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Phase 2 Y3 PPT > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What is the definition of stage 1 hypertension?

A

ambulatory BP average 135/85 or higher

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2
Q

What is the definition of stage 2 hypertension?

A

ambulatory BP average above 150/95

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3
Q

What does it mean if the difference between daytime and nighttime BP readings is <10%

A

BP not dipping at night as expected
could be underlying cause such as sleep apnoea
warrants further investigation

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4
Q

When is antihypertensive medication indicated?

A

patients under. 80 with stage 1 hypertension who have more than one of the following:

  • target organ damage
  • established cardiovascular disease
  • renal disease
  • diabetes mellitus
  • Q risk ≥20%

all patients with stage 2 hypertension, regardless of age

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5
Q
  1. When assessing hypertension, which tests are important to perform? (8)
  2. Why are these things assessed?
A 
1. albumin creatinine ratio
   haematuria
   plasma glucose
   electrolytes and creatinine
   eGFR
   serum cholesterol
   fundal examination
   12 lead ecg
  1. assessment of end organ damage as a consequence of HTN
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6
Q

What is the stepwise management of hypertension in a patient <55 and not of afrocaribbean origin?

A
  1. ACEi/ARB (ramipril)
    • CCB (amlodipine)
    • thiazide
    • spironolactone
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7
Q

What is the stepwise management of hypertension in a patient >55 and/or of afrocaribbean origin?

A
  1. CCB
  2. +ACEi/ARB (ramipril)
    • thiazide
  4. +spironolactone
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8
Q
  1. Name common side effects of ARBs?
  2. which common class of drugs should be avoided in patients taking ARBs?
  3. name 2 examples
A
  1. dizziness (particularly after first dose)
    hyperkalaemia
  2. NSAIDs
  3. losartan; candesartan
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9
Q
  1. What type of Calcium channel blockers are used in the management of hypertension?
  2. Name common side effects of CCBs
  3. In which patients should these CCBs should be avoided?
  4. Name an important interaction for CCBs
  5. Name 2 examples
A
  1. dihydropyridines
  2. bilateral ankle swelling (amlodipine)
    flushing
    headache
    palpitations
  3. unstable angina and severe aortic stenosis
  4. beta blockers
  5. amlodipine; nifedipine
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10
Q
  1. Name common side effects of Thiazide diuretics

2. Which drugs should be avoided in patients taking thiazide diuretics

A
  1. hypokalaemia
    impotence
  2. potassium lowering drugs (loop diuretics)
    NSAIDs
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11
Q
  1. Name 2 common side effects of spironolactone

2. name 4 contraindications for spironolactone

A
  1. hyperkalaemia
    gynaecomastia
  2. hyperkalaemia
    severe renal impairment
    addison’s disease
    pregnant/breast feeding women
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12
Q
  1. What needs to be monitored in patients taking antihypertensives?
  2. Which tests are performed to do this? (4)
  3. How frequently does this need to occur?
A
  1. electrolytes, creatinine (should not increase by more than 30%), eGFR (should not fall by more than 25%); serum potassium
  2. 1-2 weeks into treatment and after increasing dose
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13
Q
  1. Who is offered statin therapy as a primary prevention strategy?
  2. What statin is offered and at what dose?
A
  1. Q risk ≥10%

2. atorvostatin 20mg

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14
Q

name 4 common side effects of statins

A
  1. headaches
  2. GI disturbance
  3. effects on muscle
  4. raise in ALT
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15
Q
  1. When should statins be used with caution?

2. Which antibiotic interracts with Statins?

A
  1. hepatic impairment; renal impairment; avoided in pregnancy
  2. clarythromycin
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16
Q

Which blood test needs to be done at baseline, 3 months and 12 months in patients taking statins?

A

liver enzymes

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17
Q
  1. What is the MOA of fibrates?

2. What is the MOA of ezetimbe?

A
  1. activates PPARa agonist; promotes uptake, utilisation and catabolism of fatty acids
  2. inhibits GI absorption of cholesterol
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18
Q
  1. Which agents are used as immediate antocoagulation?
  2. How are these administered?
  3. What are the indications of immediate anticoagulation)
A
  1. unfractionated heparin and LMWH
  2. parenterally
  3. DVT (prophylaxis and management)
    ACS
    AF
    mechanical heart valve replacement
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19
Q

What is the MOA of:

  1. Unfractionated Heparin?
  2. Low Molecular Weight Heparin?
A
  1. binds to anti-thrombin and accelerates its inhibition of factor Xa and thrombin
  2. binds to antithrombin and accelerates its inhibition of factor Xa
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20
Q

Name 2 examples of LMWH?

A

dalteparin (LMWH)

fondaparinux (synthetic heparin)

21
Q

Which clotting factors are vitamin K dependent?

A

II, VII, IX and X

22
Q
  1. What is the MOA of warfarin?
  2. Why does LMWH need to be continued at the start of warfarin therapy?
  3. What is the main side effect of warfarin?
  4. What needs to be monitored regularly?
  5. What do patients taking warfarin need to carry?
A
  1. vitamin K antagonist - prevents the synthesis of vitamin K dependent clotting factors
  2. to ensure the patient has reached an appropriate and therapeutic level of anticoagulation from the warfarin)
  3. bleeding
  4. INR
  5. yellow anticoagulation book
23
Q

Name 3 examples of DOACs

A
  1. rivaroxaban
  2. apixiban
  3. edoxiban
24
Q

Name 4 conservative management techniques for PVD?

A
  1. smoking cessation
  2. supervised graded exercise therapy
  3. foot care (especially in diabetic patients)
  4. avoid cold temperatures
25
Q

How is PVD managed medically?

A

Modification of CV risk factors

  • statin
  • antiplatement (aspirin, clopidogrel)
  • antihypertensive
  • glycaemic control

Clozitol - PDE inhibitor

26
Q

Name 5 indications for surgical revascularisation in PVD?

A
  • critical limb ischaemia
  • bypass surgery using autologous vein
  • enarterectomy
  • amputation (last resort in the event of gangrene)
27
Q

In general, how do anti-antignal drugs work to reduce symptoms?

A

reduce myocardial oxygen demand

increase myocardial oxygen supply

28
Q

Which drug is used for immediate symptom relief for angina?

A

GTN

29
Q

Name 4 drugs used in angina to reduce symptoms? (and how they do so)

A

BETA BLOCKERS - decrease HR, reduce force of cardiac contraction; reduce cardiac output (therefore reduce afterload)

CCBs - peripheral artery and coronary artery dilation; negative chronotropic effect (NDCCBs only); reduced cardiac contractoloty

Long acting Nitrates - isosorbide dinitrate

30
Q

What is the MOA of:

  1. Nicorandil?
  2. Ivabridine?
  3. Ranolazine?
  4. What condition are these drugs indicated for?
A
  1. long acting nitrate + K+ channel agonist (shortens duration of AP preventing intracellular calcium overload)
  2. sinus node inhibitor; reduces HR
  3. reduces ventricular wall tension
  4. angina
31
Q
  1. Which drugs are used in the acute management of ACS?
  2. When is primary PCI indicated for STEMI?
  3. When is primary PCI indicated for NSTEMI?
A
  1. morphine and O2
    anti-ischamic agent - nitrates, beta blockers, CCBs
    dual antiplatelet therapy - aspirin + ticagrelor/clopidogrel/presurgel
    anticoagulation - LMWH/fondaparinux/unfractionated heparin
    thrombolysis - alteplase
  2. within 12 hours of symptom onset and if it can be performed within 2 hours of when thrombolysis could have been given
  3. within 72 hours if clinically stable
    within 24 hours if clinically unstable
32
Q
  1. Name the 4 drugs indicated in the ongoing management of ACS in all patients
  2. Which drug is indicated in patients with ACS whose LVEF is <35%?
A
  1. Dual antiplatelet therapy
    • aspirin (lifelong treatment)
    • ticagrelor (continued for 1 year)

ACEi/ARB
beta blocker
statin

  1. spironolactone/eplenerone
33
Q

What are the pharmacological properties of:

  1. Low dose aspirin?
  2. intermediate dose aspirin?
A
  1. antiplatelet

2. analgesic and antipyretic

34
Q

How is acute pulmonary oedema managed?

A
  1. oxygen
  2. morphine
  3. IV nitrates
  4. IV furosemide
  5. inotropes if haemodynamically unstable
35
Q
  1. What do inotropes do?

2. name 3 examples?

A
  1. increase force of cardiac contraction

2. dobutamine; adrenaline; isoprenaline

36
Q

Name 2 side effects of furosemide?

A

hypogalaemia

increases plasma concentration of renally excreted drugs

37
Q
  1. Name 3 classes of drugs used as cardioprotection in patients with chronic heart failure?
  2. Which drug should be used to treat hypertension in patients with Heart failure?
  3. Which drug should be used to treat AF in patients with heart failure?
A
  1. ACEi/ARB; Beta blockers; aldosterone antagonists
  2. amlodipine
  3. digoxin
38
Q

Name 3 classes drugs used as rate control agents

A
  1. digoxin
  2. beta blockers
  3. NDCCBs
39
Q
  1. Name 3 classes of drugs used as rhythm control agents

2. When are they indicated as a first line strategy to manage AF?

A
  1. class Ia/Ic, II and III antiarrythmics
  2. reversible AF
    HF believed to be a primary cause of AF
    new onset AF
    atrial flutter
40
Q

Which types of drugs make up the following Vaughn-Williams Classification of antiarrythmics?

  1. class I
  2. Class II
  3. Class III
  4. Class IV
A
  1. sodium channel blockers
  2. beta blockers
  3. potassium channel blockers
  4. calcium channel blockers
41
Q
  1. How do class I antiarrthmics work?

2. Name 2 examples

A
  1. act on the depolarisation phase of the cardiac AP

2. lidocaine, flecanide

42
Q
  1. How do class II antiarrythmics work?

2. Name an example

A
  1. slow conduction velocity within the heart by prolonging AV node repolarisation
  2. bisoprolol
43
Q
  1. How do class III antiarrythmics work?

2. Name 2 examples?

A
  1. prolong refractory period and AP duration

2. amiodarone; solatol

44
Q
  1. How do class IV antiarrythmics work?

2. Name 2 examples?

A
  1. negative chronotropic and dromotropic effects

2. verapamil; diltiazem

45
Q

Which drug is given to patients with supraventricular tachycardia?

A

adenosine

46
Q

How are patients with ventricular tachycardia managed if:

  1. they are stable?
  2. they are unstable?
A
  1. solatol, amiodarone; lidocaine

2. urgent defibrilation + amiodarone/lidocaine

47
Q

Which drug is given to manage bradycardia?

A

atropine

48
Q

In cardiac arrest, how often is:

  1. adrenaline given?
  2. amiodarone given?
A
  1. every 3-5 mins

2. after 3 shocks

Phase 2 Y3 PPT (8 decks)

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