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PRE-REG-Thuri > CARDIOVASCULAR SYSTEM-Arrythmia, AF > Flashcards

CARDIOVASCULAR SYSTEM-Arrythmia, AF Flashcards

1
Q

What are 7 modifiable risk factors of CVD?

A

o High blood pressure
o Physical inactivity
o Smoking
o Diet and weight
o Diabetes
o Cholesterol
o Stress

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2
Q

What are 3 non-modifiable risk factors?

A

Age/sex
Family History
Race/ethnic background

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3
Q

What are some lifestyle choices to prevent CVD?

A

Moderate alcohol
Stop smoking
Sleep well

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4
Q

6 types of CVD?

A

o Coronary Heart Disease (CHD) = disease of the blood vessels supplying the heart muscle.

o Cerebrovascular disease = disease of the blood vessels supplying the brain.

o Peripheral arterial disease = disease of blood vessels supplying the arms and legs.

o Rheumatic heart disease = damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria.

o Congenital heart disease = malformations of heart structure existing at birth.

o Deep vein thrombosis + pulmonary embolism = blood clots in the leg veins, which can dislodge and move to the heart and lungs.

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5
Q

What is Coronary Heart disease?

A

disease of the blood vessels supplying the heart muscle

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6
Q

What is cerebrovascular disease?

A

disease of the blood vessels supplying the brain.

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7
Q

Peripheral arterial disease?

A

disease of blood vessels supplying the arms and legs

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8
Q

What is rheumatic heart disease?

A

damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria.

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9
Q

What is congenital heart disease?

A

malformations of heart structure existing at birth.

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10
Q

DVT and PE?

A

blood clots in the leg veins, which can dislodge and move to the heart and lungs.

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11
Q

What 3 drug types can cause secondary HT?

A

Anti-inflammatory corticosteroids (e.g. prednisone)

Birth control pills (esp. containing estrogen)

Cold medicines (e.g. containing pseudoephedrine, phenylephrine)

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12
Q

What is clinic BP target?

A

<140/90mmHg

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13
Q

What is 1st line treatment for hypertension in patients under 55 and not afro-carribbean?

A

ACEi or ARB

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14
Q

What is 1st line HT treatment for patient over 55 years or afro-caribbean?

A

CCB

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15
Q

What is ectopic heartbeat?

A

Type of arrhythmia- irregular HB.

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16
Q

What are 2 aims of atrial fibrillation management?

A

Rate control
Rhythm control

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17
Q

What are 3 symptoms of atrial fibrillation?

A

PALPITATIONS
dizzy
Dyspnoea - difficulty breathing

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18
Q

What are the 3 meds used as rate control for atrial fibrillation?

A

-Beta Blocker
-Rate limiting CCB
-Digoxin

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19
Q

Why is Sotalol not used to treat AF?

A

Increases QT interval

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20
Q

What 2 CCBs used for AF?

A

Diltizem and verapamil

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21
Q

What 3 drugs help treat rhythm control?

A

Anti-arrythmic drug= Amiodarone , flecainide and propafenone

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22
Q

What 2 anti-arrhythmic drugs to avoid in Ishaemic Heart disease?

A

Flecainide and propafenone - can cause cardiac toxicity

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23
Q

How is Atrial flutter treated?

A

Similar to AF

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24
Q

What should we do if treatment does not work to control symptoms of AF?

A

cardioversion and ablation

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25
Q

What is CHADSVASC and what score requires anti-coagulation?

A

Risk of having stroke.
score of 2+ = needs anticoagulant.

2 in females

1 in males

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26
Q

What beta blocker is NOT used to treat AF/arrhythmias?

A

Sotalol

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27
Q

What specific group of patients are treated with digoxin for AF?

A

Sedentary patients and non -paroxysmal AF

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28
Q

What 1st line drug is used to treat rhythm control post- cardioversion?

A

Beta blocker

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29
Q

What does CHADSVAS stand for?

A

C= Chronic HF or LVSD

H= Hypertension

A= age 75 and + (+2 points)

D= DM

S = Stroke/ TIA / VTE (+2 points)

V= Vascular disease

A = 65-74 years

S = Sex, female

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30
Q

What does ORBIT stand for?

