Arrhythmias
what class of medication would you avoid if someone has HF and AF
CCB
class 4 examples
CCB verapamil diltiazem
what medication would you give to someone who does little exercise in AF
digoxin monothepray
what is cardio version
electrical shock to restore the sinus rhythm
what increases the risk of digoxin toxicity
hypokalaemia hypomagnesaemia hypercalcaemia to reduce add potassium sparing diuretic
what is the interaction between lithium and amiodarone
increased risk arrhythmias
MOA of digoxin
increases force of contractions of myocardial decreases heart rate
why is amiodarone half life special?
it has a long half life so interactions can occur several months after stopping medication
class 3 arrhythmias examples
potassium CB amiodarone, sotalol
when is electrical cardioversion preffered
ppt with AF that has persisted for more than 48 hours.
what is the main aim of treatment in AF. what condition are they trying to prevent?
prevent symptoms and stroke.
what monitoring is needed for digoxin
renal function as dose needs to be reduced in renal impairment plasma digoxin concentration 6 hours after dose given serum electrolyte as toxicity increases with imbalance
what is the special patient carer advice for amiodarone?
shield skin from sunlight during and several months after seek medical help if SOB, palpitations, fainting or chest pain
class 1 arrhythmias examples
sodium CB lidocaine and flecainide
what common medication does amiodarone interact with?
statin - increases risk of myopathy
when would felcainide not be given
structural heart disease
causes torsades de pointes
sudden noise stress drugs like sotalol, hypokalaemia and bradycardia
when would you give an anticoagulant in CHA2DS2VAS
when the score is more than or equal to 2.
what number on hasbled indicates high risk of bleeding
3 points or more - meaning you would not give anticoagulant
when should plasma concentration be checked of digoxin
6 hours after dose
what is the normal heart rate
60-100 bpm
what is rhythm control treatment
FAB BB alone fails BB+ flecainide, amiodarone or sotalol, propafenanone.
what are some monitoring requirements for amiordarone?
- Thyroid function test before and every 6 months - Liver function before and every 6 months (transaminases closely monitor) - Serum potassium before - Chest x ray before - Annual eye test - ECG and blood pressure
what is the toxic range for digoxin
1.5-3
what scores point 2 in cha2ds2vas
2 points for age over 75 and previous stroke, TIA of thromboembolism
what is the best therapeutic range for digoxin
1-2
drugs that cause QT prolongation
ABCDDE - ANTI - antiarrhythmics (amiodarone, sotalol, flecainide) - antibacterial - (quinolones, macrolides and aminoglycosides) - antipsychotics - (haloperidol, quetiapine, risperidone) - antidepressants - (SSRI and TCA) - DIURETICS - Antiemetics (ondansetron)
doses for digoxin
AF - 125-250mcg worsening HF - 62.5-125mcg once daily
what is an arrhythmia
Abnormal rate and/or rhythm of heartbeat due to problems with electrical conducting system of the heart.
what are the side effects of amiodarone?
Ami is a photogenic BITCH - Pulmonary toxicity - pneumonia suspect. - bradycardia - interstitial lung disease - thyroid disease (hypo/hyper) - corneal micro deposits - dazzled by headlights. - hepatoxicity
most common type of arrhythmias
Atrial fibrillation
class 2 arrhythmias examples
BB
what is the treatment for rate control
BB OR CCB fails 2 from BB, Diltiazem or digoxin
what are the interactions with digoxin?
CRASED CCB rifampicin amiodarone St John worth - reduces concentration of digoxin erythromycin diuretics
what medication would you give if someone had congestive HF and AF
Digoxin
what can cause arrhythmias
Heart conditions CAD HPB ageing
What two things needs to be assessed in people with AF
Risk of stroke using CHA2DS2 VASC risk of bleeding/clot using HASBLAD
what medications does amiodarone increase the concentration of
Warfarin, digoxin, ciclosporin phenytoin
what medication would you give for HF or left ventricular impairment
amiodarone
what are the signs of digoxin toxicity
arrhythmias diarrhoea dizziness n/v Yellow vision
Indication and dose of amiodarone ?
arrhythmias 200mg 3x day for 1 week and then reduce to 200mg bd for a week and then maintain at 200mg daily.
why does amiodarone cause thyroid problems
because amiodarone contains iodine
what are some symptoms of arrhythmias
because they have arrhythmias they are SAD: SOB abnormally fast, slow or irregular heart rate dizziness palpitations
what symptoms dos tornado de pointes present
blackouts fainting death
what class does digoxin belong to
cardiac glycosides
