asmi
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What is the drug of choice to treat atrial fibrillation and flutter?
* what is their MOA , side effects and imp drug interactions ?
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| Bela
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DOC is Adenosine.
MOA: Activates K+ causing hyperpolarization of tissue.
SE: flushing, hypoT
Duration of action: 15 secs. WOW!
Other than this, probably you could use Class 1A antiarrhythmics and anything else that will increase the PR interval (Class 2,4, digoxin)
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| asmi
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atrial fibrillation :
:arrow: for acute control of rate : calcium channel blockers( diltiazem)
beta blockers
:arrow: for chronic control of rate : you can use digoxin( but it has its limitations)
:arrow: start anticoagulants ( warfarin suitable in most cases)
:arrow: antiarrythmics can be used ; qunidine /sotalol / flecinide/dofetilide
:arrow: elective cardioversion
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| Bela
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hey asmi,
where r u getting this info from? Cuz I just double checked First Aid and it says that DOC for AV nodal arrhythmias is Adenosine. Pharm section, page 323 or this year's edition.
regards!
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| asmi
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http://www.cmeprograms.umn.edu/bestpractice/afib/...
:idea: don't just read FA,need to read other books too ..
regards !!
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| mjl1717
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Asmi-Thx for the great article. Im with you Harrisons is one thing, but I wouldnt just go crazy with "First Aid". Also with this litiginous (law suit happy society) and well informed public I would agree in treating A. Fib or A. Flutter cautiously with old fashion well known meds that Work with few side affects. Especially if one is very familiar with those older meds.
The main point is you dont always have to be the first guy on the block to use the newer meds.
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| asmi
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so if asked in test..we have to prefer adenosine as first choice ??
I have seen a Q on kaplan where the choice was digoxin / diltiazem.
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| Bela
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Asmi,
Thnx for the advice  I have read Pharm Recall and Katzung but I think that First Aid has some really good points when it comes to pharm, especially the last review pages. I personally think it's like a mini version of baby Katzung.
Even in Katzung, I remember seeing that Adenosine is the DOC for AV nodal arrhythmias but I could be wrong. If they ask me on the exam, that is what I will put down and if that is not one of the choices, I'd stick with the other antiarrhythmics.
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| asmi
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thanks bela,
I think i rather should go through FA 8)
But what on kaplan Q bank i got a Q about AF ..they gave digoxin as treatment .
:roll:
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| Bela
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Asmi
I think u know a lot of stuff, mashaAllah. But from most people who took the exam, I heard that Pharm First Aid was right on the money.
Now, about Digoxin being a tx for ATRIAL arrhythmia, they're right. I mean, there are a lot of tx for atrial arrhythmia, so depends what they give us in the answer choice.
The way I remember the tx for ATRIAL arrhythmias are....
1) Class 1A since they treat both Atrial/ventricular arrhythmias
2) Anything that will increase PR, which is the time for atrial depol, right? So, Class 2,4 antiarrthythmics and Digitalis can do this, too.
DOC for Ventricular arrhythmias, post MI arrhythmias, or Digitalis induced arrhythmias :arrow: LIDOCAINE
Class 3, don't use 'em unless you have to for arrhythmias b/c of their side effects.
Dat's all 
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| asmi
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I change my words...." you must try to soak everything( as much as you can ) just like a sponge"
Since our field is very vast.
8)
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| Bela
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Lol! We'll never know everything. The key is to know the big picture and not get lost in the little things (which I do often unfortunately  )
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| mistral92
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actually for the trt of A/FIB ( in europe) i that it's not different in USA; we use ca inhibitory drugs ( like diltiazem or verapamil) or b blockers like ( esmolol metoprolol or propranolol) .
digoxin is a good choice but almost of the time we use it in association with ca inhib or b block ( because the efficacy of dixo is delayed until the 24 hours...
hope this will help you...
cardioversion review it's indications and the precaution before doing it.
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| mistral92
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indication of adenosine is "ACUTE" supraventricular tachycardia
.
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| asmi
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thanks mistral92..
I agree with you and thats what i too think
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