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Case 12 > Drugs Cardiac Arrhythmias > Flashcards

Drugs Cardiac Arrhythmias Flashcards

1
Q

What is the effect of noradrenaline or adrenaline on SAN B-1 adrenoreceptors?

A

Increases slope

Reduces duration of Phase 4

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2
Q

What is the effect of increased vagal activity to AVN?

A

Activation of ACh receptors = increased AVN refractoriness = slow HR and reduce CO

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3
Q

What are the causes of arrhythmias?

A
  • Damage to cardiac conducting tissues/nodes
  • Congenital
  • Drugs
  • Electrolyte imbalances - K
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4
Q

What are the rate and rhythm drugs for AF?

A
  • VERAPAMIL - Ca channel blocker

- AMIODARONE - B-adrenoreceptor blocker and K channel blocker

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5
Q

What is the extensive ADR of amidarone?

A

Predisposes to torsades de pointes

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6
Q

What is the rhythm control drug for AF?

A

FLECAINIDE - Na channel blocker

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7
Q

What anticoagulants are used in AF?

A
  • Warfarin
  • Heparin
  • DOACs
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8
Q

What is the MOA of Warfarin?

A
  • Vit K epoxide reductase inhibitor
  • Blocks synthesis F II, VII, IX and X
  • Monitor via INR or PT time
  • Antidote = Vit k
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9
Q

What is the MOA of Heparin?

A
  • Activates anti-thrombin > inhibits thrombin + factor Xa
  • Low molecular weight heparin only blocks clotting factor - subtle
  • Monitor via APTT
  • Antidote = protamine sulfate
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10
Q

What is the MOA of DOACs?

A
  • Rivaroxaban - factor Xa inhibitor

- Dabigatran - thrombin inhibitor

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11
Q

What is seen on the ECG of SVT (AVNRT type)?

A
  • Narrow QRS

- Buried p waves

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12
Q

What are the causes of SVT (AVNRT)?

A
  • Normal structural variant with fast + slow fibres in or near AVN
  • Re-entrant arrhythmias only in absence of aberrant arterial impulse trigger

Predisposing factors:

  • Caffeine
  • Psychosocial stress
  • Hyperthyroidism
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13
Q

What are the rhythm control drugs for AVNRT?

A
  • ADENOSINE - hyperpolarises reducing excitability

- FLECAINIDE - blocks conduction in fast re-entrant circuit pathways

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14
Q

What is the rate + rhythm control drug for AVNRT?

A

VERAPAMIL

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15
Q

What is seen on the ECG of atrial flutter (SVT)?

A
  • Saw tooth flutter waves
  • Fast atrial rate - 300bpm
  • Narrow QRS
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16
Q

What are the causes of atrial flutter?

A
  • Micro re-entrant circuit in RA conducts premature impulses

Predisposing factors:

  • Hypertension
  • Cardiomyopathies
  • Valvular dysfunction
17
Q

What are the rate and rhythm drugs for atrial flutter?

A
  • VERAPAMIL (don’t use with B-blocker = cardiac arrest)

- DIGOXIN - blocks Na/K ATPase in brainstem cardiac centre to increase vagal activity of AVN

18
Q

What is the rate control drug for atrial flutter?

A

METOPROLOL - limits ventricular rate by blocking B1 adrenoreceptors

19
Q

What is seen on the ECG of VT?

A
  • QRS duration > 120
  • Rapid HR > 100

Regular BCT considered VT until proven otherwise

20
Q

What are the pre-disposing factors for VT?

A
  • Prior MI
  • Cardiomyopathies
  • Can be drug induced (digoxin)
21
Q

What are the drug options for VT?

A
  • AMIODARONE
  • FLECAINIDE
  • METOPROLOL
22
Q

What is seen on the ECG of a STEMI?

A
  • ST segment elevation
23
Q

How is STEMI treated?

A

PCI

24
Q

What are the types of STEMIs and their causes?

A
  • Depend on which CA - downstream tissue becomes ischaemic
  • LAD infarcts = worst as LV function compromised
  • Acute blockage of CA caused by atherosclerotic plaque rupture + subsequent thrombus formation
25
Q

What drug is used for STEMI during MI?

A

ALTEPLASE
- Plasmogen activating factor
= Release of plasmin to dissolve clot
- Not first line (not as effective as PCI)

26
Q

What drug is used for STEMI pain management during MI?

A

MORPHINE - for intense chest pain

27
Q

What are the drug options for STEMI post-MI?

A
  • ASPIRIN - blocks thromboxane A2 mediated platelet aggregation
  • CLOPIODGREL - inhibits ADP-receptor mediated platelet aggregation (+ clot formation)
28
Q

What drug is used for STEMI post-MI rate control?

A

BISOPROLOL

  • limits ventricular rate by blocking B-1 adrenoreceptors
  • positive inotrope

Case 12 (9 decks)

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