Cardiology

Question 1

State the prescription stages for Hypertension

Answer 1

1. ACEi if <55yrs, Ca blocker if >55 or black Africa/Caribbean
2. ACEi + Ca
3. A + C + D (thiazide-like diuretic)
4. A + C + D + additional diuretic OR alpha-blocker OR beta-blocker

Question 2

Which drugs are commonly used in Hypertension?

Answer 2

ACEi = Ramipril
Ca blocker = Amlodipine
Thiazide diuretic = Indapamide
Alpha-blocker = doxazocin

Question 3

What are the main problems with ACEi?

Answer 3

• Dry cough

- Affects renal function - needs monitoring

Question 4

What can you prescribe in the place of an ACEi?

Answer 4

ARB - Losartan

Question 5

What are the main issues with Amlodipine?

Answer 5

Ankle oedema and dizziness

Question 6

What is normally prescribed Post-MI? Name all 6

Answer 6

• 75mg aspiring OD
• 2.5mg Bisoprolol
• 2.5-5mg Ramipril
• 80mg Atorvastatin
• Clopidogrel 1 year only
• GTN PRN

Question 7

What is the difference between primary and secondary prevention for the prescription of atorvastatin?

Answer 7

• Primary is before an event, secondary is after an event such as MI
• 40mg primary
• 80mg secondary

Question 8

What is prescribed after a stroke?

Answer 8

LIFELONG:

• Clopidogrel 80mg
• Atorvastatin 80mg

Question 9

What side effects do you need to watch out for with atorvastatin?

Answer 9

Severe muscle aches and pains - not like normal –> RHABDOMYOLYSIS

• stop medication
• LFTs

Question 10

What is the benefit of blocking the action of aldosterone using and ACEi?

Answer 10

• Reduces afterload and blood pressure
• Dilates efferent glomerular arteriole, reducing pressure and slows CKD
• Promotes sodium and water excretion - reduces venous return (preload) which has beneficial effect in HF

Question 11

Which B-blocker is recommended in Heart Failure?

Answer 11

• Bisoprolol

Question 12

If a patient with LVSD is intolerant to ARBs and ACEi, what do you prescribe?

Answer 12

• Hydralazine with nitrate

Question 13

What should be given in a patient who is on ARBs, ACEI;s and still very symptomatic heart failure?

Answer 13

• Sacubitril valsartan

Question 14

Failing ACEi, ARB and Aldosterone antagonist what should be given in Heart failure?

Answer 14

• Digoxin or Ivabradine

- OR Pacemaker if LVEF <35%

Question 15

Which calcium channel blockers should you avoid in Heart Failure?

Answer 15

Verapamil

Diltiazem

Question 16

What is the standard treatment for secondary care on diagnosis of ischaemic stroke or TIA without AF for long-term vascular prevention?

Answer 16

• 75mg clopidogrel for stroke
• Dipyridamole if clopidogrel and aspirin contra-indicated
• Aspirin + clopidogrel for first 3 months following ischaemic stroke or TIA for symptoms like ACS
• 80mg Atorvastatin

Question 17

What is prescribed in ischaemic stroke or TIA with symptoms of AF?

Answer 17

• 300mg aspirin daily for 2 weeks

- Dose-adjusted warfarin or NOAC

Question 18

Which drug should be avoided in breast-feeding?

Answer 18

Aspirin

Amiodarone