ACS Flashcards
1
Q
ACE- I indications
A
- HTN in any context
- CCF
- IHD
- Diabetic nephropathy or CKD with proteinuria
2
Q
MOA of ACE-i
A
- block the action of ACE to prevent the conversion of Ang I to II. This dilates efferent arteriole reducing progression of CKD. .
3
Q
SE of ACE-i
A
- hypotension
- persistent dry cough
- hyperk+
- cause or worsen renal failure especially those with renal artery stenosis who need cosntricted efferent to maintain filtration.
- angioedema and anaphylaxis
4
Q
who should you not give ace-i
A
- renal artery stenosis
- AKI
- women who are or want to become pregnant or breastfeeding
5
Q
when should you lower the dose of ace-i
A
CKD
6
Q
interactions of ace-i
A
- avoid giving with other potassium elevating drugs.
- if given with diuretics can cause first dose hypotension
- NSAID and ACE-I = nephrotoxic risk
7
Q
name ace-is
A
ramipril, lisinopril, perindopril
8
Q
common starting dose of ramipril
A
1.25mg in HF or neohropathy or 2.5mg iin others
max dose = 10
9
Q
when should you take ace-i
A
with or without food. first doe before bed to limit hypotension
10
Q
what over the counter meds those on ace-i should not take
A
ibuprofen
11
Q
when should u check u and e after starting ace-i
A
1-2 weeks
12
Q
when do you stop ace-i
A
if serum creatine rises more than 30% or egfr falls more than 25%.
if k+ above 5, stop other k+ sparing drugs then reduce dose of ace. if >6, stop ace-i
13
Q
Indications for ARBS
A
where ACE-i are not tolerated due to cough. indications are the same as ACE-I
14
Q
MOA of ARBS
A
Block action fo ang II on AT1 receptor.
15
Q
ARBS SE
A
- First dose hypotension
- Hyperkalaemia
- Renal failure
16
Q
when should ARBS be avoided
A
- Renal artery stenosis
- AKI
17
Q
when should ARBS be used cautiously
A
Breastfeeding and Pregnancy and CKD - use lower dose in CKD
18
Q
Name ARBS
A
Losartan, Candesartan, Irbesartan
19
Q
Starting dose of losarten in HF
A
12.5mg
20
Q
Common starting dose for losartan in anythign other than HF
A
50mg
21
Q
Beta blockers indications
A
- IHD
- CCF
- AF
- SVT
- HTN
22
Q
MOA BB
A
- B1r in heart, B2r in SM
- BB reduce force of contraction and speed of conduction in heart
- slow refractory period of AVN so helpful in AF
- HTN; BB reduce renin - as this is mediated by b1 receptors
23
Q
SE of BB
A
- Cold extremities
- Fatigue
- headache
- GI distrubance
- sleep disturbance and nightmare
- Impotence in men
24
Q
Who do you not give BB to
A
Asthma, those with Heart block
25
when to use BB at low dose
- HF - as at first they impair heart function
- Hepatic failure
- avoid in haemodynamic instability
26
interactions of BB
- Non-dihydropyridine ccb - verapamil, diltiazem. do not combine unless specialist advice.
27
name b1 selective BB
Bisoprolol, metoprolol
28
advice to patients as to when to take BB
At same time everyday roughly
29
Indications fo heparin and fondaparinux
- DVT, PE
| - ACS - used with antiplatelet agents
30
MOA heparin/ fondaprinux
enhance anticoag effect of antithrombin.
- UFH = inavtivates F11a and Xa.
