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Pharmacology 2 > AF > Flashcards

AF Flashcards

1
Q

What is atrial fibrillation and complications

A
  • An irregular, often rapid heart rate that commonly causes poor blood flow
  • People with atrial fibrillation are at increased risk of having a stroke. In extreme cases, atrial fibrillation can also lead to heart failure.
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2
Q

Signs and symptoms of AF

A
  • heart palpatations
  • Increased and irregular HR
  • SOB
  • dizzy
  • chest pain
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3
Q

Rationale for drug use
AF

A

reduce symptoms and minimise morbidity by slowing ventricular rate (rate control) and/or restoring and maintaining sinus rhythm (rhythm control)
prevent stroke.

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4
Q

Drugs for AF treatment

A
  1. Beta blockers (Metoprolol or atenolol) are suggested as first line therapy for rate control
    * Warfarin
    * Heparin
    * Dabigatran
    * Rivaroxaban
    * Apixaban
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5
Q

Stroke risk assessment (CHA2DS2-VA) for non-valvular AF and anticoagulant treatment options

A
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6
Q

Suffix:

Beta-blocker

A

lol

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7
Q

Drug class

lol

A

Beta-blockers

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8
Q

Indication
Beta-blocker

A

Hypertension
Angina
Tachyarrhythmias
MI
Chronic heart failure with reduced ejection fraction as part of standard treatment
Prevention of migraine

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9
Q

MOA
Beta-blocker

A

Competitively block beta receptors in heart, peripheral vasculature, bronchi, pancreas, uterus, kidney, brain and liver.

Beta-blockers reduce heart rate, BP and cardiac contractility; also depress sinus node rate and slow conduction through the atrioventricular (AV) node, and prolong atrial refractory periods.

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10
Q

Precautions / adverse effects
Beta-blockers

A

Shock (cardiogenic and hypovolaemic)—contraindicated.

Hyperthyroidism—beta-blockers may mask clinical signs, eg tachycardia.

Phaeochromocytoma—beta-blockers may aggravate hypertension; an alpha-blocker should be given first.

History of anaphylactic reactions—beta-blockers may reduce the response to usual doses of adrenaline (epinephrine) for anaphylaxis.

Myasthenic symptoms—may worsen.

CARDIACContraindicated in bradycardia (45–50 beats/minute), second‑ or third-degree AV block, sick sinus syndrome (without pacemaker), severe hypotension or uncontrolled heart failure.
Respiratory contraindicated in asthma, alpha 1 selective drugs may be used in controlled asthma and COPD

Myasthenic symptoms (muscle weakness)

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11
Q

Adverse effects
Beta-blockers

A
  • bradycardia,
  • hypotension,
  • orthostatic hypotension
  • bronchospasm,
  • dyspnoea,
  • fatigue, dizziness
  • Mask Hypoglycemia

Can mask signs of hypoglycemia in diabetics

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12
Q

Counselling / practice points
Beta-blockers

A

Counselling
This medicine may cause dizziness or tiredness
Do not stop taking this medicine suddenly

Practice points
beta-blockers are not usually recommended first line for uncomplicated essential hypertension; they are associated with reduced protection against stroke in the elderly
**when stopping treatment, reduce dosage gradually

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13
Q

Drug class and indication

Atenolol

A

Beta-blocker
Hypertension
Angina
Tachyarrhythmias
MI

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14
Q

Drug class and Indication

Metoprolol

A

Beta-blocker
Hypertension
Angina
Tachyarrhythmias
MI
Prevention of migraine
Chronic heart failure with reduced ejection fraction as part of standard treatment

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15
Q

Drug class
Warfarin

A

Anticoagulant

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16
Q

MOA
Warfarin

A

Vitamin K antagonist; inhibits synthesis of vitamin K-dependent clotting factors (II, VII, IX, X) and the antithrombotic factors protein C and protein S.

17
Q

Indication
Warfarin

A
  • Prevention and treatment of VTE
  • Prevention of thromboembolism in patients with prosthetic heart valves
  • Prevention of stroke in patients with previous MI and increased embolic risk
  • AF and a high risk of stroke or systemic embolism
18
Q

Precautions
Warfarin

A
  • Alcoholism—contraindicated.
  • Compliance likely to be poor—avoid unless administration is supervised.
  • Protein C or protein S deficiency—increases risk of skin necrosis.
  • Risk of bleeding
19
Q

Adverse effects
Warfarin

A

bleeding

20
Q

Counselling
Warfarin

A
  • Always take the same brand of tablets.
  • Take tablets at about the same time every day
  • Regular INR blood tests
  • Stable vitamin K intake - warfarin affected by vitamin K
21
Q

Practice points
Warfarin

A
  • the different brands have not been shown to be bioequivalent and should not be interchanged
  • warfarin has a narrow therapeutic range; many drugs interact with warfarin and may decrease its efficacy or increase the risk of bleeding; it is prudent to monitor the INR when changing drug treatment
22
Q

Advantages of NOACs over Warfarin

A
  • Lower rates of intercranial bleeds and strokes
  • No routine lab monitoring
  • Fewer drug interactions
  • Fewer food interactions
23
Q

