Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BNF Chapters > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Initial NSTEMI treatment

A

Aspirin (chewed/dispersed in water - alert if aspirin given before hospital),
Clopidogrel (ticagelor, prasugrel in some patients that have a PCI),
O2 (extra care needed if COPD),
Nitrates ( GTN sublingual then IV/Buccal or iso) and Morphine for pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

STEMI treatment

A

Initial = Aspirin (chewed/dispersed in water alert if aspirin given before hospital), Clopidogrel (ticagelor, prasugrel in some patients that have PCI),
O2 (extra care needed if COPD),
Nitrates ( GTN sublingual then IV/Buccal or iso) and Morphine for pain (antiemetic too)
PCI/thrombolytic drug (reperfusion therapy) to open artery, PCI preferred.
glycoprotein iib/iiia inhibitors can also be used e.g.abciximab, eptifibatide, and tirofiban to reduce occlusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What beta blockers should be used if Left ventricular dysfunction

A

bisoprolol, carvedilol, metoprolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What CCB to use if beta blockers are contraindicated in those with left ventricular dysfunction

A

Diltiazem and verapamil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What diuretic is used for left ventricular dysfunction heart failure

A

Epleronone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How to manage Von Willebrand Disease haemophilia

A

Desmopressin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what fibrinolytic (plasminogen activator) treats DVT

A

Streptokinase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What drug inhibits fibrinolysis

A

Tranexamic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what fibrinolytic (plasminogen activator) treats PE

A

Alteplase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Role of hydralazine

A

adjunct to other antihypertensives for resistant HT, hypertensive crisis, heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Concerns with Thiazides in renal impairment

A

Not to be used below 30mL/minute/1.73 m2 (Metolazone can still be used)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Thiazide use in pregnancy and breastfeeding

A

Not to be used in pregnancy but alright in breastfeeding women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the side effects of minoxidil and how are risks reduced

A

Increasing cardiac output and fluid retention so needs to be given with beta blockers and diuretic, causes excessive hair growth too

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is methyldopa

A

a centrally acting antihypertensive, can be used in pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is clonidine

A

a centrally acting antihypertensive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Aspirin’s cardiovascular uses

A 
MI,
CVD secondary prevention,
AF, 
post CABG, 
strokes, and stent placement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Common clopidogrel side effects

A

Diarrhoea; gastrointestinal discomfort; haemorrhage; skin reactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Long Term STEMI treatment

A

Dual antiplatelet therapy, Beta blocker, ACE, Statin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Length of clopidogrel treatment for NSTEMI

A

Initially 300 mg, then 75 mg daily for up to 12 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Length of clopidogrel treatment for STEMI

A

Initially 300 mg, then 75 mg for at least 4 weeks. (if >75yo then 75mg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Dipyradimole uses

A

An adjunct to oral anticoagulation to prevent thromboembolism associated with valve replacements, the MR version can be used in secondary prevention of strokes/TIA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When is DAPT needed

A

After PCI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

DAPT combinations

A

Aspirin +cangrelor, clopidogrel, prasugrel, ticagrelor(unlicensed).
Aspirin used indefinitely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How long is aspirin used post-PCI

A

Indefinitely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How is clopidogrel used with bare metal stent

A

With Bare metal stent, clopidogrel used for at least a month

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How long is clopidogrel used with a drug eluting stent

A

For drug eluting stent, clopidogrel used for at least 6 months ( typically 12 months)
Risk of re-endotheliasation if clopidogrel stopped prematurely in those with drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Glucoprotein iib/iia inhibitors drugs

A

Abciximab, eptifibatide, tirofiban.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Glucoprotein iib/iia inhibitors use

A

Prevent platelet aggregation by blocking the binding of fibrinogen to receptors on platelets
Used to prevent ischemic complications , MI prevention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How is AF managed

A

controlling rate or rhythm control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

When is electrocardioversion used

A

Life threatening insurances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

When is rate control treatment preferred

A

If onset is more than 48 hours or there is uncertainty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is preferred if there is structural heart disease in AF

