If > 48 hours - Rate preferred

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11
Q

If a patient is going to undergo cardioversion what drug options can be given IV

A

Amiodarone or Flecanide

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12
Q

What 2 drugs are used for urgent rate control?

A

IV beta blocker + verapamil

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13
Q

How long should a patient have been anticoagulated for if they have had AF >48 hours and are going to undergo cardioversion?

A

3 weeks

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14
Q

How long after cardioversion should a patient be anticoagulated for?

A

4 weeks

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15
Q

First line rate control drugs

A

Beta blocker + RL CCB (diltiaziem or verapamil)

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16
Q

In what patients is Digoxin consider for rate control?

A

Sedentary patients or if they have CHF + AF

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17
Q

Why is Digoxin only considered for sedentary patients or CHF in AF?

A

It is only effective for controlling ventricular rate at rest

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18
Q

Drug treatment post cardioversion

A

Beta blocker or oral anti-arrythmic

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19
Q

Examples of oral anti-arrythmics

A

Flecanide, Propafone, Amiodarone, Dronedarone, Soltalol

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20
Q

How many weeks prior to cardioversion can amiodarone be started?

A

4 weeks

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21
Q

How many months after cardioversion is amiodarone continued for?

A

12 months

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22
Q

If there is no ischaemic heart disease what 2 anti-arrhythmics cannot be given?

A

Flecanide or propafenone

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23
Q

What approach can be utilised in paraoxysmal AF?

A

Pill in pocket - with flecanide

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24
Q

What should be offered to all patients wiht new onset AF?

A

Anticoagulation

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25
Q

How is paroxysmal SV tacycardia treated?

A

Usually terminates spontaneously, if not give IV adenosine

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26
Q

Examples of Class 1 anti-arrthymics

A

1A: Quinidine
1B: Lidocaine, Mexiltene
1C: Flecanide, Propafenone

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27
Q

Examples of Class II anti-arrthymics

A

Beta blockers

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28
Q

Examples of Class III anti-arrthymics

A

Amiodarone, Soltalol, Dronedarone

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29
Q

Examples of Class IV anti-arrthymics

A

Verapamil, diltiaziem

30
Q

What blood abnormality can lidocaine cause?

A

Methylhaemoglobinaemia ( treated wiht methylthionium chloride)

31
Q

If flecanide is given concurrently with amiodarone what does the BNF recommend?

A

Reduce dose by half

32
Q

What may soltatolol prolong?

A

QT interval

33
Q

What 2 electrolyte imbalances must soltalol be avoided in?

A

HypOkalaemia + HypOmagnesemia

34
Q

Dose regime of Amiodarone

A

200mg TDS 7 days, 200mg BD 7 days, 200mg OD maintenance

35
Q

IV amiodarone dose

A

5mg/kg over 20-120 mins

36
Q

What hep C drug can cause severe bradycardia wiht amiodarone

A

Sofosbuvir

37
Q

Four major side effects of amiodarone

A
  1. Corneal microdeposits
  2. Pulmonarytoxicity
  3. Thyroidtoxicity
  4. Hepatoxicity
38
Q

How is hypothyroidism associated with amiodarone treated?

A

Levothyroxine

39
Q

What symptoms suggest amiodarone associated pneumonitis?

A

SOB, new persistent cough

40
Q

What should you monitor with amiodarone therapy?

A

TFT (baseline + 6 months), LFTs ( baseline + 6 months), CXR (baseline), Potassium (baseline)

41
Q

What should be monitored with IV amiodarone?

A

ECG

42
Q

What should patients be advised about in regards to photosensitivity reactions with amiodarone?

A

Use SPF daily, shield from sunlight during and on several months of discontinuning ( long t1/2)

43
Q

What route should adenosine be given by?

A

Large or centeral vein

44
Q

What should be monitored wiht adenosine?

A

ECG

45
Q

MHRA warning with soltalol

A

QT prolongation - can cause life threatening arrhythmias. Avoid in low K+ and Mg2+

46
Q

What electrolyte imbalance should you be cautious of with Dronedarone?

A

Low K+ and low Mg2+

47
Q

When should you discontinue treatment with Dronedarone in liver injury

A

If 2 consecutive alanine aminotransferase concentrations exceed 3 x ULN

48
Q

If a patient hasa dry cough and are on dronedarone why do we need to be cautious?

A

Risk of pulmonary toxicity

49
Q

Monitoring with Dronedarone

A

ECG< monitor for HF, serum creatinine (baseline + 7 days from initiation), LFT (baseline, 1 week and 1 month then monthly for 6 months then every 3 months)

50
Q

How should adenosine be given?

A

Large central vein

51
Q

Example of a caridac glycoside

A

Digoxin

52
Q

At what HR limit should Digoxin be held?

A

<60bpm

53
Q

If patient is in sinus rhythm with HF do they need digoxin loading?

A

No a satisfactory digoxin level can be achieved over one week

54
Q

How often should Digoxin maintenance dosing be given?

A

OD dosing ( can split to BD if nausea is an issue)

55
Q

What 2 factors add to the likelihood of unwanted side effects with digoxin?

A
  1. Concentration of Digoxin

2. Sensitivity of myocardium

56
Q

What digoxin range is likely to indicate toxicity?

A

1.5 - 3 mcg/L

57
Q

What electrolyte imbalance predisposes patients to digoxin toxicity?

A

Hypokalaemia (can be managed by adding in K+ sparring diuretics / supplements)

58
Q

If Digoxin toxicity occurs, what is the antidocte?

A

Digoxin specific antibodies

59
Q

How does Digoxin work?

A

Increases force of myocardial contractility and reduces conduction at the AV node

60
Q

Dose of digoxin for rapid digitialisation

A

750 to 1500 mcg over 24 hours in divided doses

61
Q

Maintenance dose of Digoxin in AF

A

125 - 250 mcg OD

62
Q

Maintenance dose of Digoxin in HF

A

62.5 to 125mcg OD

63
Q

If a patient is on concurrent amiodarone / dronedarone / quinine what does the BNF suggest to do to the Digoxin dose?

A

Reduce by half

64
Q

By how much does the digoxin dose need to be increased by if switching from IV to PO?

A

20 - 33% in order to maintain same digoxin level

65
Q

If digoxin monitoring is indicated, when should it be carried out?

A

6 hours post dose (ideal 8 - 12 hours) after at least 7 days of treatment

66
Q

Target level of Digoxin (general)

A

0.8 to 2ng/mL

67
Q

Target level of Digoxin in HF patients

A

0.6 - 0.8ng/L

68
Q

Target level of Digoxin in AF patients

A

1 - 2 ng/L

69
Q

Signs of Digoxin toxicity

A

Blurred yellow vision, nausea, Arrhythmia, Rash, conductive disturbances

70
Q

How is the digoxin elixir administered?

A

Using pipette

BNF Cardiovascular (10 decks)

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