AF Flashcards
indications of amiodarone
- AF
- SVT
- VT
- Refractory VF
MOA amiodarone
- block na, ca, k+ channels and antagonise alpha and beta receptors.
= reduce spotnaneous depolarisation, slow ocnduction velocity and increase refractoriness including in AVN.
SE amiodarone
Acute
hypotension in IV
chronic
- pneumonitis, bracycardia, AV block, hepatitis, photosensitivity, grey skin discolouration
- has iodine in so = thyroid abnormalities
- very long half life
relative CI to amiodarone
- severe hypotension
- Heart block
- active thyroid disease
drug interactions of amiodarone
- increases conc of digoxin, diltiazem and verapamil. half the doses
in cardiac arrest what dose and when is amiodarone given
- after third shock in VF or pulseless VT. 300mg IV, followed by 20ml of 0/9% nacl or 5% glucose as flush
name some doacs
apixaban, dabigatran, eoxaban, rivaroxaban
doac indications
- VTE
- AF
MOA DOACS
apixaban, edoxaban, rivoroxaban = factor Xa inhibitors - stop prothrombin becoming htrombin
- dabigatran = direct inhibitor of thrombin
less effective for arterial - so there you use antiplts
SE of DOACS
- bleeding
- ICH
- GI bleeds
- Anaemia, GI upset, dizzxiness, elevated LFTs
Who not to give doacs to
- acitve, clinically significant bleeds
- rf for major bleed - e.g. peptic ulcer, cancer etc
- pregnancy
- breastfeeding
when to be cautionate with doacs
- patients with hepatic or renal disease
Interactions of doacs
- 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
with dabi and edoxa what interim anticoag is required before beginning doac course
5 days of heparin
when should you take rivoraxaban
with food as is absorbed better
reversal agent for dabigatran
idarucizumab
reversal agent - not yet licensed for fxa -i
andexanet alpha
warfarin indications
- VTE - treat and secodndary prevention. interim = heparin
- prevent emboli in AF or prosthetic heart valves. if non valvular AF use DOACs
MOA Warfarin
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
SE warfarin
- bleeding
how to reverse warfarin
phytomenadione = vit k or dried prothrombin complex
CI to warfarin
- immediate risk of haemoorhage including post trauma and pt needing surgery
- first trimester pregnnacy and alter to avoid too
relative CI to wafarin
- liver disease - less able to metabolise so get over dosed
interactions to warfarin
- CYP-Inducers and inhbiitors.
- abx incerase effect by killing gut flora that synthesise vit k