A

Amiodarone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What drugs are used as urgent rate control

A

Beta blocker, verapamil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What form of AF treatment is preferred first

A

Rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Rate control drugs

A

beta blockers(not sotalol), rate limiting CCB (diltiazem which is unlicensed, verapamil).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

When is digoxin useful in AF treatment

A

Sedentary patients, and CHF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What happens if monotherapy treatment for AF fails

A

Combination of two drugs (beta blocker, digoxin and diltiazem) given, if this doesn’t work then rhythm-control is considered.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Rhythm control treatment

A

Beta blocker if not then antiarrhythmic e.g.sotalol, flecainide, propafenone, amiodarone, dronedarone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Amiodarone and cardioversion

A

Started 4 weeks before cardioversion and up to 12 months afterwards to maintain sinus rhythm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

When are flecainide and propafenone contraindicated

A

If known ischaemic or structural heart disease and in paroxysmal AF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

CHADSVASC and HAS-BLED are used to …

A

evaluate stroke and bleeding risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

CHADVASC risk factors

A

prior ischaemic stroke, transient ischaemic attacks, or thromboembolic events, heart failure, left ventricular systolic dysfunction, vascular disease, diabetes, hypertension, females, and patients over 65 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

When is oral anticoagulation offered in AF

A

In confirmed diagnosis in whom sinus rhythm has not been restored within 48 hours of onset or at high risk of AF recurrence e.g. structural heart disease, previous history of AF/cardioversion and when stroke risk outweighs bleeding risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Atrial flutter treatment

A

Responds less well to drug treatment than AF
Direct current cardioversion is used and catheter ablation.
Flecainide and propafenone can be used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Paroxysmal supraventricular tachycardia treatment

A

With adenosine or verapamil, cardioversion, catheter ablation and prevented by usual suspects e.g. diltiazem beta blockers including sotalol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Treating bradycardia

A

IV dose of atropine. If risk of asystole give atropine/adrenalin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

How to restore sinus rhythm

A

Direct current cardioversion given to restore sinus rhythm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Treating sustained ventricular tachycardia

A

Amiodarone if haemodynamically stable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Cause of torsade de pointes

A

Often drug induced or caused by hypokalemia, severe bradycardia and genetics.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Result of torsade de pointes

A

self limiting but can result in impairment and loss of consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Drugs that act on supraventricular arrhythmias:

A

Verapamil (adenosine can be used against paroxymal SVT due to its short action)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Drugs acting on supraventricular and ventricular:

A

Amiodarone, beta blockers, flecainide, propafenone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What arrhythmia can lidocaine potentially treat

A

Ventricular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Digoxin and ventricular

A

Digoxin lows ventricular response in AF and atrial flutter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Amiodarone characteristics

A

It has a very long half-life. Weeks or months needed to achieve steady state.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Sotalol is used in what arrhythmias

A

Sotalol used in management of ventricular arrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Nitrates and tolerance and what to do

A

Many patients on long-acting or transdermal nitrates rapidly develop tolerance (with reduced therapeutic effects). Reduction of blood-nitrate concentrations to low levels for 4 to 12 hours each day usually maintains effectiveness in such patients.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Statins and pregnancy

A

Statins should be avoided in pregnancy (discontinue 3 months before attempting to conceive) as congenital anomalies have been reported and the decreased synthesis of cholesterol possibly affects fetal development.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Statin Mechanism of Action

A

Inhibit HMG COA reductase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

When do GTN tablets expire

A

8 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Nicorandil class

A

Potassium channel activator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Nicorandil indication

A

Prevention and long term treatment of angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Notable nicorandil side effects

A

ulceration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Ivabadrine effect and indication

A

lowers heart rate used in angina and CHF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Where do beta blockers act

A

Heart, peripheral vasculature, bronchi, pancreas and liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What is intrinsic sympathomimetic activity (ISA/Partial agonist activity)

A

Capacity of beta-blockers to stimulate and block adrenergic activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What beta blockers have ISA

