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Cardiology Flashcards

1
Q

What is a mnemonic to remember the management of unstable angina

A

H-MOAT

Heparin 
Morphine 
Oxygen 
Aspirin 
Ticagrelor
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2
Q

What antithrombin therapy is usually given in unstable angina

A

Fondaparinux

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3
Q

What dose, route, timing of fondaparinux is given

A

FONDAPARINUX
2.5mg
SC
OD

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4
Q

When is UFH given as an alternative to fondaparinux in unstable angina

A

Immediate angiography planned or creatinine >256

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5
Q

What creatinine means UFH should be given over fondaparinux

A

> 256

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6
Q

How long is fondaparinux continued for

A

8-days post discharge

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7
Q

What dose of UFH is given, what route

A

HEPARIN (UNFRACTIONATED)

5000 units loading dose STAT.
18units/Kg/hour continuous IV infusion

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8
Q

What dose, timing, route is morphine given in unstable angina

A

OROMORPH
10mg. 4-hourly
PO

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9
Q

What dose of morphine is given to an elderly patient with unstable angina

A

5mg, 4-hourly

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10
Q

In management of unstable angina what score is used

A

GRACE Score

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11
Q

When should unstable angina receive PCI

A
  1. Immediately - if haemodynamically unstable

2. 72h if a GRACE score more than 3

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12
Q

What dual antiplatelet therapy is the individual given in unstable angina is low risk of bleeding

A

Ticagrelor

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13
Q

What dual antiplatelet therapy is the individual given in unstable angina if high risk of bleeding

A

Clopidogrel

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14
Q

What is the dose/route for aspirin in unstable angina

A

ASPIRIN
300mg
PO

(Loading dose 300)

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15
Q

What is the dose/route for clopidogrel in unstable angina

A

CLOPIDOGREL
300mg
PO

(Loading dose 300)

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16
Q

What is the dose/route for ticagrelor in unstable angina

A

TICAGRELOR
180mg
PO

(Loading dose 180)

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17
Q

What is the MOA of fondaparinux

A

Enhanced anti-thrombin that inhibits F10

18
Q

What are 3 side effects of fondaparinux

A
  • Bleeding
  • Bruising at injection site
  • HYPERKALAEMIA
19
Q

What is a contraindication to Fondaparinux

A

At-risk of bleeding

20
Q

Give 4 patients that may be at risk of bleeding on fondaparinux

A
  • Renal impairment
  • Uncontrolled HTN
  • Coagulation disorder
  • Recent surgery
21
Q

If required, what monitoring is done for fondaparinux

A

Antifactor Xa activity

22
Q

What is the MOA of unfractionated heparin

A

Increases action anti-thrombin, inhibiting F2 and F10

23
Q

What are 3 adverse effects of UFH

A
  • Bleeding
  • Injection site brusing
  • Hyperkalaemia
24
Q

What is a rare, but serious, adverse event of UFH

A

Heparin induced thrombocytopenia (HIT)

25
When is UFH beneficial
Renal impairment
26
What is a contraindication to UFH
At-risk bleeding
27
What agent can be used to reverse UFH
Protamine sulphate
28
What blood tests should be ordered prior to starting UFH
Renal Profile FBC Coagulation profile
29
What is used to monitor efficacy of UFH
APTT
30
If someones been on UFH for more than 4-days what should be checked
U+E | Platelets (FBC)
31
What are 3 adverse events of aspirin
- Bronchospasm - GI irritation, peptic ulcer - Tinnitus
32
How does aspirin OD present
- Hyperventilation, changes in hearing, metabolic acidosis, convulsions, cardiovascular collapse
33
What are 3 absolute CI of aspirin
- Hypersensitivity - Under 16 (Reye Syndrome) - 3rd trimester pregnancy
34
Why is aspirin CI in the 3rd trimester of pregnancy
- Causes pre-mature closure of the ductus arteriosus
35
What are two relative CI of aspirin
- Gout | - Peptic Ulcers
36
What drugs interact with aspirin to cause bleeding
- Anti-platelets | - Anti-thrombotic agents
37
What are 3 side effects of ticagrelor
- Bleeding - GI upset: diarrhoea, abdominal pain, dyspespsia - Thrombocytopenia
38
What derrangement can Ticagrelor cause on FBC
Thrombocytopenia
39
What is a CI to ticagrelor
Active bleeding
40
What drugs interact with ticagrelor
CYP450 inducers and inhibitors
41
What drugs interact with clopidogrel
- CYP450 Inducers and Inhibitors - Antiplatelets - Antithrombin
42
Explain PPIs and clopidogrel
Omeprazole has activity on CYP450. Therefore lansoprazole or pantoprazole should be given for GI protection if on clopidogrel.

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