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Pharmacy Pre-reg > Cardio > Flashcards

Cardio Flashcards

1
Q

Initial management of Angina

A

Short acting Nitrate (GTN SL Spray) until stable then Beta blocker / CCB for prevention

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2
Q

If GTN + Beta blocker + CCB fail to control Angina what options are there

A

Long acting nitrate (Isosorbide mononitrate IR 1st then MR if required) / Ivabradine / Nicorandil / Ranolazine

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3
Q

Nitrate Contraindications

A

Aortic/Mitral stenosis, Anaemia, Hypotension, Hypovolaemia, Pericarditis, Brain bleeds with intracranial pressure, Pulmonary oedema

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4
Q

Nitrates Mechanism of Action

A

Converted into Nitric Oxide (Vasodilator) causes GTP->cGMP which causes vascular smooth muscle relaxation and dilation

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5
Q

How is Nitrate tolerance avoided

A

Maintain 10-14h Nitrate free period at night between doses, optimal ISMN dose is 8am 4pm

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6
Q

Nitrate SEs

A

Transient Hypotension (Dizzy, weak, palpitations, postural hypotension)

Headache (slow titration to avoid, subsides after 1-2w, caution if migraine)

Mouth burning, stinging, tingling = use lower strength/ GTN spray

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7
Q

Contraindicated interaction for Nitrates

A

Phosphodiesterase inhibitors (Sildenafil, Tadalafil) = excessive hypotension and myocardial infarction precipitation.

12h gap between dose of each

Angina attack during sex AVOID GTN

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8
Q

Ivabradine MoA

A

Inhibits SA node conductivity and prolongs diastolic depolarisation which slows heart rate, reducing cardiac muscle oxygen demand and so pain

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9
Q

Nicorandil MoA

A

cGMP mediated vascular smooth muscle dilation similar to nitrates

calcium channel inhibition causing muscle relaxation and dilation

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10
Q

Ranolazine MoA

A

Sodium and potassium channel inhibitor reducing contractility

Calcium channel inhibitor causing vascular smooth muscle dilation

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11
Q

Ivabradine SEs

A

Eyes - blurred vision, phosphenones (brief spots/flashes of light) v common

Bradycardia, AF, Transient headache, GI
QT prolongation, Angioedema, >Creatinine, Vertigo

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12
Q

Ivabradine interactions

A

CYP3A4ind/inh
QT prolongers
Grapefruit
rlCCBs excessive bradycardia aka heart block

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13
Q

Nicorandil issues

A

Headache in 22-48% people within 2 weeks treatment initiation
Dizzy, >HR, Flushing

uncommonly Angioedema,

GI ulcer rarely withdraw removes issue

Interacts with steroids and NSAIDs causing GI ulcer, PDE5i and AntiHTN causing hypotension

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14
Q

Ranolazine dose

A

375mg BD 2-4w -> 500mg BD, max 750mg BD

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15
Q

Ranolazine issues

A

AVOID CrCl <30mL/min, Ca 30-80mL/min
Ca if =<60kg
Interacts with = CI with CYP3A4ind/inh, statin dose adjust, QT prolonger, Immunosuppressant (Tac/Ciclo) toxicity

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16
Q

How do people score on a CHA2DS2VASc

A

CHF/ LV dysfunction 1pt
HTN (>140/90) or on AntiHTN 1pt
>=75y 2pts
DM (fasting >=7/ DM drugs/insulin)
Stroke/TIA/VTE 2pts
Vasc disease (MI/Peripheral Arterial Disease/Aortic plaque) 1pt
65-74 1pt
Female 1pt

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17
Q

What CHA2DS2VASc score warrants treatment

A

> =2 DOAC to all
1 consider DOAC unless only scoring for sex

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18
Q

When is Warfarin licensed for AF

A

2nd line to DOACs - target 2-3

1st if valvular AF (Mitral stenosis / Metallic valve, NOT graft valve) - target 3-4

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19
Q

How does a high INR affect Warfarin dosing

A

INR>8 hold Warfarin + Give Phytomenadiome (Vit K)
IV if bleeding, PO if not

Restart Warfarin when INR<5

INR 5-8 with bleeding hold Warfarin + Give IV Vit K, if not just hold 1-2 Warfarin doses

