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BNF > CHAPTER 2: CVS: Arrythmias > Flashcards

CHAPTER 2: CVS: Arrythmias Flashcards

1
Q

Which complication can AF lead to?

A

Stroke

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2
Q

What must all all patients with AF be assessed for? (2)

A
  1. Risk of stroke

2. Risk of thromboembolism

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3
Q

Which 2 things can AF treatment aim to manage?

A
  1. Rate

2. Rhythm

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4
Q

In patients with AF, how often should anticoagulation, stroke and bleeding risk be reviewed?

A

Yearly

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5
Q

What must all patients presenting with life-threatening haemodynamic instability caused by new-onset AF undergo?

A

Emergency electrical cardioversion

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6
Q

If a patient presents with acute AF less than 48 hours since onset, which is preferred: rate or rhythm control?

A

Either

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7
Q

If a patient presents with acute AF more than than 48 hours since onset, which is preferred: rate or rhythm control?

A

Rate control - but cardioversion is preferred

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8
Q

Which is first line drug treatment? Rate or rhythm control?

A

Rate

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9
Q

What are the exceptions to using rate control first line in AF? (5)

A
  1. New-onset AF
  2. Heart failure secondary to AF
  3. AF suitable for ablation
  4. AF with a reversible cause
  5. Rhythm control is more suitable
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10
Q

Which 2 drug classes are first line for rate control of AF?

A
  1. Beta-blocker

2. Rate-limiting calcium channel blocker

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11
Q

Give 2 examples of rate limiting calcium channel blockers

A
  1. Verapamil

2. Diltiazem

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12
Q

If a single drug fails to control the rate in AF, a combination of 2 drugs can be used from which selection?

A
  1. Beta-blocker
  2. Digoxin
  3. Diltiazem
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13
Q

If symptoms are not controlled with 2 rate limiting drugs in AF, what should be considered?

A

Rhythm control strategy

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14
Q

If ventricular function is diminished, a combination of which 2 drugs is preferred?

A

Beta-blocker (licensed in heart failure) + Digoxin

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15
Q

When AF is accompanied by congestive heart failure which drug is used?

A

Digoxin

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16
Q

If drug treatment is required to maintain sinus rhythm after cardioaversion, which drug is used?

A

A beta blocker

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17
Q

Which drug can be started 4 weeks before and continued for up to 12 months post-cardioversion?

A

Amiodarone

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18
Q

Which drug cannot be given if there is known ischaemic or structural disease?

A

Flecainide

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19
Q

In selected patients with paroxysmal AF, how can sinus rhythm be restored?

A

“Pill in pocket” approach where a patient takes oral flecainide to self-treat an episode of AF when it occurs

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20
Q

Which assessment tool does NICE recommend for the assessment of clotting risk?

A

CHAADSVASC

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21
Q

What does CHADSVASC stand for?

A 
C - Congestive heart disease
H - Hypertension
A - Age >70 (2)
A - Age >65
D - Diabetes
S - Stroke/TIA (2)
V - Vascular disease
S - Sex = female
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22
Q

Which 2 parameters on CHADSVASC give a score of 2?

A
  1. Age >70

2. Stroke

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23
Q

Which gender on CHADSVASC gives a score of 1?

A

Female

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24
Q

What does HASBLED stand for?

A 
H - Hypertension
A - Abnormal liver function
A - Abnormal renal function
B - Bleeding
L - Labile INRs
E - Elderly
D - Drugs and Alcohol
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25
Q

In males, what does the CHADSVASC score have to be for them not to receive any thromboprophylaxis for stroke prevention?

A

0

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26
Q

In females, what does the CHADSVASC score have to be for them not to receive any thromboprophylaxis prevention?

A

1

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27
Q

If patients present with new-onset AF, what should be provided until an assessment it made and they are started on oral anticoagulation?

A

Parenteral anticoagulation

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28
Q

Can anticoagulation therapy be held solely based on the risk of falls?

A

No

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29
Q

What are the options for oral anticoagulation in AF?

A
  1. Warfarin
  2. Rivaroxaban
  3. Apixaban
  4. Dabigatran
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30
Q

Is aspirin an option for the prevention of stroke in AF?

A

NO

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31
Q

Which drug is used to treat bradycardia after MI?

A

Atropine

32
Q

If atropine fails to treat bradycardia after MI, what should be administered?

A

Adrenaline IV infusion

33
Q

What is Torsade de Pointes?

A

A form of ventricular tachycardia associated with a long QT interval

34
Q

What can cause Torsade de Pointes? (4)

A
  1. Drugs
  2. Hypokalaemia
  3. Bradycardia
  4. Genetics
35
Q

Which electrolyte state can enhance the arrythmogenic effect of drugs?

A

Hypokalaemia

36
Q

What is the drug of choice for supraventricular arrythmias?

A

Adenosine

37
Q

Which drug prolongs the half life of adenosine? (8-10sec usually)

A

Dipyridamole

38
Q

Give an example of a cardiac glycoside

A

Digoxin

39
Q

Which other drug can be of use in supraventricular arrythmias?

A

Verapamil

40
Q

Which drug should verapamil never be given with?

A

Beta-blockers

41
Q

Can the GP initiate amiodarone?

A

No, specialist initiation only or in a hospital

42
Q

Compared with oral amiodarone, how fast does IV amiodarone act?

A

Very rapidly

43
Q

Amiodarone has a very long half life, how long can this extend?

A

Several weeks

44
Q

How long can it be required for amiodarone to reach steady state?

A

Many weeks or months

45
Q

What is the loading dose regimen for amiodarone?

A

week 1: 200mg TDS
week 2: 200mg BD
week 3 and thereafter: 200mg OD

46
Q

What are the 5 toxicities of amiodarone?

A
  1. Corneal microdeposits
  2. Thyroid
  3. Pulmonary toxicity
  4. Liver toxicity
  5. Peripheral neuropathy
47
Q

What counselling must be delivered to patients taking amiodarone due to the risk of corneal microdeposits?

A

Drivers may be dazzled by lights

48
Q

Regarding its risk of corneal microdeposits, when should treatment with amiodarone be stopped?

A

If it interfers with vision - risk of blindness

49
Q

Which substance does amiodarone contain which causes it to have a risk of thyroid toxicity?

A

Iodine

50
Q

How can amiodarone affect the thyroid?

A

Both hyperthyroidism and hypothyroidism can occur

51
Q

What should happen with a patient taking amiodarone gets thyrotoxicosis?

A

Withdraw amiodarone (at least temporarily) to help achieve control.

52
Q

Which treatment of thyrotoxicosis may be required if a patient experiences it while taking amiodarone?

A

Carbimazole

53
Q

What should happen with a patient taking amiodarone gets hypothyroidism?

A

Treatment should be continued and the patient should receive replacement therapy

54
Q

What should happen with a patient taking amiodarone shows signs of extreme liver disease?

A

Discontinue treatment

55
Q

Which side effect of amiodarone should be suspected if a patient presents with shortness of breath or cough?

A

Pneumonitis

56
Q

Which monitoring is required for patients on amiodarone? (4)

A
  1. Thyroid function before treatment then every 6 months
  2. LFTs before starting then every 6 months
  3. Chest X-ray before starting
  4. Serum potassium before starting
57
Q

Which thyroid function markers should all be measured?

A

TSH, T4 and T3

58
Q

What does a have T4 and T3 but a low TSH indicated?

A

Thyrotoxicosis

59
Q

Which diluent should amiodarone be administered with?

A

Glucose 5%

60
Q

What should patients be counselled on regarding the risk of phototoxicity with amiodarone?

A

Shield skin from light during treatment and for several months after discontinuing

61
Q

Which beta-blocker may prolong QT and cause potentially life-threatning arrhythmias?

A

Sotalol

62
Q

What is the antidote for digoxin?

A

Digoxin-specific antibody, Digifab

63
Q

In AF, what is the maintenance dose of digoxin usually determined by?

A

The ventricular rate at rest

64
Q

What must the ventricular rate at rest not fall below at rest?

A

60 BPM

65
Q

Is a digoxin loading dose required for patients who have heart failure and are in sinus rhythm?

A

No

66
Q

What is the most important determinant of digoxin dosage?

A

Renal function

67
Q

At which digoxin range does the likelihood of toxicity increase progressively?

A

1.5 to 3mcg/L

68
Q

In which population should digoxin be used with special care due to the risk of digitalis?

A

Elderly

69
Q

Is regular monitoring of digoxin necessary?

A

No, only if problems are suspected

70
Q

Which electrolyte disturbance predisposes the patient to digoxin toxicity?

A

Hypokalaemia

71
Q

How is hypokaleamia managed if a patient is on digoxin? (2)

A
  1. Potassium-sparing diuretic

2. Potassium supplements

72
Q

When digoxin is given concomitantly with amiodarone, dronedarone and quinine, what should be done to the dose?

A

Half

73
Q

How much should the dose of digoxin be increased by when switching from IV to oral route?

A

20-33%

74
Q

What should be monitored when treating with digoxin? (2)

A
  1. Renal function

2. Electrolytes

75
Q

Which calcium channel blocker is used in subarachnoid haemorrage to reduce the amount of blood reaching the area?

A

Nimodipine

BNF (28 decks)

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