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CVD - HIGH WEIGHTED > CVD - ATRIAL FIBRILATION > Flashcards

CVD - ATRIAL FIBRILATION Flashcards

1
Q

What are the symptoms of AF?

A

Heart palpitations, dizziness, SOB, tiredness

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2
Q

What are the 3 categories of AF?

A

Paroxysmal - episodes stop 48 hours without treatment

Persistent - episode lasts > 7 days

Permanent - present all the time

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3
Q

What is the general treatment for AF?

A

Rate control - BB or rate limiting CCB and monotherapy. If uncontrolled then dual therapy. If still uncontrolled then rhythm control

Rhythm control - pharmacological (e.g. amiodarone) or electrical (direct current cardioversion)

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4
Q

How long should you wait until the patient is fully anti-coagulated for before a cardioversion?

A

3 weeks

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5
Q

If monotherapy fails, which drugs can be used in combination as second line?

A

BB, Digoxin, Diltiazem

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6
Q

Which drugs are used in rhythm control to maintain sinus rhythm post-cardioversion?

A

Sotalol, Flecainide, Propafenone, Amiodarone

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7
Q

Why should you avoid verapamil in patients being treated with beta blockers?

A

Increased risk of severe hypotension and asystole

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8
Q

What does CHADSVAS stand for and what are the scores?

A

Congestive HF - 1

Hypertension - 1

Age > 75 - 2

Diabetes - 1

Stroke - 2

Vascular disease - 1

Age 65-74 - 1

Sex (female) - 1

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9
Q

After doing CHADVAS when would you decide to give an anticoagulant?

A

If the score is 2 or more

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10
Q

Which anticoagulant would you give in new onset AF?

A

Parenteral anticoagulant e.g. heparin

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11
Q

Which anticoagulant would you give if AF was diagnosed already?

A

Warfarin or NOAC

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12
Q

What would you do if a patient had unstable sustained ventricular tachycardia?

A

direct current cardioversion

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13
Q

What would you do if a patient had stable sustained ventricular tachycardia?

A

IV anti-arrhythmic drug. Amiodarone preferred

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14
Q

What would you give if a patient had non-sustained ventricular tachycardia?

A

beta blocker

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15
Q

What is the treatment of Torsades De Pointes?

A

IV magnesium sulphate

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16
Q

What can cause Torsades De Pointes?

A

Sotalol, Severe Bradycardia, Hypokalaemia

17
Q

What are the stages to treating paroxysmal supraventricular tachycardia?

A

1) terminates spontaneously or with reflex vagal nerve stimulation (carotid sinus massage or immerse face in ice cold water)
2) IV adenosine (contraindicated in COPD/asthma)
3) IV verapamil

18
Q

What is normally the loading dose for amiodarone?

A

200mg TDS 7 days

200mg BD 7 days

200mg OD as maintenance

19
Q

What are the side effects of amiodarone?

A

Eyes - corneal microdeposits (night time glares when driving), optic neuropathy (stop amiodarone if this occurs)

Skin - phototoxicity, slate-grey skin on light exposed areas (shield skin from light during treatment and use high SPF even after stopping)

Nerves - peripheral neuropathy (numbness, tingling, tremors)

Lungs - pneumonitis, pulmonary fibrosis, SOB, cough

Liver - hepatotoxicity

Thyroid dysfunction - hypothyroidism (give carbimazole if needed and withdraw amiodarone), hyperthyroidism (give levo if needed without withdrawing amiodarone)

20
Q

What do you need to monitor if a pt is on amiodarone?

A

Annual eye test, CXR before treatment, LFTs every 6 months, monitor TSH, T3 and T4 before treatment and every 6 months, BP and ECG (causes hypotension and bradycardia), serum potassium (can cause hypokalaemia)

21
Q

Amiodarone has a very long half life. What are some interactions?

A

Enzyme inhibitors - increase cp

Other CYP substrates (e.g. warfarin, digoxin, phenytoin) - amiodarone itself acts as an inhibitor

Statins - increased risk of mypopathy

BB, verapamil, diltiazem - bradycardia, AV block, myocardial depression

Drugs that prolong QT - e.g. Quinolones, Macrolides, TCAs, SSRIs, Lithium, Quinine, Hydroxychloroquine, Antimalarials, Antipsychotics

22
Q

What are the therapeutic levels for digoxin?

A

1-2 mcg/L

23
Q

When do you need to measure digoxin levels?

A

If toxicity is suspected

If the patient is renally impaired

24
Q

How is digoxin dosed?

A

Loading dose required due to long half life and to get the desired effect

Maintenance dose OD

Atrial flutter and non paroxysmal AF = 125-250 mcg

Worsening or severe heart failure = 62.5-125 mcg

25
Q

What are the bioavailabilities for digoxins different formulations?

A

Elixir - 75%

Tablet - 90%

IV - 100%

26
Q

What can cause digoxin toxicity?

A

Hypo K+, Mg+

Hyper Ca 2+

Hypoxia

Renal impairment

27
Q

What are the symptoms of digoxin toxicity?

A

Bradycardia/heart block

Nausea and vomiting

Blurred or yellow vision

Confusion/delirium

Rash

28
Q

What interacts with digoxin?

A

Diuretics, B2 agonists, steroids, theophylline - cause hypo K+ so causes digoxin toxicity

Inhibitors - increased cp

Inducers - decreased cp

NSAIDs, ACE, ARB - reduce renal excretion so lead to toxicity

CVD - HIGH WEIGHTED (10 decks)

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