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Old 01-28-2013
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Arrow Billy Step 1 Questions # 105

A 68-year-old man comes to the emergency department because of a 5-hour history of palpitations and light-headedness. He states that he has experienced shorter episodes of palpitations before, but nothing so severe. After admission to the hospital, the patient receives a full cardiac work-up and is diagnosed with rapid atrial fibrillation, most likely secondary to a moderately stenosed mitral valve. Medical treatment to convert him to sinus rhythm is unsuccessful However, his heart rate is well controlled with various atrioventricular node blocking agents. The patient is prescribed a regimen of daily medications including drugs to control potentially disastrous complications of atrial fibrillation. Which of the following drugs is most likely prescribed long-term to prevent such complications?


(A) Aspirin
(B) Protamine sulfate
(C) Streptokinase
(D) Unfractionated heparin
(E) Warfarin
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i think warfarin!u start with heparin first and then shift to warfarin tapering off the heparin eventually
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E) warfarin
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Default E

(E) Warfarin
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A 68-year-old man comes to the emergency department because of a 5-hour history of palpitations and light-headedness. He states that he has experienced shorter episodes of palpitations before, but nothing so severe. After admission to the hospital, the patient receives a full cardiac work-up and is diagnosed with rapid atrial fibrillation, most likely secondary to a moderately stenosed mitral valve. Medical treatment to convert him to sinus rhythm is unsuccessful However, his heart rate is well controlled with various atrioventricular node blocking agents. The patient is prescribed a regimen of daily medications including drugs to control potentially disastrous complications of atrial fibrillation. Which of the following drugs is most likely prescribed long-term to prevent such complications?


(A) Aspirin
(B) Protamine sulfate
(C) Streptokinase
(D) Unfractionated heparin
(E) Warfarin
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warfarin fo' shizzle

hey I have a request for you, billy. I love you for putting questions up, but could you put a title that gives a clue about what the question is about? like here it would be "treatment in atrial fibrillation" or something. it just makes it a lot easier to navigate around questions
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Old 01-28-2013
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Quote:
Originally Posted by billy View Post
A 68-year-old man comes to the emergency department because of a 5-hour history of palpitations and light-headedness. He states that he has experienced shorter episodes of palpitations before, but nothing so severe. After admission to the hospital, the patient receives a full cardiac work-up and is diagnosed with rapid atrial fibrillation, most likely secondary to a moderately stenosed mitral valve. Medical treatment to convert him to sinus rhythm is unsuccessful However, his heart rate is well controlled with various atrioventricular node blocking agents. The patient is prescribed a regimen of daily medications including drugs to control potentially disastrous complications of atrial fibrillation. Which of the following drugs is most likely prescribed long-term to prevent such complications?


(A) Aspirin
(B) Protamine sulfate
(C) Streptokinase
(D) Unfractionated heparin
(E) Warfarin

Warfarin is drug of choice in AF. Just get ready to give Fresh frozen plasma in case of overdose!!!
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I would give Vitamin k to be honest...
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What if this patient has unknown Protein C defiency and given this Warfarin; later develops tissue necrosis? Always think the big picture. Fresh frozen plasma will be treatment of Warfarin overdose in the long run.
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ans. warfarin
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Old 01-29-2013
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Correct Answer E is correct

Chronic atrial fi brillation is a risk factor for clot formation and systemic embolization. This man needs ongoing anticoagulation to prevent possible complications, such as cerebrovascular accidents or mesenteric infarction. Warfarin inhibits gamma-carboxylation of vitamin K-dependent clotting factors and is used for chronic anticoagulation. It is taken orally and has a long half-life. The degree of anticoagulation must be followed by measuring the International Normalized Ratio.
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