Cardio Meds Flashcards
What are the key clinical key indications with ACE inhibitors
- Hypertension
- Secondary Prevention of MI (stable, unstable) (SAAB + GTN)
- Heart Failure
- Chronic Kidney Disease
Name examples of ACE inhibitors
- Lisinopril
- Ramipril
Contraindications and Side Effects of ACE i
- 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
Monitoring Requirements of ACE i and counselling points
- 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
What does ARB stand for?
Angiotensin receptor blocker
What are the key clinical indications of ARBs
- Hypertension
- Chronic kidney Disease
- Heart Failure
Name examples of ARBs
- Losartan
- Candesartan
What are some contraindications and side effects of ARBs
- Renal impairment and electrolyte imbalance
- Dizziness, headache and abdominal pain
- w/ alcohol, CCB, diuretics, GTN can risk hypotension. Ibuprofen (nephrotoxicity and hyperkalaemia)
What are some counselling points of ARBs
- 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
What are the key clinical indications of Beta blockers
- Angina
- Heart Failure
- Arrythmias
Name some examples of Beta blockers
- Atenolol,
- Bisoprolol,
- Propanalol (not cardioselective)
What are some side effects and contraindications of beta blockers
- Hypotension
- Bradycardia
- Dizziness, headache, syncope, nausea
- Dont give to those with a history of asthma or brochospasm
- w/ alcohol can risk hypotension
What are some counselling points of beta blockers
- 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
What are the key clinical indications of calcium channel blockers
- Hypertension
- Stable angina (w/instead of beta blocker)
What are some examples of calcium channel blockers
- Dihydropyridine calcium channel blockers (amlodipine, felodipine, nifedipine)
- Rate limiting CCBs (verapamil and diltiazem)
What are some contra indications and side effects of dihydropyridine calcium channel blockers
- 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
What are some counselling points of calcium channel blockers
- 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
What are the indications of loop diuretics
- Used in pulmonary oedema in patients with heart failure
Name an example of a loop diuretic
Furosemide
What are the contra indications and side effects of loop diuretics
- Hypokalaemia
- Dizziness, electrolyte imbalance, fatigue, muscle spasms
- Suspended or stopped in acute kidney injury
What are some counselling points on loop diuretics
- Take in the morning so reduces fall damage if needing to get up at night
- Urea, electrolytes and renal function, BP should be monitored
What are the indications of a GTN spray
- Stable and unstable angina
Contraindications and Side Effects of GTN spray
- Flushing
- Headache
- Light headed ness
- Tachycardia
Counselling points of GTN spray
`* 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
What are the indications for DOACs
- Treatment of deep vein thrombosis or pulmonary embolism
- Prophylaxis of stroke
What are the contraindications and side effects of DOACs
- Causes active bleeding
- GI intracranial bleed
- Interactions with: Aspirin, antibiotics, Ibuprofen,
What are the counselling points of DOACs
- 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
What are the indications for statins
- Secondary prevention of MI and stroke
- Hypercholestromia
Name some examples of statins
- Atorvastatin
- Simvastatin
What are the contra indications and side effects of statins
- Dont prescribe in people with liver disease
- Can cause muscle effects/toxicity
- Dizziness, GI discomfort, headaches
- Contraindications: Alcohol, antibiotics, paracetamol (hepatotoxicity)
What are some councelling points for statins
- 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
What are the indications for Thiazide like diuretics
- Hypertension
Name an example of a Thiazide like diuretic
Indapamide
What are the contraindications and cautions of thiazide like diuretics
- In caution with hypokalaemia, severe liver disease, and renal impairment
- Can cause postural hypotension, electrolyte imbalances, dizziness and headache
- Contraindications: alcohol, aspirin
What are some counselling points of thiazide like diuretics
- 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
What is the indications for warfarin
- Deep vein thrombosis and pulmonary embolism
- Stroke (TIA)
- Embolisation w/ atrial fibrillation
What are the main contraindications and side effects of warfarin
- 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
What are some counselling effects of warfarin
- 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
What are the Cardio Medications for stage 2?
- ACE inhibitors
- ARBs
- Beta Blockers
- Dihydropyridine CCBs
- Furosemide
- GTN Spray
- DOACs
- Statins
- Thiazide like diuretics
- Warfarin
