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Respiratory and Cardio > Pharmacology of rhythm control > Flashcards

Pharmacology of rhythm control Flashcards

1
Q

Phases of the cardiac myocyte AP:

A 
4
0
1
2
3
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2
Q

Phase 4 =

A

Resting membrane potential, K+ open

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3
Q

Phase 0 =

A

Rapid depolarisation, Na+ open

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4
Q

Phase 1 =

A

K+ open, small repolarisation

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5
Q

Phase 2 =

A

Plateau phase. K+ and Ca2+ open

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6
Q

Phase 3 =

A

Repolarisation. K+ open.

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7
Q

ERP =

A

Effective refractory period

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8
Q

Phases of nodal AP =

A

4
0
3

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9
Q

Can tetanus occur in cardiac myocytes?

A

No

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10
Q

RRP

A

Relative refractory period.

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11
Q

When can cardioversion cause VF?

A

If shocked during relative refractory period.

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12
Q

Phase 4 (nodal) =

A

T-type Ca2+ and Na+ open

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13
Q

Phase 0 nodal =

A

L-type Ca2+ channels

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14
Q

Phase 3 nodal =

A

voltage gated K+ open

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15
Q

Intrinsic rate of SAN

A

60-100 bpm

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16
Q

Intrinsic rate of AVN

A

40 bpm

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17
Q

What is the HR in complete heart block?

A

40 bpm

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18
Q

Where is the SAN?

A

Junction of SVC and RA

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19
Q

Where is the AV node?

A

Inter-atrial septum

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20
Q

What part of the heart conducts the fastest?

A

His-purkinje system

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21
Q

Conduction rate of His-purkinje system

A

2-3 m/sec

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22
Q

Conduction rate of ventricular and atrial muscles

A

1 m/sec

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23
Q

Which part of the heart conducts the slowest?

A

AVN

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24
Q

Conduction velocity of AVN

A

0.05 m/sec

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25
Q

Which kind of heart block is asymptomatic?

A

Type 1

Mobitz I

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26
Q

Treatment of Mobitz 2

A

Close monitoring

Pacing

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27
Q

Why is monitoring of mobitz 2 important

A

Can progress to complete heart block

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28
Q

Treatment of complete heart block =

A

Atropine
Isoprenaline
Pacing

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29
Q

Symptoms of 2nd and 3rd degree heart block =

A 
Dizziness
Syncope
SOB
Pain 
Fatigue
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30
Q

Atrial rate in atrial flutter is usually =

A

300/min

31
Q

What can be given to see atrial flutter?

A

Adenosine

32
Q

Torsdaes de pointes is a type of

A

Ventricular tachycardia

33
Q

Causes of trosades de pointes =

A
  • Congenital long QT
  • Heart block/bradycardia
  • Hypokalaemia or hypomagnaemia
  • Drugs (Type III antiarrthymics)
34
Q

Treatment of Vfib =

A

Direct current shock

35
Q

How to manage arrthymias:

A
  • Treat causes
  • Vagotonic manoeuvres
  • DC cardioversion
  • Pacing
  • Surgery/ablation
  • Drugs
36
Q

How to treat bradycardia due to beta-blocker OD

A

Glucagon

37
Q

How to treat bradycardia due to Ca2+ blocker OD

A

Glucagon

38
Q

How to treat bradycardia due to acute digoxin toxicity

A

Digoxin-specific antibodies

Ca2+ blocker

39
Q

MoA atropine =

A

Antimuscarinic

40
Q

What to not give to cardiac transplant patient

A

Atropine

41
Q

If atropine fails, how should you treat bradycardia?

A

External pacing

42
Q

Hs and Ts describe =

A

Reversible causes of cardiac death

43
Q

Hs + Ts =

A 
Hypovolemia
Hypothermia
Hypo/Hyperkalaemia
Hypoxia
Throbosis
Toxins
Tension pneumothorax
Cardiac tamponade
44
Q

name a classification of antiarrthymics =

A

Vaughan Williams

45
Q

Class I

A

Na+ blockers

46
Q

Class II

A

Beta blockers

47
Q

Class III

A

K+ blockers

48
Q

Class IV

A

Ca2+ blockers

49
Q

MoA of Na+ blockers

A

Increase duration of depolarisation

50
Q

MoA of betablockers

A

Reduce sympathetic activity on SAN

51
Q

MoA of K+ blockers

A

Prolong repolarisation

52
Q

MoA of Ca2+ blockers

A

Prolong refractory period (nodal)

53
Q

Disopyramide

A

Na+ blockers

54
Q

Lidocaine

A

Na+ blockers

55
Q

Flecainide

A

Na+ blockers

56
Q

Antenolol

A

beta blockers

57
Q

Amiodarone

A

K+ blocker

58
Q

Verapamil

A

Ca2+ blocker

59
Q

Diltiazem

A

Ca2+ blocker

60
Q

MoA of adenosine

A

K+ channel activation - slows conduction through AV

61
Q

Use of adenosine

A

SVT

62
Q

MoA of digoxin

A

K+, Na+ ATPase inhibition

63
Q

Uses of digoxin =

A

AF
Atrial flutter
CHF

64
Q

What is digoxins ionotrophic effect?

A

+ve ionotrophy

65
Q

Low therapeutic index =

A

Dosing between therapeutic and lethal dose narrow

66
Q

What should you reduce digoxin dose in?

A

Elderly
Renal impairment
Hypokalaemia, hypomagnesia, hyperclacaemia

67
Q

Side effects of digoxin =

A
  • Arrythmias, AF
  • GI
  • Blurring of vision
  • Gynaecomastia
  • CNS effects
68
Q

First line drug in ICU for SVT and VT =

A

Amiodarone

69
Q

Side effects of amiodarone

A
  • Bradycardia, heart block, arrhythmia
  • Hypo/hyper thyroidism
  • Photosensitivity
  • Blue-grey skin
  • Lung fibrosis
  • Abnormal LFTs
70
Q

Why can amiodarone cause hyper/hypothyroidism

A

Contains iodine

71
Q

What is used in VT when amiodarne is contraindicated?

A

Lidocaine

72
Q

Class of lidocaine =

A

Class ib

73
Q

Contraindications of Ca2+ blockers =

A

Pregnancy
Cardiogenic shock
Severe bradycardia
Heart failure

Respiratory and Cardio (14 decks)

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