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PY365 AF > Treatment of Arrhythmias 1 > Flashcards

Treatment of Arrhythmias 1 Flashcards

1
Q

what is an arrhythmia

A

an abnormality of the hearts rhythm
- one of the most common clinical problems

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2
Q

what is the presentation of arrhythmias

A
  • asymptomatic
  • palpitations
  • shortness of breath
  • dizziness
  • chest pain
  • syncope
  • stroke
  • sudden death
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3
Q

What is used for the diagnosis of arrhythmias

A
  • past medical history
  • risk factors
  • ECG
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4
Q

how is an ECG taken for diagnosis of arrhythmias

A
  1. record a 12 lead ECG
  2. each lead highlights a particular pattern of the electrical activity of the heart
  3. lead II is commonly used as a rhythm strip
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5
Q

where does sinus rhythm originate

A

originates from SA node

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6
Q

How do you calculate heart rate

A

Measure R-R interval
Heart rate (bpm)= 30/ number of large squares
or 1500/number of small squares
- if heart rate is irregular= number of R waves in 30 large squares x 10

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7
Q

Give examples of Class 1A drugs

A

Procainamide and disopyramide

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8
Q

describe how procainamide/disopyramide are used

A
  1. used in atrial and ventricular arrhythmias
  2. procainamide is unlicensed in UK
  3. disopyramide has anticholinergic side effects
  4. renally excreted
  5. may prolong QT
    rarely used
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9
Q

Give examples of Class 1B drugs

A

Lignocaine/lidocaine

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10
Q

What is lidocaine used for

A

used for suppression of VT

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11
Q

where is lidocaine metabolised

A

liver metabolism

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12
Q

What cautions must be taken with using lidocaine

A
  • more sensitive in hepatic impairment, heart failure and elderly
  • caution in severe renal impairment
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13
Q

Why does lidocaine have limited uses

A

It is an IV only drug

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14
Q

What are the main side effects of lidocaine

A

main side effects tend to be neurological and hypotension

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15
Q

What is the dose of lidocaine

A

lidocaine has a short half life
1. 100mg IV bolus over a few mins, followed by
2. 4mg/min IV infusion for 30 mins
3. 2mg/min for 2 hours
4. 1mg/min and reduce further if continued for over 24 hours

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16
Q

What is an alternative to lidocaine

A

Mexiletine is an oral equivelent
- unlicensed in UK

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17
Q

What are the main side effects of mexiletine

A

nausea and vomiting- take with or after food

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18
Q

Give examples of Class 1C drugs

A

Flecanide and propafenone

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19
Q

what is flecanide and propafenone used for

A

indicated for atrial and ventricular arrhythmias
- propafenone only used under specialist supervision

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20
Q

What is the difference between flecanide and procainamide

A

flecanide is a fluorinated analogue of procainamide

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21
Q

what cautions must be taken with the use of flecanide and propafenone

A
  • not for use in heart failure or any coronary heart disease
  • use with caution as often causes other arrhythmias
22
Q

when are beta blockers indicated

A

indicated in atrial and ventricular arrhythmias
- reduce affects if sympathetic system on automaticity and conductivity

23
Q

What cautions should be taken when using beta blockers

A
  • can be co-prescribed with digoxin but not with verapamil and care with diltiazem
  • contraindicated in asthma
  • caution in COPD, PVD and diabetes
24
Q

Which beta blocker has class III action

25
which beta blocker can be used in hospital for SVT
Esmolol (IV)
26
Explain why sotalol has both class 2 and class 3 action
sotalol is a racemic mixture of D and L isomers - D sotalol is pure class III (antiarrhythmic) - L sotalol has class III and beta blocker activity
27
What doses of sotalol should be given to achieve class II or III effects
- low dose (80mg OD) achieves beta blocker effects - doses greater than 160mg/day achieve class III effects
28
What could sotalol cause
May prolong QT interval
29
What cautions must be taken in use of sotalol
- avoid in hypokalaemia
30
When is sotalol used
Used for SVT including AF and atrial flutter
31
Describe the pharmacology of how amiodarone works
1. blocks sodium channels (class 1 action) 2. inhibits sympathetic stimulation (class II action) 3. blocks potassium channels ( class III action) 4. blocks calcium channels (Class IV action) 5. lengthens the action potential duration and increases the refractory period, slowing heart rate 6. improve electrical homogeneity (convert to SR)
32
what is the solubility of amiodarone
highly lipophilic
33
What is the dose of amiodarone
1. loading dose required due to long half life (30-100 days) 2. licensed oral loading dose: - 200mg tds for 7 days then - 200mg bd for 7 days then - 200mg OD thereafter 3. IV central vein with ECG monitoring
34
Outline the adverse effects of amiodarone
1. cardiac- worsen arrhythmia, new arrhythmia, QT prolongation, new or worsening heart failure 2. skin- photosensitivity 3. optic- corneal micro deposits, optic neuropathy 4. thyroid- hypo/hyperthyroidism 5. hepatic- baseline LFTs for all new patients 6. pulmonary- pulmonary fibrosis 7. neurological- tremor, peripheral neuropathy 8. GI- nausea, vomiting, anorexia
35
what is dronedarone used for
used for non permanent atrial fibrillation - for maintenance of SR post DCCV not controlled by other drug therapy
36
What needs to be monitored in use of dronedarone
- measure creatinine 7 days after initiation - monitor liver function
37
what are the cautions with the use of dronedarone
- not for heart failure patients - increased risk of mortality - may prolong QT interval
38
What is the dose of dronedarone
400mg bd - reduce digoxin dose by 50%
39
What are the similarities between amiodarone and dronedarone
1. both require extensive monitoring 2. all 4 classes of action 3. converts to SR 4. drug interactions
40
What are the differences between amiodarone and dronedarone
1. amiodarone contains iodine, dronedarone does not 2. amiodarone has a long half life, dronedarone has a short half life 3. amiodarone accumulates in tissues, dronedarone has reduced accumulation in tissues 4. amiodarone is licensed for use in heart failure, dronedarone is not 5. amiodarone is licensed for arrhythmias including AF, SVT, VT and VF, dronedarone is only for non permanent arrhythmias 6. amiodarone is oral and IV administration, dronedarone is oral dosing only
41
Give an example of a dihydropyradine calcium channel blocker
nifedipine
42
What are the main effects of dihydropyradine calcium channel blockers
mainly peripherally acting drugs - they are vasodilators - very effective in reducing high blood pressure and in angina but have very little effect on heart rate
43
What are the main effects of diltiazem and verapamil
have antiarrhythmic properties by reducing conduction through AV node and reducing heart rate
44
What is the mechanism of action of digoxin
inhibits Na/K ATPases and increases intracellular calcium concentration by inhibiting Na/Ca exchange - has positive inotropic effect (increases force of myocardial contraction) - has negative chronotropic effect (reduces heart rate)
45
What should be monitored with use of digoxin
K+ levels- ensure K+ in range to avoid digoxin toxicity
46
How is digoxin excreted
Excreted by kidneys
47
What could digoxin cause
May cause ST and T wave changes
48
When is the peak concentration of digoxin
6 hours after oral dose
49
What are the indications of digoxin
AF, atrial flutter
50
How does adenosine work
Blocks conduction at AV node and can be used to terminate SVT
51
What is the half life of adenosine and when do its effects occur
Has a very short half life of 0.5-5 seconds - on administration, effects occur after 20 seconds
52
What are the main side effects of adenosine
flushing, chest pain, metallic taste

PY365 AF (19 decks)

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