Week 4

Question 1

What do I aim to have done by 31st august

Answer 1

I want to have both arrythmia and heartfailure finished

I want to know the finicky details about each medication

I want to be able to define the different types of insulins and their brands

I want to be able to teach the topic of epilepsy to muma by tuesday and have started

sodium valporate

Finally I want to do the next section in antibiotics and ACTUALLY do penicillins, cephalosporins and carbapenams

Question 2

What is digoxins drug class

Answer 2

cardiac glycoside

Question 3

what are the indications for digoxin

Answer 3

heart failure
some types of arrytyhmia e.g. af

Question 4

what plant is digoxin derived from

Answer 4

foxglove

Question 5

how does digoxin work

Answer 5

inhibits the sodium potassium atpase pump in heart leading to increase in intracellular calcium this increase the cardiac contractility and exerts a negative chronotropic and dromotropic effect on the heart rate and conduction through the atrioventricular node

Question 6

What are the three effects digoxin works

Answer 6

increased inotropic effect (makes the heart pump more efficiently)

decreased chronotropic effect (slows the heart rate)

decreased dromotropic effect (slows the conduction)

Question 7

what is the dose for rapid digitalisation for af or flutter

Answer 7

0.75 - 1.5mg in divided doses

given over 24 hours

Question 8

what is the maintenance dose for af or flutter

Answer 8

125mcg-250mcg daily

important that elderlies get that initial loading dose

Question 9

what is the dose for heart failure in sinus rhythm

Answer 9

62.5mcg - 125 mcg od

Question 10

what is the emergency loading dose for af

Answer 10

0.75mg - 1mg over 2 hours start maint dose same day

Question 11

what is the therapeutic range of digoxin

Answer 11

1-2mcg / L

Question 12

which of the following is not a side effect of digoxin

arrythmia
cardiac conduction disorder
cerebral impairment
diarrhoea
dizzy
eosinophilia
nausea
skin reactions
high blood pressure
vision disorders

Answer 12

high blood pressure

Question 13

What are the common side effects of digoxin

Answer 13

arrythmia
cardiac conduction disorder
cerebral impairment
diarrhoea
dizzy
eosinophilia
nausea
skin reactions
vision disorder

Question 14

what are the effects of overdosing on digoxin due to its narrow therapeutic range

Answer 14

yellow vision
nausea
vomiting
abdominal pain
confusion
rash
bradycardia

Question 15

what are the causes of digoxin toxicity

Answer 15

hypokalaemia e.g. diuretics or insulin

increased plasma concs e.g. amiodarone non dihydropyridine ccbs macrolides

reduced renal excretion e.g. nsaids ace and arbs

Question 16

which of the following is not a caution of digoxin

hypercalcaemia
hypokalaemia
hypomagnesia
hyponatreaemia
hypoxia
recent mi
severe resp disease
sick sinus syndrome
thyroid disease

Answer 16

hyponatraemia

Question 17

CRASED!

CCB
Rifampacin
Amiodarone
St johns
erythromycin
diuretics

Answer 17

ALL OF THESE INTERACT

Question 18

what are the different part of CRASED for digoxin interactions

Answer 18

CCB
Rifampacin
Amiodarone
St johns
erythromycin
diuretics

Question 19

what are the contraindications of digoxin

Answer 19

myocarditis

constrictive pericarditis
hypertrophic cardiomyopathy

intermittent complete heart block
second degree av block

supraventricular arrhythmias
ventricular tachycardia

Question 20

what is constrictive pericarditis

Answer 20

a heart condition where the protective sac around the heart (the pericardium) becomes thick and stiff, limiting the heart’s ability to fill with blood

Question 21

what is hypertrophic cardiomyopathy

Answer 21

Hypertrophic cardiomyopathy (HCM) is a disease in which the heart muscle becomes thickened, also called hypertrophied. The thickened heart muscle can make it harder for the heart to pump blood. Many people with hypertrophic cardiomyopathy don’t realize they have it.

Question 22

what is intermittitent complete heartblock

Answer 22

a condition where electrical signals from the heart’s upper chambers (atria) are completely blocked from reaching the lower chambers (ventricles). which comes and goes

Question 23

what is myocarditis

Answer 23

inflammation of the heart muscle (myocardium), which can impair its ability to pump blood and lead to symptoms like chest pain, shortness of breath, and irregular heart rhythms

Question 24

what is second degree av block

Answer 24

a form of “incomplete” heart block where some atrial electrical signals are blocked from reaching the ventricles, leading to a slow or irregular heartbeat and potentially symptoms like dizziness or fainting

Question 25

what is ventricular tachycarida

Answer 25

fast heartbeat that originates in the heart's lower chambers (ventricles

Question 26

what is supraventricular arrhythmias

Answer 26

abnormal heart rhythms originating in the heart's upper chambers (the atria), affecting the electrical signals that control the heart's pumping action

Question 27

What drugs are used in both rhythm and rate control

Answer 27

Beta blockers (NOT sotalol)

Question 28

What is the pnuemonic to remember what drugs can be used in rate control

Answer 28

DIVED BETA DILTIAZEM VERAPAMIL DIGOXIN BETABLOCKERS (NOT SOTALOL)

Question 29

what rhythm control drugs cannot be used if someone has heart disease

Answer 29

flecainide propafenone

Question 30

what do we mean by heart disease

Answer 30

Blood vessel disease, such as coronary artery disease. Disease of the heart muscle. Heart valve disease.

Question 31

What is propafenone drug class and what is it used for

Answer 31

antiarythmatic and is only used as a rhythm control

Question 32

what is the way to remember the rhythm control drugs

Answer 32

FAB rhythmS: PS

Question 33

what are the two options we used for patients with new onset af who are treated with a rhythm control

Answer 33

flecainide or amiodarone Use amiodarone if there is any structural or ischaemic heart disease

Question 34

A patient presents with new onset atrial fibrillation and is currently taking the following medications paracetamol ibuprofen ramipril amlodipine after further investigating you find from their drug history the patient has angina and has stable heartfailure they are to be started on pharmacological rhythm control

Answer 34

amiodarone

Question 35

If a patient has had atrial fibrillation for longer than 48 hours what form of rhythm control do we give

Answer 35

electrical but delay three weeks to provide coagulation to prevent risk of stroke

Question 36

what happens if a patient cannot wait three weeks for electrical cardioversion

Answer 36

if this is not possible give heparin immediately before cardioversion

Question 37

how long to provide oral anticoags after electrical cardioversion

Answer 37

4 weeks

Question 38

What are the different factors for hasbled remember three makes you bleed.

Answer 38

Hypertension Abnormal renal / liver func Stroke Bleeding tendency Labile INR Age >65 Drugs or alchohol REMEMBER THREE MAKES YOU BLEED!