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20
Q

Peri-operative bridging of Warfarin

A

Hold 5d before op
High risk Start LMWH d3- + daily INRs
d1- If INR >1.5 give Vit K
LMWH 6h post op
To restart Warfarin co-administer LMWH until 2xINR in range

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21
Q

How long must DOACs be held for perioperatively

A

Apixaban, Edoxaban, Rivaroxaban 24h

Dabigatran with CrCl >80mL/min 24h, 50-80mL/min 48h

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22
Q

Under what conditions is an edoxaban dose reduced

A

=<60kg

CrCl 15-50mL/min

P-gp inhibitor co-administration (Ciclosporin, Dronadarone, Ketoconazole)

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23
Q

Under what conditions is Apixaban dose reduced

A

When using for nvAF if Pt has 2 from:
SCr >=133
>=80y
=<60kg
CrCl 15-29mL/min

Max dose 2.5mg BD

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24
Q

Indications for Apixaban

A

VTE prophylaxis following knee / hip replacement
Treatment then secondary prevention of DVT/PE
Stroke prevention in non-valvular AF

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25
How is a DVT/PE treated with Apixaban
10mg BD 7d -> 5mg BD 6m -> secondary prevention 2.5mg BD Weight and age don’t affect dose only CrCl 15-29mL/min
26
Which dose and how long for is Apixaban used for VTE prophylaxis in joint replacement
Both 2.5mg BD Hip 10-14d Knee 32-38d
27
What can Rivaroxaban be used for
VTE prophylaxis following hip/knee replacement and ACS Treatment, then secondary prevention of DVT/PE Stroke prevention in non-valvular AF
28
How must Rivaroxaban be administered
With food
29
How is a DVT/PE treated with Rivaroxaban
15mg BD 21d -> 20mg OD 6m -> 10mg OD (high risk stay on 20mg)
30
What dose and how long for is Rivaroxaban used for VTE prophylaxis in joint replacement
Both 10mg OD Hip 2w Knee 5w
31
What is the only factor that would warrant a dose reduction of Rivaroxaban
Max 15mg OD if CrCl 15-49mL/min
32
What other drugs can affect the licenses dose of dabigatran
Amiodarone Verapamil
33
How does renal function affect Dabigatran dosing
Contraindicated in paediatrics if CrCl <50mL/min Max 110-150mg and weight based dosing for adults with a CrCl 30-50mL/min
34
Surgical VTE prophylaxis dose for Dabigatran
18-74y = 110mg STAT 1-4h post-op -> 220mg OD starting on d1 >=75y or +Amiodarone/Verapamil = 75mg STAT 1-4h post-op -> 150mg OD Hip 28-35d Knee 10d
35
Is a DVT/PE treated the same as non-valvular AF with Dabigatran
Yes 5d LMWH 1st then on d6 post-op 18-74y 150mg BD 75-79y 110-150mg BD >=80y 110mg BD Max dose 110mg if Verapamil co-administered Max 110-150mg if CrCl 30-50mL/min
36
What drugs increase bleed risk when given with DOACs
SSRIs, SNRIs, Venlafaxine Antiplatelets NSAIDs
37
What drugs can increase or decrease DOAC exposure/ efficacy
Strong inducers / inhibitors of CYP3A4 and P-gp Inducers = Carbamazepine, Phenytoin, Rifampicin, St. John’s Wort Inhibitors = Itraconazole, Ketoconazole, Ritonavir
38
How do you swap between Warfarin and a DOAC
Warfarin -> DOAC = INR <2 start DOAC, 2-2.5 start DOAC next day, >2.5 wait until <2 then start DOAC. Apixaban -> Warfarin = co-administer for 2 days then check INR if in range stop DOAC and recheck INR 24h later Edoxaban -> Warfarin = 1/2 Edoxaban dose for co-administration, check >=2XINR in range then stop Edoxaban then recheck 24h later Rivaroxaban / Dabigatran -> Warfarin = Co-administer 2d until INR >=2 then stop Rivaroxaban / Dabigatran and recheck INR 24h later
39
AF treatment pathway