A

O = Older than 75 years

R = reduced haemoglobin/ haematocrit or anaemia (2)

B = bleeding hx (2)

I= insufficient kidney function

T = treatment with anti-platelet

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31
Q

What is paroxysmal supraventricular tachycardia?

A

Fast HR that occurs in atria.

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32
Q

How do we treat Paroxysmal supraventricular Tachycardia?

A

Reflex vagal nerve stimulation.

e.g. Face in ice cold water

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33
Q

What 2 drugs can be used to treat Paroxysmal supraventricular Tachycardia If the effects of reflex vagal stimulation are transient or ineffective, or if the arrhythmia is causing severe symptoms?

A

IV adenosine

or
Verapamil

reflex vagal stimulation -1st line

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34
Q

When is IV adenosine contraindicated for treatment of Paroxysmal supraventricular Tachycardia?

A

Not for COPD, asthma patients

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35
Q

What drug/treatment can be used to treat RECURRENT episodes of Paroxysmal supra-ventricular Tachycardia?

A

Catheter ablation or anti-arrhythmic drugs (e.g. verapamil, diltiazem)

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36
Q

What is a ventricular arrhythmia?

A

Fast heart rate which happens in ventricles

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37
Q

What is the treatment for Ventricular arrhythmia if a patient is pulseless?

A

CPR/defibrillator

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38
Q

What is the treatment for Ventricular arrhythmia if a patient is at high risk of cardiac arrest?

A

Cardioverter defibrillator implant or anti-arrhythmic drug

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39
Q

What is the drug treatment for Ventricular tachycardia if a patient has haemodynamic instability?

A

If stable/sustained= IV anti-arrhythmic drug

Non-sustained = beta blocker/ sotalol

emergency direct current cardioversion- unstable sustained instability

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40
Q

What is torsade de pointes?

A

Life threatening type of ventricular tachycardia with long QT interval.

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41
Q

What are 3 main symptoms of torsade de pointes?

A

Syncope + seizures

Palpitations
Dyspnoea

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42
Q

What 3 things can cause torsade de pointes?

A

Drugs that prolong QT interval

HypOkalaemia

Severe bradycardia

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43
Q

What is 1st line drug treatment for torsade de pointes?

A

IV Magnesium sulfate

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44
Q

List 4 anti-arrhythmic drug classes?

A

Class 1 = Na+ channel blockers

Class 2 = Beta blockers

Class 3. = K+ channel blockers

Class 4 = rate limiting CCB

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45
Q

What is class 1 anti-arrythmic drug?

A

Na+ channel blockers

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46
Q

List some Na+ channel blockers

A

Lidocaine
Flecanide
Propafenone
Disopyramide

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47
Q

What class 1 anti-arrhythmic drug is CI in asthma/ copd/ IHD?

A

Propafenone

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48
Q

Give examples of class 3 - k+ channel blockers?

A

Amiodarone
Sotatolol
Dronedarone

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49
Q

What drug is a BB and also a class 3 k+ channel blocker too?

A

Sotalol

50
Q

What class 3 k+ channel blocker can cause hepatotoxicity/ HF?

A

Dronedarone

51
Q

What is MOA of Amiodarone?

A

Block K+ channel which causes repolarisation in phase 3 of cardiac Action potential

52
Q

What indication is amiodarone for?

A

Arrhythmia + CPR

53
Q

What is oral loading dose of Amiodarone?

A

200mg TDS - 1Week

then BD

then OD- maintenance

54
Q

What is a key counselling point for amiodarone

A

Provide patient alert card

55
Q

What is a MRHA 2022 alert for amiodarone?

A

Risk of serious SE which can last for 1 month after STOPPING.

Review regularly.
Monitor LFT/TFT.

CT scan if pulmonary toxicity

56
Q

What are 8 SE of amiodarone?

A

1.Corneal micro deposits

2.Optic neuropathy

3.GREY skin/phototoxicity

4.Peripheral neuropathy (pins and needles)

  1. thyroid dysfunction
  2. hepatotoxicity
  3. pulmonary toxicity
  4. QT prolongation
57
Q

What to monitor in amiodarone?

A

Eye tests, report impaired vision

Protect skin from UV.

Monitor K+- for hypOkalaemia. (Before)

CT scan for lungs (before))

LFTS + TFTS (6 months)

58
Q

What mneumonic to remember amiodarone SE?

