cardio lover 2 - a_antibody

[ArchivalUser]

You are seeing a 68-year-old woman for the first time in your office. She has just moved her care to you
after her primary care physician retired. She has a history of chronic atrial fibrillation, diabetes,
gastritis, and osteoarthritis and she takes glyburide and ranitidine. She has no known drug allergies.
During your interview you find out that she is very active and walks 3 miles a day. Her blood pressure is
128/76 mm Hg and heart rate is 80/min and irregular. Her lungs are clear to auscultation bilaterally and
her cardiac examination is significant for an irregularly irregular rhythm. A finger stick blood glucose is
87 mg/dL. Based on your history and physical examination, the most appropriate pharmacologic agent
to add to her regimen is


A. digoxin

B. ibuprofen

C. metoprolol

D. NPH insulin

E. warfarin

[ArchivalUser]

warfarin

[ArchivalUser]

E. warfarin

[ArchivalUser]

ee...

[ArchivalUser]

E. warfarin

[ArchivalUser]

should we cardiovert after warfarina or can we opt for another pharmacologic therapy to change the rythm?

[ArchivalUser]

Y not metopropanol to control rate and later warfarin.
?????????

[ArchivalUser]

B..BLOKER MASK THE EFFECT OF HYPOGLYCEMIA ...HOPE IT HELPS ..

[ArchivalUser]

Explanation:

The correct answer is E. A patient with chronic atrial fibrillation is at risk for atrial thrombi and
subsequent embolization leading to stroke. Therefore, all patients who are in chronic atrial fibrillation
should be anticoagulated unless a contraindication to anticoagulation (recent surgery) exists.

Digoxin (choice A) is an agent that is used in atrial fibrillation for both rate control and maintenance
of sinus rhythm. It is not appropriate in this setting since the patient is in atrial fibrillation with
reasonable rate control.

Ibuprofen (choice B), a nonsteroidal antiinflammatory drug, can be considered in this setting given
the patient's history of osteoarthritis. However, it is relatively contraindicated given her history of
gastritis, especially since she is so active without pharmacologic assistance.

Metoprolol (choice C) is a beta one selective beta antagonist that can be used for heart rate control
in patients with atrial fibrillation. However, since this patient has a heart rate of 80/min, it is not
merited at this time.

NPH insulin (choice D) is a long acting insulin preparation used in patients who have
insulin-dependent or insulin requiring diabetes mellitus. This patient has a finger stick blood glucose
of 87 mg/dL, and therefore, is well managed with her oral hypoglycemic agent at this juncture.

[ArchivalUser]

Am I missing something here? What is she taking to control rate and rhythm here?