A

Celiprolol, pindolol, acebutolol and oxprenolol (CAPO)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What is the advantage of ISA activity

A

Less bradycardia and coldness of extremities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Advantage of water soluble beta blockers

A

Less likely to enter brain and cause sleep disturbance/nightmare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Name water soluble beta blockers

A

Sotalol, Atenolol, Nadolol and Celiprolol - SANC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Disadvantage of water soluble beta blockers

A

Excreted by kidneys so dose reduction may be needed in renal impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What beta-blockers have OD regimen/ long duration of action

A

Atenolol, bisoprolol, celiprolol, nadolol - BANC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Who are beta-blockers contraindicated in

A

2nd/3rd degree heart block, unstable heart failure, Asthma, COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What beta blockers have arteriolar vasodilating action

A

Labetalol, celiprolol, carvedilol and nebivolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Stance on beta blockers in asthma/COPD

A

Cause bronchospasm so try to avoid but use if necessary in well-controlled asthma or COPD for heart failure or post MI. use cardioselective blockers

76
Q

Cardioselective beta blockers

A 
Acebutolol 
Atenolol.
Betaxolol.
Bisoprolol.
Celiprolol 
Metoprolol.
Nebivolol.
Esmolol.
77
Q

Notable uses of beta blockers

A

Anxiety, tremor, migraine prophylaxis and glaucoma

78
Q

Dihydropyridine calcium-channel blockers

A

Amlodipine, felodipine, lacidipine, lercanidipine hydrochloride, nicardipine hydrochloride, nifedipine, and nimodipine

79
Q

What CCB can be used in heart failure

A

Amlodipine

80
Q

Why can’t CCBs be used in heart failure

A

They further depress cardiac function and exacerbate symptoms

81
Q

Verapamil indications

A

Angina, hypertension, arrhythmias (SVT), unstable angina when beta blockers can’t be used

82
Q

How does verapamil work

A

Reduces cardiac output, slows heart rate, impairs atrioventricular conduction

83
Q

Verapamil cautions

A

Precipitates heart failure, worsens conduction disorders, don’t use with beta blockers, constipation

84
Q

What is verapamil

A

Negatively inotropic

85
Q

Nifedipine mechanism of action

A

Relaxes vascular smooth muscle, dilates arteries

86
Q

What drugs resemble nifedipine and what are they used for

A

Nicardipine, amlodipine, felodipine.

Treat angina/ hypertension

87
Q

Side effects of dihydropyridines

A

Borne from vasodilation e.g. flushing, headache (gets better after a few days), ankle swelling

88
Q

What is diltiazem used for

A

Angina, hypertension (long acting) when beta blockers can’t be used

89
Q

What CCB is used for life threatening hypertension

A

IV nicardipine

90
Q

Initial acute ischaemic stroke treatment

A

Alteplase if within 4.5 hours of symptoms by medical staff.

If intracranial excluded treat with aspirin asap within 24 hours +PPI if needed

91
Q

How to treat stroke in those with AF

A

Give aspirin for two weeks then consider anticoagulant

92
Q

What to do for patients already taking anticoagulant who have a stroke

A

Stop and substitute for aspirin for 7 days

93
Q

Hypertension treatment and stroke management

A

stop hypertension treatment in acute phase of stroke unless considered for thrombolysis

94
Q

Long term TIA / ischaemic attack treatment

A

Clopidogrel/ dipyridamole MR +aspirin/dipyradimole MR/aspirin (in preference order)
And
High intensity statin regardless of cholesterol level 48 hours after onset

95
Q

When do you give long term treatment for strokes

A

Atrial fibrillation or other indications (such as a cardiac source of embolism, cerebral venous thrombosis or arterial dissection

96
Q

Blood pressure target post stroke

A

<130/80 mmHg

97
Q

Intracerebral haemorrage initial treatment

A

Surgery to remove haematoma , blood pressure lowering therapy within 6 hours, stop and reverse anticoagulant treatment

