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Atrial Fibrillation Management and Pharmacology

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benryan95's version from 2016-01-11 10:04

Section 1

Question Answer
In Chronic Permanent Atrial Fibrillation (AF) what are the main goals?Rate control and Anticoagulation
When may rhythm control be appropriate, oppose to rate control?Symptomatic, Congestive Cardiac Failure attributable, younger patients, presenting for 1st time with lone AF, AF from a correct precipitant (e.g. electrolyte imbalance)
In Chronic AF, what can you give to anticoagulate?Warfarin, Dabigatran, Riveroxaban, Apixaban
What Scoring System is used to assess the %/year stroke risk in patients with atrial fibrillation?CHA2DS2-VASc Score
What can bleeding risk in those anticoagulated with AF be assessed by?HASBLED (or hemorr2hages)
What can be given for rate control in AF?B-blockers, rate-limiting calcium channel blockers as first line, digoxin and even amiodarone
If a rhythm control strategy is chosen for AF, what can be given 4 weeks before cardioversion?Sotalol or amiodarone, if there is increased risk of cardioversion failure
How can chronic AF be pharmaceutically cardioverted?Flecainide is 1st choice if no structural heart disease, IV amiodarone if structural heart disease
What can be given for paroxysmal AF if infrequent, BP >100mmHg systolic, no past LV dysfunction?Pill in the pocket flecainide
If AF has started in the past 48 hour, and patient is very ill or haemodynamically unstable, how should they be treated?O2, U&Es, emergency cardioversion (electrical, if unavailable IV amiodarone) use heparin until a full risk assesment for emboli is made, control ventricular rate with verapamil (1st line) or bisoprolol. 2nd line is digoxin or amiodarone
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Section 2

Question Answer
What is the mechanism of action of warfarin?Is a vitamin K antagonist, preventing the formation of vitamin K dependent clotting factors, X, IX, VII and II
What are possible indications for warfarin?Prophylaxis of embolisation in rheumatic heart disease and AF, prophylaxis after mechanical heart valve, prophylaxis and treatment of venous thrombosis and PE, transient ischaemic attacks
What INR should be aimed for in atrial fibrillation?2-3
What are contraindications to warfarin use in atrial fibrillation?Bleeding diathesis, low platelets, consistent high blood pressure, compliance issues around dosing or INR monitoring, patient choice, frequent falls, on NSAIDs, intracranial bleeds, risk of major bleeds
Can warfarin be used in pregnancy?Should not be given in first trimester. If at all possible, they should be avoided, especially in first and third.
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Section 3

Question Answer
What is the mechanism of action of dabigatran?Direct Thrombin Inhibitor
What are the possible indications for dabigatran?VTE prophylaxis. Treatment of DVT and PE. Prevention of stroke and systemic embolism with non valvular AF.
Can dabigatran be used in pregnancy?Manufacture advises avoid unless essential - toxicity in animal studies
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Section 4

Question Answer
What is the mechanism of action of rivaroxaban? Direct Factor Xa inhibitor
What are the possible indications for rivaroxaban?Prophylaxis of VTE, treatment of DVT and PE, prophylaxis of stroke and systemic embolism in patients with non-valvular AF, also following ACS.
Can rivaroxaban be used in pregnancy?Manufacture advises avoid unless essential - toxicity in animal studies
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Section 5

Question Answer
What is the mechanism of action of apixaban?Direct Factor Xa inhibitor
What are the possible indications for apixaban?Prophylaxis of VTE, treatment of DVT and PE. Prophylaxis of stroke and systemic embolisation in non-valvular AF.
Can apixaban be used in pregnancy?Manufacturer advises avoid - no information available
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Section 6

Question Answer
What is Diltiazem?Non-dihydropyridine Calcium Channel Blocker, negatively ionotropic
What are the possible indications for Diltiazem?Rate Control in Chronic AF, Angina, SVTs
What is Verapamil?Non-dihydropyridine Calcium Channel Blocker, negatively ionotropic
What are the possible indications for Verapamil?Supraventricular arrhythmias, angina, hypertension, prophylaxis of cluster headache
Which class of drugs in particular should Verapamil typically not be used with?Beta-blockers, risk of hypotension and asystole
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Section 7

Question Answer
What is Digoxin?Inhibitor of Na+/K+ ATPase, mainly in myocardium - cardiac glycoside that increases force of myocardial contraction and reduced conductivity within the AV node. Positive inotropic.
What are the possible indications for Digoxin?Persistent and permanent AF, heart failure (low down on pathway)
What is amiodarone?Class III anti-arrhythmic agent, prolongs phase 3 of cardiac action potential
What are the possible indications for amiodarone?Treatment of paroxysmal supraventricular, nodal, and ventricular tachycardias, atrial fibrillation and flutter, and ventricular fibrillation. Pharmaceutical cardioversion.
What is flecainide?Class Ic anti-arrhythmic agent
What are the possible indications for flecainide?Supraventricular tachycardias, pill in the pocket for paroxsymal, elective cardioversion of AF
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Section 8

Question Answer
What is atenolol?A cardioselective B-blocker
What are the possible indications for atenolol?Hypertension, angina, atrial fibrillation, arrhythmias, migraine prophylaxis, post MI
What is sotalol?A non-cardioselective B-blocker which additional class III anti-arrhythmic activity.
What is labetalol?A non-cardioselective B-blocker that can be used for hypertension in pregnancy
What is carvedilol?A non-cardioselective B-blocker that reduced mortality in heart failure
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Section 9

Question Answer
What is heparin?Rapid anticoagulant with short duration of action, potentiates activity of antithrombin
Which type of heparins are used in preference for treatment of DVT and PE, and MILow Molecular Weight Heparins
What can be monitored with LMW Heparins in patients at increased risk of bleeding?Anti-factor Xa activity
Can heparins be used in pregnancy?Yes
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