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18 Cards in this Set
- Front
- Back
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What are the two actions of digoxin on the heart?
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1) increases force of contraction
2) reduces conductivity of the AV node |
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"Digoxin is most useful for controlling ___ response in persistant and permanant ___ ___ and ____ _____."
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Ventricular
atrial fibrillation atrial flutter |
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Ventricular rate at rest should NOT be allowed to fall persistantly below ___ bpm.
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60
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What is the most important determinant of digoxin dosing?
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Renal function
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Toxicity is a major concern with digoxin. What factors increase the risk of digoxin toxicity?
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Age
Renal function Hypokalaemia Heart disease |
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What treatment is required for ectopic beats?
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No treatment is normally required. If particularly bad, then beta blockers may be trialled.
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How can atrial fibrillation be managed? (heart control, not drug treatment)
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Control of ventricular rate (rate control)
restoring sinus rhythm (rhythm control) |
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What is paroxysmal atrial fibrillation?
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A type of AF that often comes on suddenly and ends spontaneously. The irregular heart rhythm may last for a few seconds, minutes, hours or longer before the heart returns to a normal rhythm on its own.
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A _____ control strategy is preferred for patients with paroxysmal AF, whereas a ______ control strategy is preferred for persistant AF.
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rhythm
rate |
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Ventricular rate can be controlled with which drugs?
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Beta blockers
diltiazem digoxin |
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Digoxin is a good choice for control of ventricular rate.
T/F? Why/Why not? |
Only in sedentary patients - only useful in controlling rate at rest, so it's use is limited to predominantly sedentary patients.
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What drugs can be used to improve the efficiency of electrical cardioversion? When should they be started?
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Amiodarone and sotalol - usually started 4 weeks before electrical cardioversion.
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What other considerations are there with electrical cardioversion?
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Risk of stroke/PE. If AF has persisted for >48hrs, then cardioversion should NOT take place until the pt. has been fully anti-coagulated for at least 3 weeks. Failing that, parenteral anti-coagulation should begin and a left atrial thrombus ruled out before cardioversion.
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What considerations are there with AF?
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Risk of VF
Risk of thrombus formation - Stroke/PE |
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Is atrial flutter treated the same as atrial fibrillation?
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Yes, generally. Atrial flutter responds less well to pharmacological intervention than atrial fibrillation.
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What effects does amiodarone have on the body, other than treating arrhythmia?
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most patients develop microdeposits (reversible on withdrawal of treatment)
Can cause thyroid issues Can cause hepatotoxicity Can cause pneumonitis Can cause peripheral neuropathy |
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Why does a patients thyroid need to be monitored during treatment with amiodarone?
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Amiodarone contains iodine, and so can cause both hypo and hyperthyroidism. Thyrotoxicosis has also been reported.
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Why is amiodarone significant in terms of drug interactions?
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Amiodarone has a long half life - several weeks - and so can interact with new drugs long after amiodarone has been stopped.
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