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28 Cards in this Set
- Front
- Back
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What are the 2 types of treatments in AF, and when are they most appropriate? |
Rate control - permanent AF Rhythm control - paroxysmal AF |
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What 3 drugs, along with heparin for thromboprophylaxis, are used in rate control? |
B blockers - atenolol*, bisoprolol* Calcium channel blockers - verapamil*, diltizaem* Digoxin* (cardiac glycoside) |
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What are the indications for use of B blockers? (7) |
Angina Hypertension Arrhythmias Heart failure MI Hyperthyroidism Glaucoma |
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What are the adverse effects of B blockers? (9) |
Bronchospasm - take care in asthma Negative inotropism - decreased cardiac contractility, can precipitate HF Negative chronotropism - decreased HR Dizziness Tiredness Blurred vision Diarrhoea, nausea Cold hands & feet |
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What are the indications for calcium channel blocker use? (4) |
Angina Hypertension Raynaud's AF |
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What are the adverse effects of calcium channel blockers? (6) |
Negative inotropism (decreased contractility) Negative chronotropism (decreased HR) Headache Constipation Ankle oedema Hypotension |
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What are the indications for use of digoxin? (2) |
Heart failure AF |
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What are the adverse effects of digoxin? (6) |
Dizziness Blurred vision Diarrhoea, nausea Heart block Thrombocytopaenia |
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What are the criteria for rhythm control? (5) |
Reversible cause of AF HF or left ventricular impairment New onset AF Atrial flutter Paroxysmal AF |
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What management method is used for paroxysmal AF? |
Pill in the pocket |
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What are the 2 forms of cardioversion in rhythm control? |
Electrical and pharmacological cardioversion |
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What should be done before electrical cardioversion and why? |
Trans-oesophageal echo - ensure there are no clots in the left atrium that could dislodge and cause MI/CVA |
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What other methods can be used in rhythm control? (2) |
Radiofrequency ablation - if paroxysmal, persistent and symptomatic AF Pacemaker |
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What are the classes of drugs used in pharmacological cardioversion? (2) |
Class 3 agent - amiodarone* Class 1c agent - flecanide*, propafenone |
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What are the adverse effects of amiodarone (class 3 agent)? (10) |
Bradycardia Nausea, vomiting, taste disturbances Sleep disturbance, vivid dreams Photosensitivity Hypo/hyperthyroidism Pulmonary fibrosis Ventricular arrhythmias |
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What 2 drugs does amiodarone interact with and what is its effect on these drugs? |
Digoxin & warfarin - increases their effect |
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What are the adverse effects of flecanide (class 1c agent)? (7) |
Blurred vision, dizziness Abdominal discomfort Nausea Tremor Abnormal taste sensations Paraesthesia |
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When should class 1c agents be avoided and why? |
In structural heart disease - increase risk of ventricular arrhythmias |
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By what mechanism of action does anticoagulation reduce the activity of thrombin? |
Limits thrombin generation by inhibition of clotting factors Inhibits thrombin activity by activating pathway that produces antithrombin |
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Warfarin* is what type of drug? |
Oral vitamin K antagonist |
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What conditions should have a target INR = 2.5? (3) |
Treatment of DVT & PE Prevention of VTE in - MI, mitral stenosis, TIA, AF and mechanical prosthetic aortic valves |
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What conditions should have a target INR = 3.5? (2) |
Recurrent DVT/PE Arterial disease with mechanical prosthetic mitral valves |
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The higher the INR, the _____ it takes the blood to clot |
Longer
(And so increased risk of bleeding) |
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What are the adverse effects of warfarin? (2) |
Bleeding Teratogenic (contraindicated in 1st trimester) |
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What is the antidote to warfarin? |
Vitamin K |
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What are some common interactions of warfarin? (9) |
NSAIDs ABx - chloramphenicol, ciprofloxacin, erythromycin, metronidazole, rifampicin Antiarrhythmics - amiodarone Anticonvulsants Antidepressants (SSRIs especially) Omeprazole Statins, fibrates Tamoxifen
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Dabigatran* is what type of drug? |
Thrombin inhibitor |
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What are the potential problems with dabigatran? (2) |
No antidote Interacts with amiodarone |