98
Q

Digoxin cautions

A

Hypokalaemia, renal function, elderly (STOPP), hypercalcaemia, hypomagnesaemia, hypoxia, thyroid disease

99
Q

Initial endocarditis treatment

A

Amoxicillin maybe add gentamicin, give vancomycin if penicillin allergy, if severe sepsis riskfactors and gram negative give vancomycin and meropenem

100
Q

Endocarditis caused by staphylococci treatment

A

Flucloxacillin for 4 weeks, if penicillin allergy/MRSA give vancomycin+rifampicin

101
Q

Streptococci endocarditis treatment

A

Benzylpenicillin sodium

102
Q

Endocarditis caused by enterococci treatment

A

Amoxicillin+gent/benzylpenicillin

103
Q

HACEK endocarditis treatment

A

Amoxicillin

104
Q

Heart failure effect/symptoms

A

Reduced cardiac output, SOB, coughing, wheezing, ankle swelling, fatigue, reduced exercise tolerance, pulmonary oedema/crackles, jugular venous pressure higher, pink frothy sputum

105
Q

Reduced heart failure is

A

Left ventricle loses its ability to contract normally and therefore presents with an ejection fraction of less than 40%

106
Q

Preserved heart failure

A

Left ventricle loses its ability to relax normally therefore the ejection fraction is normal or only mildly reduced

107
Q

Heart failure non-pharmacological treatment

A

smoking stop, less alcohol, more exercise, weight control, healthy diet, report weight gain of more than 1.5kg in 2 days, salt restricted if intake already high9 less than 6 g of salt a day)

108
Q

Why are diuretics recommended for treatment of reduced heart failure

A

Relieve breathlessness and oedema for those with fluid retention

109
Q

Reduced Ejection fraction heart failure treatment

A

Beta blocker+ ACEi
Loop diuretic
Aldosterone antagonist - eplerenone

110
Q

What to check when initiating ACE/ARB

A

serum potassium and sodium, renal function, and blood pressure

111
Q

Thiazide use in HF

A

To relieve oedema due to chronic heart failure and, in lower doses, to reduce blood pressure.

112
Q

Loop diuretic use in HF

A

Pulmonary oedema due to left ventricular failure and in patients with chronic heart failure or in resistant hypertension

113
Q

Thiazide mechanism

A

Inhibit sodium reabsorption at the beginning of the distal convoluted tubule

114
Q

Thiazide mechanism

A

Inhibit sodium reabsorption at the beginning of the distal convoluted tubule

115
Q

When do thiazide diuretics work and how long for

A

Within 1-2 hours for 12-24 hours

116
Q

Furosemide and bumetanide action and duration timings

A

Act in one hour and complete diuresis within 6 hours

117
Q

Spironolactone indications

A

Cirrhosis, primary hyperaldosteronism, heart failure,oedema

118
Q

Mannitol diuretic type

A

osmotic

119
Q

dorzalamide/brinzolamide indication

A

Inhibit formation of aqueous humour and used in glaucoma

120
Q

What to look out for when initiating ACE

A

First dose hypotension with heart failure patients taking loop diuretic, so may temporarily remove loop, this may need specialist supervision

121
Q

What do fibrates do e.g. fenofibrate

A

Reduce triglyceride concentration

122
Q

Risk of concomitant use of statin and fibrate

A

Muscle related side effects

123
Q

High intensity statins and dose

A

atorva 20mg = rosuva 10mg = simvastatin 80mg

124
Q

Low intensity statins

A

Simvastatin 10mg=prava 40mg=fluva 40mg

125
Q

When should alteplase/streptokinase be given for MI

A

6-12 hours of MI, ideally within an hour

126
Q

Hypertension lifestyle treatment

A

Clinic BP between 140/90 and 160/100 or >135/85 at home

127
Q

When to consider treatment for patients of >80YO with hypertension

A

If >150/90

128
Q

When to consider treatment for under 60 years old with hypertension

A

Stage 1 and estimated 10 year cv risk >10%

129
Q

When to consider hypertension treatment under age of 80

A

established cardiovascular disease, renal disease, diabetes, or a 10 year cardiovascular risk ≥10%.

