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Therapeutics > Exam 2 lecture 7 > Flashcards

Exam 2 lecture 7 Flashcards

1
Q

Risk factors for A fib

A

Age
Cigarette smoking
Alcohol
sedentary lifestyle
Obesity
HFrEF and HFpEF
CKD
genetic
idiopathic
DM
HTN

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2
Q

reversible A fib etiologies

A

Hyperthyroidism
Thoracis surgery
-CABG
-Lung resection

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3
Q

A fib symptoms

A

May be asymptomatic
palpitations
dizziness
fatigue
lightheadedness
SOB
Hypotension
Syncope
Angina (in pts with coronary artery disease)
exacerbation of HF

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4
Q

morbidity and mortality risks of A fib

A

Strokes/embolism- risk increases 5X
HF- risk increases 3X
dementia and mortality increase 2X

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5
Q

prevention of A fib

A

weightloss
physical fitness- target 210 mins of vigorous exercise each week
smoking cessation
minimize/eliminate alcohol
BP and glucose control

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6
Q

goals of therapy of A fib

A

prevention of stroke/embolism
maintain sinus rhythm
Convert A fib to normal sinus rhythm

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7
Q

CHADSVASC score calculation

A

Congestive HF-1
Hypertension- 1
Age> or = 75- 2
Diabetes- 1
Stroke- 2
vascular disease- 1
Age- >65
Sex (female)- 1

max score 9

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8
Q

What are vascular diseases for CHADSVASC

A

Prior MI
PAD
aortic plaque

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9
Q

When are oral antibiotics recommended for pts with A fib

A

CHADSVASC score > or = 1 in men

CHADSVAC score > or = 2 in women

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10
Q

when can Oral anticoags be OMITTED for pts with A fib

A

0 in men
0-1 in women

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11
Q

should most A fib pts be on DOAC or warfarin

A

DOAC

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12
Q

when is warfarin preferred over DOAC in A fib

A

Pts with mechanical heart valves
A fib associated with heart valve disease (moderate to severe mitral valve stenosis)

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13
Q

Target INR for warfarin in pts with A Fib and mechanical heart valve

A

2.5-3.5

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14
Q

target INR for warfarin in pts with A fib associated with heart valve disease (mitral valve stenosis)

A

INR- 2-3

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15
Q

which anticoags to use for pts with ESRD or CrCl<15 and hemodialysis

A

Warfarin or apixaban preferred

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16
Q

warfarin monitroing

A

measure INR weekly during therapy initiation
measure atleast monthly in all pts after INR is stable

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17
Q

What are DOAC drugs

A

Dabigatran
Rivaroxaban
Apixaban
Edoxaban

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18
Q

Drugs for ventricular rate control

A

Diltiazem and verapamil
BB
digoxin
Amiodarone

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19
Q

How do diltiazem and verapamil affect AV nodal conduction

A

Inhibit AV nodal conduction

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20
Q

Do we administer diltiazem or verapamil to pts with ADHF?

A

Never

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21
Q

How to treat hemodynamically unstable A fib

A

No drugs, DCC shock

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22
Q

Hemodynamically unstable definition

A

SBP<90 mm/Hg
HR>150 BPM
Lost consciousness
are experiencing ischemic chest pain

if they have at least 1 of these, pt is hemodynamically unstable

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23
Q

If pt is hemodynamically stable and goal is acute ventricular rate control in A fib what is the next step?

A

we need to see if they have decompensated HF

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24
Q

If pt is hemodynamically stable and goal is acute ventricular rate control in A fib and they have decompensated HF what drug do we use?

