Cardiovascular Flashcards
1
Q
When would you initiate statins fo primary prevention of CVD?
A
- T1DM
- Only in type 2 if QRISK ?10%
- CKD /albuminuria
- familial hypercholesterolaemia
- > 85 y/o
2
Q
When would you initiate statins for secondary prevention?
A
Established CVD e.g. angina, MI, stroke/TIA, PAD
3
Q
When is QRISK score not suitable to use?
A
Score would be underestimated in high risk pts eg.
- T1DM
- established CVD
- > 85
- CKD
- familial hypercholestereolaemia
4
Q
What is the cholesterol level that diagnoses hyperlipidaemia?
A
6mmol/L
5
Q
What is the treatment pathway for primary and familial hypercholesterolaemia?
A
High intensity statin e.g. atorvastatin
If C/I or not tolerated= ezetimibe
Moderate triglyceridaemia if statin not tolerated/Ci = fibrate
6
Q
What are the doses of atorvastatin for primary and secondary prevention
A
Primary: 20mg OD
Secondary: 80mg OD
7
Q
What is the MHRA alert fo simvastatin 80mg?
A
High risk of myopathy - only give if risk of CV complications and treatment goals not achieved at lower dose
8
Q
What are the 3 common side effects of statins and counselling point?
A
Myopathy
Myositis
rhabdomyolysis
To report any tender, weak and painful muscles
9
Q
What monitoring is involved with statins
A
Baseline lipids
Renal function
Thyroid function
HbA1c
Creatine kinase - discontinue if 5x upper limit
Liver function- discontinue if 3x upper limit
10
Q
Can statins be used in pregnancy?
A
No - teratogenic
- need effective contraception during and1 month after stopping
- stop taking 3 months before conception and restart after finishing breastfeeding
11
Q
What increases the risk of muscle toxicity with statins?
A
- personal/family history of muscle disorder
- alcohol
- renal impairment
- hypothyroidism
- concomitant ezetimibe/fibrates esp gemfibrozil
- concomittant fusidic acid
- interaction with clarithromcyin and atorvastatin
12
Q
What is the interaction between clarithromycin & atorvastatin?
A
Increases atorvastatin levels - adjust or avoid - monitor for rhabdo
would generally hold statin for abx course
13
Q
What is the interaction of statins with Fusidic acid?
A
Increased statin levels - hold statin and re-start 7 days after last oral fusidic acid dose
14
Q
Which drugs concomittantly require a maximum dose of simvastatin 20mg?
A
- Amlodipine
- amiodarone
- diltiazem
- verapamil
15
Q
What is the max dose of atorvastatin with ciclosporin?
A
10mg
16
Q
What is the max dose of rosuvastatin with clopidogrel?
A
20mg
17
Q
What is ezetimibe?
A
Reduces cholesterol by inhibiting the absorption of cholesterol by the small intestine
Can be used as alternative or if statins not tolerated
18
Q
What is the general treatment pathway of lipid lowering therapies?
A
Statins
Ezetimibe
Fibrates
Bile acid sequestrates / nicotinic acid
19
Q
if myalgia is a risk then would you add ezetimibe?
A
No - consider other drugs e.g
fibrates if triglycerides are high
or bile acid sequestrants
20
Q
What fibrate can you NOT use with statins due to risk of myopathy?
A
Gemfibrozil
21
Q
When are fibrates used?
A
Severe hypetriglyceridaemia when >10mmol/L or cannot tolerate statin (specialist)
22
Q
What is an advisory label for colestyramine (bile acid sequestrant)?
A
Take other medicines one hour before or 4 hours after
4 hours before colesevelam
23
Q
What is the limitation of using nicotinic acid?
A
Flushing - prostaglandin mediated reaction - within 1 hour of dosing and lasts for 30mins esp with initial doses
24
Q
What is a contraindication if nicotinic acid
A
peptic ulcer disease
25
What is the treatment for an acute angina attack
Short acting nitrate
- GTN - 2 sprays, wait 5 min, 2 sprays
OR isosorbide dinitrate SL
26
How long do the effects of GTN last for
20-30 mins
if using 2-3x a week then need long term prophylaxis
27
What is counselling for GTN spray
Take when sitting down (dizziness)
1s dose under tongue, wait 5 min
2nd dose and wait 5 min if pain not subsided
3rd dose wait 5 mins
Still present = 999
Max 3 doses
28
What is the special container for GTN sublingual tabs
expiry 8 weeks after opening - foil-lined container with no cotton wadding
29
What is the treatment fo long term prophylaxis of angina?
