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BNF crash course > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What is the treatment for paroxysmal supraventricular tachycardia?

A

First line: Reflex vagal nerve stimulation e.g. Valsalva manoeuvre
Second line: IV adenosine
Third line: IV verapamil

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2
Q

What is adenosine CI in ?

A

Asthma and COPD

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3
Q

What is the first line maintenance drug treatment for arrhythmia rate control?

A

Rate control

  1. beta blockers except sotalol
  2. Rate limiting CCB
  3. Digoxin
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4
Q

What is the second line maintenance drug treatment for arrhythmia rhythm control?

A
  1. beta blockers

2. oral anti-arrhythmic drugs

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5
Q

What are Class I anti-arrhythmic and what is their MOA?

A

Sodium channel blockers

  • Disopyramide
  • Lidocaine
  • Flecainide acetate
  • Propafenone hydrochloride
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6
Q

What are Class II anti-arrhythmic and what is their MOA?

A 
Beta blockers
Propranolol 
Metoprolol 
Atenolol 
Timolol
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7
Q

What are Class III anti-arrhythmic and what is their MOA?

A

Potassium channel blockers

  • Sotalol
  • Dronedarone
  • Amiodarone
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8
Q

What is amiodarone MOA?

A

Potassium channel blockers but also blocks beta receptors, sodium and calcium channels

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9
Q

What is the recommended dose of amiodarone?

A

200mg TDS for 1/52, then 200mg BD for 1/52 then a maintenance dose of 200mg OD

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10
Q

How many days is amiodarone half life?

A

50 days

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11
Q

What are the monitoring requirements of amiodarone?

A

Thyroid function before and every 6 months
Annual eye test
Liver function before and every six month
Potassium - as can result in hypokalaemia

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12
Q

What action is taken if a patient has hypothyroidism due to amiodarone?

A

Treat with levothyroxine without withdrawing amiodarone

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13
Q

What action is taken if a patient has hyperthyroidism due to amiodarone?

A

Withdraw amiodarone and give carbimazole

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14
Q

What are the warning signs of amiodarone?

A
  • sSigns and symptoms of hypo/hyper thyroidism
  • Impaired vision i.e. optic neuritis/optic neuropathy
  • Photophobia / dazzled by headlights
  • Progressive SOB/ Cough
  • Neurological effects such as tremor, peripheral neuropathy
  • Phototoxic skin reactions
  • Slate grey skin discoloration
  • Bradycardia
  • Taste disturbance
  • Nausea/ Vomiting
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15
Q

When is it recommended for amiodarone to be withdrawn?

A
  • Hepatotoxicity i.e. jaundice
  • Peripheral neuropathy
  • Pulmonary toxicity
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16
Q

What are the signs of hepatotoxicity?

A 
Jaundice 
Nausea
Vomiting
Malaise 
Itching 
Burning 
Abdominal pain
Decreased liver function
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17
Q

What are the signs of pulmonary toxicity?

A

New or progressive SOB or dry cough

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18
Q

What are the signs of peripheral neuropathy?

A

Numbness
Tingling hands and feet
Tremors

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19
Q

What juice does amiodarone interact with and what does it result in?

A

Grape fruit juice (enzyme inhibitor) and it results in increased plasma amiodarone concentration

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20
Q

What is the treatment dose for AF with digoxin and what is the maintenance dose?

A

Treatment is 0.75mg to 1.5mg

Maintenance is 125-250mcg

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21
Q

What is the maintenance dose of digoxin in HF?

A

62.5-125mcg

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22
Q

What class is digoxin?

A

Cardiac glycoside

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23
Q

What is digoxin therapeutic target?

A

1-2mcg/L measured after 6 hours of taking first dose

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24
Q

What are the monitoring requirements of digoxin?

A
  • Potassium
  • Liver and kidney function
  • Heart rate
  • Plasma concentration
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25
Q

What are the warning signs of digoxin?

