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