29/4/22 Flashcards
What is the drug used in secondary prevention of stroke?
Aspirin for 2 weeks then clopidogrel in normal
AF = DOAC or warfarin
How do you approach the management of AF?
Manage rate and rhythm
Invx and make sure no reversible cause
If haemodynamically unstable (HISS) -> urgent admission and cardio version
- RATE
- B-blockers - bisoprosol
- CCB - diltiazem and verapamil
- Digoxin if sedentary - RHYTHM (ONLY if HF or reversible cause) - MAKE SURE 48hr AC FIRST
- amiodarone or cardio version - Assess stroke risk
Use CHA2DS2VAS score
If 1 - male start AC, if female no AC
2+ - start AC - DOAC
- Warfarin (if artificial heart valve - first one)
What consitutes haemodynamically unstable?
nice mnemonic
HISS
HF
Ischaemia
Syncope
Stroke
What is the CHA2DS2VAS score?
Congestive heart failure/LV dysfunction Hypertension Age =/> 75 - 2 points Diabetes mellitus Stroke/TIA/thrombo-embolism - 2 points Vascular disease Age 65-74 Sex - female sex
How do you prevent reoccurrence of torsades des pointes?
IV magnesium sulphate
How do you manage VT?
No pulse = defibrillator
Pulse
- evidence of haemodynamic instability - DCCV
- no HISS - amiodrane
amioDarone - D = doopy doopy doop = slow down
What medical management can you use to increase HR in haemodynamically unstable?
Atropine
P = pacy = get faster
Explain how and when meds are given when doing CPR?
After 3rd shock
- > chest compressions
- > adrenaline 1mg + amiodarone 300mg IV
- > adrenaline 1mg IV after every other shock
Go over how you would present DOAC vs warfarin to a patient who has to start them for AC post AF diagnosis?
- Advantages and disadvantages of DOAC vs warfarin
DOAC
Advantages
- fixed dose
- no need for INR monitoring (with warfarin the range that it works best is very narrow and we need to bring you in regularly for more monitoring)
- lower incidence of intracranial hameorrhage
- less drug and diet interactions
- easier to manage if ever need surgery or procedure
Disadvantage
- still need to monitor kidney function although less frequent than warfarin monitoring
- higher incidence of GI side effects
- no specific antidote unlike warfarin
- limited long-term data (warfarin is a much older tried and tested drug)
ATHLETICS
Action - reduces risk of blood clots forming that can travel through blood vessels to the brain and cause a stroke
Timeline - start asap
How to take - once a day tablet with food
Length of treatment - for the foreseeable future important to be compliant
Effects - reduces clots and stroke risk
Tests - regular monitoring of kidney function
Important side effects - can’t get pregnant on it! GI side effects and if any excessive bleeding from anywhere seek medical advise. Any hit to the head or major trauma seek immediate medical attention
Contradictions - avoid NSAIDS, aspirin and herbal medications - ask pharamectist if unsure
Supplentary advice - GP, pharmacy, local AC clinic
Go over how you would present DOAC vs warfarin to a patient who has to start them for AC post AF diagnosis?
- Advantages and disadvantages of DOAC vs warfarin
DOAC
Advantages
- fixed dose
- no need for INR monitoring (with warfarin the range that it works best is very narrow and we need to bring you in regularly for more monitoring)
- lower incidence of intracranial hameorrhage
- less drug and diet interactions
- easier to manage if ever need surgery or procedure
Disadvantage
- still need to monitor kidney function although less frequent than warfarin monitoring
- higher incidence of GI side effects
- no specific antidote unlike warfarin
- limited long-term data (warfarin is a much older tried and tested drug)
ATHLETICS
Action - reduces risk of blood clots forming that can travel through blood vessels to the brain and cause a stroke
Timeline - start asap
How to take - once a day tablet with food
Length of treatment - for the foreseeable future important to be compliant
Effects - reduces clots and stroke risk
Tests - regular monitoring of kidney function
Important side effects - can’t get pregnant on it! GI side effects and if any excessive bleeding from anywhere seek medical advise. Any hit to the head or major trauma seek immediate medical attention
Contradictions - avoid NSAIDS, aspirin and herbal medications - ask pharamectist if unsure
Supplentary advice - GP, pharmacy, local AC clinic
If asked to discuss stroke risk remember to say how many out of 100 would get it rather than percentages
What kind of CK levels would you expect to see in rabdomyolsis?
CK> 10,000
What drug should be given to patients who are recognised to be dying as they become agitated and confused?
Midazolam
What does the CURB 65 score stand for?
When is it used?
Community acquired pneumonia
Confusion Urea (>7) Resp Rate (>30) BP (low BP) >65
0-1 = low risk - home based care 2-3 = hospital based care >3 = intensive care