A
  • Blurred/yellow vision
  • Cardiac e.g. arrhythmia / heart block
  • neurological
  • GI- anorexia, nausea, vomiting, diarrhoea, abdominal pain
  • Hyperkalaemia
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26
Q

What is unfractionated heparin “standard heparin” MOA?

A

Activates anti-thrombin

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27
Q

What is LMWH MOA and what does it include?

A

Tinzeparin, enoxaprin, dalteparin

inactivates factor Xa

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28
Q

What are the benefits of standard heparin?

A

good in renal impairment and high risk of bleeding as its easily reversible

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29
Q

What is used to reverse heparin?

A

Protamine

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30
Q

What are the benefits of LWMH?

A

Pregnancy and osteoporosis

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31
Q

What are the colours of warfarin tablets?

A

0.5 mg- white
1mg- brown
3mg - blue
5mg- pink

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32
Q

What is the MOA of warfarin?

A

Antagonises vitamin K

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33
Q

What is the duration of treatment and conditions with warfarin?

A

Isolated calf DVT- 6 weeks
Provoked DVT- 3months
Unprovoked DVT- 3months to long term

34
Q

What are the target INR?

A
  1. 5 for VTE, AF, MI, cardioversion, bio-prosthetic mitral valve
  2. 5- recurrent VTE
  3. 0- mechanical valve

Can vary -/+0.5

35
Q

What is the target BP for over 80 and under 80 with no further complications?

A

over 80- <150/90

under 80- <140/90

36
Q

What is the target BP for under 80 with further complications?

A

<130/80

37
Q

What is the target BP during pregnancy?

A

150/100 chronic hypertension

<140/90 for chronic hypertension with organ damage or giving birth

38
Q

What are the treatment for gestational hypertension? and what is first line

A

Labetalol- first time
Methyldopa stopped after 2 days of birth
MR nifedipine - unlicensed use

39
Q

What are the side effects of ACE inhibitors?

A
  • persistent dry cough
  • hyperkalaemia so also hypoglycaemia
  • nephrotoxic so avoid the DAMN drugs - diuretics, ACE, ARB, metformin, NSAIDs
  • cholestatic jaundice, hepatic failure
  • avoid in pregnancy
40
Q

Which beta blockers have intrinsic sympathomimetic activity and less cold extremities / less bradycardia SE?

A

ice PACO

Pindolol
Acebutolol
Celiprolol
Oxprenolol

41
Q

Which beta blockers don’t cross the BBB and has less sleep disturbance and nightmares SE?

A

water CANS

Celiprolol
Atenolol
Nadolol
Sotalol

42
Q

Which beta blockers have cardio-selective properties therefore cause less bronchospasm?

A

Be A MAN

Bisoprolol 
Atenolol 
Metoprolol
Acebutolol 
Nebivolol
43
Q

Which beta blockers have a long duration of action therefore are taken once daily?

A

BACoN

Bisoprolol
Atenolol
Celiprolol
Nadolol

44
Q

What are dihydropyridine calcium channel blockers? and what do they include?

A
  • amlodipine
  • felodipine
  • lacidipine
  • lercanidipine
  • nifedipine - maintain on same MR Brand

they have vasodilating effects

45
Q

What are dihydropyridine calcium channel blockers side effects?

A

Ankle swelling
flushing
headaches

46
Q

What are Amlodipine and nifedipine CI in?

A

unstable angina

47
Q

What are rate limiting calcium channel blockers? and what do they include?

A

More selective for the heart; lowers HR and force contraction

  • Verapamil
  • Diltiazem maintain on same brand when dose over 60mg
48
Q

What are rate-limiting CCB CI in?

A

heart failure

49
Q

What is a BNP test and what does it indicate?

A

A BNP test is a blood test that measured the level of BNP protein.

When BNP levels are high it means you have heart failure

50
Q

What is first line treatment for heart failure?

A

ACEi/ARB + B blocker
ARB- candesartan/valsartan
mild-mod stable HF/70+= nebivolol
All grades of LVSD= Bisoprolol/Carvedilol

51
Q

What is second line treatment for heart failure?

