Heart And Blood Flashcards
What does amiodarone treat?
Arrhythmias
What are the side effects of amiodarone?
Mnemonic: Please Check Patient’s Tired Livers
- Pulmonary toxicity,
- Corneal micro deposits (reversible),
- Phototoxicity,
- Thyroid dysfunction (hypo/hyperthyroidism),
- Liver disorders (jaundice etc.)
Additional:
Nausea,
vomiting,
taste disturbance,
slate grey discolouration,
tremor,
sleep disorder,
What are the main interactions with amiodarone?
Mnemonic: We Beat Quickly Like Steel Drums Can
- Warfarin – amiodarone inhibits warfarin metabolism, enhancing the anticoagulant effects
- Beta blockers – increased risk of bradycardia, AV block and myocardial depression
- QT prolonging drugs - risk of QT Prolongation
- Lithium – risk of ventricular arrhythmias
- Simvastatin - max 20mg
- Digoxin – plasma concentration of digoxin increased by amiodarone
- CYP3A4 inhibitors
What are the indications of the digoxin?
- Atrial fibrillation,
- tachycardia,
- heart failure
What is the mechanism of action of digoxin?
It is a positive inotrope – it increases the force of myocardial contraction and reduces conductivity within the AV node
What monitoring is required for digoxin?
Serum electrolytes, especially potassium and renal function
How can you manage the risks of developing digoxin toxicity?
And what group are most susceptible?
Digoxin toxicity is made worse by hypokalaemia.
To combat this, give potassium-sparing, diuretics, or potassium supplements
- the elderly are more susceptible to digoxin toxicity
What are the main side-effects of digoxin?
Nausea, vomiting, diarrhoea, dizziness, blurred vision
What are the main interactions with digoxin?
Mnemonic: EARS DC
Amiodarone – plasma concentration is increased by amiodarone
Erythromycin – plasma concentration is increased by erythromycin (enzyme inhibitor)
Rifampicin – plasma concentration is reduced by rifampicin (enzyme inducer)
St John’s wort– plasma concentration is reduced by Saint Johns wort (enzyme inducer)
Diuretics – increased toxicity if hypokalaemia occurs with a loop and thiazide
Calcium channel blockers – plasma concentration is increased by calcium channel blockers
What are the symptoms of bradycardia? (HR<60bpm)
- Fatigue
- Dizziness
- Confusion
- Shortness of Breath
- Chest Pain
What drugs cause Bradycardia?
Mnemonic: BAD CAB
- Beta Blockers
- Alpha Agonists (Clonidine)
- Digoxin
- Calcium Channel Blockers
- Anticholinergics (Donepezil)
- Baclofen
What are the main side effects of DOACs?
Mnemonic: BARE LOT
- Bleeding/Bruising
- Angioedema
- Renal Failure
- Epidermal Necrolysis
- Low BP
- Oedema
- Tachycardia
What monitoring is required for DOACs?
Before and During: FBC, U+Es, LFTs