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Geriatrics > AF > Flashcards

AF Flashcards

1
Q

What is the initial presentation of AF in the elderly?

A

May be asymptomatic/stroke

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2
Q

How de we treat a hemodynamically unstable AF?

A

Direct current cardioversion

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3
Q

How do we treat a hemodynamically stable AF?

A

Acute ventricular rate control

Select agent based on LV function

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4
Q

What medications are used for hemodynamically stable AF?

A

BB (monitor bradycardia, hypotension)

Non-DHP CCB (monitor constipation, hypotension)

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5
Q

According to the Beers list, how is rhythm control compared to rate control?

A

Rhythm control can have outcomes as good as or better than rate control

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6
Q

Is rate or rhythm control more important in symptomatic therapy?

A

Rhythm control

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7
Q

What type of therapy is used in symptomatic AF?

A

Pharmacologic or electrical cardioversion

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8
Q

What type of therapy is used in non-symptomatic AF?

A

Select agent to maintain HR

Non-DHP CCB, BB (alt: dig, amiodarone)

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9
Q

Is rate or rhythm control more important in non-symptomatic AF?

A

Rate control

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10
Q

What other therapy is recommended in AF along with rate/rhythm control?

A

Consider anticoagulation

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11
Q

What does the Beers list say about amiodarone use?

A

Avoid 1st line (because of increased risk of toxicities) unless pt has HF or substantial left ventricular hypertrophy

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12
Q

What does the Beers list say about dronedarone?

A

Avoid if permanent AF or severe/decompensated HF because potentially worse outcomes

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13
Q

What does the Beers list say about disopyramide?

A

Avoid because highly anticholinergic and as a potent negative inotrope may induce HF

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14
Q

What does the Beers list say have digoxin?

A

Avoid 1st line because other more effective alternatives exist and may be associated with increased mortality

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15
Q

What does the CHADSVASC score stand for and how many points go with which pieces?

A 
Congestive HF/LV dysfunction = 1
HTN = 1
Age >/= 75 = 2
DM = 1
Stroke/TIA/systemic embolism = 2
Vscular disease (post-MI, PAD, aortic plaque) = 1 
Age 64-75 years = 1
Female = 1
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16
Q

What dose the CHADS score stand for and how many points go with which pieces?

A 
Congestive HF/LV dysfunction = 1
HTN = 1
Age >/= 75 = 2
DM = 1
Stroke/TIA = 2
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17
Q

What are the 2012 CHEST guidelines according to the CHADS score?

A 
0 = No antithrombotic
1 = OAC > ASA + plavix > ASA > no treatment
>/= 2 OAC > ASA + plavix > ASA > no treatment
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18
Q

Which OAC is preferred?

A

Dabigatran is preferred over warfarin

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19
Q

What are the 2014 AHA/ACC guidelines according to the CHASVASc Score?

A

0 = no antithrombotic
1 = No antithrombotic or ASA or OAC
>/=2 Warfarin, dabigatran, rivaroxaban, apixiban

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20
Q

If a patient has a mechanical heart valve, which OAC is avoided?

A

Dabigatran

21
Q

Which OAC is used in patients with ESRD/hemodialysis?

A

Warfarin

22
Q

What doses of warfarin do we start in older patients?

A

2.5-5mg

23
Q

What is the reversal agent for warfarin?

A

Vitamin K

24
Q

What is the reversal agent for dabigatran?

A

Idarucizumab (praxbind)

25
Q

What is the dosing for dabigatran?

A

150mg BID

26
Q

How is dabigatran adjust with CrCl?

A

CrCl 15-30 ml/min: 75 mg BID

27
Q

What is the brand for dabigatran?

A

Pradaxa

28
Q

What trial studied dabigatran?

A

RE-LY

29
Q

What did the RE-LY trial prove?

A

Dabigatran is superior for decreased stroke, decreased IC bleed, and increased GI bleed

30
Q

What does the Beers list say about dabigatran?

A

Caution in those 75 or older and CrCl < 30 d/t increased GI bleeds

31
Q

What is the dose of Xarelto?

A

20mg QD

32
Q

What is the dose of Xarelto with decreased renal clearance?

A

CrCl 30-49 ml/min: 15 mg daily

33
Q

What trial studied Xarelto?

A

Rocket-AF

34
Q

What did the ROCKET-AF trial prove?

A

Xarelto is noninferior for strokes, emboli, and bleeds

35
Q

What is the brand for apixaban?

A

Eliquis

36
Q

What is the dosing for apixaban?

A

5mg BID

37
Q

How do we dose adjust apixaban?

A

2 of the following is 2.5mg BID:
>/= 80 years
= 60kg
SCr >/= 1.5 mg/dl

38
Q

What trial studied apixaban?

A

ARISTOTLE

39
Q

What did the ARISTOTLE trial prove?

A

Apixaban was superior for decreased stroke, emboli and bleeds

40
Q

What is the generic of Savaysa?

A

Edoxaban

41
Q

What was the trial for edoxaban?

A

ENGAGE-AF TIMI 48

42
Q

What is the dosing for edoxaban?

A

> 50 ml/min = 60mg QD
15-50 ml/min = 30mg QD
Do not use if > 95 ml/min = increased risk of stroke

43
Q

What does the Beers list say about edoxaban?

A

Avoid if CrCl < 30 = increased bleed

44
Q

What did the ENGAGE-AF TIMI 48 trial prove in edoxaban 60mg?

A

Superior decrease in stroke, systemic emboli; decreased major/life-threatening bleed; increased GI bleed in those >/= 75 yo

45
Q

What did the ENGAGE-AF TIMI 48 trial prove in edoxaban 30mg?

A

Non inferior for stroke, systemic emboli (except >/= 75 yo favors warfarin); decreased bleed in all areas (including >/= 75 yo)

46
Q

What are RFs for AF?

A

HTN
CAD
HF
Rheumatic/valvular heart disease

47
Q

What did the ACTIVE-A trial determine?

A

Plavix + ASA > ASA monotherapy for stroke and major bleeding

48
Q

What did the BAFTA trial show?

A

Warfarin > ASA for stroke, ICH, arterial embolism

Geriatrics (15 decks)

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