Competency > AF > Flashcards

AF Flashcards

(24 cards)

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1
Q

Possible sx of AF?

A
  • palpitation
  • chest pain
  • dyspnea
  • fatigue
  • lightheadedness
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2
Q

What are the two types of pharm therapy for AF?

A
  • rate control
  • rhythm control
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3
Q

What’s the target HR for rate control?

A

< 100-110bpm
without HF

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4
Q

Treatment options for rate control?

A

BB, non-DHP CCB, digoxin, amiodarone

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5
Q

When is BB indicated for rate control?

A
  • 1st line
  • preferred in pts with MI hx
  • for HFrEF: Bisoprolol, carvedilol, metoprolol
  • for HTN: labetalol, carvedilol
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6
Q

When is non-DHP CCB indicated for rate control? When to avoid?

A
  • pts CI to BB
  • preferred over BB in pts with asthma or COPD
  • avoid if concomitant LV systolic dysfunction (HFrEF)
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7
Q

When is digoxin indicated for rate control?

A
  • pts CI to BB
  • add-on to BB or non-DHP CCB
  • add-on for pts with HFrEF
  • for pts with uncontrolled HR, decompensated HF
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8
Q

When is amiodarone indicated for rate control?

A
  • last line
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9
Q

What is considered tachyarrhythmias and bradyarrhythmias in terms of HR?

A
  • tachy: >100bpm
  • Brady: <60bpm
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10
Q

What drugs cause QTc-prolongation?

A
  • antiarrhythmics (amiodarone, sotalol)
  • antimicrobials: FQ, macrolides, azoles
  • antidepressants: SSRI, TCA, SNRI
  • antipyschotics
  • triptans
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11
Q

What is the approach to managing AF?

A

ABC
- Avoid stroke (anticoagulation)
- Better sx control (rate, rhythm control)
- CV risk factors & concomitant disease (manage)

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12
Q

What are the lines of treatment for rate control?

A
  1. BB or non-DHP CCB
    - use BB if HFrEF
    - use non-DHP CCB if BB CI
  2. BB or non-DHP CCB (if not tried yet)
    - add digoxin to BB if HFrEF
    - replace or add digoxin to non-DHP CCB if CI BB
  3. amiodarone
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13
Q

When to consider rhythm control?

A
  • sx despite rate being well-controlled
  • pt would benefit from being in sinus rhythm (e.g. young age)
  • high likelihood to maintain sinus rhythm (short history, precipitated by temporary event)
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14
Q

What classes of antiarrhythmic drugs are used for rhythm and rate control?

A
  • rhythm: class I & III
  • rate: class II & IV
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15
Q

What are class I and III antiarrhythmics?

A

Class 1(c): flecainide, propafenone
Class III: amiodarone, dronedarone, sotalol

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16
Q

What are class II and IV antiarrhythmics?

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A

Class II: BB
Class IV: non-DHP CCB (diltiazem, verapamil)

17
Q

What antiarrhythmics are used for rhythm control in:
- no/min. signs of structural heart disease
- CAD, HFpEF, significant valvular disease
- HFrEF

Study These Flashcards
A
  • no/min. signs of structural heart disease: class Ic (flecainide, propafenone), class III (dronedarone, sotalol)
  • CAD, HFpEF, significant valvular disease: class III (amiodarone, dronedarone, sotalol)
  • HFrEF: amiodarone
18
Q

What monitoring should be done for amiodarone? (9)

Study These Flashcards
A
  • LFT
  • TFT
  • chest radiography
  • pulmonary function tests
  • ECG
  • ophthalmologic examination
  • skin toxicities
  • neurologic toxicity
  • N/V
19
Q

What do different CHA2DS2VASc scores mean?

Study These Flashcards
A
  • 0 in men / 1 in women: no need anticoagulant
  • 1 in men / 2 in women: consider anticoagulant
  • 2 in men / 3 in women: anticoagulant
20
Q

What does CHA2DS2VASc stand for?

Study These Flashcards
A
  • congestive HF
  • HTN (>140/90 on ≥2 occasions or current antiHTN tx)
  • age ≥75y (+2)
  • DM (FBG >2 or on DM meds) (+1)
  • prev stroke, TIA or thromboembolism (+2)
  • vascular disease (prev MI, PAD)
  • age 65-74y
  • sex category (not counted in modified version)
21
Q

Difference between antiplatelets & anticoagulants?

Study These Flashcards
A
  • antiplatelets block platelet aggregation (primary haemostasis) = prevent clots from forming
  • anticoagulants block activation of fibrin polymerisation (secondary haemostasis) = prevent clots from growing (clots already formed)
22
Q

Which group of pts have exceptionally high thromboembolic risk that oral anticoagulants should be started no matter what? What anticoagulant should these pts be started on?

Study These Flashcards
A
  • Presence of mechanical heart valves
  • Moderate-severe mitral stenosis

Start warfarin

23
Q

Are antiplatelets or anticoagulants used for preventing AF-related stroke?

Study These Flashcards
A

Antigcoagulants

24
Q

Which pts are at higher risk for stroke? (5)

Study These Flashcards
A
  • 65-74y
  • HF & ≥35y
  • HTN & ≥50y
  • DM & ≥50y
  • vascular disease & ≥55y
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