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CPTP - Af & Anti Coagulation
CPTP - Af & Anti Coagulation
ATRIAL FIBRILLATION
Definition
Disorganised atrial depolarisation propagating in different directions without effective atrial contraction
Atrial fib 350-600 beats /min.
ventricular response is grossly irregular at 100-160 beats
Types
Management
CLASS 1
AF
Mechanism of Action
Shortens phase 3
repolarisation
Slows phase 3; Flecanide,
Propafenone
Adverse effects
Indications
Interaction/CI
AF & ANTI-COAGULATION
CLASS 2
CLASS 3
OTHERS
K channel blockers
Amiodarone (IV
loading dose)
CLASS 4
Acute
Bronchospasm B2
antagonism (Caution in
asthma)
Negative inotropism
Negative
chronotropism
Chronic
Fatigue
Peripheral vasculature
Photosensitivity
Thyroid dysfunction
Pulmonary fibrosis
Many others
Inhibit Ca - dependent
depolarisation
Inhibits action potential in SA
and AV nodes.
Headache
Constipation
Ankle oedema
Hypotension
Cardiac glycosides
Vagolytic
Adenosine
Antipurinergic
Magnesium sulphate
SUMMARY
Acute pharmacological cardioversion
o Class 1C Flecanide or III - K channel blockers Amiodarone
Rhythm control
o Standard BB
Supraventricular
arrhythmias, Angina,
Hypertension, Prophylaxis of
cluster headache
AF & ANTI-COAGULATION
o Class 1C or III
Rate control B, C, D
o BB, CCB, Digoxin
Stroke risk reduction
o Antiplatelet or anticoagulant
Anti-coagulation
Stroke risk with AF
THROMBIN I.
A.PLATELETS
A.COAGULATION
ASPIRIN
Mechanism of action
Inhibits TA2 synthesis from arachidonic acid in platelets by
preventing arachidonate from binding to the active site.
Inhibition of COX-1.
Irreversibly inhibit the binding of ADP to its receptors on
platelets and thereby the action of GP IIb/IIa receptors
required for platelets to bind to fibrinogen and to each
other.
Indication
Prophylaxis of TIA
Method used
Should be taken 30 min before
ibuprofen or 8h after ibuprofen.
50 to 325mg oral.
Oral
Metabolise by CYP450
ENOXAPARIN
Injectable. Parenteral
Safe for pregnant
DABIGATRAN
CLOPIDOGREL
HEPARIN
Mechanism of action
Indication
Method used
AF & ANTI-COAGULATION
WARFARIN
Reduced vitamin K is an essential co-factor for
the synthesis of the clotting factors II, VII, IX
and X. Reduced vitamin K is achieved by the
actions of vitamin K reductase on vitamin K.
Warfarin antagonise the actions of Vitamin
K reductase on Vitamin K. This underlies the
therapeutic role of Vitamin K in the reversal of
the effects of Warfarin in cases of overanticoagulation.
Oral coagulants
INR was adopted to monitor
[warfarin] keep between 2 to 3
DO NOT give to PREGNANT pt.
Teratogenic; could cause
abortion and birth defects.
Inducers
Carbamazepine
Rifampicin
Alcohol chronic
St Johns Wort
Inhibitors x de metaboliser
Amiodarone
Erythromycin
Simvastatin
Ciprofloxacin
Grapefruit juice
Phenytoin