- Beta blocker or CCB e.g. diltiazem OR
- Beta blockere + dihydropyridine CCB (Amlodipine, nifedipine MR, felodipine) - max 2 dugs
Vasodilator--> long acting nitrate e.g. MR isosobide mononitrate
30
What is the MHRA alert regarding Nicorandil?
Now given 2nd line due to risk of ulcer complications in mouth, skin, eye, GIT
31
What are common S/E of nitrates
```
Flushing
throbbing headache
postural hypotension
heartburn
dizziness
```
32
What is needed for nitrates to stop tolerance developing?
Occurs with long acting + transdermal
- need to reduce the [nitrate] fo 4-12 hours a day
- patch = leave off ovenight
- tabs = take 2nd dose after 8 hours not 12 hours
- MR isosorbide mononitrate taken OD so no tolerance
33
Long term management of ACS?
NSTEMI: DAPT 12 months then aspirin lifelong for secondary prevention
Statin - high dose/intensity e.g. Atorvastatin 80mg or Rosuvastatin 20mg
ACEi - within 24hrs
Beta blocker- within 24hrs - cardioselective e.g. bisoprolol, metoprolol, atenolol,nebivolol
34
Symptoms of ACS?
```
Chest pain radiating to left arm
dizziness, fatigue
indigestion
Radiation to back and jaw
lasting >15min
```
35
Treatment of cardiac arrest (adult)
CPR 30 compressions: 2 breaths
| IV adrenaline 1 in 1000 every 3-5min
36
What is the mechanism of thiazide diuetics?
Inhibit Na/Cl transporter in distal convoluted tubule
37
What thiazide diuretics are perferred in hypertension?
Chortalidone (given on alternate days due to long duration of action)
Indapamide (less metabolic disturbance/glucose)
38
What is the risk of using thiazides
Changes in uric acid, glucose and lipids causing
- Hyperglycaemia
- Hyperuricaemia
precipitating diabetes and gout
39
What thiazide diuretic can be used in severe renal failure?
metolazone
| but monitor for profound diuresis
40
What is the mechanism of loops diuretics
Inhibit Na/K/Cl transporte in ascending loop of henle, onset in 1 hou
41
What are adverse effects of loop diuretics
- ototoxicity - tinnitus, deafness
- acute urinary retention--> caution in BPH
- Hyperglycaemia
- Hyperuricaemia
- Hypoakalaemia, Hyponatraemia, HypoCl, Hypomagnesaemia
42
What is the mechanism of potassium sparing diuretics and name some
```
Promotes urination (diuresis) without the loss of potassium by inhibiting sodium channels in the distal convoluted tubule
e.g. triameterine, amiloride
```
43
What is the mechanism of aldosterone antagonists?
Inhibit aldosterone which is responsible for causing sodium reabsorption via the Na/K/H co-transporter
Less K+ and hydrogen ions exchanged for sodium so less lost in urine
sodium not reabsorbed or water
44
What is an MHRA alert of aldosterone antagonists?
Use of Aldosterone antagonists in conjunction with ACE/ARB in heart failure - risk of potentially fatal/severe hyperkalaemia - monitor electrolytes
44
What are common side effects of spironolactone?
- gynaecomasstia / benign breast tumour / menstrual disturbances
- hypertrichosis (excessive hair growth on body)
- changed libido
- hyperkalaemia, hyperuricaemia, hyponatraemia
44
What are common side effects of spironolactone?
- gynaecomasstia / benign breast tumour / menstrual disturbances
- hypertrichosis (excessive hair growth on body)
- changed libido
- hyperkalaemia, hyperuricaemia, hyponatraemia
45
What are treatment options in simple gravitational oedema in the elderly?
Aim to try alternatives first e.g stockings, raise legs, movement
Can use low dose diuretic but not long term
46
What are treatments for occlusive peripheral vascula disease
(intermittent claudication caused by atherosclerosis)
- aspirin 75mg daily
- statin secondary prevention
- lifestyle advice
47
What is the therapeutic range of digoxin
1-2 micrograms/L (1.5-3)
48
What is the dosing for digoxin based on?
