308 Cardiovascular drugs: 1 and 2 Flashcards
What is HBPM?
Home BP Monitoring
What are the symptoms of hypertension?
None – ‘Silent Killer’
Headache
Blurred vision
Dizziness
Shortness of breath
Palpitations
Epistaxis
What is a fundoscopy?
Ophthalmoscopy
Detects eye problems, such as glaucoma, macular degeneration, eye cancer, optic nerve problems, or eye injury
What are some non-drug treatments for hypertension?
Weight reduction
DASH eating plan
Dietary sodium restriction
Physical activity
Alcohol moderation
What are the target blood pressures for different ages?
140/90 mmHg in people aged under 80
150/90 mmHg in people aged 80 and over
What are some reasons why treatment for hypertension may fail?
-Pseudo-resistant Hypertension (Non adherence; white coat effect; multiple intolerance to antihypertensive drugs)
-Secondary Hypertension
-Resistant Hypertension
What is the difference between and hypertensive emergency and urgency?
Emergency:
Severe “hypertension”
(BP≥ 180/120 mmHg) with acute damage to the target organs
Lower BP in minutes to hours
Urgency:
Severe “hypertension” without acute damage to the target organs
Lower BP after a review within 7 days
What are some clinical features of a hypertensive crisis?
Asymptomatic
Headache
Epistaxis
Presyncope
Palpitations
Chest pain
Dyspnoea
Neurological deficit
What are some acute signs of target organ damage for a hypertensive crisis?
Eyes (papilloedema)
Brain (encephalopathy, stroke)
Heart (pulmonary oedema, MI)
Kidneys (AKI)
Aortic dissection
What are some non-acute signs of target organ damage?
-Fundoscopy – Hypertensive retinopathy
-Urinalysis – Proteinuria
-ECG – LVH, AF
-Blood tests – U&E
What is the treatment for a hypertensive emergency?
Same day specialist review
IV Therapy – Labetalol, GTN, Sodium nitroprusside, Esmolol
What is the treatment for a hypertensive urgency?
Check for target organ damage
ABPM/HBPM
GP follow up within 7 days
Oral treatment
What is Ezetimibe therapy?
Used to treat primary hypercholestrolaemia in adults where initial statin therapy didn’t work or is contraindicated
Can be co-administered with statins
What is QRISK used for?
Risk of cardiovascular disease in the next 10 years
What are the risk factors for AF?
-Hypertension
-Age
-Cardiac disorders - Valvular heart disease; Coronary artery disease; Cardiomyopathy; Congenital heart disease; Previous cardiac surgery; Pericarditis
-Lung disease - PE, Pneumonia, COPD, OSAS
-Hyperthyroidism
-Alcohol, High BMI, Smoking
-Electrolyte disorders – Magnesium; Potassium
-Diabetes
What are the different types of AF?
-Lone AF
-Paroxysmal (<7 days)
-Persistent (>7 days)
-Permanent (>7 days ± Cardioversion)
What are clinical features of AF?
Asymptomatic
Palpitations
SOB
Chest pain
Syncope
Pre-syncope
Heart failure
What are the different treatment strategies for AF?
Rate control
Rhythm control
Anticoagulation
When do you do rhythm control vs rate control to treat AF?
<48hrs: rhythm control
>48hrs: rate control
When is rhythm control treatment preferred?
Symptom improvement
Younger patient
Inadequacy of rate control
Heart failure related to AF
Name some beta-blockers
Non-cardioselective:
Propanolol
Carvedilol
Sotalol
Cardioselective:
Atenolol
Bisoprolol
Esmolol
Metoprolol
Nebivolol
Vasodilatory:
Labetalol
Carvedilol
Name some rate limiting calcium channel blockers
Verapamil
Diltiazem
What is the CHA2DS2 VaSc score?
The risk of developing a stroke with AF
At what CHA2DS2 VaSc score are DOAC’s or warfarin prescribed?
> 2
What is the HAS-BLED score?
Estimates risk of major bleeding for patients on anticoagulation to assess risk-benefit in atrial fibrillation care
H – Hypertension = 1
A – Abnormal renal/liver function = 1 point each
S – Stroke in the past = 1
B – Bleeding history = 1
L – Labile INRs = 1
E – Elderly = 1
D – Drugs/Alcohol concomitantly = 1 point each
What is the ORBIT score?
Estimates the risk of major bleeding for patients on anticoagulation for AF
What are some non-drug treatments for AF?
Radiofrequency catheter or cryo-ablation – pulmonary veins
(Useful for paroxysmal AF)
Left atrial appendage occlusion (LAAO)
What are some reversible causes of AF?
Hypoxia
Hypovolemia
Hypo/hyperkalemia/metabolic
Hypothermia
Tension pneumothorax
Tamponade
Toxins
Thromboembolism
What is the initial management for STEMI?
Morphine/Diamorphine (+antiemetic)
Oxygen
Nitrates ie. GTN infusion
Aspirin
Clopidogrel/Prasugrel/Ticagrelor
Percutaneous Coronary Intervention (PCI)
What is Percutaneous Coronary Intervention (PCI)?
Minimally invasive procedures used to open clogged coronary arteries
Name some ACE inhibitors
Ramipril
Lisinopril
Enalapril
Perindopril
What are the causes about causes of sudden SOB?
Acute bronchospasm
Arrhythmia
Anxiety
Pulmonary oedema
Pneumothorax
Pulmonary embolism
