Apixaban renal dose — GPhC CRA MCQ
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Correct answer: A — Withhold flecainide and query its use in structural heart disease
Withhold flecainide and query its use in structural heart disease: Class Ic antiarrhythmics can be pro-arrhythmic in structural or ischaemic heart disease; a normal current rate or baseline QRS does not remove that contraindication. Supply flecainide and arrange an ECG after three months: Delayed monitoring does not make initiation safe in a patient with the stated structural heart disease. Reduce flecainide to 50 mg twice daily because of age and body size: Age alone is not the decisive issue and an empirical lower dose does not remove structural-heart-disease risk. Add bisoprolol and supply flecainide at the prescribed dose: A nodal blocker may address atrial-flutter conduction in selected patients but does not make flecainide safe after myocardial infarction with reduced ejection fraction. Use propafenone at the same dose after confirming a normal baseline QRS: Another class Ic antiarrhythmic shares the structural-heart-disease concern and cannot be substituted independently.
Reference: BNF: flecainide acetate: https://bnf.nice.org.uk/drugs/flecainide-acetate/