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RBF > Neigel Lever > Flashcards

Neigel Lever Flashcards

1
Q

What are the types of arrhythmias?

A

Bradycardia - physiological, sinus node, AV node, neural mediated

Tachycardias - atrial, junctional SVT, ventricular (scar, normal hearts)

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2
Q

What does amiodarone?

A

A drug for the treatment of arrhythmias - it prolongs phase 3 of the cardiac action potential by blocking the potassium channels that take K+ out of the cells.

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3
Q

What is a treatment for an arrhythmia?

A

Cardiac device - one chanber or multiple chamber - used for people who are at risk for sudden cardiac death.

Functions -
- Pacemaker - for high grade AV block or symptomatic sinus node disease

Defibrillator:

  • Aborted SCD/ sustained VT in structural heart disease
  • high risk for SCD

Cardiac Resyncronisation Therapy
- cardiomyopahy and left bundle branch block.

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4
Q

What are some common conditions?

A

Sinus tachycardia
- stress, fever etc
Can be an irritation of the SA node.
- treat with a beta blocker

Ectopy - most are benign

  • just investigate cause
  • may need surgical removal or ablation of cause of ectopy.
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5
Q

What are the Vaughen Williams classification of drugs for anti-arrhythmia?

A

Class 1 drugs are Na channel agents (predominant blocking)
1A - prolong action potential

1B - shorten AP

1C - slow conduction

Class 2 agents are beta blockers
- metoprolol, propanolol

Class 3 are potassium channel blockers - decrease repolarisation- amiodarone

Class 4 drugs slow calcium channel blockers
- verapamil, dltiazem, nifedipine

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6
Q

What do antiarrhythmia drugs do?

A

The effect the cell membrane, autonomic nevous system, and vagal tone

Cell membrane activity affects - conduction velocity, length of the refractory period, and automaticity through the SA or AV nodes.

Increased vagal tone decreases heart rate, decreases SA automaticity and causes slower conduction through the AV node.
Decreased vagal tone - increase HR, increases SA automaticity and causes faster conduction through the AV node.

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7
Q

What is the class 1A drugs?

A

Procainamide

Prolongs the refractory period, decreases conduction velocity (reduces rate ofdepolarisation)
Widens the QRS interval and increases the QT interval.

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8
Q

What is the class 1B drugs?

A

Lignocaine
Phenytoin

Decreases the duration of the action potential and shortens the refractory period.

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9
Q

What is the class 1C drugs?

A

Decreases the conduction velocity of the action potential - no effect on refractory period

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10
Q

What is the class 2 drugs?

A

Beta blockers
Metoprolol, carvedilol

Cause fatigue and bradycardia

Start lo go slow

Prescribed for atrial and ventricular arrhythmias

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11
Q

What is the class 3 drugs?

A

Class 3 are potassium channel blockers - decrease repolarisation increasing the duration of the action potential. Increases duration of the refractory period.

Amioderone affects the Na and Ca channels

May slow but not stop VT. Prescribed for atrial or ventricular arrhythias.

Reduce digoxin dose if using with amiodarone.

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12
Q

What is the class 4 drugs?

A

Verapamil and diltiazem

Blocks the Ca chaneels
Affects mainly the SA andAV nodes.

Not pro-arrhythmic

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13
Q

What is the class 5 drugs?

A

Others

Digoxin - increases PNS activity and slows the atrial rate
- slows AV conduction

Adenosine - typically IV - AV node block and some SA node effect.

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14
Q

What can makes drugs proarrhythmia?

A

Increasing the duration of repolarisation.
Developent of early-after-depolarisations, which cause torsades.
Alterations in reentry pathways.

There is an increased risk of causing an arrhythmia in heart failure

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15
Q

What can amioderone cause?

A

Long QT syndrome - can result in torsades

Drug interactions with warfarin

Toxicities:

  • Pulmonary fibrosis
  • thyroid issues
  • liver failure
  • bone marrow suppression
  • renal failure
  • photosensitivity
  • corneal deposits

Side effects

  • myalgias
  • gait disturbances
  • insomnia
  • prolongation of coagulation time
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16
Q

What does adenosine do?

A

Blocks the AV node. Stops any tachycardia that uises the AV node in the loop:

  • AV reentrant tachycardia - can also use ablation
17
Q

What are some features of atrial fibrillation?

A

Common
Various symptoms - often none

Anticoagulation issues

Rate vs rhythm control - drug, device, intervention

Drugs to target the AV node

  • beta blockers
  • Ca antagonists
  • amioderone
  • digoxin

Risk factors - hypertension, diabetes, fibrosis

18
Q

What do you do to treat VT/VF?

A

Call 777 - resuscitation

Treat the underlying pathology
- ischaemia
- bradycardia
-structural disease
metabolic or drug causes

Give antiarrhythmia drugs
Devices

RBF (9 decks)

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