2. Cardiovascular drugs 1 Flashcards

Question

What to consider when giving anticoagulation?

Answer 1

Risk vs benefits - bleeding risk via HAS-BLED score

Answer 2

``` Bleeding risk H- Hypertension =1 A- Abnormal renal/liver function = 1 point each S- Stroke in past = 1 B- Bleeding history =1 L- Labile INRs =1 E- Elderly =1 D- drugs/alcohol concomitantly =1 point each ```

Answer 3

Radiofrequency catheter or cryo-ablation | Left atrial appendage occlusion (LAAO)

Answer 4

Ischaemic (blocked up) | Haemorrhagic (bleed out)

Answer 5

``` Fibrinolysis Antithrombotics -aspirin -clopidogrel -warfarin or DOACs Lipid modification Treat hypertension ```

Answer 6

For primary and secondary prevention Exclude secondary cause of increased lipids e.g. excess alcohol, uncontrolled diabetes, hypothyroidism, liver disease and nephrotic syndrome

Answer 7

Consider referral if: 1. Total serum cholesterol >7.5mmol/l + family history of premature coronry artery disease 2. Total serum cholesterol >9mmol/l

Answer 8

``` Total 5 or below HDL 1 or above LDL 3 or below Non-HDL 4or below Triglycerides 2.3 or below ```

Answer 9

Offer atorvastatin for primary prevention of CVD to people who have: - 10% or greater 10 year risk of developing CVD - T1DM - CKD

Answer 10

Atorvastatin for ANYONE who has had a stroke or MI regardless of cholesterol

Answer 11

Monotherapy treats primary (heterozygous familial or non familial) hypercholesterolaemia in adults in whom initial statin therapy is contraindicated or not tolerated Ezetimine coadministered w initial statin therapy might be appropriate

Answer 12

Nicotinic acid - stops FFA formation Fibrates - oxidise DDas and stop VLDLs and promote formation of HDLs Statins - inhibit HMG-CoA making cholesterol, and promote uptake of cholesterol to liver Ezetimibe - inhibits dietary cholesterol absorption into blood Resins - promote fats into the bile to be excreted?

Answer 13

Alirocumab, evolocumab bind to PCSK9, inhibiting the receptor binding to LDLRs on hepatocytes and causing their degradation which leads to more blood LDL-C levels, so results in less LDL cholesterol in the blood

Answer 14

Poor ventricular function/myocardial damage (e.g. post MI or dilated cardiomyopathy) leads to decreased SV and CO leads to neurohormonal response leads to activation of sympathetic system and RAAS result in vasoconstriction, increased sympathetic tone, angiotensin II, endothelins, impaired NO release -> sodium and fluid retention, increased vasopressin and aldosterone leads to further stress on ventricular wall and dilatation (remodelling) leads to worsened ventricular functioning leads to further heart failure

Answer 15

Relieve symptoms | Reduce mortality

Answer 16

Lifestyle - exercise, decrease alcohol, smoking cessation Drugs Devices Surgery

Answer 17

Diuretics (improve symptoms) ACEI (slightly improve symptoms, mostly reduce mortality) Beta-blockers (improve symptoms and massively improve mortality) Aldosterone antagonists (improve symptoms and reduce mortality) ARBs (improve symptoms and reduce mortality) Hydralazine/nitrates (improve symptoms and reduce mortality) Digoxin (improve symptoms)

Answer 18

loop diuretics: -furosemide thiazides: - bendroflumethiazide - metolazone (thiazide-like) K+ sparing: - spironolactone (mineralocorticoid receptor antagonists) - amiloride

Answer 19

Furosemide | act at Na/K/Cl symporter

Answer 20

bendroflumethiazide Metolazone (thiazide-like) act at Na/Cl symporter

Answer 21

spironolactone and amiloride act at epithelial Na channel

Answer 22

provide symptom control reduce cardiac preload side effects

Answer 23

increase life expectancy vs placebo Effect more marked in patients with more severe LV dysfunction Benefit for all NYHA classes Reduces risk of hospitalisation

Answer 24

ACE inhibitors inhibit ACE forming Angiotensin II from Angiotensin I, and bradykinin's effect ARB inhibit angiotensin receptors Effects: vasoconstriction, salt and water retention, aldosterone secretion

Answer 25

``` Ramipril Lisinopril Enalapril Perindopril Captopril (not used as much due to short half-life) ```

Answer 26

losartan, candersartan, valsartan Reduces mortality Some data on QOL, symptom control used in patients who can't tolerace ACE-I

Answer 27

BB increase life expectancy vs placebo All NYHA classes Reduces hospitalisation Low dose, titrate up, monitor HR, BP, clinical progression

Answer 28

Patients w severe heart failure, NYHA III-IV Increases life expectancy Reduces hospital admission low dose (12.5-25mg)

Answer 29

inhibits aldosterone secretion

Answer 30

Diuretics ACE-i (ARBs) Beta blockers Spironolactone

Answer 31

Ivabradine - use with or instead of BB if HR >75bpm Hydralazine & nitrate - use if ACEi/ARB not tolerated or contraindicated or in people of African origin Sacubitril(neprilysin inhibitor)/valsartan (ARB) - with NYHA class II to IV, a left ventricular ejection fraction of 35% or less and, who are already taking a stable dose of an ACE inhibitor or angiotensin receptor antagonist

Answer 32

inhibitors of sodium-glucose cotransporter 2 (SGLT2) - works at S1 segment proximal tubule - 90% of renal glucose reabsorption diabetes drug but treats heart failure as a second result

Answer 33

Sit patient upright | High dose oxygen -> corrects hypoxia

Answer 34

IV loop diuretics - venodilation and diuresis IV opiates/opioids (morphine) - reduce anxiety and preload (venodilatation) IV, buccal or sublingual nitrates - reduce preload& afterload, ischaemia and pulmonary artery pressures Continue beta blockers but DO NOT initiate!