Renal function
| Loading dose needed as it has a long half life to get to steady state
49
What are risk factors for digoxin toxicity
```
Hypokalaemia
Renal impaiment
Elderly
Hypomagnesaemia
Hypercalcaemia
Hypoxia
```
50
What are symptoms of digoxin toxicity
```
Bradycadia
Nausea, vomiting
Diarrhoea
abdominal pain
confusion
YELLOW vision/blurred ivsion
confusion
rash
```
51
What are the interactions of digoxin? (think CRASED)
Calcium channel blockers e.g. verapamil - inhibitor
Rifampicin - reduced digoxin as it is an inducer
Amiodarone - inhibitor - need to half dig dose
st johns wort - inducer
Erythromycin/macrolides - inhibitors
Diuretics - risk hypokalaemia
(also other drugs that cause hypokalaemia will interact e.g. b2 agonists, steroids, theophylline)
NSAIDS and ACEi/ARB can reduce renal excretion which is also a risk for toxicity
52
In pt taking digoxin, if K+ is <4.5 mmol/L what is done?
K+ supps or K+ sparing diuretic (preferred)
53
Common symptoms of atrial fibrillation
```
Palpitations
SOB
Dizziness,fainting
ches tpain
abnormally fast,slow,irregular pulse
```
54
What tool is used to assess stroke risk in Af patients?
CHADS2VASC
Congestive heart failure
Hypertension >140/90 or current anti-hypertensives
Age >75 (2 points) or 65-74 (1 point)
Diabetes - glucose >7mmol/L or treatment
Stroke/Tia/thromboembolism - 2 points
Vascular disease e.g. previous MI/PAD/aortic plaque
Sex - feemale (2), male (1)
55
What is classed as no risk/ no need for anticoagulation in CHADASVASC?
If a male is 0, female 1 = no need
Score of 1: low to moderate - consider antiplatelet/anticoag
2 or more: moderate/high - definite need
56
What tool is used to assess bleed risk with anticoagulation?
```
ORBIT
Old age >75
Reduced Hb (<130 in Males, <120 females) = score of 2
Bleeding history
Insufficient renal function eGFR <60
Antiplatelets
```
57
How is New onset AF managed? (not maintenance but initial)
Haemodynamic instability onset <48hrs and unstable = urgent= electrical CV and heparin prior, anticoagulate
Haemodynamically stable:
<48hrs=electrical CV preference, can also use rate control (dilt/verap)
>48hrs=pharmacological - amiodarone or flecainide
If structural heat disease use amiodarone
58
What is 1st line maintenance therapy for AF?
Rate control e.g. beta blocker (not sotalol)
| OR a rate limiting CCB e.g. Verap or dilt [unlicensed]
59
What situation would you give digoxin for AF?
Sedentary pts with non paroxysmal AF
60
What is 2nd line for mainenance AF?
Rhythm control e.g. sotalol, amiodarone, flecinide
| maintaining sinus rhythm post CV
61
When can amiodarone be started in AF?
4 weeks before and continue up to 2 months after electrical cardioversion to maintain sinus rhythm in paroxysmal or persistent Af but not for long term rate control
62
What drugs would you NOT use for AF in ischaemic or structual heart disease?
What drug would you use and how long?
Flecainide or propafenone rhyhm control
| Use amidoarone - if persistent AF use for >7days, if permenant = all time
63
When would you do cardiovesion?
Wait until fully anticoagulated for 3 weeks before and continue 4 weeks after
64
when would you NOT offer stoke prevention with anticoagulation in AF pts?
- <65 with AF and no other risk factors other than sex
BUT do not withhold anticoag solely based on age or falls risk
65
What is unique about dabigatran DOAC?
It has a diffeent MoA to the others - it is reversible inhibitor of free thrombin, fibrin bound thrombin and thrombin induced platelet aggregation
66
What is the MHRA advice on DOACs?
Caution in pts at risk of bleed (elderly, renal imp, low BW)
Monitor interactions & do not take with strong enzyme inhibitors or p-glycoprotein
Dose dependent on renal function
67
Which DOAC is contraindicated in eGFR <30ml/min?
Dabigatran
68
What is the renal function cut off for apixaban?
<15ml/min
69
In renal impairment, how would you know how often to monitor a patient on DOACs?
CrCl/10 gives how often to monitor renal
70
What circumstance would you dose reduce apixaban to 2.5mg BD for AF?
