Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Patient PCP > DOACs and AF > Flashcards

DOACs and AF Flashcards

1
Q

Why is anticoagulation therapy necessary in AF?

A

The risk of a stroke is five times higher in a person with AF than in a person in sinus rhythm.

Stroke severity is usually greater when stroke is associated with AF than with other causes.

Anticoagulation treatment reduces the risk of stroke by about two-thirds.

For most people, the benefit of anticoagulation outweighs the risk of bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the advantages of using DOACs instead of warfarin ?

A
  • Risks associated with treatment — DOACs are associated with a reduced risk of haemorrhagic stroke and intracerebral haemorrhage compared with warfarin.
  • ## DOACs have predictable pharmacokinetics, so coagulation control does not need to be monitored. Warfarin, on the other hand, needs regular blood tests to monitor coagulation control.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What two things can you try and control in a patient with AF?

A

Rate and rhythm control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

In patients without life-threatening haemodynamic instability, if a patient has onset of AF less than 48 hours ago, what can be offered to the patient?

A- rate control
B- rhythm control
C- both

A

C - both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

If a patient presents with AF and the onset is more than 48 hours ago or uncertain, is it preferable to control rate or rhythm?

A

Rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What beta blocker should you not use in rate control for AF?

A

Sotalol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q
  1. How can ventricular rate be controlled in AF?

2. If this does not work, what can be used?

A
  1. Monotherapy:

Standard beta blocker (not sotalol)
Rate limiting CCB e.g. verapamil
Diltiazem is used but unlicensed
Digoxin

  1. Combination of beta blocker, digoxin or diltiazem
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What group of patients should digoxin monotherapy be used for ventricular control in AF?

A

Only effective for controlling the ventricular rate at rest, so should only be used as monotherapy in sedinetary (inactive) patients with non-paroxysmal atrial fibrillation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is meant by paroxysmal AF?

A

Episodes come and go

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

If dual ventricular rate therapy does not control symptoms in AF, what can then be considered?

A

Rhythm control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

In patients with AF and diminished ventricular function, what should be used to control rate?

A

Beta blockers that are licensed for use in heart failure and digoxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Post cardioversion in AF, what is used to maintain sinus rhythm?

A

Beta blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is 1st line for long term rhythm control in AF?

A

Beta blocker (not sotalol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

If amiodarone is needed in an electrical cardioversion patient, how long before and after the procedure can they be on it for?

A

4 weeks before and up to 12 months after

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

For rhythm control in AF, when what group of patients would flecainide acetetate or propafenone NOT be suitable for?

A

Known ischaemic or structural heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When would dronedarone be used in rhythm control for AF?

A

As an option for the maintenance of sinus rhythm after successful cardioversion in people with paroxysmal or persistent atrial fibrillation:

  • whose atrial fibrillation is not controlled by first‑line therapy (usually including beta‑blockers), that is, as a second‑line treatment option and after alternative options have been considered and who have at least 1 of the following cardiovascular risk factors:
  • hypertension requiring drugs of at least 2 different classes
  • diabetes mellitus
  • previous transient ischaemic attack, stroke or systemic embolism
  • left atrial diameter of 50 mm or greater or
  • age 70 years or older and

And:
who do not have left ventricular systolic dysfunction and
who do not have a history of, or current, heart failure.
(consider amiodarone in these patients)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What group of patients would you consider amiodarone for in rhythm control for AF?

A

Left ventricular impairment or heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What tool do you use to assess for stroke risk in AF patients?

A

CHADVASC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What tool do you use to assess for bleeding risk?

A

HAS BLED

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

At what CHADVASC score in men would you consider anticoagulation in AF?

At what score should you offer (taking into account bleeding risk)?

A

1

2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

At what CHADVASC score in females would you consider anticoagulation to in AF?

A

2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Is aspirin monotherapy recommended for stroke prevention in AF?

A

NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Anticoagulation should be considered post stroke if the patient has AF. When should you consider aspirin before considering anticoagulation treatment?

A

If it is a disabling ischaemic stroke, give the aspirin 300mg for 2 weeks

Then, consider the value of anticoagulation for prevention of stroke in AF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When do you reduce dose of apixaban in terms of weight?

