Cardiac Drugs

Question 1

What are the stages of blood pressure?

Answer 1

Stage 1…
Clinical Blood pressure > or equal to 140/90mmHg and subsequent daytime average BP > or equal to 135/85

Stage 2…
>160/100mmHg

Severe…
Clinic systolic BP > or equal to 180mmHg or clinic diastolic > or equal to 110mmHg

Question 2

How do you manage hypertension?

Answer 2

Lifestyle advice- low salt diet, reduce caffeine intake, stop smoking, drink less alcohol, eat a balanced diet rich in fruit and veg, exercise, lose weight

Step 1…
Patients <55 year old or a background of type 2 diabetes mellitus- ACE- I or ARB

ARBS should be used when ACE-I are not tolerated (ie: due to cough)

Patients >55 y/o or of black african or african- caribbean origin should be offered a calcium channel blocker

Question 3

How does spironolactone affect the K+ levels?

Answer 3

Spironolactone is a K+ sparing diuretic and is used as a treatment for step 4 resistant hypertension which increases potassium

Question 4

How does an alpha or beta blocker affect the K+?

Answer 4

Will lower the k+, used in resistant hypertension if the K+ is >4.5

Question 5

How does ramipril work?

Answer 5

Is an angiotensin converting enzyme inhibitor and therefore Angiotensin 1 does not convert to angiotensin 2, therefore you get less Na+CL- reabsorption and H2O retention

Question 6

How does amlodipine work?

Answer 6

Is a calcium channel blocker and therefore prevents vasoconstriction of vessels, it relaxes and widens blood vessels.

Question 7

What are the side effects of amlodipine?

Answer 7

OEDEMA
PULMONARY OEDEMA
HEADACHE
FATIGUE
PALPITATIONS
DIZZINESS
NAUSEA 
FLUSHING

Question 8

How does aspirin work?

Answer 8

Blocks prostaglandin synthesis, non selective for COX-1 and COX-2 enzymes

Inhibition of COX-1 results in the inhibition of platelet aggregation

Question 9

What are the contra-indications of aspirin?

Answer 9

Active peptic ulceration 
Bleeding disorders
Children under 16- risk of Reye’s 
Haemophilia 
Previous peptic ulceration 
Severe cardiac failure

Question 10

When may aspirin be inappropriate in the elderly?

Answer 10

at long-term doses greater than 160 mg daily (increased risk of bleeding, no evidence for increased efficacy)
with a past history of peptic ulcer disease without concomitant proton pump inhibitor use (risk of recurrent peptic ulcer)
with concurrent significant bleeding risk, such as uncontrolled severe hypertension, bleeding diathesis or recent non-trivial spontaneous bleeding (high risk of bleeding)
when used with clopidogrel as secondary stroke prevention unless the patient has a coronary stent(s) inserted in the previous 12 months, or concurrent acute coronary syndrome,or has a high grade symptomatic carotid arterial stenosis (no evidence of added benefit over clopidogrel monotherapy)
when used with vitamin K antagonists, direct thrombin inhibitors or factor Xa inhibitors in patients with chronic atrial fibrillation (no added benefit from aspirin)

Question 11

What are the side effects of aspirin?

Answer 11

Common or very common…
With oral use- dyspepsia, haemorrhage

Uncommon- dyspnoea, rhinitis, severe cutaneous adverse reactions, skin reactions

Rare- aplastic anaemia, GI haemorrhage, granulocytosis