<48h dc/pharm Cardioversion >48h 3w Anticoagulation then dc Cardioversion Stroke prevention = DOAC / Warfarin depending on risk/ valves + Beta blocker (not sotalol and only choice if decompensated HF) / rlCCB (if LVf >=40% Verapamil) 2nd = + Digoxin (monotherapy 1st if others unsuitable and sedentary) Rhythm = Amiodarone/ Flecainide / Sotalol
40
CCB SEs
Gingivinal hyperplasia, ankle oedema
41
What must be monitored when treating with Amiodarone
Thyroid, Liver, Potassium, Lungs, corneal deposits in visual field, dazzling halo surrounding lights, peripheral neuropathy, phototoxic
42
What causes bradycardia, AV block and depressed heart function when given with Amiodarone
Beta blockers rlCCBs
43
What can cause ventricular arrhythmias when given with Amiodarone
Chloroquine, citalopram, escitalopram, haloperidol, lithium, mefloquine, phenothiazines, quinine, TCAs, quinolones
44
Signs of an AKI
Anuria, confusion, N&V, dehydration
45
ACEi issues
AKI, Hyperkalaemia, Dry cough, lithium toxicity, postural hypotension, hypotension
46
Which antiemetic can exacerbate heart failure
Cyclizine
47
What heart failure medicines are contraindicated in asthma and why
Beta blockers cause bronchoconstriction
48
What antihypertensive can cause renal failure
ACEi
49
How must ramipril be initiated
1st dose of 2.5mg at night to avoid fall due to 1st dose hypotension side effect
50
A patient with AF taking max dose bisoprolol had a heart rate of 120bpm so a new medicine was started. Their HR is now 30 and blood pressure 85/55. What medicines would be a likely culprit?
Rate limiting calcium channel blockers with beta blockers cause fatal heart block Amiodarone will also do this
51
What medicine will cause bronchospasm when given with a beta blocker and so should be avoided
Theophylline/ aminophylline
52
What class of antihypertensive can cause lithium toxicity and why
ACEi, ARB, TLD, Loops, MRA, sodium bicarbonate nephrotoxic, lithium renally cleared
53
Most common side effect of Isosorbide mononitrate
Headache Due to intracranial vasodilation Disappears after 1-3w
54
What population shouldn’t long term diuretics be used in
Elderly if only treating gravitational oedema aka ankle oedema. Can be used in HF though
55
What is the digoxin maintenance dose in elderly and why
125mcg Reduce risk of blood disorders aka bone marrow suppression
56
What is the maintenance dose of digoxin in renal patients and why
62.5mg to reduce risk of blood disorders like bone marrow suppression
57
Drugs that cause what should be avoided in elderly or renal patients taking digoxin
Bone marrow suppression Eg. Co-trimoxazole
58
What is the best CCB for HF
Amlodipine
59
rlCCB contraindications
Porphyria, HFrEF, Heart block, Bradycardia, Aortic stenosis, Sick sinus syndrome, postural drop >=20
60
Hyponatraemia symptoms
Headache Dry coated tongue Poor skin turgor/ no recoil Sunken eyes Convulsions Irritable N&V
61
Hypernatraemia symptoms
SALT Skin flushed Agitated Low grade fever Thirsty Convulsions Low blood pressure
62
Hypokalaemia symptoms
Skeletal muscle weakness Slurred speech Arrhythmias Constipation Hypertonic/tense Irregular/ weak pulse Orthostatic hypotension Numbness
63
Hyperkalaemia symptoms
Irritable Muscle weakness Abdominal cramps Hypotension Numbness Irregular pulse Arrhythmias Nausea Diarrhoea
64
Hypocalcaemia symptoms
Fractures Numbness Confusion Muscle twitches/fasciculations Diarrhoea Anxiety Irritable
65
Hypercalcaemia symptoms
Fatigue Confusion Constipation Bradycardia Polyuria Anorexia Renal failure Muscle weakness Lethargy Coma N&V
66
Hypomagnesaemia symptoms
N&V Tremor Dysphasia Hallucinations Tachycardia Confusion Drowsiness Hypertension Personality changes Anorexia Decreased appetite
