cardiology drugs

Question 1

Aspirin main uses

Answer 1

Acute coronary syndrome and acute ischaemic stroke
Long-term secondary prevention of thrombotic arterial events in patients with CVD, cerebrovascular and peripheral arterial disease
Atrial fibrillation – where warfarin is contraindicated
Mild – to – moderate pain and fever

Question 2

Aspirin MOA

Answer 2

Irreversibly inhibits COX to reduce production of pro-aggregratory factor thromboxane from AA, reducing platelet aggregation and risk of arterial occlusion.

Question 3

Aspirin Side Effects

Answer 3

GI irritation
GI ulceration and haemorrhage
Hypersensitivity reactions – bronchospasm
High dose therapy – tinnitus
Overdose: hearing changes, metabolic acidosis, confusion, convulsions, cardiovascular collapse and respiratory arrest

Question 4

Cautions and Contraindications: conditions

Answer 4

Avoid under 16 years – causes Reye’s syndrome
Avoid in aspirin hypersensitivity
Caution – No contraindicated in asthma if patient has responded well
Caution in peptic ulceration – prescribe gastroprotection
Caution in gout – may precipitate an attack
Avoid in 3rd trimester of pregnancy

Question 5

Cautions and Contraindications Drugs

Answer 5

Other antiplatelet – synergistic activity can lead to increased risk of bleeding
Anticoagulants – increased anticoagulant effect – increase bleeding
SSRi – increased risk of bleeding
Methotrexate – increases methotrexate toxicity

Question 6

Aspirin Monitoring

Answer 6

Presence of side effects

Question 7

Aspirin Counselling

Answer 7

Take with food

Question 8

Clopidogrel main uses

Answer 8

Usually prescribed with aspirin but can be used alone when aspirin is not tolerated

Acute coronary syndrome
Prevent occlusion of coronary artery stents
Secondary prevention of thrombotic arterial events – cardiovascular, cerebrovascular, peripheral arterial disease

Question 9

Clopidogrel MOA

Answer 9

Prevents platelet aggregation and reduces risk of arterial occlusion by binding irreversibly to adenosine diphosphate receptors on the surface of platelets. Synergistic with aspirin

Question 10

Clopidogrel side effects

Answer 10

Bleeding
GI upset
Dyspepsia
Abdominal pain
Diarrhoea
Thrombocytopenia – rare

Question 11

Clopidogrel cautions and contraindications- conditions

Answer 11

Avoid in significant active bleeding
Stop 7 days before surgery
Caution in renal and hepatic impairment

Question 12

Clopidogrel cautions and contraindications- drugs

Answer 12

Aspirin – increased risk of bleeding – but usually given together
Carbamazepine, chloramphenicol, cimetidine, ciprofloxacin, erythromycin, fluconazole – antiplatelet effect reduced
Courmarins – antiplatelet effect enhances anticoagulant effect – increased risk of bleeding – avoid with warfarin

Question 13

Clopidogrel monitoring

Answer 13

Monitor side effects

Question 14

Clopidogrel counselling

Answer 14

Treatment is usually for 12 months

Question 15

ARB main uses

Answer 15

1st line/ 2nd line for Hypertension
1st line for chronic heart failure
Ischaemic heart disease
Diabetic nephropathy and CKD with proteinuria = to reduce proteinuria and progression of nephropathy

Question 16

MOA

Answer 16

Block actions of ATII on the AT1 receptor. Therefore reducing peripheral vascular resistance which lowers blood pressure.
Dilates efferent glomerular arteriole which reduces intraglomerular pressure and slows progression of CKD.

Question 17

ARB side effects

Answer 17

Hypotension – first dose
Hyperkalaemia
Renal failure

Question 18

ARB cautions and contraindications- conditions

Answer 18

Avoid in renal artery stenosis
Avoid in acute kidney injury
Avoid in pregnancy
Avoid in breastfeeding
Caution in CKD – lower dose
Caution in severe heart failure

Question 19

ARB cautions and contraindications drugs

Answer 19

ACE inhibitors – increased risk of hyperkalaemia, hypotension, and impaired renal function
Amiloride/ Spironolactone – increased risk of severe hyperkalaemia
Diuretics – enhanced hypotensive effects
Lithium – reduce excretion of lithium
Ibuprofen – risk of kidney damage

Question 20

ARB monitoring

Answer 20

Symptoms
Check electrolytes
Renal function before treatment and then 1-2 weeks after starting

Question 21

ARB counselling

Answer 21

This is an alternative to ACE inhibitor and doesn’t cause dry cough
May experience dizziness after first dose
Avoid taking ibuprofen OTC
May need to have regular blood tests to check kidney function

Question 22

Dipyridamole main uses

Answer 22

Cerebrovascular disease – secondary prevention of stroke
1st line after transient ischaemic attack
2nd line following ischaemic stroke

Question 23

Dipyridamole MOA

Answer 23

Has antiplatelet and vasodilatory effects.
Increases intra-platelet cyclic adenosine monophosphate(CAMP) that inhibits platelet aggregation, reducing the risk of arterial occlusion.
Blocks cellular uptake of adenosine, prolonging its effects on blood vessels to produce vasodilation

Question 24

Dipyridamole Side effects

Answer 24

Headache
Flushing
Dizziness
GI symptoms
Bleeding risk
Thrombocytopenia – rare

Question 25

Dipyridamole cautions and contraindications

Answer 25

Caution in ischaemic heart disease
Caution in aortic stenosis
Caution in heart failure
Caution in recent myocardial infarction

Question 26

Dipyridamole cautions and contrainidications drugs

Answer 26

Coumarins – antiplatelet action enhances anticoagulant effect of coumarins – avoid
Adenosine – dipyridamole inhibits cellular uptake of adenosine – prolongs its effects on the heart increasing cardiac arrest – reduce adenosine dose
Antiplatelet – increased risk of bleeding

Question 27

Dipyridamole monitoring

Answer 27

side effects

Question 28

Dipyridamole counselling

Answer 28

Modified-release capsules should be dispensed in original container (pack contains a desiccant) and any capsules remaining should be discarded 6 weeks after opening