arrythmias + hypertension + heart failure Flashcards
what is the first line treatment to get rate control
a standard beta blocker (that is, a beta blocker other than sotalol) or a rate limiting calcium channel blocker (diltiazem or verapamil).
- note: If question has both beta blocker + CCB, chose beta-blocker as first line*
which class of drugs should not be given to to patients with severe peripheral vascular disease
betablockers (e.g bisoprolol, atenolol)
note: this is because peripheral vascular disease is a common side effect of betablockers
what is white/pink frothy sputum a common symptom of
heart failure
what is , breathlessness particularly at night and swollen ankles/legs a common symptom of
heart failure
why is the use of both ACE inhibitors and ARBs contraindicated
contraindicated because it increases the risk of hypotension, hyperkalemia and renal impairment
which antihypertensive should be avoided in patients with severe bilateral renal artery stenosis
ramipril
which class of antihypertensives interact with lithium
ACE inhibitors interact with lithium- they increase the concentration of lithium
note: ACE inhibitor e.g ramipril, enalapril, lisinopril
which class of medications can cause peripheral coldness as a common side effect
beta blockers
note: it is common for beta blockers to cause cold extremities e.g cold hands + feet as a side effect
what are the main side effects of Heparins
Heparin e.g: enoxaparin, dalteparin, heparin
- Haemorrhage
- Heparin-induced thrombocytopenia
- Hyperkalaemia
which diagnostic technique can be used to assess what type of anticoagulation is required in patients suffering from atrial fibrillation
CHA2DS2VASc
what is the first-line long term therapy for stable angina
- first line: beta-blockers
- rate-limiting CCB used if beta blockers not tolerated or patient has Prinzmetal’s angina
note: if a patient has prinzmetal angina they can also be treated with Dihydropyridine derivative calcium-channel blockers (such as amlodipine)
which type of beta-blockers can be used in patients with asthma if there is no suitable alternative to beta-blockers
cardioselective beta-blockers e.g Atenolol, bisoprolol, metoprolol, nebivolol
note: beta-blockers are avoided in patients with asthma due to bronchospasm but if there are no other alternative, you can use cardioselective beta-blockers with caution
which drugs should be avoided in patients with hyperlipidaemia + moderate liver disease
Statins & Ezetimibe should be avoided in liver disease
what increases the risk of Rhabdomyolysis from statins
- HYPOthyroidism (should be managed before starting statin)
- Concomitant treatment with drugs that increase plasma-statin concentration
- concomitant treatment with a fibrate
- high doses of statin (e.g simvastatin 80mg, atorvastatin 20mg +, rosuvastatin 10mg +)
- personal or family history of muscular disorders/ muscular toxicity
- a high alcohol intake
- renal impairment
which type of sulfonylureas have a higher risk of hypoglycemia
longer acting sulphonylureas (such as Glibenclamide, glyburide and glimepiride) have a higher risk of causing hypoglycemia than shorter acting sulphonylureas (such as gliclazide, glipizide, and tolbutamide)
how does amlodipine interact with simvastatin
Amlodipine slightly increases the exposure to simvastatin.
Manufacturer advises adjust simvastatin dose to a max. 20 mg daily with concurrent use of amlodipine
what is the first line treatments for hypertension WITH diabetes
ACEi or ARB
why should patients taking hydrochlorothiazide report any new skin lesions or changes to skin lesions
MHRA warning: long-term use of hydrochlorothiazide increases the risk of non-melanoma skin cancer, especially in long-term use
what is the preferred first-line diuretic for the management of hypertension
indapamide (a thiazide-like diuretic)
what is the first line treatment for an afro-carribean patient WITH diabetes + hypertension
In Afro-Caribbean patients, a calcium channel blocker is usually the first choice of antihypertensive drug.
