Home CPD An update on atrial fibrillation

An update on atrial fibrillation

CPD

November 29, 2018

CPD credits

Accreditation Number : CAP1811A

Group 1 : 0.75 CPD credits

Group 2 : 1.5 CPD credits

This activity has been accredited for 0.75 hours of Group 1 CPD (or 0.75 CPD credits) suitable for inclusion in an individual pharmacist's CPD plan, which can be converted to 0.75 hours of Group 1 CPD (or 1.50 CPD credits) upon successful completion of relevant assessment activities.

Case scenario

Mr Jones, a 59-year-old man, was recently discharged from hospital following an admission for breathlessness and palpitations. His 12-lead electrocardiogram (ECG) confirmed fast atrial fibrillation, and a transthoracic echocardiogram showed a dilated left atrium and mitral stenosis. His past medical history includes hypertension treated with amlodipine 5 mg daily. He also currently takes aspirin 75 mg daily and simvastatin 40 mg daily.

He presents to your community pharmacy with new prescriptions for:

metoprolol 50 mg twice daily
warfarin 1 mg and 3 mg tablets as per international normalised ratio (INR)
simvastatin 40 mg at night.

He asks you about the changes in his medication.

Learning objectives

After successful completion of this CPD activity, pharmacists should be able to:

Discuss the prevalence and sequelae of atrial fibrillation
Describe key steps in the diagnosis of atrial fibrillation
Discuss key features of latest evidence-based guidelines for the management of atrial fibrillation
Discuss the importance of pharmacist-led patient education on atrial fibrillation.

Competencies (2016) addressed: 1.1, 1.5, 3.1, 3.2, 3.5.

Accreditation code: CAP1811A

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Rosuvastatin	Ridker Paul M, MacFadyen Jean G, Fonseca Francisco AH, et al. Number needed to treat with rosuvastatin to prevent first cardiovascular events and death among men and women with low low-density lipoprotein cholesterol and elevated high-sensitivity c-reactive protein. Circ Cardiovasc Qual Outcomes 2009;2(6):616–23.
Atorvastatin	Sever PS, Dahlöf B, Poulter NR, et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial--Lipid Lowering Arm (ascot-lla): a multicentre randomised controlled trial. Lancet 2003;361(9364):1149–58.
Pantoprazole	Pilotto A, Leandro G, Franceschi M. Short- and long-term therapy for reflux oesophagitis in the elderly: a multi-centre, placebo-controlled study with pantoprazole. Aliment Pharmacol Ther 2003;17(11):1399–406.
Esomeprazole	Gralnek IM, Dulai GS, Fennerty MB, et al. Esomeprazole versus other proton pump inhibitors in erosive esophagitis: a meta-analysis of randomized clinical trials. Clin Gastroenterol Hepatol 2006;4(12):1452–8.
Perindopril	Campbell DJ. A review of perindopril in the reduction of cardiovascular events. Vasc Health Risk Manag 2006;2(2):117–24.
Cefalexin	Rosengren H, Heal CF, Buttner PG. Effect of a single prophylactic preoperative oral antibiotic dose on surgical site infection following complex dermatological procedures on the nose and ear: a prospective, randomised, controlled, double-blinded trial. BMJ Open 2018;8(4):e020213.
Metformin	O'Connor PJ, Spann SJ, Woolf SH. Care of adults with type 2 diabetes mellitus. A review of the evidence. J Fam Pract 1998;47(5 Suppl):S13–22.
Escitalopram	Montgomery S, Hansen T, Kasper S. Efficacy of escitalopram compared to citalopram: a meta-analysis. Int J Neuropsychopharmacol 2011;14(2):261–8.
Amoxicillin	Little P, Stuart B, Moore M, et al. Amoxicillin for acute lower-respiratory-tract infection in primary care when pneumonia is not suspected: a 12-country, randomised, placebo-controlled trial. Lancet Infect Dis 2013;13(2):123–9.
Sertraline	Cipriani A, Furukawa TA, Geddes JR, et al. Does randomized evidence support sertraline as first-line antidepressant for adults with acute major depression? A systematic review and meta-analysis. J Clin Psychiatry 2008;69(11):1732–42.
Top 10 drugs	Top 10 drugs 2019–20. Aust Prescr 2020;43:209.

