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Top 100 drugs > ACS > Flashcards

ACS Flashcards

1
Q

ACE- I indications

A
  1. HTN in any context
  2. CCF
  3. IHD
  4. Diabetic nephropathy or CKD with proteinuria
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2
Q

MOA of ACE-i

A
  1. block the action of ACE to prevent the conversion of Ang I to II. This dilates efferent arteriole reducing progression of CKD. .
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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
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4
Q

who should you not give ace-i

A
  • renal artery stenosis
  • AKI
  • women who are or want to become pregnant or breastfeeding
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5
Q

when should you lower the dose of ace-i

A

CKD

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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
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7
Q

name ace-is

A

ramipril, lisinopril, perindopril

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8
Q

common starting dose of ramipril

A

1.25mg in HF or neohropathy or 2.5mg iin others

max dose = 10

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9
Q

when should you take ace-i

A

with or without food. first doe before bed to limit hypotension

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10
Q

what over the counter meds those on ace-i should not take

A

ibuprofen

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11
Q

when should u check u and e after starting ace-i

A

1-2 weeks

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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

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13
Q

Indications for ARBS

A

where ACE-i are not tolerated due to cough. indications are the same as ACE-I

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14
Q

MOA of ARBS

A

Block action fo ang II on AT1 receptor.

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15
Q

ARBS SE

A
  • First dose hypotension
  • Hyperkalaemia
  • Renal failure
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16
Q

when should ARBS be avoided

A
  • Renal artery stenosis

- AKI

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17
Q

when should ARBS be used cautiously

A

Breastfeeding and Pregnancy and CKD - use lower dose in CKD

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18
Q

Name ARBS

A

Losartan, Candesartan, Irbesartan

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19
Q

Starting dose of losarten in HF

A

12.5mg

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20
Q

Common starting dose for losartan in anythign other than HF

A

50mg

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21
Q

Beta blockers indications

A
  1. IHD
  2. CCF
  3. AF
  4. SVT
  5. HTN
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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
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23
Q

SE of BB

A
  • Cold extremities
  • Fatigue
  • headache
  • GI distrubance
  • sleep disturbance and nightmare
  • Impotence in men
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24
Q

Who do you not give BB to

A

Asthma, those with Heart block

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25
Q

when to use BB at low dose

A
  • HF - as at first they impair heart function
  • Hepatic failure
  • avoid in haemodynamic instability
26
Q

interactions of BB

A
  • Non-dihydropyridine ccb - verapamil, diltiazem. do not combine unless specialist advice.
27
Q

name b1 selective BB

A

Bisoprolol, metoprolol

28
Q

advice to patients as to when to take BB

A

At same time everyday roughly

29
Q

Indications fo heparin and fondaparinux

A
  • DVT, PE

- ACS - used with antiplatelet agents

30
Q

MOA heparin/ fondaprinux

A

enhance anticoag effect of antithrombin.

  • UFH = inavtivates F11a and Xa.
  • MWH = FXa
  • Fonda = Xa
31
Q

SE of heparin/fondaprinux

A
  • Haemorrhage (lower with fonda)
  • bruising at injection site
  • Hyperk+
  • HIT/HITT - less with MWH
32
Q

Use anticoags cautiously in which patients

A
  • clotting disorders
  • severe uncontrolled HTN
  • Recent surgery or trauma
  • Renal impairment - use lower dose and use UFH
33
Q

when to withhold anticoags

A
  • before and after surgery +LP and anaesthesia
34
Q

protamine reverses which heparin

A

UFH

35
Q

indications for nitrates

A
  • angina and acs
  • long acting for angina prophylaxis
  • pulmonoary oedema rx with furosemide and o2
36
Q

MOA of nitrates

A
  • increases cGMP and refuces calcium in vascular smooth muscle cells = relax = reduce cardiac work and myocardial o2 demans
  • relax systemic arteries - reduce afterload
37
Q

SE Nitrates

A
  • 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
Q

CI of nitrates

A
  • severe aortic stenosis - cause CVS collapse

- haemodynamic instability esp hypotension

39
Q

Nitrate interactions

A
  • PDE -i

- use carefully in those with HTN meds as can have opposite effect

40
Q

plasma lif eof GTN

A

<5minutes

41
Q

In ACS or HF - how do you prescribe GTN

A

= IV infusion

42
Q

isosorbide mononitrate half life

A

4-5 hours BD or TDS use.

43
Q

IV GTN dose

A

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
Q

strong opioid examples

A

morphine

oxycodone

45
Q

indications for strogn opioids

A
  • 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
Q

MOA strng opioids

A

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
Q

SE strong opioids

A
  • 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
Q

When to reduce strong opioid doses

A
  • hepatic and renal failure

- old

49
Q

CI to strong opioids

A
  • Resp failure untill senior approved
  • biliary colic - spasms sphincter of odii = worse pain
  • other sedating drugs
50
Q

Acute pain what route do you give strong opioids

A

IV - initial 2-10mg but can give IM and SC

51
Q

Chronic pain route for strong opioids

A

oral

52
Q

statins indications

A
  • Primary prevention CVD
  • Secondary prevention CVD
  • primary hyeprlipidaemia
53
Q

MOA of Statins

A
  • inhibit HMG CoA reductase which makes cholesterol
  • reduce cholesterol production in liver and increase clearance of LDL
  • reduce TG and increase HDL
54
Q

SE statins

A
  • Headahce
  • GI disturbance
  • myopathy
  • rhabdomyolysis
  • rise in ALT
  • drug induced hepatitis - rare
55
Q

reduce dose of statins for which patients

A
  • hepatic impairment
  • renal impairment
  • pregnant females ir breastfeeding as need cholesterol for foetal development
56
Q

Interactions with statins

A

CYP450 reduces metabolism e.g. amiodarone, diltiazem, itraconazole, macrolides. = accumulation = increased SE
- withold statin when necessary STM treatment on above drugs

57
Q

when should patients take simvastatin

A

evening as cholesterol synthesis is most in early morning hours

58
Q

warnings to patients taking sivmastatin or atorvastatin

A

dont drink too much alcohol, avoid grapefruit juice

59
Q

what bloods need to be done before statin given

A
  • 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
Q

what disease should be ruled out before prescribing statin for hyperlipidaemia

A
  • Hypothyroid

- note hypothyroid will give increaed risk of myositis with statins

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