However, as this patient has diabetes, the first-line antihypertensive should be an ACE-inhibitor
what monitoring is needed for patients taking proton pump inhibitors
serum-magnesium concentrations
PPIs cause hypomagnesemia
note: need to monitor especially when used with other drugs that cause hypomagnesaemia or with digoxin
how often should patients taking amiodarone have their thyroid function monitored
Thyroid function tests need to be conducted before
treatment and then every 6 months
- amiodarone can cause HYPERthyroidism as common side effect
what is the interaction between digoxin and itraconazole
Itraconazole increases the concentration of Digoxin
note: itraconazole normally used for different types of candidiasis infections, Athlete’s foot (tinea pedis), Ringworm (tinea corporis)
what is the interaction between Sotalol + Citalopram/Escitalopram
Sotalol, Citalopram + Escitalopram all prolong the QT interval.
Most manufacturers advise avoiding the use of two or more drugs that are associated with QT prolongation
what should a patient taking amiodarone do if they experience symptoms such as:
abdominal pain or tenderness; clay-coloured stools; dark urine; decreased appetite; skin rash, yellowing of skin or eyes
seek immediate medical attention - symptoms of hepatotoxicity
what is the blood pressure for patients with hypertension who are UNDER 80 yrs old
- give clinic blood pressure and ambulatory/ home blood pressure
- clinic blood pressure: below 140/90 mmhg
- ambulatory/ home blood pressure: below 135/85 mmhg
what is the target clinic blood pressure for patients with hypertension who are OVER 80 yrs old
- give clinic blood pressure and ambulatory/ home blood pressure
- clinic blood pressure: below 150/90 mmhg
- ambulatory/ home blood pressure: below 145/85 mmHg
name the 3 antihypertensives that can be used in pregnancy
- labetalol (first line)
- methyldopa
- nifedipine (unlicensed)
which statin is recommended for the primary prevention of CVD for people who have a 10% or greater 10-year risk of developing CVD
low dose statin- atorvastatin 20mg daily
note: also given as primary prevention in patients with: type 1 diabetes who are either aged over 40 years, have had diabetes for more than 10 years, have established nephropathy, or have other CVD risk factors
which statin is recommended in secondary prevention of CVD
high dose statin - atorvastatin 80mg once daily
which antihypertensives can cause “first dose hypotension”
Alpha-adrenoceptor blockers: e.g doxazosin, alfuzosin, prazosin
which class of diuretics is associated with gynecomastia
aldosterone antagonists: e.g eplerenone, spironolactone
note: eplerenone is used in heart failure
which 2 antihypertensive classes can cause oedema
- ACE inhibitors: they cause angioedema (more common in black patients)
- CCB: can cause peripheral oedema
what advice should you give to a patient if they describe to you symptoms of digoxin toxicity
digoxin should be withdrawn - patient should stop taking it
note: A digoxin plasma concentration within the therapeutic range does not exclude digoxin toxicity. so patients can still have digoxin toxicity but plasma- concentration won’t show it
which diagnostic test is used to measure cardiac function in heart failure
Pro B-type natriuretic peptide
- this will be raised in heart failure
which classes of antihypertensives cause hyperkalemia
- ACE inhibitors
- ARBs
which electrolytes are affected by thaizide-like diuretics and how
- HYPOkalaemia
- hyponatraemia
- hyperglycaemia
- hyperuricaemia
how does amiodarone affect thyroid function
it can cause both HYPERthyroidism + HYPOthyroidism
what can be given to a patient with unstable angina if glyceryl trinitrate spray is ineffective
Aspirin 300mg dispersible tablets + glyceryl trinitrate spray/ tablets
which CHA2DS2-VASc Scores mean the patient doesn’t need to start anticoagulants (for both men + women)
low/ no risk of stroke is:
- score of 0 for men
- score of 1 for women
CHAD2DS2-VASC tells us a patients risk of stroke. Adults with non‑valvular atrial fibrillation and a CHA2DS2-VASC stroke risk score of 2 or above are offered anticoagulation
what is a high HAS-BLED score
score of 3+ means high risk of bleeding
- need to review pt meds
- note: ORBIT is now also used to calculate risk of bleeding. An ORBIT score of 0-2 is low risk, 3+ is medium/high risk*
what is the treat for STABLE angina
- GTN spray when required (can be used before exercise)
- For long-term prevention of chest pain: beta-blockers. verapamil + diltiazem can be used as alternatives e.g in For long-term prevention of chest pain in patients with stable angina,
secondary prevention:
- low dose aspirin (75mg) + statin (atorvastatin 80mg)
