Aust Prescr
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Atrial fibrillation carries a markedly increased risk of stroke and left ventricular dysfunction, and is associated with reduced quality of life In light of the potential for poor outcomes and the likely understated presence of silent atrial fibrillation, opportunistic screening should be carried out in general practice Modifying the risk factors for atrial fibrillation is the cornerstone of management with adjuvant drug therapy to help maintain sinus rhythm, control the ventricular rate and reduce the risk of cerebral thromboembolism The need for anticoagulant therapy can be assessed by using the revised CHA2DS2-VASc score. Direct oral anticoagulants are now preferred to warfarin in those who qualify for their use Catheter ablation is an effective option to improve survival in patients with left ventricular dysfunction. It also improves quality of life and reduces arrhythmia-related hospital admissions
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Penicillin allergies are not always lifelong. Approximately 50% are lost over five years A reaction to penicillin during a childhood infection is unlikely to be a true allergy Only 1–2% of patients with a confirmed penicillin allergy have an allergy to cephalosporins. In patients with a low risk of severe allergic reactions, cephalosporins are a relatively safe treatment option Patients with a history of delayed non-severe reactions, such as mild childhood rashes that occurred over 10 years ago, may be suitable for an oral rechallenge with low-dose penicillin. This should be done in a supervised hospital environment In many cases, with appropriate assessment and allergy testing, it may be possible to remove the penicillin allergy label