67
Hypermagnesaemia symptoms
N&V Flushing Headache Cognitive impairment Hypotension Hyporeflexia aka poor reflexes
68
AKI symptoms
N&V Dehydration Confusion Reduced urine output Urine colour change Hypertension Abdominal pain often in rear Oedema
69
Ambulatory / home BP targets
<80y <135/85 >=80 <145/85
70
HTN definition BP
120-129/80 elevated 130-139/80-89 stage 1 >140/90 stage 2
71
Clinic BP Targets
<80y <140/90 >=80y <150/90
72
Pre-eclampsia treatment
New Hypertension in pregnancy 1st Labetalol 2nd Nifedipine 3rd Methyldopa Existing use normal HTN meds
73
When can’t tranexamic acid be used
Vision colour change discontinue Diarrhoea reduce dose Embolism Convulsions
74
Loperamide MHRA warning
Cardiac side effects and fatal arrhythmias due to QT prolongation
75
Pruritus is caused by an Imbalance of what
Hyperphosphataemia
76
Ramipril in renal impairment
Hold in AKI Max 5mg if CrCl 30-60
77
Statin therapy target reductions
40% in 3 months
78
Outline the CHA2DS2VASC scoring system
1 CHF / LV dysfunction 1 HTN / on AntiHTN 2 Age >=75 1 Diabetes / on AntiDM / Insulin / Fasting CBG >=7 2 Stroke / TIA 1 Vascular disease / MI / Peripheral Arterial Disease / Aortic plaque 1 Age 65-74 1 Sex Female
79
What do different CHA2DS2VASC scores mean
>=2 warrants DOAC therapy If male scoring 1 consider benefits of DOAC all females score minimum 1 so their minimum score for therapy is 2
80
Outline the ORBIT scoring system
2 Male Hb <130 / Haematocrit <40% 2 Female Hb <120 / Haematocrit <36% 2 Prev bleed 1 Age >=75 1 eGFR <60mL/min 1 Antiplatelet Low 0-2 Medium 3 High 4-7
81
What qualifies someone for DC Cardioversion
Life threatening haemodynamic instability caused by AF Or When rhythm control indicated after rate control failure >48h after AF symptom onset Caution patient must be fully anti coagulated for 3 weeks before and 4 weeks after cardioversion
82
When can rhythm control be started in AF
Onset AF <48h Or If dual rate control not effective
83
Rate control drugs in AF
Beta blockers not sotalol Or rlCCBs never together If sedentary and non-pAF and above not controlling Digoxin
84
What drugs are required surrounding electrical Cardioversion
Beta blocker rate control Antiarrhythmic 4 weeks before and 12 months after to improve success Anticoagulant 3 weeks before and 4 weeks after
85
How does atrial flutter treatment differ from AF
Rate control temporary until normal sinus rhythm restored Additional Cardioversion option using catheter ablation aka manual pacing for recurrent atrial flutter
86
Things that can induce torsades de pointes aka QT prolongation
Hypokalaemia SEV bradycardia Amiodarone Macrolides Antifungals SSRIs TCAs Haloperidol
87
Classes of antiarrhythmics
1 membrane stabilisers - Lidocaine, Flecanide 2 beta blockers 3 Amiodarone, Sotalol 4 rlCCBs
88
Amiodarone side effects
AVOID in Bradycardia = Heart block STOP if corneal microdeposits = blurred vision affecting driving Hypo / Hyper Thyroidism Photosensitivity = suncream + avoid exposure STOP if Hepatotoxic signs = Jaundice, pale stools DR if Pulmonary fibrosis signs = SoB, cough
89
Amiodarone interactions
Will interact for minimum 1 month after treatment cessation Hypokalaemia causers QT prolongers CYP substrates as it is an inhibitor, also a substrate itself Bradycardia causers
90
Amiodarone HCP monitoring
TFT pre- treatment then q6m LFT pre-treatment then q6m K+ pre-treatment Chest XR pre-treatment Eye test annually
91
Digoxin therapeutic range
0.7-2
92
Digoxin toxicity
