Cardiology

Question 1

What are the main adverse effects of ACEIs?

Answer 1

related to reduced angiotensin II formation:
hypotension
acute renal failure
hyperkalaemia
teratogenic effects in pregnancy

related to increased kinin production:
cough
rash
anaphylactoid formation

Question 2

What are the main adverse effects of ARBs?

Answer 2

symptomatic hypotension (hypovolaemic patients)
hyperkalaemia

potential for renal dysfunction
rash
angio-oedema

contraindicated in pregnancy

Question 3

What are the main adverse effects of beta-adrenoceptor blockers?

Answer 3

fatigue
headache

sleep disturbance/nightmares

bradycardia
hypotension
cold peripheries

erectile dysfunction

Question 4

What are the adverse effects of CCBs?

Answer 4

due to peripheral vasodilation (mainly dihydropyridines as heart increases rate and pressure to match dilation)

flushing
headache
oedema
palpitations

Question 5

What are the main adverse effects of diuretics?

Answer 5

hypovolaemia
hypotension (boh mainly loop diuretics)
hypokalaemia
hyponatraemia

Question 6

What are the adverse effects of amiodarone?

Answer 6

QT prolongation
polymorphic ventricular tachycardia

interstitial pneumonitis
abnormal liver function
hyperthyroidism/hypothyroidism
sun sensitivity
slate grey skin discolouration
corneal microdeposits
optic neuropathy

multiple drug interactions - especially warfarin - amiodarone displaces warfarin from its binding site to blood proteins causing a lot of free warfarin which will cause over-anticoagulation and bleed to death

very large volume of distribution so it gets everywhere

Question 7

How would you medically manage a patient with atrial fibrillation?

Answer 7

1. tx underlying cause: alcohol, thyroid disease, hypertension, valve disease, heart failure etc
2. rate control: beta blockers, calcium channel blockers, digoxin
3. return sinus rhythm: electrical or pharmacological (amiodarone) cardioversion
4. Maintain sinus rhythm: sotalol, amiodarone