- MWH = FXa
- Fonda = Xa
31
SE of heparin/fondaprinux
- Haemorrhage (lower with fonda)
- bruising at injection site
- Hyperk+
- HIT/HITT - less with MWH
32
Use anticoags cautiously in which patients
- clotting disorders
- severe uncontrolled HTN
- Recent surgery or trauma
- Renal impairment - use lower dose and use UFH
33
when to withhold anticoags
- before and after surgery +LP and anaesthesia
34
protamine reverses which heparin
UFH
35
indications for nitrates
- angina and acs
- long acting for angina prophylaxis
- pulmonoary oedema rx with furosemide and o2
36
MOA of nitrates
- increases cGMP and refuces calcium in vascular smooth muscle cells = relax = reduce cardiac work and myocardial o2 demans
- relax systemic arteries - reduce afterload
37
SE Nitrates
- flushing
- headache - warn many initially
- light-headedness
- hypotension
can become tolerant - reduce by timing doses. always have a nitrate free period in day often before bed
38
CI of nitrates
- severe aortic stenosis - cause CVS collapse
| - haemodynamic instability esp hypotension
39
Nitrate interactions
- PDE -i
| - use carefully in those with HTN meds as can have opposite effect
40
plasma lif eof GTN
<5minutes
41
In ACS or HF - how do you prescribe GTN
= IV infusion
42
isosorbide mononitrate half life
4-5 hours BD or TDS use.
43
IV GTN dose
50mg in 50ml = 1mg = 1ml infusion rate. increase related to sx. so increase by 0.5ml/hr every 15-30mins till sx relieved. but systolic to stay abouve 90mmhg
44
strong opioid examples
morphine
| oxycodone
45
indications for strogn opioids
- acute severe pain including post op and MI
- Relief of chronic pain if other methods on ladder havent worked
- relief of SOB in palliative care
- Relief of SOB and anxiety in acute pulmonary oedema along with o2, furosemide, nitrates
46
MOA strng opioids
mew receptor activation = GPCR on = reduced neuronal excitability and transmission.
- in medulla - blunt response to hypxia and hypercapmoea = low RR
- relieve pain as above = reduce Sympathetic NS response - reduce cardiac demand and o2 demand
47
SE strong opioids
- Resp depression
- Euphoria and detachment and neurologicald epression
- N and V
- pupil constriction as stimulate edinger westphal
- constipation as mew receptors increase SM tone and reduce motility
- skin - histamine release = itching, urticaria, vasodilatation and sweat
- dependance and tolerance - withdrawal reactions
48
When to reduce strong opioid doses
- hepatic and renal failure
| - old
49
CI to strong opioids
- Resp failure untill senior approved
- biliary colic - spasms sphincter of odii = worse pain
- other sedating drugs
50
Acute pain what route do you give strong opioids
IV - initial 2-10mg but can give IM and SC
51
Chronic pain route for strong opioids
oral
52
statins indications
- Primary prevention CVD
- Secondary prevention CVD
- primary hyeprlipidaemia
53
MOA of Statins
- inhibit HMG CoA reductase which makes cholesterol
- reduce cholesterol production in liver and increase clearance of LDL
- reduce TG and increase HDL
54
SE statins
- Headahce
- GI disturbance
- myopathy
- rhabdomyolysis
- rise in ALT
- drug induced hepatitis - rare
55
reduce dose of statins for which patients
- hepatic impairment
- renal impairment
- pregnant females ir breastfeeding as need cholesterol for foetal development
56
Interactions with statins
CYP450 reduces metabolism e.g. amiodarone, diltiazem, itraconazole, macrolides. = accumulation = increased SE
- withold statin when necessary STM treatment on above drugs
57
when should patients take simvastatin
evening as cholesterol synthesis is most in early morning hours
58
warnings to patients taking sivmastatin or atorvastatin
dont drink too much alcohol, avoid grapefruit juice
59
what bloods need to be done before statin given
- ALT in LFT at base, 3 and 12 months. rise up to 3x UNL is acceptable but no more
- also check lipid profile before and 3 months after rx if priamry prevention
60
what disease should be ruled out before prescribing statin for hyperlipidaemia
- Hypothyroid
| - note hypothyroid will give increaed risk of myositis with statins