Age >80
weight <60kg
Cr >133 micromol/L
If 2 or more =reduce
71
What DOAC interacts with verapamil?
Dabigatran - need to reduce the dose of Dabi to 110mg BD as opposed to 150mg BD.
72
What is the target INR in AF patients?
2.5
73
Which DOAC is taken with food?
Rivaroxaban
| Can also be crushed and mixed with apple puree/put through NG tube
74
What is the onset of action of DOACs?
1-4 hrs - around 2-4hours to peak
| Dabigatran fastest 0.5-2hrs
75
Which DOACs should not be used in severe liver disease due to hepatic metabolism?
Apixaban
| Rivaroxaban
76
Which DOAC has the warning label - swallow whole, do not chew or crush
Dabigatran (increased bleed risk)
77
Which DOAC cannot be put in a compliance aid? WHY?
Dabigatran
| Moistue sensitivie
78
If a dose of a DOAC is missed is this a risk?
Yes- shorter half life so missed dose means no anticoagulation
If miss, take it ASAP(within 6hrs if Dabigatran)
Warfarin less of an issue - just skip the dose
79
If a patient has type 2 diabetes with hypetension - what is 1st line after lifestyle?
ACE or ARB
80
What is the first line for stage 1 hypertension? (140/90)
What situation would you treat stage 1 HTN?
Lifestyle advice
| Only treat if >80, or if <80 and risk factors such as CKD, retinopathy, QRISK 20% or more, diabetes
81
What is classed as stage 2 HTN?
160/100
| always treat
82
If a person is <55 and not of african/caribbean origin and their BP isnt controlled by ACEi, what is next line step 2 management?
CCB or thiazide like diuretic (use thiazide if high risk heart failure)
83
If a patient is >55 or african/caribbean origin - what drug treatment is indicated as step 1?
CCB
| Wouldnt use ACE first line due to low plasma renin activity
84
Which dug is used in hypertensive emergency?
IV hydralazine - reduce slowly due to risk of reduced organ perfusion and organ damage
85
```
What are the clinic BP targets for
<80
>80
renal disease
diabetic
```
<80 = <140/90
>80 = <150/90
Renal: <140/90 but <130/80 if CKD, diabetes, proteinuria
Diabetic: <140/80 but <130/80 if diabetic complications
86
What are the target BP in pregnancy and which anti-hypertensives are used?
<150/100 chronic HTN
<140/90 for chronic HTN if target organ damage or given birth
- labetalol 1st choice
- Alternatives methyldopa [stop 2 days post birth] or MR nifedipine [unlicensed]
87
What is a risk with labetalol?
hepatotoxicity
88
Which ACE inhibitor is BD
Captopril
Rest are OD
89
What are the common side effects of ACEi
```
=persistent dry cough
= hyperkalaemia
= angioedema
= nephrotoxic in AKI, avoided in renovascular disease
= cholestatic jaundice and hepatic failure
= oral ulcers
= taste disturbance
= hypoglycaemia
```
90
What counselling advice would you give for ACEi first time?
Take first dose at bedtime to avoid first dose hypotension
91
What warning label for perindopril?
Take 30-60min before food
92
What are key interactions of ACEI
Inceased risk hyperkalaemia = K+ sparing diuretics, aldosteone antagonists, ARBs, aliskeren
Nephrotoxicity/reduced eGFR = NSAIDS
Hypotension= diuretics (volume depletion)
Avoid concomitant ACE/ARB therapy/drugs affecting RAAs system
93
What is a common issue with methyldopa for hypertension? (centrally acting antihypertensive not as common)
Drowsiness
| Fever,hepatic disordes=stop
94
What is a side effect of clonidine? (centrally acting antihypertensive less ocmmon)
Flushing
95
What are side effects of hydralazine and when is it used
Fluid retention
tachycardia
used in hypertensive emergency / heart failure with long acting nitrate under specialist / severe HTN
96
Before initiation of hydralazine what is measured?
Poteinuria
antinuclear factor
acetylator status
97
What is a side effect of sotalol
Torsades de pointes - prolong QT
98
What are the cardioselective BB
```
Bisoprolol
atenlol
metoprolol
acebutalol
nebivolol
```
Less bronchospasm
99
Can cardioselective BB be used in asthmatics
Yes if well controlled asthma under specialist if no other choice
100
Which beta blockers have less bradycardia and less cold extremities and why?
ice PACO
Pindolol
Acebutalol
celiprolol
oxprenolol
These have less intrinsic sympathomimetic activity
101
Which beta blockers have less nightmares and why?
