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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Name examples of ACE inhibitors

A
  • Lisinopril
  • Ramipril
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does ARB stand for?

A

Angiotensin receptor blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the key clinical indications of ARBs

A
  • Hypertension
  • Chronic kidney Disease
  • Heart Failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Name examples of ARBs

A
  • Losartan
  • Candesartan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the key clinical indications of Beta blockers

A
  • Angina
  • Heart Failure
  • Arrythmias
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Name some examples of Beta blockers

A
  • Atenolol,
  • Bisoprolol,
  • Propanalol (not cardioselective)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the key clinical indications of calcium channel blockers

A
  • Hypertension
  • Stable angina (w/instead of beta blocker)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are some examples of calcium channel blockers

A
  • Dihydropyridine calcium channel blockers (amlodipine, felodipine, nifedipine)
  • Rate limiting CCBs (verapamil and diltiazem)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
What are the indications for DOACs
* Treatment of deep vein thrombosis or pulmonary embolism * Prophylaxis of stroke
23
What are the contraindications and side effects of DOACs
* Causes active bleeding * GI intracranial bleed * Interactions with: Aspirin, antibiotics, Ibuprofen,
23
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
24
What are the indications for statins
* Secondary prevention of MI and stroke * Hypercholestromia
25
Name some examples of statins
* Atorvastatin * Simvastatin
26
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)
27
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
28
What are the indications for Thiazide like diuretics
* Hypertension
29
Name an example of a Thiazide like diuretic
Indapamide
30
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
31
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
32
What is the indications for warfarin
* Deep vein thrombosis and pulmonary embolism * Stroke (TIA) * Embolisation w/ atrial fibrillation
33
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
34
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
35
What are the Cardio Medications for stage 2?
* ACE inhibitors * ARBs * Beta Blockers * Dihydropyridine CCBs * Furosemide * GTN Spray * DOACs * Statins * Thiazide like diuretics * Warfarin