Brian (cardiac)

Question 0

Brian has been warned not to stop taking metoprolol abruptly. Y?

Answer 0

Up regulation of beta receptors. Which will cause a rebound hypertension

Question 1

2 potential adverse effects of metoprolol that have significance for Brian’s care at the clinic today

Answer 1

Postural hypertension- cannot increase heart rate to compensate from going from lying to standing
LA- adds to affect of beta blocker. Drops BP

Question 2

Elimination half life of metoprolol is 3.5hrs. Explain the meaning of this statement

Answer 2

Half life is the time it takes for the plasma concentration of drug to be reduced by 50%. For metoprolol this is 3.5hours

Question 3

What therapeutic class of drug is bendroflumethazide

Answer 3

Thiazides diuretic

Question 4

Outline the rationale for prescribing bendroflumethazide in the tx of heart failure

Answer 4

Prescribed a diuretic to get rid of excess na and water.

Decrease workload on heart and helps reduce peripheral swelling.

Question 5

Why is Brian prescribed warfarin in the management of his atrial fibrillation

Answer 5

To stop clot formation and reduce the risk of stroke

Question 6

Warfarin has a narrow therapeutic range explain the meaning of this statement.

Answer 6

There is a large gap between the minimum effective concentration and the minimal toxic concentration

Question 7

Told not too eat lots of cabbage whole on warfarin. Y?

Answer 7

Cabbage contains high levels of vitamin K. Warfarin interferes with vitamin k clotting factors by increasing production. INR will decrease making the risk of clotting higher.

Question 8

What info should be obtained prior to imitating treatment.

Answer 8

What is his last IRN

When did he last have it

Question 9

Brian’s most recent IRN was 2.5. Explain the meaning.

Answer 9

INR- international normalised ratio

Takes him 2.5 times longer to clot. Goal is 2-3 so is sighing normals so can continue with treatment

Question 10

State your professional responsibilities regarding Brian’s GTN prescription.

Answer 10

Tell him to bring GTN to appointment 
Make sure it is available
1 spray infecting under tongue
Wait 5 mins
If still in pain call ambulance

Question 11

Dentist suggest oxygen use with GTN spray. Outline response to suggestion

Answer 11

No unless hypoxia which we can’t tell

Oxygen can worsen and cause basis past, vasoconstriction. could worsen infarction

Question 12

Mechanism of action of GTN in relief to chest pain

Answer 12

Angina when oxygen demand is greater than supply.
GTN increases vasodilation leads to decrease in venous return leads to decreases in systemic vascular resistance. Leads to decreased cardiac workload

Question 13

Option to consider for la p

Answer 13

Mepivacaine