Blurred vision Yellow vision Bradycardia N&V Confusion Palpitations Headache Dizziness Lethargic / Weak Diarrhoea
93
Digoxin side effects
Hypokalaemia Hypomagnesaemia Hypercalcaemia Arrhythmias Heart block Nephrotoxic Pericarditis
94
Digoxin reversal agent
Digoxin specific antibody Digifab
95
Max digoxin dose in specific populations
125mcg elderly 62.5mcg CrCl <30mL/min 125mcg with bone marrow suppressors like Co-trimoxazole
96
Digoxin interactions
TCA arrhythmias Hypokalaemia causers induce toxicity CYP inducers decrease efficacy CYP inhibitors cause toxicity
97
Desmopressin advice
Restrict fluid intake before bed
98
How long after surgery should a patient receive VTE Prophylaxis
Minimum 7d or until mobility re-established 28d after major cancer abdominal surgery 30d after spinal surgery 28d after hip surgery 42d after ankle surgery 14d after knee surgery
99
VTE treatment lengths
Distal aka Calf DVT 6 weeks Proximal aka any higher 3 months (6 if active Ca) Provoked VTE 3 months if causative factor gone (immobility, HRT) Unprovoked VTE 3 months Recurrent VTE lifelong warfarin
100
Patient has a major bleed whilst taking warfarin what do you do
STOP Warfarin GIVE IV Vit K and Dried Prothrombin
101
What indications warrant a target INR of 3-4
Mechanical heart valves Recurrent VTEs
102
What indications warrant a target INR of 2-3
VTE AF Cardioversion MI Cardiomyopathy
103
Warfarin MHRA warnings
Calciphylaxis - see Dr if painful skin rash Antivirals that induce CYP reduce efficacy
104
Warfarin in pregnancy
Teratogenic in 1st and 3rd trimester use LMWH instead AVOID 48h post-partum
105
Warfarin interactions
CYP inducers and inhibitors affect INR Specifically avoid Azole antifungals and CYP inducers Pomegranate, cranberry increase INR Vitamin K foods decrease INR (green leafy veg and green tea)
106
Warfarin management around surgery
Minor procedures when INR <2.5 and restart within 24h Major procedures stop 3-5d before, check INR day before if >=1.5 GIVE Vit K and bridge with LMWH 24h before Emergency if it can be delayed 6-12h GIVE IV Vit K, if not GIVE IV Vit K + Dried Prothrombin
107
Heparins contraindications
Heparin induced thrombocytopenia Can cause Hyperkalaemia Haemorrhage, if occurs during therapy treat with Protamine Renal impairment affects dose - UNF best here LMWH preferred in pregnancy
108
What is 1st like antihypertensive for a 56 year old with type 2 diabetes
ACEi
109
What is 2nd line for a Jamaican man aged 45
Already on CCB + ARB preferred to ACEi
110
What is 4th line for hypertension if potassium is 5
Alpha blocker Or Beta blocker
111
ACEi + ARB side effects
Dry cough ACEi only Hyperkalaemia Hepatic failure Angioedema Renal impairment Dizziness Headaches
112
ACEi/ARB interactions
Vomiting / Diarrhoea STOP Lithium Toxicity Hyperkalaemia with heparins, NSAIDs, Ksparing, Beta blockers Hypovolaemia with diuretics Renal failure with Ksparing, Diuretics, NSAIDs
113
Cardioselective beta blockers and what that means
Bisoprolol Atenolol Metoprolol Acebutolol Nebevilol Less likely to cause bronchospasm
114
Water soluble beta blockers and what that means
Water CANS Celiprolol Atenolol Nadolol Sotalol Won’t cross BBB so less Nightmares
115
Lipid soluble beta blockers and what that means
Propranolol Pindolol Penbutalol Timolol Will cross BBB can cause nightmares
116
Intrinsic sympathomimetic beta blockers and what that means
Pindolol Acebutol Celiprolol Oxprenolol Labetalol Less likely to cause cold extremities
117
Beta blocker side effects
Bradycardia leading to HF Dampen symptoms of Hypoglycaemia Can cause Hyperglycaemia Bronchospasm so CI in Asthma Peripheral vasoconstriction so CI in PVD
118