Disadvantages of NOACs over Warfarin

A
  • Higher cost
  • lack of availablity of reversal agent
  • Increased risk of GI bleed
  • Higher rate of VTE with poor compliance
  • No clear efficacy in cancer patients
24
Q

Drug interactions
Warfarin

A

EVERYTHING!!!

aspirin + warfarin
Combination increases risk of bleeding (as well as antiplatelet effect, aspirin causes GI bleeding and doses of 2–4 g daily have a direct hypoprothrombinaemic effect); avoid combination (except low-dose aspirin in selected patients at high risk for thromboembolism where close monitoring is required).

corticosteroids + warfarin
Corticosteroids may increase warfarin’s anticoagulant effect, increasing the risk of bleeding; monitor INR and decrease warfarin dose if necessary.

fibrates + warfarin
Fibrates may increase warfarin’s anticoagulant effect and risk of bleeding; monitor INR and decrease warfarin dose if necessary.

flucloxacillin + warfarin
Flucloxacillin may decrease warfarin’s anticoagulant effect; monitor INR within the first 3 days of flucloxacillin treatment and increase warfarin dose if necessary.

NSAIDs + warfarin
All NSAIDs (including selective COX‑2 inhibitors) increase the risk of serious GI bleeding. Nonselective agents (antiplatelet effect) and selective COX‑2 inhibitors (may increase INR) may further increase the risk of bleeding; avoid combination if possible or monitor regularly (INR and clinically). Combination with ketorolac is contraindicated.

SSRIs + warfarin
SSRIs may increase anticoagulant effect and risk of bleeding; monitor INR and decrease warfarin dose as needed.

St John’s wort + warfarin
St John’s wort increases metabolism of warfarin, decreasing its anticoagulant effect; avoid combination.

statins + warfarin
Fluvastatin, rosuvastatin and simvastatin may increase warfarin’s anticoagulant effect, increasing the risk of bleeding; consider using atorvastatin or pravastatin (do not appear to interact with warfarin) or decrease the warfarin dose according to INR.

tetracyclines + warfarin
Tetracyclines may increase warfarin’s anticoagulant effect, occasionally causing bleeding; monitor INR within the first 3 days of tetracycline treatment and decrease warfarin dose if necessary.

vitamin K + warfarin
Vitamin K decreases warfarin’s anticoagulant effect by increasing synthesis of blood clotting factors; patients should keep their dietary vitamin K intake constant. Vitamin K is used to reverse bleeding caused by excessive anticoagulation.

25
Q

Generic drug names
Factor Xa inhibitors / NOAC

NOAC = Novel oral anticoagulants

A

Apixaban
Fondaparinux
Rivaroxaban

26
Q

“aban” Suffix

A

Factor Xa inhibitors / NOAC

NOAC = Novel oral anticoagulants

27
Q

Suffix
Factor Xa inhibitors / NOAC

NOAC = Novel oral anticoagulants

A

“aban”

28
Q

MOA
Factor Xa inhibitors / NOAC

NOAC = Novel oral anticoagulants

A

Selectively inhibit factor Xa, blocking thrombin production, conversion of fibrinogen to fibrin, and thrombus development.

29
Q

What does thrombin do?

A

thrombin is in blood and lumps together to form clumps

30
Q

Precautions
Factor Xa inhibitors / NOAC

NOAC = Novel oral anticoagulants

A

Risk of bleeding

31
Q

Precautions and adverse effect
Anticoagulants

A

Risk of bleeding

32
Q

Adverse effects
Factor Xa inhibitors / NOAC

NOAC = Novel oral anticoagulants

A

bleeding, signs of bleeding (eg anaemia)

33
Q

Counselling
Factor Xa inhibitors / NOAC

NOAC = Novel oral anticoagulants

A

Take oral meds at the same time everyday

34
Q

Practice points
Factor Xa inhibitors / NOAC

NOAC = Novel oral anticoagulants

A

regular renal function monitoring
notify dr if bleeding

35
Q

Drug class and indications

Apixaban

A

NOAC - Factor Xa inhibitor
* Non-valvular AF and a high risk of stroke or systemic embolism
* Prevention of VTE
* Treatment of acute VTE

NOAC = Novel oral anticoagulants

36
Q

Drug class and indication

Fondaparinux

A

NOAC - Factor Xa inhibitor
* Prevention of VTE
* Treatment of VTE
* Treatment of unstable angina or non-STEMI
* Treatment of STEMI

NOAC = Novel oral anticoagulants

37
Q

Drug class and indication

Rivaroxaban

A

NOAC - Factor Xa inhibitor
* Prevention of VTE
* Treatment of acute VTE
* Non-valvular AF and a high risk of stroke or systemic embolism
* Stable coronary artery disease (CAD) or peripheral artery disease (PAD); use with aspirin

NOAC = Novel oral anticoagulants

38
Q

Drug interactions
Anticoagulants

A

Avoid drugs that increase risk of bleeding

Pharmacology 2 (41 decks)

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