Chapter 2: Random Stuff

Question 1

For AF what is the preferred 1st line treatment strategy?
When is it not preferred?
What drugs are used?

Answer 1

Rate control.

Avoid in new onset AF, HF secondary to AF

Drugs:

• beta blockers (NOT SOTALOL)
• or verapamil or diltiazem (unlicensed)
• digoxin

Question 2

When is digoxin therapy preferred?

Answer 2

Rate control at rest.

Used as monotherapy in predominantly sedentary patients with non- paroxysmal AF.

AF with congestive HF

Question 3

How can sinus rhythm be restored?

Answer 3

By electrical cardioversion

Or pharmacological cardioversion (flecanide or amiodarone, sotalol )

Question 4

What drugs are used for supraventricular arrhythmias?

Answer 4

• Adenosine.
• Very short half life (8-10sec) but can be prolonged when given with dipyridamole.
• verapamil may be preferable to adenosine in asthmatics.

-amiodarone

Question 5

What are the further side effects info associated with dronedarone?

Answer 5

• Liver injury: STOP if 2 conservative ALTconcs exceed 3 times the upper limit.
• HF: STOP if new onset or worsening HF.
• pulmonary toxicity: STOP lung disease, pulmonary fibrosis, pneumonitis, SOB

Question 6

What is the important safety information associated with sotalol?

Answer 6

Prolonged QT interval.

Avoid hypokalaemia in patients taking sotalol.

Low Mg2+ and low K+ should be corrected before starting treatment

Question 7

When should the dose of digoxin be reduced by 1/2?

Answer 7

Concurrent use with amiodarone, quinine and dronedarone.

Question 8

What is used for subarachnoid haemorrhage?

Answer 8

Nimodipine oral/IV

IV Dosing:

Weight up to 70kg= 0.5mg/hr

Weight 70kg and above: 1mg/hr

Question 9

Which patients are considered to be at high risk of VTE?

Answer 9

• Substantial reduction in mobility
• obesity
• malignant disease
• history of VTE
• over 60 years
• HRT/COC
• Pregnancy
• significant co-morbidites

Question 10

When is infractionated heparin preferred?

Answer 10

Renal impairment
High risk of bleeding
Due to shorter duration of action.

Question 11

What is used for VTE in pregnancy and why?

Answer 11

-heparins do not cross the placenta

• LMWH is preferred because they have a lower risk of osteoporosis and heparin induced thrombocytopenia.
• LMWH are eliminated more rapidly and will require dose alternations

Question 12

What therapy is given in transient ischaemic attack?

Answer 12

• Aspirin ASAP 300mg

- Clopidrogel if aspirin is not suitable.

Question 13

What is the initial management of ischaemic stroke?

Answer 13

• Alteplase- if can be administered within 4.5 hours of symptom control. Given by experienced staff.
• aspirin should be started 24 hrs after thrombolysis OR ASAP within 48 jr if no thrombolysis.
• or clopidrel

Question 14

For PCI patients what it the duration of antiplatelet therapy with a drug elating stent?

Answer 14

Dual therapy: aspirin + clopidogrel 75mg

6 months

Question 15

For PCI patients what it the duration of antiplatelet therapy with a bare metal stent?

Answer 15

Dual therapy: aspirin + clopidogrel 75mg

1 month