Dysrhythmia (Week-12 $ Workshop-36) Flashcards
Dysrhythmia vs AF?
Dysrhythmia or AF both, Any of these may cause the heart to skip a beat, beat too fast, or beat too slow.
Atrial fibrillation (AF) is a form of arrhythmia, or irregular heartbeat, in which the atria (the two small upper chambers of the heart) quiver instead of beating effectively.
What are the risk factors Peter has for Atrial Fibrillation?
Increasing age
Hypertension
Alcohol Consumption
Family history of CVD - father died from acute myocardial infarction at age 70
How you determine paroxysmal Persistent and permanent AF?
Paroxysmal AF – recurrent episodes of AF which last less than seven days.(Rhythm control)
Persistent AF – episodes of AF Which last more than seven days and that has not spontaneously resolved within this time. (Rate and rhythm control)
Permanent AF – AF that has been present for more than one year and cardioversion has failed or not been attempted. (Rate control)
We cannot be sure because we don’t have enough information for his diagnosis. WE have to do ECG required.
test to identify Dysarythemia ?
ECG EKG
Epideomiology of Arterial fibrilation?
5% of all age 65 in nz suffer
What is the mechanism of Dysrhythmia?
Abnormal impulse by increased automaticity
Electrical instability
Abnormal conduction like conduction delay
Types of Dysrhythmia?
Tachycardia (>100 bpm)
Bradycardia (<60 bpm)
Supraventricular dysrhythmias (e.g. atrial fibrillation)
Ventricular dysrhythmias (e.g. ventricular fibrillation)
Bradyarrhythmias
Treatment options of dysarhythmia?
Beta blockers (slow impulse generation in SA node) Non-dihydropyridine calcium channel blockers (slow conduction in SA/AV node)
Causes/risk factors of dysrhythmia?
Coronary artery disease High blood pressure Cardiomyopathy (changes in heart muscle) Valve disorders Electrolyte imbalances Injury (i.e. myocardial infarction) Healing process after heart surgery Drugs
Signs and symptoms of dysrhythmia
Asymptomatic Palpitations / “racing heart” Feeling of pause Anxiety Shortness of breath Dizziness, loss of consciousness Cardiac arrest
Atrial Fibrillation - Classification?
First detected
Only one diagnosed episode
Paroxysmal
Recurrent episodes that stop on their own < 7 days
Persistent
Recurrent episodes that last > 7 days
Permanent
Ongoing long-term episode
Ris factors for Arterial Fibrilation?
Age. The older you are, the greater your risk of developing atrial fibrillation Heart disease High blood pressure Other chronic conditions Drinking alcohol Obesity Family history
Cmopare when we need to control HR and when we control Rhythm Control?
Rate control: Persistent arrythmia, less symtomatic, age below 65, No heart failure, Hypertension
Rhythm control: Paroxysmal arrythmia, On going symptoms show dispite rate control, Age above 65, Heart failure
Please design a treatment plan for Peter. Please consider pharmacist-specific goals of therapy, options, and a recommendation.
Pharmacist goals
To alleviate symptoms of arrhythmia (i.e. heart racing, feeling lightheaded and anxious, etc) by controlling heart rate (<110 bpm) & restoring sinus rhythm
To prevent complications associated with arrhythmias, e.g. stroke
To prevent mortality
To normalise signs (target HR < 110bpm)
Treatment option for arterial fibrilation to control rate?
First Line:Beta blocker 2nd Line: CCB
Metoprolol succinate MR 95 - 190mg OD - better evidence base
Monitoring:
Aim for HR < 110bpm
Side effects, e.g. fatigue, nightmares, cold toe and finger
Bisoprolol [dose dependent on the degree of heart rate elevation, NZF] - usual dose 1.25-10mg OD
Carvedilol
CCB:
Diltiazem IR 60mg TDS
Verapamil IR 40mg TDS or verapamil CR 120 - 480mg (CCB; BPAC)
Treatment option for arterial fibrilation to control Rhythm?
Amiodarone 200mg TDS for 1 weeks, and then titrate dose
Flecainide 50mg BD and then titrate dose
Sotalol 80mg OD or 40mg BD
Nothing
Electrical conversion maybe considered (if presenting within 48 hrs of symptom onset)
Non-pharmacological therapy for arterial fibrilation:
Reduce alcohol intake
Regular physical exercise - recommended 30 minutes per day for at least 5 days per week (total of 150 minutes)
Manage stress
Healthy, balanced diet - reduce sodium and saturated fat intake
Aim for a healthy weight. Currently, his BMI is under 25, but should ensure he maintains a BMI below 25.
When we have to change or modify patients antithrombotic medication and why or why not?
By assessing CHADA VASc score and HASBLED score
give Dabigatran
Patient complience no need INR test
No dose adjustment required
HASBLED (risk of bleeding) score
Hypertension Abnormal LIver/Renal Stroke Bleeding Labile INR ELderly over 65 Drug or Alcohol
What medication is recommended if HASBLED score is high ?
1) Warfarin 3mg OD (Adjust with INR result (Chenck INR every week) warferin takes 7-10 days or 3 weeks to reach steady state INR
2) Dabigatran 150 BD
What do you need to monitor during Dabigatran use?
Signs of bleeding or anemia
Monitor or Assess renal function
AE: Abdominal pain Anaemia nausea diarrhoea
“Peter is in the hospital with a stomach bleed. Why didn’t you tell him not to take aspirin along with his other medications?” You respond, “I’m sorry to hear this but Peter never mentioned he was taking aspirin.” She replies, “Did you ask? He bought it here after he read about it online”.
List one or two strategies you could implement as a community pharmacist to prevent this situation from happening again. Try to think about it from the perspective of the ‘system’, rather than the ‘individual’.
attach DDI alerts to their customer rewards card
ask when they’re buying aspirin or nsaids if they take any other medications, counsel on appropriate use - this works best if they are only buying from your pharmacy.
Ask if there have been any medication changes when collecting prescriptions and repeats on high risk medications (Anticoagulants).
Teach everyone (including shop staff) to ask about their current medication
Ask patients about any side effects they may have noticed from their medicines
Make sure the patient knows what to watch out for (warning signs of bleeds ect) and ask them everytime you see them if there have been any changes, if he is taking anything OTC and double check about all his meds.
Mandatory counselling for any patients on anticoagulants & ask if they’ve had any new meds, OTCs, supplements, etc.
Attach a sign with the aspirin, saying that if you have these conditions/taking these medications etc, talk to pharmacist