What drugs are a complete no go with beta blockers
Rate limiting calcium channel blockers will cause complete heart block leading to death by bradycardia
119
What is the name of non-rate-limiting calcium channel blockers
Dihydropyridine
120
What are the dihydropyridine calcium channel blockers
Amlodipine Felodipine Larcidipine Lercanidipine Nifedipine
121
Side effects associated with dihydropyridine calcium channel blockers
Dizziness Gingivinal hyperplasia Vasodilatory effects = Flushing, Headaches, Ankle oedema bradycardia
122
Side effects associated with rate limiting calcium channel blockers
Dizziness Gingivinal hyperplasia Bradycardia leading to complete heart block Flushing, headaches, ankle oedema more with dihydropyridines
123
Who is high risk for pre-eclampsia and how do we manage said risk
Kidney disease Diabetes Autoimmune disorders HTN Aspirin from w12 until birth
124
Treatment pathway for pre-eclampsia
BP >140/90 1st Labetalol 2nd Nifedipine MR 3rd Methyldopa Aiming for BP <135/85
125
BP Target age cutoff
80
126
BP Target for over 80 year olds in clinic and home
Clinic <150/90 Ambulatory <145/85
127
BP Target for under 80 year olds in clinic and at home
Clinic <140/90 Ambulatory <135/85
128
BP Target in renal disease
140/90
129
BP Target in Pregnancy
135/85
130
BP Target for type 1 diabetics
<135/85
131
Normal lipid profile
Total cholesterol >=5 HDL >=1 LDL >=3 non-HDL =<4 Triglycerides =<2.3
132
What is high intensity statin therapy
Atorvastatin 20,40,80 NOT 10 Simvastatin 80 NOT 10,20,40 Rosuvastatin 10,20,40 NOT 5 NOT Pravastatin or Fluvastatin
133
What should be checked before starting a statin
Lipid profile TFT - hypothyroid should be managed before starting statin therapy If DM do fasting HbA1c and repeat at 3m Renal function <30mL/min max simvastatin 10, avoid Rosuvastatin, max fluvastatin 40 30-60 max 40 Rosuvastatin Titrate from lowest doses of a Atorvastatin and Pravastatin Liver function pre-treatment at 3 months then every 12 months, STOP if ALT 3xULN Creatine Kinase if muscle aches or long lies, STOP if 5xULN
134
Statin SEs
Muscle aches or weakness sign of Rhabdomyolysis SoB, cough, weight loss sign of Interstitial lung disease Teratogenic AVOID in pregnancy
135
Statin interactions
CYP inducers make them ineffective CYP inhibitors increase toxicity aka rhabdomyolysis, suspend with Macrolides AVOID grapefruit as CYP inh Simvastatin max 20mg with Amlodipine, rlCCBs, Ticagrelor (40mg), Ciclosporin (10mg), HIV drugs (10mg)
136
What drug that isn’t a statin also increases risk of rhandomyolysis
Ezetimibe and fibrates
137
What must we do to manage nitrates
8-12h Nitrate free period to prevent tolerance aka move BD dosing to 8am and 4pm to allow for 8h between doses
138
What antiplatelet is only indicated if a patient with a heart attack undergoes percutaneus coronary intervention
Prasugrel
139
Cardiac secondary prevention
DAPT 1y then Aspirin lifelong ACEi Beta blocker High intensity statin
140
Pillars of heart failure
SGLT2i (Dapagliflozin, Empagliflozin) Beta blocker MRA (Spironolactone, Eplerenone) ACEi/ARB
141
What is indicated for heart failure if both ACEi and ARBs are contraindicated
1st Hydralazine / Nitrates 2nd Entresto (Sacubitril with Valsartan)
142
How long do the effects of loop diuretics last and what does that allow us to do with dosing
6 hours Can give BD morning and lunch Without affecting sleep
143
Arrange the loop diuretics in order of strength
Lowest Torasemide Furosemide Bumetanide Highest
144
Why must thiazide like diuretics be given In the morning
They last 24h so can disrupt sleep causing nocturia