130
Q

SIGN guidance on antihypertension treatment eligibility

A

Treatment offered if >140/90 regardless of age or stroke even if normal BP

131
Q

Stage 2 hypertension

A

Clinic BP160/100 - 180/120 mmHg or 150/95 at home

132
Q

When to refer hypertension patients on the same day

A

> 180/120, consider starting antihypertensive treatment immediately

133
Q

Aspirin and hypertension caution

A

BP must be controlled before giving aspirin

134
Q

BP target if under 80

A

140/90

135
Q

BP target in over 80yo

A

<150/90

136
Q

SIGN BP target

A

140/90

137
Q

Strategy for: Hypertension with type 2 diabetes in all patients (any age or origin), or hypertension without type 2 diabetes in those aged 55 years or below and not of black African or African-Caribbean origin

A
  1. ACE/ARB
  2. CCB/thiazide like diuretic +ACE/ARB
  3. ACE/ARB+ CCB and a thiazide-like diuretic
  4. Seek advice
138
Q

Hypdertension without type 2 diabetes in patients age 55 and over, or all ages of black African or African-Caribbean origin patients without type 2 diabetes

A
  1. CCB
  2. CCB+ACE/ARB/Thiazide
  3. ACE/ARB+CCB+Thiazide
  4. Seek advice + confirm
139
Q

T1DM hypertension aim

A

135/85 mmHg

140
Q

Antihypertensives with the potential of causing hypoglycaemia

A

Beta blockers

141
Q

Antihypertensives with the potential of causing hyperglycaemia

A

Thiazide, CCB

142
Q

Hypertension in pregnancy

A

intravenous labetalol hydrochloride, intravenous hydralazine hydrochloride, or oral nifedipine modified-release to achieve a target blood pressure of 135/85 mmHg or less.

143
Q

First line pre-eclampsia/ hypertension pregnancy treatment if >140/90

A

Labetalol (nifedipine mr if unsuitable then methyldopa)

144
Q

First line pre-eclampsia/ hypertension pregnancy treatment if 160/90

A

Labetalol if not then nifedipine, methyldopa

145
Q

Severe hypertension and pregnancy

A

Magnesium in critical care setting

146
Q

Methyldopa and pregnancy discontinuation

A

2 days before birth and switch

147
Q

Hypertension medicines used in breastfeeding

A

Enalapril first line or nifedipine/amlodipine in afro-Caribbean

148
Q

Nitrates action

A

Flushing, headache, and postural hypotension

149
Q

Length of GTN effect

A

20-30 minutes

150
Q

Nitrate indication

A

Angina prophylaxis, CHF adjunct

151
Q

When is isosorbide dinitrate used

A

Infrequent and prophylaxis

152
Q

Isosobide mononitrate use

A

Prophylaxis

153
Q

Anticoagulant use reason

A

Prevent thrombus formation/extension in the slower venous side

154
Q

Why are anticoagulants not that effective against artery thrombus prevention

A

Not that effective in preventing thrombus formation in arteries as they are faster flowing and the platelets have less fibrin

155
Q

Vitamin k antagonists

A

Warfarin, acenocoumarol, phenindione

156
Q

What anticoagulant is preferred before surgery

A

LMWH or heparin (can continue warfarin if already on it and at high risk of VTE)

157
Q

INR 2.5 is for

A 
DVT treatment
Treatment pulmonary embolism
AF
MI
Cardioversion (achieve at least 3 weeks before and 4 weeks after with higher targets may be used just to prevent cancellation)
158
Q

When is an INR of 3.5 recommended

A

Recurrent DVT/PE in patients already receiving anticoagulation with an INR >2
Mechanical prosthetic heart valves

159
Q

How to stop major bleeding from warfarin

A

Stop warfarin

Give phytomenadione IV , dried prothrombin complex or fresh frozen plasma (less effective) restart INR when <5.0

