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PY365 AF > Therapeutics 2 > Flashcards

Therapeutics 2 Flashcards

1
Q

Give examples of conditions of bradycardia

A
  1. Sinus node disease
  2. AV nodal disease (heart block)
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2
Q

What could cause sinus bradycardia

A
  • age related, loss of pacemaker cells
  • hypothyroidism
  • ischaemia
  • pharmacological therapy
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3
Q

What could cause AV nodal disease

A
  • ischaemia
  • pharmacological therapy
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4
Q

Give examples of drugs that could induce bradycardia

A

amiodarone, verapamil, diltiazem, digoxin, donepezil, carbamazepine, lithium

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5
Q

Describe what an ECG would show for sinus bradycardia

A
  • impulses originate at SA node at slow rate
  • all complexes normal and evenly spaced
  • rate less than 60bpm
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6
Q

Describe what an ECG would show for first degree AV block

A
  • atrioventricular conduction lengthened
  • P wave precedes each QRS complex
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7
Q

Describe what an ECG would show for a second degree AV block

A
  • sudden dropped QRS complex
  • intermittently skipped ventricular beat
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8
Q

Describe what an ECG would show for a third degree AV block

A
  • impulses originate at AV node and proceed to ventricles
  • atrial and ventricular activities are not synchronous
  • P-P interval normal and constant
  • QRS complexes normal
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9
Q

Describe the treatment of bradycardia

A
  1. withdraw/correct the cause
  2. atropine IV/ isoprenaline infusion (unlicensed in UK)
  3. Temporary pacemaker- AV node often recovers
  4. permanent pacemaker
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10
Q

What factors should a pharmacist think about when considering pacemakers

A
  1. infection risk- antibiotics choice and timing
  2. bleeding risk- care if anticoagulated
  3. lead placement- movement, analgesia
  4. for patients with tachy-brady syndrome
    - will allows patient to be prescribed rate lowering drugs
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11
Q

Give examples of conditions of tachycardia

A
  1. sinus tachycardia
  2. supraventricular tachycardia (atrial)
    - AF
    - atrial flutter
    - re-entry/junctional tachycardias (WPW)
  3. ventricular tachycardia
    - monomorphic/polymorphic
    - ventricular fibrillation
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12
Q

what would an ECG of sinus tachycardia show

A
  • impulses originate at SA node at rapid rate
  • all complexes normal and evenly spaced
  • rate greater than 100bpm
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13
Q

what can sinus tachycardia be caused by

A

thyrotoxicosis, hypotension, pulmonary emboli, stress, caffeine, cocaine, alcohol, pain
- may be self terminating
- treat underlying cause

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14
Q

what would an ECG of ventricular tachycardia show

A
  • impulses originate at ventricular pacemaker
  • wide ventricular complexes
  • rate greater than 120bpm
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15
Q

what is ventricular tachycardia defines as

A

3 or more consecutive ventricular beats
- broad complex
- 2 types: monomorphic and polymorphic

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16
Q

Outline the presenting complaints of ventricular tachycardia

A
  • dizziness, syncope, palpitations
  • reduced cardiac output
  • often self terminating
17
Q

What could ventricular tachycardia lead to

A

may lead to ventricular fibrillation which could lead to death

18
Q

What can ventricular tachycardia be caused by

A
  • AMI (infarcted area)
  • often drug induced: antiarrhythmics, amiodarone, sotalol
  • low potassium and magnesium
  • cardiomyopathies
  • congenital defect (TDP)
19
Q

What are the treatments of ventricular tachycardia

A
  1. precordial thump
  2. IV amiodarone
  3. IV lidocaine
  4. DCCV once anaesthetised
  5. atenolol (non sustained )
  6. correct potassium and magnesium
  7. may require ICD
20
Q

What are the characteristics of polymorphic ventricular tachycardia (TDP)

A
  • twisting axis
  • long QT
21
Q

What is the treatment of polymorphic ventricular tachycardia

A
  1. reduce/treat the cause and correct electrolytes
  2. magnesium
  3. beta blockers to reduce QT
  4. temporary pacing
22
Q

what would an ECG of ventricular fibrillation show

A
  • chaotic ventricular depolarisation
  • irregular, rapid and no organised contraction of the ventricle
  • no cardiac output so no pulse
23
Q

What does ventricular fibrillation cause

A

rapidly causes LOC and sudden cardiac death

24
Q

what is ventricular fibrillation caused by

A

commonly caused by AMI

25
Q

What is the treatment for ventricular fibrillation

A
  1. DCCV
  2. precordial thump
  3. resuscitation
26
Q

describe the non pharmacological therapy that can be used

A
  1. electrical cardioversion- recent onset (AF)
  2. pacing
    - temporary
    - permanent
  3. implantable cardioverter defibrillator (ICD)- if at risk of VT and usually combined with drug therapy
  4. catheter ablation or cryotherapy
    - WPW, SVT or atrial flutter
  5. surgical ablation for AF

PY365 AF (19 decks)

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