A

Amiodarone

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25
If pt is hemodynamically stable and goal is acute ventricular rate control in A fib and they do not have decompensated HF what drugs do we use?
IV BB IV diltiazem IV verapamil
26
What to do if pt is hemodynamically stabel and goal is acute ventricular rate control in A fib and they do not have decompensated HF and BB, verapamil and diltiazem do not work?
Use Digoxin
27
What is digoxin, BB, diltiazem and verapamil do not work in hemodynamically stable pt with A fib without decompensated HF what drug do we use
Amiodarone
28
goal HR for a fib pts
<100-110 BPM
29
longterm ventricular rate control for A fib pts
Is LVEF>40 or <40
30
long term ventricular rate control if LVEF< 40 in a fib pts
BB
31
long term ventricular rate control in pts with LVEF<40 in a fib pts and BB does not work
digoxin
32
longterm ventricular rate control if LVEF>40 % in A fib pts
BB, diltiazem, verapamil
33
Longterm ventricular rate control in LVEF>40% in a fib pts and BB, diltiazem and verapamil do not work
Digoxin
34
Can we administer veraamil and diltiazem if LVEF < 40%
no
35
can we use verapamil and digoxin together
no
36
WHat to do if pt is on verapamil and digoxin
switch verapamil to diltiazem and alter digoxin dose
37
What are some rules before converting to sinus rhythm in a fib pts
If AF has been present <48 hrs, conversion to sinus rhythm is safe If AF has been present>48 hrs conversion to sinus rhythm should not be performed
38
What to do if AF has been present >48 hrs and we want to convert to sinus rhythm
Sinus rhythm should not be performed until pt has been anticoagulated for 3 weeks or unless TEE has been performed to rule out clot in atrium
39
What are some drugs to convert to sinus rhythm
DCC (non pcol) Amiodarone Ibutillide IV drugs Procainamide Flecainide Propafenne oral drugs
40
amiodarone adverse effects
Hypotension, bradycardia, QT prolongation
41
Ibutillide adverse effects
Torsades de pointes
42
Procainamide adverse effects
QT prolongation torsades de pointes, hypotension, HFrEF exacerbation
43
Flecainide and propafenone adverse effects
Dizziness Blurred vision HFrEF exacerbation
44
What do we have to be concerned about when doing DCC
Do not administer shock on T wave
45
hemodynamically stable AF to sinus rhythm treatment parameters
Normal LV function LV function<40 AF occuring outside hospital in pt with normal LV function
46
hemodynamically stable AF to sinus rhythm with normal LV function treatment
IV amiodarone Ibutilide
47
what to do in hemodynamically stable AF to sinus rhythm in normal LV when IV amiodarone and Ibutilide do not work
use Procainamide
48
Hemodynamically stable AF to sinus rhtyhtm in HFrEF (LVEF<40%) treatment
IV amiodarone
49
Hemodynamically stable AF to sinus rhythm treatment in AF occuring outside the hospital in pt with normal LV function
Felcainide/propafenone (pill in the pocket)
50
When should we not administer procainamide
If pt has already received amiodarone or ibutilide
51
Why should we not give procainamide if pt has already received amiodarone or ibutilide
Due to risk of excessive QT prolongation and torsades de pointes
52
Flecainide and propafenone should not be given in patients with
HFrEF
53
Drugs for maintainence of sinus rhythm and prevention of recurrence
Amiodarone Dofetillide Dronedarone Sotalol Propafenone Flecainide
54
How long does it take amiodarone to reach steady state? what is its half life?
It takes 10 months to get to steady state 2 month half life
55
What is a notable thing to know about amiodarone for the exam
Inhibits metabolism of warfarin
56
What to do if someone is on amiodarone and we add warfarin
We need to reduce warfarin dose by 1/3 and monitor INR until steady state
57
What to do if patient is on Digoxin and we add amiodarone
Put pt on half of digoxins dose (0.125 mg/day)
58
What is the most feared adverse effect of amiodarone
Pulmonary fibrosis
59
Dofetilide dosing
Crcl>60- 500 mcg po BID CrCl 40-60- 250 mcg po BID CrCl- 20-39- 125 mcg po BID
60
When is dofetilide contraindicated
CrCl<20
61
Adverse effect of dofetilide
torsades de pointes
62
Amiodarone monitoring
hypo/hyperthyroid baseline testing before therapy and monitor TSH. initial follow up 3-6 months additional follow up 6 months hepatotoxicity- ALT,AST baseline test and initial follow up 3-6 months, additional follow up 6 months QT prolongation- Baseline ECG follow up annually Pulmonary fibrosis- Baseline initial chest x ray
63

Therapeutics (38 decks)

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