	Grade of recommendation*	Level of agreement (0–10)^†
1. Education and training in ergonomic principles, pacing of activity and use of assistive devices should be offered to every patient	A	9.3 (1.1)
2. Exercises to improve function and muscle strength, as well as to reduce pain, should be considered for every patient	A	9.1 (1.6)
3. Orthoses should be considered for symptom relief in patients with thumb-base OA. Long-term use is advocated	A	9.3 (1.0)
4. Topical treatments are preferred over systemic treatments because of safety reasons. Topical NSAIDs are the first pharmacological topical treatment of choice	A	8.6 (1.8)
5. Oral analgesics, particularly NSAIDs, should be considered for a limited duration for relief of symptoms	A	9.4 (0.9)
6. Chondroitin sulfate may be used in patients with hand OA for pain relief and improvement in functioning	A	7.3 (2.7)
7. Intra-articular injections of glucocorticoids should not generally be used in patients with hand OA but may be considered in patients with painful interphalangeal joints	A	7.9 (2.4)
8. Patients with hand OA should not be treated with conventional or biological disease-modifying antirheumatic drugs	A	8.8 (1.8)
9. Surgery should be considered for patients with structural abnormalities when other treatment modalities have not been sufficiently effective in relieving pain. Trapeziectomy should be considered in patients with thumb-base OA and arthrodesis or arthroplasty in patients with interphalangeal OA	D	9.4 (1.4)
10. Long-term follow-up of patients with hand OA should be adapted to the patient’s individual needs	D	9.5 (1.7)

Aged care funding confirmed

Addressing MBS access for pharmacists

Making pay and working conditions a priority

Other commitments

Actions speak louder than words

How can you make a difference?

Reaping the benefits

A pharmacy service blueprint

Top tips for aspiring sharks

New career heights

Get involved

Changing fortunes

Retaining pharmacists

Pharmacists’ role in opioid management

Promoting the standard in a community setting

Carefully dispensing opioids

Opioid safety is everyone’s responsibility

1. Perfect your co-administration technique

2. Patient care improves when barriers are removed

3. Remind overseas travellers to get vaccinated against flu at least 2 weeks before flying

4. Protecting children under 3 is a priority

5. Queensland-based pharmacists can vaccinate children 5 years and older

1. ATAGI recommends influenza vaccines for everyone over 6 months of age

2. NIP vaccines won’t arrive until early April. Eligible patients should wait

3. You need to check AIR before every jab (and upload it, too)

4. Despite administering COVID-19 vaccines, pharmacists still can’t vaccinate against influenza in kids <10 years

5. Children <3 years have never been exposed to influenza and are now a priority

6. Influenza vaccination should be offered throughout the flu season, not just at the start

PSA continues to fight to remove barriers to vaccination

Endometriosis quick facts

Periods shouldn’t be this painful

Professional obligation to oversee medicine profile

Resources

Case scenario

Learning objectives

Already read the CPD in the journal? Scroll to the bottom to SUBMIT ANSWERS.

Introduction

Illicit drug use and adverse events in Australia

What are novel psychoactive substances?

What is MDMA?

Drug checking in Australia

The drug checking process

What is the evidence?

Knowledge to practice

Case scenario continued

Conclusion

Key points

Case scenario

Learning objectives

Already read the CPD in the journal? Scroll to the bottom to SUBMIT ANSWERS.

Introduction

Aetiology and pathophysiology

Signs and symptoms

Diagnosis

Staging

Screening and prevention

Smoking cessation

Management of lung cancer

Targeted therapy – monoclonal antibodies

Chemotherapy NSCLC

Chemotherapy SCLC

Palliative care

Management of adverse effects of lung cancer treatment

Patient resources

Knowledge to practice

Case scenario continued

Conclusion

Key points

Case scenario

Learning objectives

Already read the CPD in the journal? Scroll to the bottom to SUBMIT ANSWERS.

Introduction

Statistical measures

Calculating the NNT

Interpreting the NNT

Informing patients about risk

Case scenario continued

Conclusion

Key points

Case scenario