A

P = pulmonary toxic/ prolonged qt
H = hyper/hypothyroidism
O = optic neuritis
N = neuropathy limbs
E= eyes. corneal microdeposits
S = skin - sensitive to sunlight.

59
Q

How can amiodarone levels rise? (2 things interact)

A

Interacts with grapefruit juice and cimetidine

60
Q

What are grapefruit juice and cimetidine examples of

A

Enzyme inhibitor

61
Q

What is enzyme inhibitor?

A

(prevent liver enzyme breaking down the drug so levels rise)

62
Q

Is Amiodarone and enzyme inhibitor or inducer?

A

Inhibitor

63
Q

How does amiodarone cause bradycardia?

A

Interacts with BB, CCB

64
Q

What 2 CCB can cause cardio depression?

A

Diltiazem

Verapamil

65
Q

What interacts with amiodarone to cause rhabdomyoloysis and myopathy?

A

Statin - adjust dose

66
Q

What dose digoxin should be given with amiodarone?

A

1/2 dose

67
Q

What 6 drugs can interact with amiodarone to cause peripheral neuropathy?

A

Cisplatin

Isoniazid

Metronidazole

Nitrofurantoin

Phenytoin

Vinca alkaloid

68
Q

What drugs can interact with amiodarone?

A

TCA
SSRI
Macrolides
5 HT3 antagonist
Antipsychotics

Anti-arrhythmics

69
Q

What is MOA of digoxin?

A

Reduces force of contraction, inhibits Na+/K+ ATPase in myocardium

Reduces HR + SA node automaticity

70
Q

What is digoxin indication?

A

Atrial fibrillation + HF.

71
Q

What is digoxin therapeutic index?

A

0.7- 2 ng/L

72
Q

How to do therapeutic drug monitoring for digoxin?

A

Plasma conc. checked 6 hrs after dose.

NO reg monitoring needed unless RI/toxicity. Monitor electrolytes and renal function.

73
Q

What is digoxin loading dose for rapid digitalisation?

A

0.75–1.5 mg in divided doses, dose to be given over 24 hours.
Reduce dose in elderly.

74
Q

What is digoxin maintenance dose for Non-paroxysmal AF in sedentary patients

A

125-250 mcg OD

75
Q

What is digoxin maintenance dose for worsening HF?

A

62.5- 125mcg OD

76
Q

What is Tablet Digoxin bioavailability?

A

63%

77
Q

What is digoxin elixir bioavailability?

A

75%

78
Q

What formulation of digoxin has best bioavailability?

A

IV = 100%

79
Q

What are signs of digoxin toxicity?

A

G= GI - Nausea/vom, abdo pain
Rash
Arrhythmia
CNS = confusion
Eyes - blurred vision, YELLOW HALO

80
Q

What are signs of digoxin toxicity related to eyes?

A

Yellow halos

81
Q

What 3 electrolyte imbalances can digoxin toxicity cause?

A

RI

HypOkalaemia

HypOmagnesia

HypERcalcaemia

82
Q

What can hypOkalaemia cause for patients taking digoxin?

A

Digoxin toxicity

83
Q

What 4 drug classes can cause hypOkalaemia?

A

B2 agonist

Corticosteroids

Diuretics - loop + thiazide

Theophyline

84
Q

What 4 drugs/classes can increase digoxin levels?

A

Amiodarone

Rate-limiting CCB

Macrolides

Itraconazole/ ketaconazole

85
Q

What ———– inhibitors cause increased digoxin levels/toxicity

A

p-glycoprotein

86
Q

What to do when giving (amiodarone/quinine/dronedarone) with digoxin?

A

REDUCE dose to 1/2 of digoxin

87
Q

What —— can reduce digoxin levels and stop it from working?

A

P-glycoprotein inducers

88
Q

What are 3 =-glycoprotein inducers which reduce digoxin levels?

A

Phenytoin

St john’s wart

Rifampicin

89
Q

What are 4 examples of P-glycoprotein Inhibitors?

A

Amiodarone
CCB

Macrolides

Itraconazole/ ketaconazole

90
Q

What 2 drug classes reduce renal excretion of digoxin?

A

ACEi/ARB

NSAIDs

91
Q

What 2 drug classes increase bradycardia when given with digoxin?