145
What shouldn’t you take with mineralocorticoid receptor antagonists
Potassium supplements, risk of Hyperkalaemia
146
How do potassium sparing diuretics affect the urine
Amiloride and Triamterene turn urine blue
147
Diuretic side effects
All Hyponatraemia All Hypomagnesaemia Ksparing Hyperkalaemia Loop and Thiazide Hypokalaemia, Hypotension, exacerbate DM Loop exacerbates Gout
148
Diuretic interactions
Hypokalaemia causers for Loop and TLDs Hyperkalaemia causers for Ksparing Aminoglycosides and Loop are both nephrotoxic and ototoxic Lithium toxicity with Ksparing or Loop as more hypovolaemic
149
How do you treat reynaud’s phenomena
Avoid cold exposure Smoking cessation Nifedipine
150
What are the ranges for each type of HF
HFrEF <40 HFmEF 40-50 HFpEF >50
151
Which Cardio med must be prescribed by brand
Diltiazem
152
Which calcium channel blockers are best in HF
Avoid all apart from Amlodipine
153
What meds do rlCCBs interact with
Statin increased exposure Beta blocker fatal heart block Ivabradine fatal bradycardia Reduce digoxin dose as increased exposure Amiodarone and other antiarrhythmics cause heart block and bradycardia Ritonavir, Dabigatran, carbamazepine, Ciclosporin, colchicine, Rifampicin, phenytoin, NSAIDs
154
Which cardiac med affects Uric acid levels
Hyperuricaemia with loop and thiazide like diuretics
155
Drugs that cause bradycardia
Beta blockers rlCCBs Fentanyls AChEi Antiarrhythmics Ivabradine Ticagrelor Clonidine
156
Drugs that prolong the QT interval
Antiarrhythmics Antipsychotics SSRI Fluconazole, Voriconazole Erythromycin Quinolones Ondansetron Methadone Quinine Ranolazine Sotalol
157
Drugs that cause Hyperkalaemia
ACEi/ARB NSAIDs MRAs Heparins Tacrolimus Trimethoprim
158
Drugs that cause Hypokalaemia
Theophylline Corticosteroids Diuretics Beta 2 agonists Amphotericin B
159
Drugs that cause first dose hypotension
ACEi Alpha blockers
160
Drugs that cause hypotension
ACEi/ARB Alpha and Beta blockers Alcohol CCBs SGLT2i TCAs Antipsychotics Diuretics MAOi Ketamine Methyldopa Nitrates
161
Drugs with antiplatelet effects
NSAIDs Clopidogrel Benzydamine Phosphodiesterase inhibitors SSRI/SNRI Omega-3
162
Pulmonary embolism symptoms
Pain on inspiration or expiration Haemoptysis (sputum) Cough Sudden Dyspnoea (SoB)
163
Deep vein thrombosis symptoms
Throbbing pain in area of clot that is exacerbated by movement or standing Firm swelling that is sensitive to the touch Warm red/darkened skin Unilateral symptoms or whole abdomen if there
164
Stroke symptoms in community
Facial dropping Arm weakness Slurred speech Test/Time
165
Stroke symptoms in HCP setting
V3FAST Vision loss, blurred, double/ abnormal eye movements Vertigo Vestibular instability aka weakness, ataxia (slow movements), sideways veering when walking Facial drooping Arm weakness Slurred speech Test time Rule out seizures and hypoglycaemia
166
When is fondaparinux indicated
When thrombosis isn’t indicated
167
When is thrombolysis indicated
Within 4.5h of stroke onset Within 12h of STEMI onset and Primary PCI can’t be given within 2h (surgery) No bleeds / risk of including drugs thinning blood No surgery Recent clots Cancer Good glucose control NIHSS >=3
168
LMWH doses in VTE based on risk and what makes them those risks
High risk 1mg/kg BD PE - Obese, Symptomatic PE, Ca, recurrent VTE, Surgery DVT - Obese, Ca, Recurrent VTE, active Proximal DVT, Surgery Low risk 1.5mg/kg OD
169
Subarachnoid haemorrhage treatment
Aneurysmal get Nimodipine 60mg every 4h for 21d course Trauma get nothing

Pharmacy Pre-reg (5 decks)

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