Cardiac drugs Flashcards
What is the most appropriate first line drug to reduce serum cholesterol + risk of cardiovascular events? How do you prescribe it and what are some other important things to know?
Drug: Atorvastatin 10mg tablets
D/R/F: 20mg PO OD (at night)
SE: myalgia (more likely if co-prescribing with macrolides (e.g.clarithromycin) as it inhibits CYP450 system - slow statin metabolism, ++ SEs), discontinue if CK >5x ULN; LFT derrangement, GI + sleep disturbance, headache
Indicated if Qrisk >10%
Caution: chronic renal impairment
Monitoring:
LFTs before, 3/12 and 12/12 months of treatment
Slight ALT derangement is expected but not an indication to withdraw treatment - only if 3x upper limit of ref range
What is the risk of prescribing an ACE inhibitor with and NSAID?
NSAID e.g. ibuprofen - in sufficient doses - inhibits prostaglandin synthesis in the kidney, reducing cortical blood flow and renal function
ACEi e.g. ramipril blocks renal production of angiotensin 2 which protects GFR when renal blood flow is reduced
Together, can precipitate a significant drop in renal blood flow and subsequent pre-renal AKI
What are the key features of betablockers? (names, mechanism, indications, route/dose, SE/CIs, monitoring, counselling)
Drugs:
- Bisoprolol, atenolol
Mechanism:
- Block Beta adrenergic receptors and thus acts as a negative chrono- and inotrophic effects
Indications + Route/dose:
- HTN, angina -
SEs:
- Headache, fatigue, diarrhoea
CIs:
- Asthma
Monitoring:
Counselling:
THIS DOESNT FEEL LIKE A GOOD SYSTEM/WORTHWHILE USE OF TIME … ESPECIALLY WHEN WE HAVE TO USE THE BNF FOR ALL PRESCRIBING… AND WHEN WE WILL MOST LIKELY HAVE ELECTRONIC PRESCRIBING AND PHARMACISTS TO CATCH OTHER ERRORS…
What are the key side effects of ACE-i’s?
ACE-i
A - Angieodema - of the face, any time within the 1st yr (ACE gives you a swollen fACE)
C - Cough - bradykinin build-up; CI asthmatics
E - Elevated potassium
i - 1st dose hypotension
