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Medicines (Stage 2) > Cardio Meds > Flashcards

Cardio Meds Flashcards

1
Q

What are the key clinical key indications with ACE inhibitors

A
  • Hypertension
  • Secondary Prevention of MI (stable, unstable) (SAAB + GTN)
  • Heart Failure
  • Chronic Kidney Disease
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2
Q

Name examples of ACE inhibitors

A
  • Lisinopril
  • Ramipril
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3
Q

Contraindications and Side Effects of ACE i

A
  • History of angio oedema in black patients
  • Dont use in acute kidney impairment
  • Dry cough
  • Hyperkalaemia and electrolyte imbalances
  • Dizziness and Headaches (hypotension)
  • W/ alcohol , CCB, diuretics, GTN increase risk of hypotension. Ibuprofen nephrotoxicity/ hyperkalaemia
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4
Q

Monitoring Requirements of ACE i and counselling points

A
  • Start low and go slow and titrated at short intervals until max dose is reached
  • Can take ARB if not ACE
  • Renal function, serum electrolytes and blood pressure measured before starting and 1/2 weeks of starting
    Take before bed - avoid dizziness
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5
Q

What does ARB stand for?

A

Angiotensin receptor blocker

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6
Q

What are the key clinical indications of ARBs

A
  • Hypertension
  • Chronic kidney Disease
  • Heart Failure
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7
Q

Name examples of ARBs

A
  • Losartan
  • Candesartan
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8
Q

What are some contraindications and side effects of ARBs

A
  • Renal impairment and electrolyte imbalance
  • Dizziness, headache and abdominal pain
  • w/ alcohol, CCB, diuretics, GTN can risk hypotension. Ibuprofen (nephrotoxicity and hyperkalaemia)
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9
Q

What are some counselling points of ARBs

A
  • Monitor renal function and serum electrolytes before starting and 1-2 weeks after every upward titration
  • Start low and go slow and titrate up every 4 weeks until target or max
  • BP every 4 weeks after dose titration
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10
Q

What are the key clinical indications of Beta blockers

A
  • Angina
  • Heart Failure
  • Arrythmias
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11
Q

Name some examples of Beta blockers

A
  • Atenolol,
  • Bisoprolol,
  • Propanalol (not cardioselective)
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12
Q

What are some side effects and contraindications of beta blockers

A
  • Hypotension
  • Bradycardia
  • Dizziness, headache, syncope, nausea
  • Dont give to those with a history of asthma or brochospasm
  • w/ alcohol can risk hypotension
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13
Q

What are some counselling points of beta blockers

A
  • Titrate dose to target dose or max dose according to response
  • Assess heart rate after each titration
  • Assess blood pressure before and after each increment
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14
Q

What are the key clinical indications of calcium channel blockers

A
  • Hypertension
  • Stable angina (w/instead of beta blocker)
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15
Q

What are some examples of calcium channel blockers

A
  • Dihydropyridine calcium channel blockers (amlodipine, felodipine, nifedipine)
  • Rate limiting CCBs (verapamil and diltiazem)
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16
Q

What are some contra indications and side effects of dihydropyridine calcium channel blockers

A
  • Not used in uncontrolled heart failure
  • Severe hypotension
  • Side effects: abdominal pain, swelling in ankles, tachycardia and dizziness
  • w/ alcohol can increase risk of hypotension.
  • Amlodipine causes a small increase to exposure of simvastatin
17
Q

What are some counselling points of calcium channel blockers

A
  • Start at low dose and titrate upwards at intervals of 4 weeks until target reached
  • Measure the blood pressure 4 weeks after each dose change
18
Q

What are the indications of loop diuretics

A
  • Used in pulmonary oedema in patients with heart failure
19
Q

Name an example of a loop diuretic

A

Furosemide

20
Q

What are the contra indications and side effects of loop diuretics

A
  • Hypokalaemia
  • Dizziness, electrolyte imbalance, fatigue, muscle spasms
  • Suspended or stopped in acute kidney injury
21
Q

What are some counselling points on loop diuretics

A
  • Take in the morning so reduces fall damage if needing to get up at night
  • Urea, electrolytes and renal function, BP should be monitored
22
Q

