AF

Question 1

indications of amiodarone

Answer 1

• AF
• SVT
• VT
• Refractory VF

Question 2

MOA amiodarone

Answer 2

• block na, ca, k+ channels and antagonise alpha and beta receptors.
  = reduce spotnaneous depolarisation, slow ocnduction velocity and increase refractoriness including in AVN.

Question 3

SE amiodarone

Answer 3

Acute
hypotension in IV
chronic
- pneumonitis, bracycardia, AV block, hepatitis, photosensitivity, grey skin discolouration

• has iodine in so = thyroid abnormalities
• very long half life

Question 4

relative CI to amiodarone

Answer 4

• severe hypotension
• Heart block
• active thyroid disease

Question 5

drug interactions of amiodarone

Answer 5

• increases conc of digoxin, diltiazem and verapamil. half the doses

Question 6

in cardiac arrest what dose and when is amiodarone given

Answer 6

• after third shock in VF or pulseless VT. 300mg IV, followed by 20ml of 0/9% nacl or 5% glucose as flush

Question 7

name some doacs

Answer 7

apixaban, dabigatran, eoxaban, rivaroxaban

Question 8

doac indications

Answer 8

• VTE

- AF

Question 9

MOA DOACS

Answer 9

apixaban, edoxaban, rivoroxaban = factor Xa inhibitors - stop prothrombin becoming htrombin

• dabigatran = direct inhibitor of thrombin

less effective for arterial - so there you use antiplts

Question 10

SE of DOACS

Answer 10

• bleeding
• ICH
• GI bleeds
• Anaemia, GI upset, dizzxiness, elevated LFTs

Question 11

Who not to give doacs to

Answer 11

• acitve, clinically significant bleeds
• rf for major bleed - e.g. peptic ulcer, cancer etc
• pregnancy
• breastfeeding

Question 12

when to be cautionate with doacs

Answer 12

• patients with hepatic or renal disease

Question 13

Interactions of doacs

Answer 13

• heparin, antiplt and NSAIDs - all increase bleeds
• CYP inducer/inhibitors
• macrolides, protease inhibitors and fluconazole = increase effect
• rifampicin and phenytoin decrease effect and DO NOT GIVE with doacs

Question 14

with dabi and edoxa what interim anticoag is required before beginning doac course

Answer 14

5 days of heparin

Question 15

when should you take rivoraxaban

Answer 15

with food as is absorbed better

Question 16

reversal agent for dabigatran

Answer 16

idarucizumab

Question 17

reversal agent - not yet licensed for fxa -i

Answer 17

andexanet alpha

Question 18

warfarin indications

Answer 18

• VTE - treat and secodndary prevention. interim = heparin

- prevent emboli in AF or prosthetic heart valves. if non valvular AF use DOACs

Question 19

MOA Warfarin

Answer 19

inhibits hepatic production of vit k dependant clotting factors - II, VII,IX,X, Protein C and S. Inhibits vit K epoxide reductase which is needed to produce a cofactor for clotting

Question 20

SE warfarin

Answer 20

• bleeding

Question 21

how to reverse warfarin

Answer 21

phytomenadione = vit k or dried prothrombin complex

Question 22

CI to warfarin

Answer 22

• immediate risk of haemoorhage including post trauma and pt needing surgery
• first trimester pregnnacy and alter to avoid too

Question 23

relative CI to wafarin

Answer 23

• liver disease - less able to metabolise so get over dosed

Question 24

interactions to warfarin

Answer 24

• CYP-Inducers and inhbiitors.

- abx incerase effect by killing gut flora that synthesise vit k

Question 25

dose of warfarin

Answer 25

5-10mg on day 1, with lower dose for elderly, lighter or bleeding risk

Question 26

when to take warfarin

Answer 26

6pm every day for consistent effects on warfarin daily.

Question 27

what should all patients on warfarin get to help them track there doses

Answer 27

yellow book

Question 28

what clotting cascade is IRN measuring

Answer 28

Prothrombin time.