```
WATER CANS
Celiprolol
atenolol
nadelol
sotalol
```
Why? because they are water soluble, cannot cross BBB and less likely to cause nightmares, sleep disturbances
102
What is the caution of water soluble beta blockers
excreted renally so caution in renal impairment
103
what beta blockers have ONCE daily dosing?
```
BACoN
Bisopolol
atenolol
Celiprolol
Nadolol
```
Instrinsically longer duration of action
104
What are contraindications of beta blockers?
- asthma including eye drops (non selective bind to beta2 receptors in lungs so bronchospasm risk)
- worsening unstable heart failure (reduced CO )
- 2/3 degree AV block
- severe hypotension and bradycardia (will worsen)
105
Common side effects of Beta blockers?
- bradycardia - reduced CO
- fatigue
- cold extremities
- hypotension
- hyper or hypoglycaemia due to disturbing carbohydrate metabolism
- masking symptoms of hypo e.g. tachy due to brady
106
What are 2 main interactions of beta blockers?
Verapamil injection = causes Asystole and hypotension (even risk with oral verap)
Thiazide like diuetics due to risk of hyperglycaemia = would avoid in diabetes/high isk
107
Which CCBs are more selective fo the vasculature?
Dihydopyridines e.g. amlodipine etc
108
Which dihydopyridine CCB needs to be maintained with same MR brand?
Nifedipine
109
What are common S/E of dihydropyridine CCBs
ankle swelling
flushing
headaches
110
When would you need to maintain brand of diltiazem
When doses >60mg
111
What condition should rate limiting CCBs be avoided
Heart failure-can precipitate worsening due to the fact they reduce HR and force of contraction
112
What is a common interaction for CCBs
enzyme inhibitors = increase CCB concs e.g. grapefruit juice
113
What factors increased risk of VTE
- immobility
- obesity >30BMI
- cancer
- +60y/o
- personal history or first degree relative
- clotting disorders (thrombophilia)
- HRT or combined contraceptives
- varicose veins w/phlebitis
- pregnancy
- critical care
- significant co-morbditiies
114
What factors are increased risk of bleeding
- Thrombocytopenia - low platelets <150x109 g/dL
- acute stroke
- bleeding disorders e.g. liver failure, haemophilia, WBD
- anticoagulation
- systolic hypertension
115
What is the treatment of VTE
LNWH or UFH (renal) at least 5 days until INR 2 or more for at least 24hrs
start oral anticoagulant at the same time e.g. warfarin o DOAC
116
What pharmacological VTE prophylaxis is used? and duration?
LMWH or UFH if eGFR >30 or fondaparinux in ACS
General surgery: 5-7 days or until sufficiently mobile
Major cancer surgery/abdomen/pelvis: 28 days
Knee/hip surgery: extended duration
117
What medication is used for VTE in pregnancy and why?
LMWH - less risk of osteoporosis and heparin induced thrombocytopenia
- stop when labour starts
118
What are the 4 common side effects of heparins
1. Haemorrhage - withdraw. If antidote: Protamine
2. Hyperkalaemia - monitor before and if >7 days
3. Osteoporosis
4. Heparin induced thrombocytopenia which can occur 5-10 day safter
119
How is heparin induced thrombocytopenia identified and when does it occur?
5-10 days after heparins
- 30% reduction in platelets
- skin allergy
- thrombosis
Keep monitoring plt if >4 days
Use heparinoid instead if HIT
120
When is UFH preferred to LMWH?
- If there is Higher risk of bleeding due to short half life
- Renal impairment
121
What is an essential monitoring parameter with UFH
APTT - activated partial thromboplastin time
122
Why is bridging needed when initiating warfarin
Takes 48-72hours to work
123
What are the durations of treatment for
isolated calf DVT
Provoked VTE
Unprovoked DVT
isolated calf DVT: 6 weeks
Provoked VTE: 3 months
Unprovoked VTE: at least 3M = long term
124
What is the target warfarin INR for
| VTE, AF, MI, cardioversion, biprosthetic mitral valve?
2.5
| within 0.5units
125
What is the target warfarin INR for recurrent VTE in patients already receiving an anticoagulant and INR>2?
