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27 Cards in this Set
- Front
- Back
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CHADS2 Score
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CHF
HTN Age Diabetes Stroke (2 Points) 0 = ASA, 1 = ASA/Warfarin/Pradaxa, 2 = Warfarin/Pradaxa |
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Paroxsymal
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Less than 7 days
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Persistent
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Greater than 7 days
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Recurrent
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More than 2 episodes
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Symptoms of AF
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Palpitations, Exercise Intolerance, Fatigue on exertion, Cough, Chest pain/pressure, Diaphoresis, Dizziness,
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RATE CONTROL
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IV Beta Blocker or Nondihydropyridine CCB (if EF > 40%)
IV Digoxin or Amiodarone if < 40% |
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Verapamil Drug Interactions
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Digoxin, Dofetilide (C/I), Simvastatin, Lovastatin (3A4 Inhibitor)
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Which AF patients should use digoxin?
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HF patients,
Hypotensive patients, Pts who aren't physically active, Patients who are contraindicated to BB or CCB |
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Metoprolol Dose
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25 - 100 mg BID
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Diltiazem Dose
Change from IV -> PO |
120-360 mg/day
IV dose X 3 + 3 X 10 |
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Verapamil Dose
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120-360 mg/day
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Digoxin
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0.125-0.375/day
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High Risk Factors for CHADS2
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Previous CVA, TIA, or VTE
Mitral Stenosis Prostetic Heart Valve |
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Moderate Risk Factors
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Age > 75 yo
HTN DM HF EF < 35% |
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Class I Anti Arrhythmics
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Sodium Channel Blockers
Disopyramide (Norpace) Procainamide (Procanbid) Quinidine (Quinidex/Quinaglute) |
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Class IB
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NOT FOR ATRIAL ARRHYTHMIAS
(Lidocane, Mexiletine, Tocainide) |
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Class IC
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DO NOT USE IN PATIENTS WITH STRUCTURAL HEART DISEASE
Flecainide (Tambocor) Propafenone (Rythmol) |
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Class II
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Beta Blockers
only used for rate control |
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Class III
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Potassium Channel Blockers
Amiodarone (Pacerone, Cordarone) |
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Amiodarone Interactions
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Warfarin (decrease dose by 25-50%)
Digoxin (Decrease dose by 50%) Statins (Lovastatin max does = 40 mg, Simvastatin max dose = 20 mg) |
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If using Amiodarone with a Statin, which should you use?
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Can use Pravastatin, Fluvastatin or Rosuvastatin instead
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Amiodarone ADRs
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Pulmonary Fibrosis, Hypo/Hyperthyroidism, Hepatotoxicity, Optic Neurpathy, Bradycardia/Heart Block, Photosensitivity/Change in skin color, Neurologic effects (tremor, ataxia, peripheral neuropathy)
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Dronedarone (Multaq) ADRs
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Inhibits 3A4 and 2D6
Shorter half like No Thyroid function problems Hypokalemia C/I: NYHA Class IV or Class 2-3 if recent hosptialization 2nd/3rd degree heart block Long qt interval Hepatic Impairment Pregnancy/Nursing |
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3A4 Inhibitors
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Verapamil, Azoles, Macrolides, Cyclosporine, Ritanovir
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3A4 Inducers
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Rifampin, Phenobarbital, Carbamezepine, St. Johns Wort
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Class III
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Potassium Channel Blockers
Amiodarone Multaq Dofetilide (Tikosyn)--Monitor for 3 days Ibutilide (Covert) Sotalol (Betapace AF) Monitor 4 hours |
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What dose of aspirin to take?
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81-325 mg daily
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