Week 5 Flashcards
What are the principal fatal diseases caused by smoking?
- Cancer, COPD and CVD
- On average cigarette smokers lose 7.5 years of life
What are the effects of quitting smoking?
20 mins: BP and pulse rate back to normal
8 hours: Blood nicotine and CO halved, oxygen back to normal
24 hours: CO eliminated, lungs start to clear mucus
48 hours: nicotine eliminated, sense of taste and smell improve
72 hours: breathing is easier, bronchial tubes relax
2-12 weeks: circulation improves
3-9 months: lung function increased by <10%, coughs decrease
5 years: risk of heart attack halved
10 years: risk of lung cancer halved compared to continued smoking
What disease risks are decreased due to smoking cessation?
- Minimised risk of bone loss, hip fracture and periodontal disease
- Rheumatoid arthritis risk reduced
- Cataract risk reduced
- Aortic aneurysm
- Peripheral arterial disease
What is the stage model of behaviour change?
Pre-contemplation -> Contemplation -> Preparation -> Action -> Maintenance -> Relapse ->
What is pre-contemplation?
Lack of awareness or lack of intent to change
What is contemplation?
Increased awareness of negative aspects of smoking. Has intention to quit within 6 months
What is preparation?
Some small behavioural changes to quit have been made: intent to quit within 1 month
What is action?
Individual has implemented plan to stop, still adjusting to change
What is maintenance?
Long term adjustment as a non smoker, content with new lifestyle without cigarettes
What are the 4 As to Approach Smoking Cessation?
- ASK about tobacco use
- ADVISE to quit
(assess willingness to make a quit attempt) - ASSIST in quit attempt
- ARRANGE follow up
What are the 5 Rs?
- Relevance
- Risks
- Rewards
- Roadblocks
- Repetition
What is relevance of cessation of smoking?
Ask patient to identify why quitting might be relevant such as:
- children
- need for money
What is risks of smoking?
Reiterate benefits for patient and his/her children after you’ve asked what they know about smoking
What are the rewards of cessation of smoking?
Get more oxygen Clothes and hair smell better Have more money Food will taste better Will have more energy
What are the roadblocks of cessation of smoking?
Negative moods
Being around other smokers
Triggers and cravings
Time pressures
What is a dysrythmmia?
Where coordinated electrical sequences in the heart are disrupted
What 3 things could Dysrhythmias be due to?
- Changes in the heart cells
- Changes in the conduction of the impulses through the heart
- Combination of these
How are Dysrhythmias Classified?
- Atrial (supraventricular)
- Junctional (Associated with AV node)
- Ventricular
- Tachycardia/Bradycardia
What are the 4 categories of events which can cause Dysrhythmias?
- Ectopic pacemaker activity
- Delayed after-depolarisations
- Circus re-entry
- Heart block
How are arrythmias identified clinically?
ECG
What system is used to classify antiarrythmic drugs?
Vaughan Williams System
What are class 1 antiarrythmics?
Sodium channel blockers
What are class 2 antiarrythmics?
Beta blockers
What are class 3 antiarrythmics?
Potassium channel blockers
What are class 4 antiarrythmics?
Calcium channel blockers
What are the class 1 sodium channel blockers?
Disopyramide
Lignocaine
Flecainide
What types of dysrhythmmias are class 1 drugs used to treat?
Ventricular ectopic beats
What is the 1a drug?
DISOPYRAMIDE
Whats is the 1b drug?
LIGNOCAINE
What is the 1c drug?
FLECAINIDE
What is class 1a used to treat?
Ventricular dysrhythmmias, prevention of atrial fibrillation
What is class 1b used to treat?
Prevention of ventricular tachycardia and fibrillation during/after MI
What is class 1c used to treat?
Supress ventricular ectopic beats, prevents paroxymsmal atrial fibrillation and recurrent tachycardias
What are the effects of beta blockers?
Slow heart rate and decrease cardiac output
What are the beta blockers used in the treatment of dysrhythmmias?
SOTOLOL
BISOPROLOL
ATENOLOL
What is the class 3 potassium channel blocker used in the treatment of dysrhythmmias?
AMIODARONE
What effect do potassium channel blockers have?
Prolong the cardiac action potential by prolonging the refractory period. Altering the excitability of the cell
What condition and named condition specifially does amiodarone treat?
Re-entry tachycardia as found in wolff-parkinson white syndrome
Which kinds of arrythmias can be treated wiith amiodarone?
Supraventricular and ventricular tachycardias
Which type of calcium channel is targetted by class 4 drugs?
Voltage gated L type calcium channels
what affect do class 4 drugs have on the heart?
- Slows conduction as slows calcium entry in cell through the nodes.
- Shorten plateau of depolarisation caused by slow L type channels, shortening contraction.
- Also less forceful contraction as less calcium influx to activate ryanodine receptors
Which class 4 drugs usually used to treat dysrhtymmias?
Verapamil- prevents recurrence of supraventricular tachycardias and reduces ventricular rate in patients with AF if they don’t have WPW.
Diltiazem- more effect on smooth muscle
Which syndrome would you NOT use calcium blockers?
Wolff-parkinson white syndrome
What are the 2 unclassified drugs?
- Adenosine
2. Digoxin