Amiodarone - Drug class + Mechanism - Indications - Side effects - Contraindications

Antiarrhythmic agent - Blocks voltage gated K and Ca channels= prolongs phase 3 of cardiac potential (repolarisation) Indications - Atrial fibrillation/ flutter - VF, V tach Side effects - Lungs: pulmonary fibrosis/ ILD - Eye: corneal deposits - Liver: abnormal LFTs - Sensitivity to sun/ Blueish skin? - Thyroid dysfunction (hyper or hypo) - Gynaecomastia Contraindications - Pregnancy, breastfeeding - Thyroid disease - Av block/ bradycardia

Prasugrel - MI treatment - Side effects

Loading dose= 60mg Maintenance dose - > 60kg= 10mg OD - 75 years= 5mg OD - Up to 12 months Side effects - GI bleeds

PO or IV - They are not equal, IV peaks quicker Loading - 750mg-1mg over 24 hours - Lower dose in elderly Maintenance - 125-250 mg OD

Cardiology Flashcards by aderonke adesanoye

Alteplase

Drug class + Mechanism
Indications
Side effects
Contraindications

Thrombolytic drug

Protease that binds to fibrin and enables fibrinolysis.
Activates plasminogen into plasmin= degrades fibrin

Indications
- Thrombotic events: Acute MI, PE, Acute ischaemic Stroke

Side effects

Bleeding

Contraindications

Bleeding states: haemorrhagic stroke,
Hypersensitivity to gentamicin

How well did you know this?

Not at all

Perfectly

Amiodarone

Drug class + Mechanism
Indications
Side effects
Contraindications

Antiarrhythmic agent
- Blocks voltage gated K and Ca channels= prolongs phase 3 of cardiac potential (repolarisation)

Indications

Atrial fibrillation/ flutter
VF, V tach

Side effects

Lungs: pulmonary fibrosis/ ILD
Eye: corneal deposits
Liver: abnormal LFTs
Sensitivity to sun/ Blueish skin?
Thyroid dysfunction (hyper or hypo)
Gynaecomastia

Contraindications

Pregnancy, breastfeeding
Thyroid disease
Av block/ bradycardia

How well did you know this?

Not at all

Perfectly

Amlodipine

Drug type/ mechanism
Indications
Side effects
Contraindications/ Caution

Calcium channel blocker
- Blocks L-type Ca channels (dihydropyridine) on vessels and cardiomyocytes= vasodilation

Indications

Hypertension (first line for <55/ Black)
Heart failure

Side effects

Peripheral oedema
Abdominal pain
Dizziness/ flushing

Contraindicatons/ Caution

Caution in elderly
Cardiogenic shock/ Unstable angina/ severe AS

How well did you know this?

Not at all

Perfectly

Clopidogrel

Drug type/ mechanism
Indications
Side effects
Contraindications/ Caution
Pregnancy + breastfeeding

Antiplatelet

Reversible P2Y-12 inhibitor
Prevents platelet aggregation

Indications

Cardiovascular prophylaxis = 75mg
Before PCI= loading dose = 300mg/ 600mg

Side effects

Bleeds
Gi discomfort

Caution/ contraindications

Active bleeding/ risk of bleeds
Caution in elderly

Pregnancy + breastfeeding
- Avoid

How well did you know this?

Not at all

Perfectly

Cellulitis

Description
Most common causative agents
Presentation
Complications

Infection of the connective tissue: especially dermis and subcutaneous fat
- Most commonly caused by S pyogenes, S aureus

Symptoms

Red, hot and painful area with increasing margins overtime
Localised oedema
Fever, chills

Complications

Abscess
Fasciitis
Sepsis
Osteomyelitis

How well did you know this?

Not at all

Perfectly

Aspirin

ACS treatment
Administration instructions

Loading dose= 300mg
- Maintenance= 75mg OD

Take with food

How well did you know this?