What are the indications of a GTN spray

A
  • Stable and unstable angina
23
Q

Contraindications and Side Effects of GTN spray

A
  • Flushing
  • Headache
  • Light headed ness
  • Tachycardia
23
Q

Counselling points of GTN spray

A

`* Use it before any planned exertion
* Sit down and hold onto something if feeling light headed
* Spray once and repeat after 5 minutes if the pain has not gone
* Call an ambulance if the pain hasnt gone after 5 mins of the second dose
* 400-800 micrograms administered sublingually (under the tongue)
* Dont drink anything straight away

23
Q

What are the indications for DOACs

A
  • Treatment of deep vein thrombosis or pulmonary embolism
  • Prophylaxis of stroke
23
Q

What are the contraindications and side effects of DOACs

A
  • Causes active bleeding
  • GI intracranial bleed
  • Interactions with: Aspirin, antibiotics, Ibuprofen,
23
Q

What are the counselling points of DOACs

A
  • Seek medical advice if spontaneous bleeding occurs and doesnt stop (bruising/ bleeding gums/ nose bleed), severe back pain, SOB or chest pain
  • Seek medical advice before taking OTC and herbal remedies because they have possible drug interactions
  • At the start of treatment: baseline clotting screen, renal and liver function tests and full blood count. Review on a regular basis. 1 month initially and every 3 months thereafter.
  • Missed dose: Forgotten dose should be taken as normal
  • Dont double dose and resume treatment 24 hours after double dose
  • There are reversal agents: Apixaban and Rivaroxaban (Andexanet Alfa) and Dabigatran (idarucizumab)
  • Take same time each day
24
Q

What are the indications for statins

A
  • Secondary prevention of MI and stroke
  • Hypercholestromia
25
Q

Name some examples of statins

A
  • Atorvastatin
  • Simvastatin
26
Q

What are the contra indications and side effects of statins

A
  • Dont prescribe in people with liver disease
  • Can cause muscle effects/toxicity
  • Dizziness, GI discomfort, headaches
  • Contraindications: Alcohol, antibiotics, paracetamol (hepatotoxicity)
27
Q

What are some councelling points for statins

A
  • Risk of muscle pain and tenderness, rate of severe muscle effects (rhabdomyolysis) is low
  • Some foods and supplements (e.g. grapefruit juice) can interact and to consult with pharmacist before taking
  • Before starting do baseline tests: smoking, alcohol, BP, BMI, diabeties, full lipid profile and renal function
  • Measure liver transaminase and full lipid profile 2-3 months after starting
  • Must adhere and comply with lifestyle and dietary advice
28
Q

What are the indications for Thiazide like diuretics

A
  • Hypertension
29
Q

Name an example of a Thiazide like diuretic

A

Indapamide

30
Q

What are the contraindications and cautions of thiazide like diuretics

A
  • In caution with hypokalaemia, severe liver disease, and renal impairment
  • Can cause postural hypotension, electrolyte imbalances, dizziness and headache
  • Contraindications: alcohol, aspirin
31
Q

What are some counselling points of thiazide like diuretics

A
  • Should be taken in the morning to reduce chance of fall in night
  • Plasma sodium and potassium levels should be monitored before treatment then at regular intervals after
  • Renal and liver function should be checked before starting treatment
32
Q

What is the indications for warfarin

A
  • Deep vein thrombosis and pulmonary embolism
  • Stroke (TIA)
  • Embolisation w/ atrial fibrillation
33
Q

What are the main contraindications and side effects of warfarin

A
  • Contraindicated in people with haemorrhagic stroke, significant bleeding, severe hepatic impairment
  • Bleeding is a common adverse effect
  • Sudden severe back pain
  • Contraindications: Avoid binge drinking/ anything that will increase bleeding
34
Q

What are some counselling effects of warfarin

A
  • Have blood tested regularly to check INR
  • Take yellow book to warfarin clinic which has advice and alert card
  • Take warfarin at same time each day
  • Not miss dose or take additional dose without advice from healthcare professional
  • Can be affected by diet, alcohol, some OTC, dont have vit K
  • Any spontaneous bleeding (bruising, bleeding gums or severe back pain) they seek medical advice
35
Q

What are the Cardio Medications for stage 2?

A
  • ACE inhibitors
  • ARBs
  • Beta Blockers
  • Dihydropyridine CCBs
  • Furosemide
  • GTN Spray
  • DOACs
  • Statins
  • Thiazide like diuretics
  • Warfarin

Medicines (Stage 2) (3 decks)

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