3. Investigations and Drug Therapy

Question 1

Three main groups of antiplatelet agents

Answer 1

Aspirin
Clopidoggrel, prasugrel, Ticagrelor
GPIIb/IIIa inhibitors - Tirofiban, Epifibatide ( IV)

Question 2

What is dual antiplatelet therapy for and what it is, how long doe sit last for

Answer 2

For AC, Aspirin + Clopidogrel, for 6 mo followed by lifelong single antiplatelet

Question 3

Rx for stable CAD

Answer 3

Single antiplatelet, aspirin or clopi

Question 4

Side effects of antiplatelets

Answer 4

GI bleeding, consider prescribing with PPI

Question 5

Vit K antagonist and main con

Answer 5

Warfarin, requires close INR monitoring

Question 6

Direct Factor Xa inhibitor

Answer 6

Apixaban, Rivaroxaban, Edoxaban

Question 7

Direct thrombin inhibitor

Answer 7

Dabigatran

Question 8

What is an antithrombin III agonist and its half life, what should be monitored

Answer 8

UFH, 60 mins, APTT/ACT

Question 9

What is fondaparinux (mech) and half life

Answer 9

ANtothrombin III-mediated selective inhibitor of factor Xa, half life 15h

Question 10

Anticoag for ACS, what if undergoing emergency PCI

Answer 10

Fonda
UFH

Question 11

AF anticoag

Answer 11

Apixaban or warfarin, or direct thrombin inhibitor eg. dabigatran

Question 12

Anticoag for metallic prostethic valve

Answer 12

WARFARIN,
or UFH

Question 13

What should be used in end-stagge renal failure

Answer 13

warfarin or UFH

Question 14

Reversal agent for UFH and direct factor Xa inhib

Answer 14

Protamine and adexanet alfa

Question 15

How do statins work

Answer 15

They are HMG-CoA reductase inhibitors

Question 16

Contrainidications of lipid lowering therapies

Answer 16

Acute liver disease, pregnancy and breastfeeding

Question 17

Side effects of lipid lowering therapies

Answer 17

Diarrhoea, muscle aches, rheabdomyolysis ( esp with concurrent fibrates and cytochrome p450 inhibitors)

Question 18

Indications (3) for RAAS antagonists and specify which one

Answer 18

Acei//ARB +MRA for CHF
ACEi/ARB for hyperT and post-MI sec prevention

Question 19

Contraindications for Acei/ARBS

Answer 19

Severe AS, bilateral renal artery stenosis, pregnancy

Question 20

Side effects of ACEi

Answer 20

Angioedema, first dose hypotensionm dry cough

Question 21

Does ARB produce dry cough

Answer 21

No

Question 22

Side effect of RAAS antagonists

Answer 22

Angioedema, first dose hypotension

Question 23

What is the effect of neprilysin inhibitors

Answer 23

Vasoconstrictions as neprilysin is involved in vasodilation by degrading NP

Question 24

Heart failure drugs, in order

Answer 24

Loop diuretics
B blockers/Ace I
MRA
SGLT2/ARNI

Question 25

How do K sparing diuretics work

Answer 25

Inhibit sodium absorption in the DCT, used to treat hyperT, may also be used in combination with loop diuretics to treat pts with sever fluid retention

Question 26

Side effects of diuretics and specify

Answer 26

Hypovol, hypona Loop- Hypokal K sparing- Hyperkal Renal impairment

Question 27

Effect of diuretics on calcium

Answer 27

Loop- hypo Thiazide - hyper K sparing-nil

Question 28

what kind of diuretic is indapamide

Answer 28

Thiazide

Question 29

What kind of diuretic is amiloride

Answer 29

K sparing

Question 30

What do B blockers inhibit

Answer 30

Noradrenaline

Question 31

Indications of B blockers

Answer 31

Angina, CHD, post mi sec prevention, AF,V and SC arrhythmia suppression

Question 32

Contrainidcations of B blockers

Answer 32

2 and 3 degreee heart block, severe PVD, asthma, patients on VERAPAMIL

Question 33

Difference between both types of CCBs

Answer 33

DHP has higher affinity fo vasc smmoth muscle eg. amlodipine- causes peripheral edemavasodilation, reduction in BP and afterload` , NDHP has more afinity on myocardium, -ve ino and chrono eg.verapamil and diltiazem

Question 34

WHat CCB can be used for angina

Answer 34

Both dhp and ndhp

Question 35

What CCB can be used for AF

Answer 35

NHDP

Question 36

Contraindications for CCB

Answer 36

Hypotension, severe AS, AV block (NDHP), heart failure, B blockers (NDHP)

Question 36

Side effects of CCB

Answer 36

Ankle oedema, constipation, bradyC, hypoT

Question 37

How do nitrates afect preload and afterload

Answer 37

reduce both, improving coronary blood flow and myocardial oxygen demand

Question 38

When will IV GTN be used

Answer 38

Acute decompensated heart failure

Question 39

Contraindications for nitrates

Answer 39

Aortic stenosis, HOCM, viagra, hypotension

Question 40

Side effects of nitrates

Answer 40

Headache

Question 41

How does nicorandil work and side effects

Answer 41

Activate potassium channels, causing vasodilation and venodilation, similar to nitrates Headache, hypoT, skin/mucosal membrane ulceration

Question 43

How does ivabradine work

Answer 43

Reduces heart rate only in patients in sinus rhym , inibits channel in SA node Used in patients intolerant to B blockers, used to treat CHF