A

Spironolactone/ eplerenone after acute MI with LVSD or mild HF

52
Q

What are the alternative second line treatment for HF?

A

Hydralazine+ Isosorbide dinitrate (esp. in African/ Caribbean)
ARB (on top of ACE)
Entresto

53
Q

What is third line treatment for heart failure?

A

Ivabradine (added if patient in sinus rhythm/ HR >75bpm)
or
Digoxin in worsening or severe HF

54
Q

Pregnancy and statins

A

Statins are teratogenic

use effective contraception during and 1 month after stopping

55
Q

How long before conceiving do you stop statins and when do you restart them?

A

3 month before conceiving and restart after finishing breast feeding

56
Q

What is the max dose of statin with fibrates?

A

10mg

57
Q

what is the max dose of statin with amiodarone, amlodipine, diltiazem, and verapamil?

A

20mg

58
Q

What is the max dose of atorvastatin with ciclosporin?

A

10mg

59
Q

What is the max dose of Rosuvastatin with clopidogrel?

A

20mg

60
Q

What is GTN converted into and what does it do?

A

GTN is converted into nitric oxide and its a vasodilator

61
Q

How long does the effects of GTN last?

A

20-30minutes

62
Q

What is the dose instructions for GTN? and what is the dose equivalence for tablets and spray?

A

1 dose = 1 tablets or 1-2 sprays

Maximum of 3 doses with 5 minutes interval between each
After the third dose if the symptoms are not relieved call 999

63
Q

What is the first line treatment for long term prophylaxis of stable angina?

A

Beta blocker or CCB

64
Q

What is the second line treatment for long term prophylaxis of stable angina?

A

Beta blocker + CCB

65
Q

What can be used for the prophylaxis of stable angina if beta blockers or CCB are CI?

A

Vasodilators such as isosorbide mononitrate
Ivabradine
Nicorandil

66
Q

What actions are taken if tolerance is suspected

A
  1. leave patches off for 8-12 hours overnight

2. take second dose after 8 hours not 12 hours for the isosorbide mononitrate/dinitrate

67
Q

What are the side effects of nitrates?

A
  • flushing of the face
  • throbbing headache
  • dizziness
  • postural hypotension
68
Q

What is the long-term management plan for STEMi/ NSTEMi?

A
  1. statin
  2. treat blood pressure i.e ACE/ARB….
  3. Aspirin + Clopidogrel for short term use
  4. beta blockers
69
Q

What is used to access stroke risk?

A

CHA₂DS₂-VASc

70
Q

What is is used to access bleeding risk?

A

HASBLED

71
Q

Which diuretic is to be avoided with gout?

A

furosemide

72
Q

which diuretic causes musculoskeletal pain?

A

Torasemide

73
Q

What the onset of action and duration of action of loops? and how many times can they be taken a day?

A

they can be taken BD with last one at 4pm

onset of action is 1 hr
duration of action is 6 hrs

74
Q

What are the side effects of loop diuretics ?

A
  • ototoxicity at high doses
  • Acute urinary retention= too rapid diuresis
  • Hyperglycaemia
  • hyperuricaemia
  • Hypo K+, Na+, Cl-, Mg2+, Ca2+
75
Q

Which thiazide like diuretic is used in severe renal impairment?

A

Metolazone

76
Q

Which thiazide like diuretic is less aggravating to diabetes and is used for hypertension and HF?

A

Indapamide

77
Q

What the onset of action and duration of action of thiazide?

A

1-2hr onset of action

12-24 hr duration of action

78
Q

What is the dose of Bendroflumethiazide for HF and hypertension?

A 
HF= 5mg OM 
Hypertension= 2.5mg OM
79
Q

What are the SE of spironolactone?

A
  • Gynaecomastia
  • hypertrichosis
  • Change in libido
  • Hyperkalaemia, Hyperuricemia, Hyponatraemia
80
Q

What includes osmotic diuretics and what is it used for ?

A

Mannitol and cerebral oedema

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