ANTICOAGULATIONS FOR AF

Question 1

List the two types of anticoagulants used in AF

Answer 1

Parenteral and Oral Anticoagulants

Question 2

What should be offered to patients with new onset AF who are receiving no anticoagulation until an assessment is made and appropriate anticoagulation is started?

Answer 2

Heparin(Parenteral anticoagulation

Question 3

State the first-line Anticoagulant treatment for AF.

Answer 3

DOACS

Question 4

State what is offered to patient with confirmed AF if DOACS are contraindicated eg renal impairment

Answer 4

Give a Vitamin K antagonist eg Warfarin

Question 5

Oral anticoagulants are offered to patients with confirmed AF. True/false?

Answer 5

True

Question 6

List the drugs used to treat SUPRAVENTRICULAR ARRHYTHMIA

Answer 6

Verapamil, adenosine, cardiac glycoside(digoxin)

Question 7

List the drugs used to treat Ventricular Arrythmia

Answer 7

Sotalol, Lidocaine

Question 8

What drugs are used to treat supraventricular and ventricular arrhythmia?

Answer 8

Amiodarone, beta blockers

Question 9

state the classifications of Arrhythmias

Answer 9

Vaughan Williams Classification

Question 10

Define Vaughan William Classification

Answer 10

Classification according to effects on electrical activity of heart

Question 11

List the drugs in class 1 Vaughan William classification of Arrhythmia

Answer 11

Membrane stabilizing drugs such as Lidocaine and Flecainide plus Na channels blockers

Question 12

list the drugs in class 2 VW classification

Answer 12

Beta blockers

Question 13

List the drugs in class 111 VW

Answer 13

Amiodarone, Sotalol and Potassium Channel blocker

Question 14

List drugs in class 4 VG classification

Answer 14

verapamil but not Dihydropyridines

Question 15

T he preferred FIRST LINE treatment strategy for AF EXCEPT IN PATIENT WITH NEW ONSET AF IS

Answer 15

RATE CONTROL

Question 16

State when not to use Rate control treatment in AF

Answer 16

New onset AF
Atrial flutter suitable for an ablation strategy
AF with reversible cause eg MI, PE, HYPERTHYROIDISM, EXCESS CAFFEINE AND ALCOHOL
Heart failure primarily caused by AF
or if Rhythm control is more suitable

Question 17

What are the drugs for rate control

Answer 17

beta-blockers (NOT SOTALOL)
or rate-limiting CCBs such as Diltiazem(unlicensed) or Verapamil as monotherapy
or Digoxin

Question 18

When should you use digoxin in AF

Answer 18

Digoxin monotherapy should only be considered for the initial rate control in patients with nonparoxysmal AF who are predominantly sedentary or in those where other rate-limiting drugs are unsuitable

Question 19

Digoxin are also used when AF is accompanied by—-

Answer 19

Congestive Heart Failure

Question 20

If monotherapy fails to adequately control ventricular rate, list the two drugs that can be used in combination

Answer 20

BB DD mnemonic
Beta blockers
digoxin
diltazem

Question 21

State what to do if symptoms of AF are not still controlled with a combination of 2 drugs

Answer 21

Consider a rhythm control strategy

Question 22

List the drugs used for rhythm control (post cardioversion)

Answer 22

Mnemonic: FABS(rhythmS) PD
Beta-blocker(not sotalol) as FIRST LINE
OR
Flecainide( avoid in heart disease)
Amiodarone
Propafenone(Avoid in Heart Disease)
Dronedarone

Question 23

When is cardioversion used?

Answer 23

For patients with new-onset AF who are treated with a rhythm control strategy

Question 24

Cardioversion can be pharmacological or electrical. True/False?

Answer 24

True

Question 25

Cardioversion restores what?

Answer 25

Sinus rhythm

Question 26

State two examples of pharmacological cardioversion

Answer 26

Flecainide or Amiodarone (if structural or ischaemic heart disease)

Question 27

State what kind of cardioversion treatment is preferred if AF lasts for more than 48hours.

Answer 27

Electrical cardioversion is preferred over pharmacological cardioversion

Question 28

What should you look out for when administering electrical cardioversion to patients with AF

Answer 28

Ensure that the patient is fully anticoagulated for at least three weeks because there is a risk of stroke with electrical cardioversion

Question 29

State what to do if electrical cardioversion cannot be delayed until the patient is fully anticoagulated

Answer 29

Give heparin immediately before cardioversion

Question 30

Oral anticoagulation should be given after CARDIOVERSION and continued for at least 4 weeks. True/false?

Answer 30

True

Question 31

Name the tool used to assess the risk of stroke in AF patients prior to and during anticoagulation

Answer 31

CHA2DS2-VASC tool ATRIA Stroke risk tool and QStroke calculator

Question 32

State the tools used to assess bleeding risk in AF patient

Answer 32

ORBIT (Higher accuracy than other tools eg HAS BLED, ATRIA)

Question 32

State the following meaning of CHA2DSC-VASC SCORE

Answer 32

C- Congestive heart failure adds 1 point H- Hypertension adds 1 point A- Age greater than or equal to 75yrs adds 2 point - Diabetes mellitus or T2D adds 1point S- Prior Stroke or TIA adds to 2point V- Vascular disease adds to 1 point A- Age between 65 and 74years adds 1point S- Female sex adds 1 point

Question 32

Anticoagulant for a man starts from what number ?

Answer 32

1

Question 32

When to give anticoagulants?

Answer 32

Give Anticoagulant when CHASDVAS2C score is greater than or =2

Question 33

memory trick to give anticoagulants

Answer 33

ANtwocoagulants