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
dose of warfarin
5-10mg on day 1, with lower dose for elderly, lighter or bleeding risk
when to take warfarin
6pm every day for consistent effects on warfarin daily.
what should all patients on warfarin get to help them track there doses
yellow book
what clotting cascade is IRN measuring
Prothrombin time.
