Cardio Flashcards
Antidote dabigatran
Idarucizumab
Cardio selective beta-blockers
Bisoprolol
Atenolol or Acebutolol
Metoprolol
Nebivolol
Beta-blockers licensed for AF and HF
Bisoprolol
Carvedilol
Nebivolol
Beta-blocker of choice for people with AF and a previous MI
Needs to be without HF
Metoprolol
Atenolol
Propanolol
Signs and symptoms of fast AF in a haemolytic instable patient
rapid pulse > 150 bpm low BP with systolic < 90 mmHg loss of consciousness severe dizziness syncope ongoing chest pain increase breathlessness
First-line treatment fast AF
use B-blockers
DO NOT USE CCB
Interactions simvastatin
Bezafibrate and ciprofibrate: MAX 10 MG
Amiodarone, amlodipine, ranolazine: MAX 20 MG
Verapamil and Diltiazem (moderate CYP3A4 inhibitor): MAX 20 MG
Elbasvir with grazopevir: MAX 20 MG
Lomitapide and ticagrelor: MAX 40 MG
Erythromycin: C/I, stop simva and continue abx.
Drugs that cause Hypokalaemia
Laxatives (excessive use - stool excretion) Diuretics (renal excretion) Beta-blockers (high dose - taken up by cells) Corticosteroids (renal excretion) Insulin (taken up by cells) Theophylline (taken up by cells) Penicillins (high dose - renal excretion) Verapamil (overdose - taken up by cell) Gentamicin Sodium Bicarbonate Amphotericin Echinochandin antifungals Cisplatin Parecoxib
Dabigatran S/E
Hepatic impairment - avoid if LFT 2X baseline
Haemorrhage
hyperbilirubinaemia
Thrombocytopenia
MHRA: DOACS increase risk recurrent DVT in pt with antiphospholipid syndrome
Dabigatran Indications
Prophylaxis DVT after hip/knee surgery - decrease dose in 75+
Prophylaxis DVT after hip/knee replacement for pt on amiodarone/verapamil - decrease dose in 75+
Treatment DVT or prophylaxis recurrent DVT - decrease dose in 75-79 and a further decrease in 80+
Prophylaxis DVT in renal impairment/high bleeding risk (same dose all ages)
Prophylaxis DVT for pt on verapamil (same dose all ages)
Prophylaxis DVT in non-valvular AF with one of more risk (a previous stroke or MI, LEVF < 40%, symptomatic HF, age 75+,
age 65+ with diabetes or HTN or CVD) - diff dose 18-74, then decrease 75-79, then decrease 80+
Prophylaxis DVT in non-valvular AF with 1+ factor for pt on verapamil
Prophylaxis DVT in non-valvular AF with 1+ factor for pt with renal impairment
WHEN TAKEN WITH AMIODARONE OR VERAPAMIL DOSE TO BE TAKEN AT THE SAME TIME
Dabigatran monitoring
S+S bleeding and anaemia
Renal function - AVOID UNDER CRCL 30 ML/MIN - before and annually
Erythormycin and statins
high-risk rhabdomyolysis
C/I use with simvastatin
okay atorvastatin max 20mg OD
Rosuvastatin (use with caution), pravastatin and fluvastatin are okay
treatment HTN
under 55 or T2DM:
1. ACEI/ARB
2. ACEI/ARB + CCB OR Thiazide-like diuretic
55+ or black african carribean:
1. CCB
2. CCB + ACEI/ARB OR Thiazide like diuretic
3rd line:
ACEI/ARB + CCB + Thiazide like diuretic
after:
low dose spironolactone if potassium less or equal to 4.5 mmol/l
B-blocker or A-blocker if potassium above 4.5 mmol/l
aims BP in HTN
under 80: 140/90 mmHg
80+: 150/90 mmHg
T2DM: 140/90 mmHg
if eye or cerebral complications: 130/80 mmHg
CKD: 120-139/80-90 mmHgmanagement of TIA/Stroke
initially: 300mg aspirin ASAP for 14 days - unless C/I or already on a daily low dose of aspirin
NP: increase physical activity and smoking cessation and diet optimisation, decrease alcohol consumption
P:
1. antiplatelet for 12 mths thereafter
Clopidogrel 75mg OD
M/R dipyridamole 200mg BD AND Aspirin 75mg OD (if clopi C/I)
2. High-intensity statin
Atorvastatin 20-80mg OD
aim non-HDL reduction by >40% in 3 mths
3. antihypertensive - ACEI/CCB/thiazide like diuretic
aim BP < 130mmHg (140-150 in severe aortic stenosis)
4. if pt has AF - anticoagulant
start after 14 days of TIA/stroke - give aspirin 300mg
INR target 2-3
5. contraception - progestogen-only contraception or non-hormonal contraception ONLY. Care with post-menopausal treatment.
6. vaccine - annual influenza vaccine
7. DVLA - pt to report incident to DVLA