Not at all

Perfectly

Clopidogrel

- MI treatment

Loading dose= 300mg or 600mg

Maintenance= 75mg

NSTEMI= for 1 year
STEMI= up to 1 year

Stents

BMS= 1 month
DES= 6-12 months

How well did you know this?

Not at all

Perfectly

Ticagrelor

MI treatment
Side effects

Loading dose= 180mg

Maintenance= 90mg BD
- Up to 12 months

Side effects= SO

How well did you know this?

Not at all

Perfectly

Prasugrel

MI treatment
Side effects

Loading dose= 60mg

Maintenance dose

> 60kg= 10mg OD
< 60kg/ >75 years= 5mg OD
Up to 12 months

Side effects
- GI bleeds

How well did you know this?

Not at all

Perfectly

Bisoprolol

Drug type/ mechanism
Indications
Side effects
Contraindications/ Caution
Pregnancy + breastfeeding

Cardioselective beta-blocker

Blocks B1 on heart= slows SAN= slower HR
B2 on lungs, liver

Indications

Hypertension
Heart failure
Variceal bleed prophylaxis

Side effects

Hypotension, bradycardia: fatigue, dizziness
Bronchospasms
Hypoglycaemia
Cold hands/ feet

Contraindications

Asthma/ COPD
2nd/ 3rd degree heart block
Unstable heart failure

How well did you know this?

Not at all

Perfectly

Erysipelas

Description
Presentation
Most common causative agents

Bacterial infection of the upper dermis

Extends to subcutaneous lymphatic vessels
More superficial than cellulitis

Presentation

Red, hot lesion
Lethery, rough skin
Well-defined margins
More typically affects the face

Causative agent
- Beta-hameolytic Strep (S pyogenes)

How well did you know this?

Not at all

Perfectly

Furuncles

Description
Causative organism
Presentation

Deep folliculitis

Deep infection of the hair follicle
Most common caused by Staph aureus

Presenation

Swollen area, due to accumulation of pus/ dead tissue
Boils= pus filled.

How well did you know this?

Not at all

Perfectly

Glyceryl trinitrate (GTN)

Drug type/ mechanism
Indications
Side effects
Contraindications/ Caution
Pregnancy + breastfeeding

Pro-drug
- Release of NO2 = vasodilation

Indications
- Angina treatment/ prophylaxis

Side effects

Flushing, headache, dizziness
Postural hypotension

Caution/ Contraindications

Caution with driving
Alcohol increases dizziness

How well did you know this?

Not at all

Perfectly

Nicorandil

Drug type/ mechanism
Indications
Side effects
Contraindications/ Caution
Pregnancy + breastfeeding

Nirate and ATP-K+ agonist

Coronary Vasodilation at low K+
Reduces coronary vascular resistance at high K+

Indications
- Second line for angina

Side effects

dizziness
Headaches
nausea

How well did you know this?

Not at all

Perfectly

Digoxin

- Dosing

PO or IV
- They are not equal, IV peaks quicker

750mg-1mg over 24 hours
Lower dose in elderly

Maintenance
- 125-250 mg OD

How well did you know this?

Not at all

Perfectly

Digoxin excretion and monitoring

Renally excreted

Digoxin needs to be monitored regularly

Dose taken >6 hours post dose
Toxic levels >1.5-3mcg/L

How well did you know this?

Not at all

Perfectly

Factors that increase digoxin toxicity

AKL

Hypokalaemia

Hypercalcaemia

Hypomagnesaemia

Digoxin toxicity signs

Lethargy

Confusion

Vomiting

Loss of appetite

Diarrhoea

Visual changes

Amiodarone dosing

Loading= 5-10g

Oral= 200 rule

200mg TDS for 1 week
200mg BD for 1 week
200mg OD maintenance

IV
- Loading= 5mg/ Kg over 20-120mins

Infusion 1.2g/ 24hrs centrally

Diltiazem

Drug type/ mechanism
Indications
Side effects
Contraindications/ Caution
Pregnancy + breastfeeding

Non-DHP calcium channel blocker

Longer acting
Cardioselective
Vasodilation
Antiarrhythmic

Indications

AF
Hypertension
Angina prophylaxis

Side effects

Constipation
Facial flushing
Headaches
Ankle swelling
Fatigue
Dizziness

Apixaban

Drug type/ mechanism
Indications
Side effects
Contraindications/ Caution
Pregnancy + breastfeeding

DOAC
- Factor X inhibitor

Indication
- Thrombosis prophylaxis= stroke

Side effects
- Bleeds

Contraindications/ caution

Active bleeding
Low weight (>61)= hald dose
Elderly, >80= half dose
Serum Cr 133/ 15-29ml/min = half dose

Furosemide

Drug type/ mechanism
Indications
Side effects
Contraindications/ Caution
Pregnancy + breastfeeding

Loop diuretic
- Inhibits Na+ and water reabsorption in ascending loop of henle

Indications

Resistant Hypertension
Oedema

Side effects

Dehydration
Hypotension: dizziness, fatigue
Electrolyte imbalance= hypokalaemia
Renal function abnormalities
Metaboic alkaolosis

Caution/ contraindication

Elderly (lower dose)
Urinary retention in large prostate

Pregnancy and breastfeeding

Not used in pregnancy because of hypovalaemia
Okay in breastfeeding, may inhibit lactation

Furosemide dosing

40mg-80mg PO

Lower dose for oedema
40-80 for HTN
80-120 for resistant oedema

Bendroflumethiaide

Drug type/ mechanism
Indications
Side effects
Contraindications/ Caution
Pregnancy + breastfeeding

Thiazide like diuretic
- Inhibits Na, Cl- reabsorption in distal convoluted tubule.

Indications

Hypertension (third line after ARB/ ACEi and CCB)
Oedema

Side effects

Exacerbates gout
Dizziness/ fatigue/ orthostatic hypotension
Hypokalaemia
Alkalosis hypochloraemia

Contraindications/ caution

Kidney function= not used in eGFR <30
Weight
Monitor electrolyes

Pregnancy and breastfeeding

Not used in pregnancy because of hypovalaemia
Okay in breastfeeding, may inhibit lactation

Spironolactone - Drug type/ mechanism - Indications - Side effects - Contraindications/ Caution - Pregnancy + breastfeeding

Aldosterone receptor antagonist (K+ sparing diuretic) - Blocks aldosterone receptor on distal convoluted tubule= retention of K+, Na and water excretion Indications - Resistant hypertension - Ascites - Primary hyperaldosteronism Side effects - Gynaecomastia - Hyperkalaemia - Dizziness, fatigue Contraindications and caution - Hyperkalaemia, Addison's - Elderly - Avoid in renal impairment Pregnancy and breastfeeding - Can use in pregnancy if benefits outweigh risk - Okay in breastfeeding

Ivabradine - Drug type/ mechanism - Indications - Side effects - Contraindications/ Caution - Pregnancy + breastfeeding

Acts on funny channel (pacemaker potential) - Slows than current in SAN= slower HR Indications - Chronic HF Side effects - Dizziness, headache - Visual disorder - Arrhythmias, AV block Caution/ contraindication - Caution in elderly, AF. - HR <70, heart block, severe hypotension, acute MI Pregnancy + breastfeeding - Avoid

Rivaroxaban - Drug type/ mechanism - Indications - Side effects - Contraindications/ Caution - Pregnancy + breastfeeding

DOAC- Factor Xa inhibitor Indications - Thrombolysis, stroke prophylaxis - Treatment for DVT, PE Side effects - Bleeding - GI discomfort Contraindications/ caution - Elderly - Low body weight <60 - Avoid in CrCl <15

Warfarin - Drug type/ mechanism - Indications - Side effects - Contraindications/ Caution - Pregnancy + breastfeeding

Vitamin K antagonist - Anticoagulant - Inhibits formation of factors in the intrinsic pathway: Factors 2,7,9, 10 Indications - Thrombosis prophylaxis: PE, DVT, Stroke, AF, prosthetic valves Side effects - Bleeding Contraindications/ caution - Active bleeding - Other anticoagulants/ antiplatelets - Elderly Pregnancy + breastfeeding - TERATOGENIC- especially first and third trimester - Safe for breastfeeding

Isosorbide mononitrate - Drug type/ mechanism - Indications - Side effects - Contraindications/ Caution - Pregnancy + breastfeeding

Nitrate? - Vasodilator Indicator - Angina - HF Side effects - Dizziness, drowsiness, hypotension Contraindications - Hypotension - constrictive heart disease/ obstructive heart faiure - Raised ICP Caution - Recent MI - In elderly, stopp if persistent postural hypotension Pregnancy - Avoid unless benefits> risk.

Indapamide - Drug type/ mechanism - Indications - Side effects - Contraindications/ Caution - Pregnancy + breastfeeding

Thiazide-like diuretic - Blocks Na+ reabsorption in distal tubule Indications - Essential hypertension Side effects - Hypokalaemia - Dizziness, fatigue, headaches - Alkalosis hypochloaemia Contraindications/ caution - Elderly - Addison's - Hypokalaemia - Hyponatraemia Pregnancy and breastfeeding - Avoid

Folliculitis - Description - Most common causative agents - Presentations

Infection of the hair follicle - Most commonly caused by staph aureus Superficial - Presents with tender/ painless pustule with hair shaft symptoms - Pustules - Pruritis - Tenderness

Cellulitis - Description - Most common causative agents - Presentation - Complications

Infection of the connective tissue: especially dermis and subcutaneous fat - Most commonly caused by S pyogenes, S aureus Symptoms - Red, hot and painful area with increasing margins overtime - Fever, chills Complications - Abscess - Fasciitis - Sepsis - Osteomyelitis

Impetigo treatment - Local infection - Widespread infection

Local - Topical fusidic acid (7 days) Widespread - Oral flucloxacillin/ clarithromycin

Cellulitis treatment - First line - Severe

First line - Flucloxacillin - Clarithromycin/ doxycycline if penicillin allergy - Erythromycin if prengnant If near eyes/ nose - Co-amoxiclav - clarithromycin with metronidazole if allergy Severe - Co-amoxiclav - Clindamycin - IV cefuroxime

Class 1 cellulitis - Description - Treatment

Infection with no systemic signs or uncontrolled co-morbidities Treatment - Flucloxacillin 500-100mg QDS, 7 days Alternatives - Clarithromycin 500mg BD - Doxycycline 200mg, then 100mg OD - If pregnant, erythromycin 500 QDS

Severe cellulitis treatment

1. Co-amoxiclav or clindamycin/ IV cefuroxime Add IV vancomycin if MRSA

Erysipelas - Description - Presentation - Most common causative agents

Bacterial infection of the upper dermis - Extends to subcutaneous lymphatic vessels - More superficial than cellulitis Presentation - Red, hot lesion - Lethery, rough skin - Well-defined margins Causative agent - Beta-hameolytic Strep (S pyogenes)

Furuncles - Description - Causative organism -

Deep folliculitis - Deep infection of the hair follicle - Most common caused by Staph aureus Presenation - Swollen area, due to accumulation of pus/ dead tissue - Boils= pus filled.

Necrotising fasciitis - Description - Causative organism - Presentation - Management

Infection of the deep soft tissue - Causing destruction of muscle fascia and subcutaneous fat - Typically caused by S.pyogenes Presentation - Affects extremities, progresses rapidly - Starts off with red tissue, which progresses rapidly Management - Surgical removal of necrotic tissue (debridement) - Amputation if limb is compromised - Antibiotics= broad spectrum IV antibiotics

Necrotising fasciitis antibiotic treatment

IV Tazocin (piperacillin- tazobactam) + clandamycin Benylpenicillin+ clindamycin + gentamicin