A

BB
CCB rate limiting

92
Q

What drugs can cause hypercalcaemia causing digoxin toxicity?

A

Vit D supplement

93
Q

What is half-life of amiodarone?

A

50 days

94
Q

Does digoxin cause hyper or Hypo calcaemia?

A

Hypercalcaemia

95
Q

What phrase is used to describe digoxin toxicity?

A

Slow and sick

96
Q

What is the mnemonic for enzyme inhibitors? - increasing drug levels to toxicity

A

SICK FACES

97
Q

What does enzyme inhbitor- SICK FACES stand for?

A

Sodium valproate
Izoniziad
Cimetidine
Ketaconazole
Fluconazole
Alcohol + grapefruit juice
Chloramphenicol
Erythromycin
Sulfonamides

Ciprofloxacin
Omeprazole
Metronidazole

98
Q

If left ventricular ejection fraction (LVEF) is ≥40% what CCB is given?

A

verapamil hydrochloride

99
Q

If urgent rate control is needed, what 2 drugs needed>

A

BB IV

Verapamil

100
Q

In patients with suspected concomitant acute decompensated heart failure, what should be AVOIDED?

A

CCB

101
Q

Patients with life-threatening haemodynamic instability caused by new-onset atrial fibrillation, what is done?

A

Emergency electrical cardioversion, without delaying to achieve anticoagulation.

102
Q

When is rate or rhythm control offered in acute presenting AF?

A

offered if the onset of arrhythmia is less than 48 hours

103
Q

If AF has been present for more than 48 hours, what type of cardioversion better?

A

Electrical cardioversion - delay it until patient has been fully anti-coagulated for at least 3 weeks.

104
Q

Why is rapid IV administration of digoxin avoided?

A

Risk of hypertension and reduced coronary flow.

105
Q

What drug acts on supraventricular and ventricular arrhythmias?

A

amiodarone hydrochloride

106
Q

What drug acts on supra-ventricular arrhythmia only?

A

Verapamil

107
Q

What drug acts on ventricular arrhythmia only?

A

lidocaine

108
Q

What is ‘pill in pocket’ approach for Arrhythmia?

A

patient taking an oral anti-arrhythmic drug to self-treat an episode of atrial fibrillation when it occurs

propefenone + flecanide

109
Q

What is ORBIT score out of?

A

7

110
Q

What does the ORBIT scoring mean- low, medium, high?

A

0-2 Low
3 Medium
4-7 High

111
Q

For amiodarone what 2 types of patients need close monitoring?

A

Patients at high risk of bradycardia should be monitored continuously for 48 hours.

Concomitant use of amiodarone with sofosbuvir and daclatasvir, simeprevir and sofosbuvir, or sofosbuvir and ledipasvir.

112
Q

What symptoms should patients look out for if using amiodarone with concurrent sofosbuvir-containing regimens?

A

bradycardia and heart block

e.g. SOB, light-headedness, palpitations, fainting, unusual tiredness, chest pain

113
Q

What condition is contraindicated in digoxin?

A

Hypoxia

114
Q

Amiodarone and digoxin?

A

Increase risk of bradycardia

115
Q

What 6 drug CLASSES cause QT prolongation? (ABCDE)

A

A - antiArrhythmics (amiodarone, sotalol, Flecainide)
B - antiBiotics (quinolones, macrolides, aminoglycosides)
C - antipsyChotics (Haloperidol, quetiapine, risperidone)
D - antiDepressants (SSRIs, TCAs)
Diuretics
E - antiEmetics (ondansetron)

116
Q

What is max HB for patients on digoxin to avoid bradycardia?

A

maintenance dose – HR should not decrease below 60 bpm.

117
Q

What drugs interact with digoxin? CRASED

A

CRASED (Calcium channel blockers - verapamil, Rifampicin, Amiodarone, SJW, Erythromycin, Diuretics except potassium spearing)

118
Q

What 5 situations to not give rate control first line?

A

New onset AF

Atrial flutter suitable for an ablation strategy

AF with reversible cause (MI, hyperthyroidism, PE, excess caffeine & alchol)

HF primarily caused by AH
If rhythm control is more suitable

119
Q

What is interaction between BB + verapamil

A

increases the risk of cardiovascular adverse effects.

120
Q
A

PRE-REG-Thuri (44 decks)

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