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Pharmacology > Afib > Flashcards

Afib Flashcards

1
Q

What are two ways afib can occur? (2 marks)

A

stimulus from a site other than the SA node or the stimulus spreading across the heart in an abnormal pathway

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2
Q

What is afib also known as? (1 mark)

A

Cardiac dysrhythmias

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3
Q

What is afib? (3 marks)

A

quiver/squirm
300 + per min
no effective contraction

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4
Q

Describe three types of afib? (6 marks)

A

paroxysmal afib- self terminating episodes for 48 hours
valvular afib- afib in pts with moderate or severe mitral stenosis or a mechanical heart valve
non-valvular afib- afib in pts without moderate or severe mitral stenosis or a mechanical heart valve

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5
Q

Why might patients not know they have afib? (1 mark)

A

Afib is usually asymptomatic

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6
Q

What are some symptoms of afib? (4 marks)

A

tiredness, breathlessness, dizziness and palpitations

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7
Q

What are the two types of haemostasis related complications of afib and what is the difference? (4 marks)

A

thrombus- clot which forms in the vessel and stays there
embolus- clot which forms in the vessel and moves

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8
Q

How can AF lead to ischaemic stroke or TIA? (2 marks)

A

clots form in the atria as the atria doesn’t contract
they become emboli and are pumped out of the heart blocking brain vessels

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9
Q

what are the two broad treatment options for afib and what do they do? (4 marks)

A
  • rhythm control- reverses HR to sinus rhythm
  • rate control- slows conduction rate of the AV node and increases refractory period of the AV node
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10
Q

List three ways you can treat afib with rhythm control (3 marks)

A

cardioversion, catheter ablation and antiarrhythmic therapy

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11
Q

What is the mechanism of action of digoxin? (2 marks)

A

reduces AV conduction and increases contraction force

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12
Q

What is digoxin’s effect on hospitalisation and mortality? (2 marks)

A

reduces hospitalisations but no effect on mortality

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13
Q

Would digoxin be used for rhythm or rate control? (1 mark)

A

Rate control

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14
Q

What does CHADS stand for? (5 marks)

A

Congestive heart failure hx
Hypertension
Aged 75+
Diabetes mellitus
Stroke or TIA hx

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15
Q

What are two drugs you could use to prevent risk of stroke for patients with Afib? (2

A

Warfarin and NOACs (apixaban, rivaroxaban and dabigatran)

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15
Q

Should you use aspirin or P2Y12 inhibitors such as clopidogrel to prevent thromboembolic events in a patient with afib? (1 mark)

A

No

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15
Q

What is the difference between CHADS2 and CHA2DS2-VA? (2 marks)

A

CHA2DS2-VA further stratifies low-risk people with non-valvular AF

15
Q

When should a patient nor be switched from warfarin? (3 marks)

A

They cannot maintain an INR of 2-3 for 60-70% of the time due to poor adherence

16
Q

What are three scenarios where you should consider switching a patient from Warfarin? (3 marks)

A

Pt cannot undergo routine INR monitoring
They cannot tolerate warfarin
Patient preference

17
Q

How do you switch from warfarin to a NOAC? (3 marks)

A

stop warfarin, start NOAC when INR reaches below 2

18
Q

How do you switch from a NOAC to warfarin? (3 marks)

A

Start Warfarin, continue NOAC until INR is under 2

19
Q

What are five factors to consider when choosing a NOAC for a patient? (5 marks)

A

age, bleeding risk, effect of food, compliance aid, renal function, half-life, comorbidities, antidotes available, drug interactions, dosing frequency and compliance

20
Q

Whatis AFib and what complications can it lead to? 7 marks

A

AFib is a cardiac dysrhythmia (1) which is fast (1), disorganised electrical activity in the atria (1). The atria quivers and squirms 300 times a minute. (1) It can lead to clots forming in the atria (1) and an ischaemic stroke (1) or TIA (1)

21
Q

What are 2 rationales for AFib treatment?

A

o Reduce symptoms and minimise morbidity by slowing ventricular rate and maintain sinus rhythm
o Prevent stroke
o Treatment can focus on rhythm control or rate control

22
Q

What is the drug class of digoxin?

A

cardiac glycoside

23
Q

what are 3 adverse effects of digoxin

A

nausea, vomiting, diarrhoea, bradycardia, arrhythmia

24
Q

what is the MOA of digoxin?

A

increases the refractory period of the AV node and slows conduction

25
Q

what should you not put with a beta blocker in afib?

A

verapamil

26
Q

What are two adverse effects of beta blockers?

A

bradycardia and reduced cardiac output

27
Q

what is the drug class of Diltiazem and verapamil? What is one side effect?

A

non-dihydropine ccbs. Bradycardia

28
Q

What is an adverse effect of a beta blocker?

A

bradycardia

29
Q

What should you monitor for when using amiodarone? 3 marks

A

Monitor BP, check liver function and electrolytes before starting

30
Q

What are 3 side effects of amiodarone?

A

nausea and vomiting, constipation

31
Q

what are 3 side effects of Flecainide?

A

nausea, vomiting , diarrhoea

32
Q

what do you monitor when using flecainide?

A

drug concentration

33
Q

what are two side effects of Sotalol?

A

palpitations and hypotension

34
Q

what do you need to monitor when using sotalol?

A

Monitor QT interval with dose increases

35
Q

Name 4 drugs/drug classes for rate control

A

Digoxin, BBs, Diltizam and verapamil

36
Q

Name 3 drugs/drug classes for rhythm control

A

Amiodarone, flecainide and soltalol

37
Q

What is the MOA of digoxin?

A

Slows heart rate, reduces atrioventricular (AV) nodal conduction, increases vagal tone, reduces sympathetic activity and increases the force of myocardial contraction

38
Q

What is the MOA of non dihydropyridine CCBs?

A

act on cardiac and arteriolar smooth muscle. They reduce cardiac contractility, heart rate and conduction

Pharmacology (23 decks)

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