A

<61 kg - reduce dose to 2.5 mg BD for stroke prophylaxis in AF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
How many days before is warfarin usually stopped before elective surgery? If they are at high risk of clot e.g. VTE in last 3 months, AF with previous stroke, what would you do?
5 days Bridge with LMWH and stop this 24 hours before surgery
26
What is the only DOAC that has a reversal agent?
Dabigatran
27
What is the reversal agent for dabigatran?
Idarucizumab
28
Are DOACs recommended in patients with prosthetic heart valves?
No- efficacy has not been established
29
Can apixaban be crushed?
Yes- mix with water or apple juice/puree
30
Is apixaban once or twice daily dosing?
Twice daily
31
Is edoxaban once or twice daily dosing?
Once daily
32
If a patient is taking one of the following drugs: - ciclosporin - dronedarone - erythromycin - ketoconazole And needs to be on edoxaban, what is the maximum daily dose?
30mg OD
33
What DOACs are black triangle drugs?
Rivaroxaban and edoxaban
34
When would you reduce the dose of edoxaban in renal impairments?
15-50 mL/min Max 30mg OD
35
What is the cut off point for renal impairment for edoxaban?
Avoid if < 15mL/min
36
When do you reduce dose of edoxaban in terms of weight?
<61 kg reduce to 30mg OD
37
What is the cut off point for renal impairment for rivaroxaban?
Avoid if < 15mL/min
38
Can rivaroxaban be crushed?
Yes in water/apple juice or puree
39
Which DOAC should be taken with food?
Rivaroxaban
40
Which DOAC cannot be put in a blister pack?
Dabigatran
41
What is the cut off point for renal impairment for dabigatran?
Avoid if < 30 mL/min
42
When would you reduce dose of dabigatran in renal impairment?
30-50 mL/min
43
What is the advice around a patient on dabigatran who is taking one of the following: - Verapamil - Amiodarone
Reduce dabigatran dose Take doses at the same time
44
When do you take anti factor Xa levels?
3-4 hours after dose
45
Are multidose or single vials of dalteparin and enoxaparin recommended in pregnancy and why?
Single vials Multidose vials contain benzyl alcohol
46
Are DOACs licensed in cancer patients?
NO
47
Are DOACs licensed in antiphospholipid syndrome?
NO
48
Do DOACs interact with alcohol?
NO
49
Which DOAC has the least risk of GI bleed?
Apixaban
50
Do DOACs or warfarin carry higher GI bleed risk?
DOACs (apart from apixaban which has same risk as warfarin)
51
What sort of AF are DOACs licensed in?
Non valvular
52
What is valvular AF?
AF + artificial heart valve | Mitral stenosis
53
What would you use for prophylaxis of stroke in valvular patients?
Vit K antagonists | Not DOACs
54
Why is missing a DOAC dose more dangerous than missing a warfarin dose?
DOACs have a shorter half life
55
What is the dose for rivaroxaban in AF?
20mg OD
56
What is the dose for apixaban in AF?
5mg BD
57
Is dabigatran OD or BD?
BD
58
What are the counselling points for missed doses in BD preps?
> 6hrs till next dose take ASAP | < 6 hours till next dose omit (skip)
59
What can missed doses increase the risk of?
Missed doses can increase the risk of insufficient anticoagulation, which can lead to a clot
60
What are the counselling points for missed doses in OD preps?
>12 hours till next dose take ASAP | <12 hours till next dose omit (skip)
61
What are the 4 classes for AF?
1. Paroxysmal: self limiting, less than 7 days 2. Persistent: more than 7 days or requires cardioversion 3. Long standing persistent: continuous AF, more than a year 4. Permanent: decision made not to attempt cure of persistent AF
62
What are the signs of bleeding?
o Bruising, haematuria, haemoptysis, malaena o Minor bleeds/malaena, visit GP o Major trauma/bleeds >15m, go to A&E
63
What do chromogenic anti-factor Xa assays do?
measure plasma concentration of apixaban (due to overdose)

Patient PCP (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions