Cardiology Flashcards
What is the definition of stage 1 hypertension?
ambulatory BP average 135/85 or higher
What is the definition of stage 2 hypertension?
ambulatory BP average above 150/95
What does it mean if the difference between daytime and nighttime BP readings is <10%
BP not dipping at night as expected
could be underlying cause such as sleep apnoea
warrants further investigation
When is antihypertensive medication indicated?
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
- When assessing hypertension, which tests are important to perform? (8)
- Why are these things assessed?
1. albumin creatinine ratio haematuria plasma glucose electrolytes and creatinine eGFR serum cholesterol fundal examination 12 lead ecg
- assessment of end organ damage as a consequence of HTN
What is the stepwise management of hypertension in a patient <55 and not of afrocaribbean origin?
- ACEi/ARB (ramipril)
- CCB (amlodipine)
- thiazide
- spironolactone
What is the stepwise management of hypertension in a patient >55 and/or of afrocaribbean origin?
- CCB
- +ACEi/ARB (ramipril)
- thiazide
- +spironolactone
- Name common side effects of ARBs?
- which common class of drugs should be avoided in patients taking ARBs?
- name 2 examples
- dizziness (particularly after first dose)
hyperkalaemia - NSAIDs
- losartan; candesartan
- What type of Calcium channel blockers are used in the management of hypertension?
- Name common side effects of CCBs
- In which patients should these CCBs should be avoided?
- Name an important interaction for CCBs
- Name 2 examples
- dihydropyridines
- bilateral ankle swelling (amlodipine)
flushing
headache
palpitations - unstable angina and severe aortic stenosis
- beta blockers
- amlodipine; nifedipine
- Name common side effects of Thiazide diuretics
2. Which drugs should be avoided in patients taking thiazide diuretics
- hypokalaemia
impotence - potassium lowering drugs (loop diuretics)
NSAIDs
- Name 2 common side effects of spironolactone
2. name 4 contraindications for spironolactone
- hyperkalaemia
gynaecomastia - hyperkalaemia
severe renal impairment
addison’s disease
pregnant/breast feeding women
- What needs to be monitored in patients taking antihypertensives?
- Which tests are performed to do this? (4)
- How frequently does this need to occur?
- electrolytes, creatinine (should not increase by more than 30%), eGFR (should not fall by more than 25%); serum potassium
- 1-2 weeks into treatment and after increasing dose
- Who is offered statin therapy as a primary prevention strategy?
- What statin is offered and at what dose?
- Q risk ≥10%
2. atorvostatin 20mg
name 4 common side effects of statins
- headaches
- GI disturbance
- effects on muscle
- raise in ALT
- When should statins be used with caution?
2. Which antibiotic interracts with Statins?
- hepatic impairment; renal impairment; avoided in pregnancy
- clarythromycin
Which blood test needs to be done at baseline, 3 months and 12 months in patients taking statins?
liver enzymes
- What is the MOA of fibrates?
2. What is the MOA of ezetimbe?
- activates PPARa agonist; promotes uptake, utilisation and catabolism of fatty acids
- inhibits GI absorption of cholesterol
- Which agents are used as immediate antocoagulation?
- How are these administered?
- What are the indications of immediate anticoagulation)
- unfractionated heparin and LMWH
- parenterally
- DVT (prophylaxis and management)
ACS
AF
mechanical heart valve replacement
What is the MOA of:
- Unfractionated Heparin?
- Low Molecular Weight Heparin?
- binds to anti-thrombin and accelerates its inhibition of factor Xa and thrombin
- binds to antithrombin and accelerates its inhibition of factor Xa
Name 2 examples of LMWH?
dalteparin (LMWH)
fondaparinux (synthetic heparin)
Which clotting factors are vitamin K dependent?
II, VII, IX and X
- What is the MOA of warfarin?
- Why does LMWH need to be continued at the start of warfarin therapy?
- What is the main side effect of warfarin?
- What needs to be monitored regularly?
- What do patients taking warfarin need to carry?
- vitamin K antagonist - prevents the synthesis of vitamin K dependent clotting factors
- to ensure the patient has reached an appropriate and therapeutic level of anticoagulation from the warfarin)
- bleeding
- INR
- yellow anticoagulation book
Name 3 examples of DOACs
- rivaroxaban
- apixiban
- edoxiban
Name 4 conservative management techniques for PVD?
- smoking cessation
- supervised graded exercise therapy
- foot care (especially in diabetic patients)
- avoid cold temperatures
How is PVD managed medically?
Modification of CV risk factors
- statin
- antiplatement (aspirin, clopidogrel)
- antihypertensive
- glycaemic control
Clozitol - PDE inhibitor
Name 5 indications for surgical revascularisation in PVD?
- critical limb ischaemia
- bypass surgery using autologous vein
- enarterectomy
- amputation (last resort in the event of gangrene)
In general, how do anti-antignal drugs work to reduce symptoms?
reduce myocardial oxygen demand
increase myocardial oxygen supply
Which drug is used for immediate symptom relief for angina?
GTN
Name 4 drugs used in angina to reduce symptoms? (and how they do so)
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
What is the MOA of:
- Nicorandil?
- Ivabridine?
- Ranolazine?
- What condition are these drugs indicated for?
- long acting nitrate + K+ channel agonist (shortens duration of AP preventing intracellular calcium overload)
- sinus node inhibitor; reduces HR
- reduces ventricular wall tension
- angina
- Which drugs are used in the acute management of ACS?
- When is primary PCI indicated for STEMI?
- When is primary PCI indicated for NSTEMI?
- morphine and O2
anti-ischamic agent - nitrates, beta blockers, CCBs
dual antiplatelet therapy - aspirin + ticagrelor/clopidogrel/presurgel
anticoagulation - LMWH/fondaparinux/unfractionated heparin
thrombolysis - alteplase - within 12 hours of symptom onset and if it can be performed within 2 hours of when thrombolysis could have been given
- within 72 hours if clinically stable
within 24 hours if clinically unstable
- Name the 4 drugs indicated in the ongoing management of ACS in all patients
- Which drug is indicated in patients with ACS whose LVEF is <35%?
- Dual antiplatelet therapy
- aspirin (lifelong treatment)
- ticagrelor (continued for 1 year)
ACEi/ARB
beta blocker
statin
- spironolactone/eplenerone
What are the pharmacological properties of:
- Low dose aspirin?
- intermediate dose aspirin?
- antiplatelet
2. analgesic and antipyretic
How is acute pulmonary oedema managed?
- oxygen
- morphine
- IV nitrates
- IV furosemide
- inotropes if haemodynamically unstable
- What do inotropes do?
2. name 3 examples?
- increase force of cardiac contraction
2. dobutamine; adrenaline; isoprenaline
Name 2 side effects of furosemide?
hypogalaemia
increases plasma concentration of renally excreted drugs
- Name 3 classes of drugs used as cardioprotection in patients with chronic heart failure?
- Which drug should be used to treat hypertension in patients with Heart failure?
- Which drug should be used to treat AF in patients with heart failure?
- ACEi/ARB; Beta blockers; aldosterone antagonists
- amlodipine
- digoxin
Name 3 classes drugs used as rate control agents
- digoxin
- beta blockers
- NDCCBs
- Name 3 classes of drugs used as rhythm control agents
2. When are they indicated as a first line strategy to manage AF?
- class Ia/Ic, II and III antiarrythmics
- reversible AF
HF believed to be a primary cause of AF
new onset AF
atrial flutter
Which types of drugs make up the following Vaughn-Williams Classification of antiarrythmics?
- class I
- Class II
- Class III
- Class IV
- sodium channel blockers
- beta blockers
- potassium channel blockers
- calcium channel blockers
- How do class I antiarrthmics work?
2. Name 2 examples
- act on the depolarisation phase of the cardiac AP
2. lidocaine, flecanide
- How do class II antiarrythmics work?
2. Name an example
- slow conduction velocity within the heart by prolonging AV node repolarisation
- bisoprolol
- How do class III antiarrythmics work?
2. Name 2 examples?
- prolong refractory period and AP duration
2. amiodarone; solatol
- How do class IV antiarrythmics work?
2. Name 2 examples?
- negative chronotropic and dromotropic effects
2. verapamil; diltiazem
Which drug is given to patients with supraventricular tachycardia?
adenosine
How are patients with ventricular tachycardia managed if:
- they are stable?
- they are unstable?
- solatol, amiodarone; lidocaine
2. urgent defibrilation + amiodarone/lidocaine
Which drug is given to manage bradycardia?
atropine
In cardiac arrest, how often is:
- adrenaline given?
- amiodarone given?
- every 3-5 mins
2. after 3 shocks