3.5
126
Provide counselling points for warfarin
```
Yellow treatment book/alert card
Signs of bleeding - blood in stools/urine, nose bleeds, easily bruising
Report painful skin rash
Do not do drastic diet changes e.g. coumarins, leafy greens
Reduce alcohol / no binge drinking
Inform dentist of any procedures
Care with teeth/shaving - gentle
not drink pomegranate juice
```
127
What is the MHRA alert regarding warfarin and a major side effect?
RISK OF CALCIPHYLAXIS
pts to report painful skin rashes and stop
Risk factor is end stage renal disease
128
What are the side effects of warfarin
bleeding --> nose bleeds <10min, gums, bruising
Calciphylaxis / painful skin rash
129
What are 2 key interactions of warfarin that have an MHRA warning?
1. With miconazole (otc miconazole daktarin oral gel) - increased bleeding as miconazole enzyme inhibitor
2. Direct acting antivirals to treat Hep C- monitor INR
Other interactions= enzyme inhibitors
130
For elective surgery what is the protocol for warfarin
Stop 5 days before
If INR >1.5 the day before then give phytomenadione PO
Re-start warfarin evening or next day
If high risk of VTE (e.g. VTE in last 3M, AF with previous stroke/TIA, mechanical valve: bridge with treatment dose LMWH and stop 24hrs prior to surgery
131
If there is emergency surgery what changes are needed to warfarin
Delay 6-12hrs
| If no delay - IV phytomenadione and dried prothrombin complex
132
What is treatment if there is major bleeding with warfarin
STOP
IV phytomenadione
Dried prothrombin complex or fresh frozen plasma
133
if a patients INR comes back at e.g. 5.6 (or within 5-8 range) with no bleeding - what is the protocol
- withhold 1-2 doses
- reduce maintenance
- measure INR in 2-3 days
134
If INR is beteween 5-8 with minor bleeding what is the protocol
- omit warfarin
- IV phytomenadione
- repeat if INR still high in 24hrs
- re-start when INR >5
135
If INR >8 but no bleeding?
Omit warfarin
Oral phytomenadione
Repeat if INR still high after 24hrs
Re start when IN <5
136
If INR >8 with minor bleeding?
Omit wafarin
IV phytomenadione
repeat if still high in 24hrs
start when INR <5
137
What is the special storage/packaging for Dabigatran?
It is a special container - with a 4month expiry
138
What are contraindications of DOACs
- GI ulceration
- malignancy
- recent brain/spinal surgery or haemorrhage
- varices in oesphagus
- vascular aneurisms
- Arteriovenous malformations
139
What is the cut off for use of apixaban in renal impairment
<15 ml/min
140
What are the treatments for HF with reduced EF?
- always offer diuretics for congestive symptoms/fluid retention
1st line: ACEi and BB
add in mineralocoticoid receptor antagonist if symptoms continue e.g. spiro/epl
Consider hydralazine and nitrate if intolerant of ACE and ARB
persistent symptoms - replace ACE/ARB with sacubitril/valsasrtan if EF <35%
Add ivabradine for sinus rhythm with HF >75 and EF <35%
Add hydralazine and nitrate esp if ACS decent
Digoxin for HF with sinus rhythm
141
At what LVEF is entresto used?
LVEF <35%
142
What is the dose titration for beta blockers in HF
Start low and go slow
| assess HR and BP after each dose increase
143
What is used for fluid overload symptoms in HF
Loop diuretic - potent.
If monotherapy doesnt work = add in thiazide diuretic (thiazides not in <30ml/min)
If still uncontrolled: metolazone and thiazide like diuretic added
144
If HF with preserved EF, what dosage of furosemide is used
low to medium dose loop e.g. <80mg furosemide daily
145
What is some lifestyle advice for HF patients
Vaccinations + annual flu and pneumococcal
Dont routinely advise to restrict salt/fluids but ask about consumption - if its high then do
Avoid salt substitutss containing K+
smoking + alcohol
Driving and air travel
146
Which ACEi can cause stomatitis/mouth ulcers/sores
Ramipril
147
What is the use of sodium nitroprusside
Hypertensive emergency
148
Which anti-platelet drug can cause throbbing headache S/E
Dipyridamole
149
What is the max daily dose of furosemide
120mg in divided doses
150
What medication is ONLY indicated for hypertension
Lercanidipine
151
Which CCB is the only one used in heart failure patients?
amlodipine