160
Q

When to stop warfarin before elective operations (days)

A

Stop 5 days before elective surgery

161
Q

At what INR do you still need to give phytomenadione if warfarin is stopped before surgery

A

Dose given the day before a procedure If INR greater than >1.5
Can bridge with LMWH

162
Q

When to bridge warfarin

A

High risk of thromboembolism

163
Q

Who is at high risk of thromboembolism

A

VTE in last 3 months
AF with previous stroke/TIA
Mechanical valve

164
Q

Antiplatelet +anticoagulant indication

A

ACS

PCI

165
Q

Why are LWMH preferred to heparin in VTE prevention

A

Equally effective and lower risk of HIT (heparin-induced thrombocytopenia)

166
Q

Fondaparinux action

A

Synthetic pentasaccharide that inhibits activated factor X

167
Q

Raynauds treatment

A

Smoking cessation

Aspirin

168
Q

QRISK factors

A 
Smoking status:	
non-smoker
Diabetes status:	
none
Angina or heart attack in a 1st degree relative < 60
Chronic kidney disease (stage 3, 4 or 5)	
Atrial fibrillation	
On blood pressure treatment	
Do you have migraines	
Rheumatoid arthritis	
Systemic lupus erythematosus (SLE)	
Severe mental illness
(this includes schizophrenia, bipolar disorder and moderate/severe depression)	
On atypical antipsychotic medication
Are you on regular steroid tablets	
A diagnosis of or treatment for erectile disfunction
Ethnicity
Age
BMI
Cholesterol
169
Q

When is heparin preferred to LMWH

A

Renal impairment

170
Q

Who is at risk of hospital acquired blood clots

A

post-surgery, immobility, malignancy, obesity, acquired/inherited hypercoaguable states, pregnancy and postpartum, hormonal therapy,

171
Q

Who should stockings be given to

A

acute stroke, thrombocytopenia, bleeding disorders

172
Q

What to use in general or orthopaedic surgery when the risk of VTE outweighs the risk of bleeding

A

LWMH( first line) , fondaparinux, aspirin+ stockings /rivaroxaban/apixa/dabigatran

173
Q

Who is at risk of hospital acquired blood clots

A

Post-surgery, immobility, malignancy, obesity, acquired/inherited hypercoaguable states, pregnancy and postpartum, hormonal therapy,

174
Q

First line confirmed proximal DVT/PE

A

Apixaban / rivaroxaban if contraindicated then LMWH for 5 days then dabigatran/edoxaban or LMWH with vitamin K antagonist until INR is at least 2.0

175
Q

Heparin antidote and downfalls

A

Protamine sulfate is a specific antidote to heparin (and LMWH but only partially reverse its effects)

176
Q

Stable angina is characterized by

A

Predictable chest pain/pressure often due to physical exertion/stress increasing hearts oxygen demand.

177
Q

Acute attack of angina

A

Treated with GTN, can also be used as a preventer, used just before activities known to result in attack.

178
Q

How does angina pain radiate

A

Starts at front of chest and may go to neck, shoulders, jaws or arms

179
Q

When are statin doses lowered

A

Lowered if side effects, low dose if CKD, high dose simvastatin avoided due to myopathy risk, maximum dose of 20mg when given with amlodipine

180
Q

When and what statin alternatives are used

A

Ezetimbe and bile acid sequestrants when elevated CVD risk and statin contraindicated

181
Q

Aim for reduction in non-HDL-cholesterol concentration with statins

A

> 40%

182
Q

Who should be offered low dose atorvastatin

A

T1DM patients who are over 40 or have other risk factors , patients over 85

183
Q

CVD risk greatest in>

A

South asian, men, family history, over 50 years,

184
Q

Resus

A

CPR - adrenaline every 3-5 minutes chest compressions , can be given (lidocaine is an alternative) amiodarone

185
Q

Long term angina prevention

A

beta-blocker first line
CCB if beta contraindicated
combine CCB and beta if monotherapy fails, try long acting nitrate monotherapy

BNF Chapters (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions