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Pharmacy > Chapter 4: Arrythmias > Flashcards

Chapter 4: Arrythmias Flashcards

1
Q

What is an arrhythmia? List some examples

A

Abnormal heart rhythm caused by problems in the conduction system of the heart.

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2
Q

What are the general symptoms of arrhythmia?

A 
Palpitations 
SOB
Tired
Dizziness
Chest pain
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3
Q

What are the main types of arrhythmia?

A

AF

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4
Q

What are ectopic beats and how are they managed?

A

Atrial fibrillation
Ventricular tachycardia
Paroxysmal supraventricular tachycardia

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5
Q

What is the most common type of arrhythmia?

A

Premature heart beats often caused by a missed or extra beat.
Treatment is rarely required. If very bothersome BB are sometimes effective

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6
Q

What are some of the possible causes of Atrial fibrillation?

A

CVDs
Congenital (heart defects from birth)
Lifestyle: medication, alcohol abuse, infection

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7
Q

What should ALL patients with AF be assessed for?

A

Stroke and bleeding risk

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8
Q

What is the main complication of AF and how is it managed?

A

Stroke and Heart failure

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9
Q

What are the THREE broad categories for managing AF?

A

Rate control
Rhythm control
Cardioversion

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10
Q

What are the signs of haemodynamic instability?

A

Haemodynamic stability describes how stable blood flow is. If a person Is haemodynamically stable that means they have a stable pumping of the heart and good circulation of blood.

  • Low BP
  • Abnormal heart rate
  • Chest pains
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11
Q

What is the treatment option for a patient presenting with an acute onset of AF WITH life threatening haemodynamic instability?

A

Emergency electrical cardioversion

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12
Q

What is the treatment option for a patient presenting with an acute onset of AF WITHOUT life threatening haemodynamic instability?

A

If the onset of arrythmia <48 hours = rate or rhythm control
If the onset of arrythmia >48 hours or uncertain = rate control

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13
Q

Why is it essential to have an anticoagulant 3 weeks before cardioversion?

A

Cardioversion increases risk of blood clot forming. However, in an emergency 3 weeks cannot be waited hence a parenteral anticoagulant is given.

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14
Q

What drugs are used for pharmacological cardioversion for people with no evidence of structural or IHD

A

IV amiodarone or flecainide

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15
Q

Which drug is preferred for pharmacological cardioversion in people with evidence of structural heart disease?

A

Amiodarone

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16
Q

Describe the dosing directions for amiodarone?

A

200mg tds for 7 days
200mg BD for 7 days
200mg OD maintenance dose

17
Q

What are the patient counselling for those on amiodarone?

A

Photo toxic reactions - patients on amiodarone should be advised to shield from sunlight during treatment and several months after. Always put high SPF sun cream.

Corneal micro deposits- may interfere with drivers and may become dazzled at night.

Thyroid function tests- amiodarone contains iodine and cause thyroid dysfunction

Pneumonia and pulmonary fibrosis should always be suspected if new progressive SOB or dry cough develops in person taking amiodarone.
Hepatoxicity – discontinue if severe liver function abnormalities e.g., jaundice

18
Q

List the top interactions with Amiodarone

A

Coumarins (warfarin)- amiodarone inhibits metabolism of coumarins –> risk of bleeding

Beta blockers- increases risk of bradycardia, AV block and Myocardial depression.

Lithium

Digoxin, non-dihydropyridines CCB- need to halve dose of digoxin if giving to together.

19
Q

What SHOULD NOT be offered as pharmacological cardioversion for those with an acute onset of AF?

A

Magnesium or CCB

20
Q

What is the first line of treatment for long term maintenance therapy of AF?

A 
1st line= rate control
Monotherapy 
BB (not sotalol)
CCB (diltiazem or verapamil) 
Digoxin (in sedentary patients with non-paroxysmal AF) 
Dual therapy 
BB 
Diltiazem 
Digoxin (in sedentary patients with non-paroxysmal AF)
21
Q

Which Betablockers should be avoided in rate control treatment for AF?

A

Sotalol

22
Q

What should be given if first line of treatment fails?

A

Rhythm control

23
Q

Who should not receive rate control in the treatment of AF?

A

Those with a new onset of AF
AF which has a reversible cause
Atrial flutter who is suitable for ablation strategy to restore sinus rhythm
For those whom rhythm control is more suitable based on clinical judgement

24
Q

What are the 2 assessment tools used for determining risk of stroke and bleeding?

A 
CHA2DS2VASc = stroke risk 
HASBLED = Bleeding risk
25
Q

Using the stroke risk assessment tool when should an anticoagulant be given?

A

If CHADSVAS score of 2 or more = give anticoagulant

If stroke risk outweighs that of the bleeding risk, then an anticoagulant should be given.

26
Q

Ventricular tachycardia is a type of arrythmia. What are the 4 main types of ventricular tachycardia and the management of each one?

A

Pulseless = Immediate defibrillation and CPR
If ineffective = IV amiodarone (lidocaine if CI)

Unstable sustained = Direct cardioversion If ineffective = IV amiodarone

Stable sustained = IV anti-arrhythmic drug (amiodarone preferred)

Non-sustained = BB given

27
Q

What is torsade de pointes?

A

Torsade de pointes is a lethal form of ventricular tachycardia with a prolonged QT interval.

28
Q

How is torsade de pointes managed?

A

IV magnesium sulphate

29
Q

What causes torsade de pointes?

A

Drugs
Diahorrea
Low serum magnesium

30
Q

Which drugs cause Torsade de pointes / QT prolongation?

A

Antiarrhythmics – Disopyramide, procainamide, quinidine, sotalol
Macrolides – Azithromycin, clarithromycin, erythromycin
Fluoroquinolones- Ciprofloxacin, levofloxacin, moxifloxacin
Antifungals – Azoles (e.g., fluconazole etc.)
Antipsychotics- haloperidol, thioridazine
Antidepressants- citalopram, escitalopram
Antiemetics- ondansetron
Opioids- methadone
Misc- cocaine, donepezil

31
Q

What is pill in the pocket?

A

An approach when you only take a flecainide 300mg or propafenone tablet when you have an episode of AF. This requires you to always carry the medication with you. It is used for people who have paroxysmal AF who has been assessed suitable by a cardiologist.

32
Q

What are the signs of digoxin toxicity?

A 
bradycardia 
N&V, diarrhoea 
abdominal pain 
blurred vision/ yellow skin
Confusion 
delirium 
rash
33
Q

How is paroxysmal supraventricular tachycardia managed?

A

Reflex vagal nerve stimulation e.g., carotid sinus massage, immerse face in ice cold water, Valsalva manoeuvre

IV adenosine (CI in COPD and ASTHMA)

IV Verapamil

In patients who are haemodynamically unstable = direct current cardioversion

In patients with recurrent episodes= catheter ablation OR drugs (verapamil, diltiazem, BB , flecainide or propafenone).

34
Q

What can be used to treat an arrythmia after an MI?

A

Lidocaine

Disopyramide

35
Q

What should you do if both flecainide and amiodarone are used together?

A

Reduce dose of flecainide by half when concurrent use with amiodarone.

Pharmacy (6 decks)

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