cardio

Question 1

clopidogrel

1. mechanism of action
2. which drug makes it less effective?

Answer 1

1. antagonist of the P2Y12 adenosine diphosphate (ADP) receptor, inhibiting the activation of platelets
2. omeprazole (and other PPIs)

Question 2

statin & dose for cardiac:

1. primary prevention
2. secondary prevention

Answer 2

1. atorvastatin 20mg
2. atorvastatin 80mg

Question 3

adverse effects of statins (2):

Answer 3

1. myopathy
2. liver impairment (thus LFTs at baseline, 3 months and 12 months)

Question 4

contra-indication to statins (2):

Answer 4

1. macrolide therapy
2. pregnancy

Question 5

who should receive a statin?

Answer 5

all people with established cardiovascular disease (stroke, TIA, ischaemic heart disease, peripheral arterial disease)
following the 2014 update, NICE recommend anyone with a 10-year cardiovascular risk >= 10%
patients with type 2 diabetes mellitus should now be assessed using QRISK2 like other patients are, to determine whether they should be started on statins
patients with type 1 diabetes mellitus who were diagnosed more than 10 years ago OR are aged over 40 OR have established nephropathy

Question 6

MI secondary prevention drugs (4):

Answer 6

• dual antiplatelet (aspirin + another)
• ACEI
• B blocker
• statin

Question 7

beta blocker side effects (5):

Answer 7

bronchospasm
cold peripheries
fatigue
sleep disturbances, including nightmares
erectile dysfunction

Question 7

normal ECG variants in the SPORTY: (4)

Answer 7

1. sinus bradycardia
2. junctional rhythm
3. first degree heart block
4. Mobitz type 1 (Wenkebach)

Question 8

beta blocker contra-indications (4):

Answer 8

1. uncontrolled heart failure
2. asthma
3. sick sinus syndrome
4. concurrent verapamil use (may precipitate severe bradycardia)

Question 9

adenosine

1. what’s it used to treat?
2. who should it be avoided in?
3. adverse effects (4)

Answer 9

1. SVT
2. asthmatics
3. chest pain
   bronchospasm
   transient flushing
   can enhance conduction down accessory pathways, resulting in increased ventricular rate (e.g. WPW syndrome)

Question 10

loop diuretics (e.g. furosemide)

adverse effects:

Answer 10

hypotension
hyponatraemia
hypokalaemia, hypomagnesaemia
hypochloraemic alkalosis
ototoxicity
hypocalcaemia
renal impairment (from dehydration + direct toxic effect)
hyperglycaemia (less common than with thiazides)
gout