Atrial Fibrillation

Question 1

Components of CHA2DS2VASc Score

Answer 1

C: Congestive HF
H: HTN
A: Age > 75 years (2 pts)
D: Diabetes
S: Stroke/TIA/Systemic Embolism (2 pts)
V: Vascular Disease
A: 65-74 years
Sc: Female

Question 2

Anticoagulation indicated in men with a CHA2DS2VASc Score ≥ ___

Answer 2

2

Question 3

Anticoagulation indicated in women with a CHA2DS2VASc Score ≥ ___

Answer 3

3

Question 4

HASBLED Componenets

Answer 4

H: HTN - SBP > 160 mm Hg
A: Abnormal liver/kidney function (1 each)
S: Stroke history
B: Bleeding history
L: Labile INR
E: Elderly > 65 years
D: Drug/Alcohol abuse (1 each)

Question 5

Lenient Rate Control HR Goal

Answer 5

110 bpm

Question 6

Patients who qualify for Lenient Rate Control

Answer 6

Asymptomatic AND EF > 40%

Question 7

Strict Rate Control HR Goal

Answer 7

< 80 bpm

Question 8

Patients who qualify for Strict Rate Control

Answer 8

Symptomatic OR EF ≤ 40%

Question 9

Type of Cardioversion in Hemodynamically Unstable Patient

Answer 9

Immediate DCCV

Question 10

Type of Cardioversion in Symptomatic Patient Desite Rate Control

Answer 10

DCCV, Chemical Cardioversion, or Both

Question 11

Type of Cardioversion in a Patient Unable to Achieve Rate Control

Answer 11

DCCV, Chemical Cardioversion, or Both

Question 12

Type of Cardioversion in a Patient Unable to Achieve Rate Control

Answer 12

DCCV, Chemical Cardioversion, or Both

Question 13

Vaughan-Williams Class I Anti-arrhythmic Class

Answer 13

Sodium Channel Blockade

Question 14

Vaughan-Williams Class I Anti-arrhythmics

Answer 14

Ia: Disopyramide, quinidine, procainamide
1b: Lidoacine, mexiletine
1c: Flecainide, Propafenone

Question 15

Vaughan-Williams Class II Anti-arrhythmics Class

Answer 15

Beta-blockers

Question 16

Vaughan-Williams Class III Anti-arrhythmics Class

Answer 16

Potassium Channel Blockade

Question 17

Vaughan-Williams Class III Anti-arrhythmics

Answer 17

Sotalol, dofetilide, amiodarone, dronedarone, ibutilide

Question 18

Vaughan-Williams Class IV Anti-arrhythmic Class

Answer 18

CCB

Question 19

Antiarrhythmics that can be used for ACUTE chemical cardioversion

Answer 19

Flecainide, propafenone, dofetilide, amiodarone, ibutilide

Question 20

Antiarrhythmics that can be used for CHRONIC Rhythm Control

Answer 20

Flecainide, propafenone, sotalol, dofetilide, amiodarone, dronedarone

Question 21

Class IC Antiarrythmics Metabolism/DDI

Answer 21

CYP2D6

Question 22

Propafenone specific AE

Answer 22

Metallic Taste

Question 23

Dofetilide Initation

Answer 23

3 days inpatient

Question 24

Dofetilide DDI

Answer 24

Verapamil: decreases absorption
HCTZ: Impacts clearance/electrolytes
Metformin/Trimethoprim: Competes for active tubular secretion
Additive QT prolongation

Question 25

Dofetide CI Renal Funciton

Answer 25

< 20 mL/min

Question 26

Sotalol Initiaton

Answer 26

3-days inpatient

Question 27

Sotalol DDI

Answer 27

Additive QT prolongation

Question 28

Sotalol CI Renal Function

Answer 28

< 40 mL/min

Question 29

Amiodarone Half-Life

Answer 29

~50 days

Question 30

Amiodarone DDI

Answer 30

Inhibits: CYP3A4, 2D6, 2C9, PGP
Additive QT prolongation

Question 31

Amiodarone load goal

Answer 31

8-10 grams over 2-4 weeks

Question 32

Amiodarone AEs

Answer 32

1. Bradycardia
2. QT prolongation
3. Pulmonary fibrosis
4. Thyroid dysfunction (hypo or hyper)
5. Corneal deposits
6. Hepatotoxicity
7. Blue/Gray Skin

Question 33

Amiodarone Monitoring

Answer 33

1. Baseline ECG, Q3-6 months
2. Baseline TFTs, Q6 months
3. Baseline LFTs, Q6 months
4. Baseline CXR, Q12 months
5. Baseline PFTs, Q12 months

Question 34

Dronedarone Brand

Answer 34

Multaq

Question 35

Dronedarone CI

Answer 35

HF, permanent AF

Question 36

Dronedarone metabolism/DDI

Answer 36

Inhibits: CYP3A4, 2D6, PGP
Additive QT prolongation

Question 37

Dronedarone AE

Answer 37

1. Bradycardia
2. QT prolongation
3. Hepatotoxicity