Heart And Blood

Question 1

What does amiodarone treat?

Answer 1

Arrhythmias

Question 2

What are the side effects of amiodarone?

Answer 2

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,

Question 3

What are the main interactions with amiodarone?

Answer 3

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

Question 4

What are the indications of the digoxin?

Answer 4

• Atrial fibrillation,
• tachycardia,
• heart failure

Question 5

What is the mechanism of action of digoxin?

Answer 5

It is a positive inotrope – it increases the force of myocardial contraction and reduces conductivity within the AV node

Question 6

What monitoring is required for digoxin?

Answer 6

Serum electrolytes, especially potassium and renal function

Question 7

How can you manage the risks of developing digoxin toxicity?

And what group are most susceptible?

Answer 7

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

Question 8

What are the main side-effects of digoxin?

Answer 8

Nausea, vomiting, diarrhoea, dizziness, blurred vision

Question 9

What are the main interactions with digoxin?

Answer 9

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

Question 10

What are the symptoms of bradycardia? (HR<60bpm)

Answer 10

• Fatigue
• Dizziness
• Confusion
• Shortness of Breath
• Chest Pain

Question 11

What drugs cause Bradycardia?

Answer 11

Mnemonic: BAD CAB

• Beta Blockers
• Alpha Agonists (Clonidine)
• Digoxin
• Calcium Channel Blockers
• Anticholinergics (Donepezil)
• Baclofen

Question 12

What are the main side effects of DOACs?

Answer 12

Mnemonic: BARE LOT

• Bleeding/Bruising
• Angioedema
• Renal Failure
• Epidermal Necrolysis
• Low BP
• Oedema
• Tachycardia

Question 13

What monitoring is required for DOACs?

Answer 13

Before and During: FBC, U+Es, LFTs