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PRE REG > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What is an ectopic beat?

A

can be treated with bb but usually harmless

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2
Q

What should all patients with AF be assessed for?

A

Risk of stroke and thromboembolism

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3
Q

How can AF be managed?

A

By either controlling the ventricular rate or by attempting to maintain and restore sinus rhytm

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4
Q

How are patients with life threatening new onset AF managed?

A

Emergency electrical cardioversion

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5
Q

How are patients with acute non life threatening AF managed?

A

Rate or rhthym control if less than 48 hours. If more than 48 hours then rate control is preferred

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6
Q

Why should special care be taken when two or more anti-arrythmic drugs are used?

A

The negative inotropic effects of anti-arrhythmic
drugs tend to be additive. Therefore, special care
should be taken if two or more are used, especially if
myocardial function is impaired. Moreover,
hypokalaemia enhances the pro-arrhythmic effect of
many drugs.

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7
Q

What is the indication of HAS-BLED tool?

A

Assess bleeding risk

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8
Q

What is the indication of CHA2-DS2-VASc tool?

A

Assess stroke risk

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9
Q

What patients do not require antithrombotic for stroke prevention:

A

Low risk:
Males = score 0
Females = score 1

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10
Q

Which anticoagulant is given for patients with new onset Atrial fibrillation:

A

Parenteral anticoagulant such as heparin for e.g

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11
Q

In diagnosed Atrial fibrillation:

A

Give warfarin or NOAC

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12
Q

Which oral anticoagulant is given in non-valvular AF:

A

Apixaban, edoxaban, rivaroxaban, dabigatran

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13
Q

What is antidote for dabigatran:

A

Idarucizumab

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14
Q

Define Torsade de pointes:

A

Form of ventricular tachycardias associated with long QT syndrome (hypokalaemia, severe bradycardia, genetic predisposition are also implicated

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15
Q

Which beta-blocker drug should not be used in torsade de pointes:

A

Sotalol

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16
Q

What is the treatment for torsade de pointes:

A

IV magnesium sulphate

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17
Q

What conditions is IV adenosine contraindicated in:

A

COPD/Asthma

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18
Q

What is the duration of action of IV adenosine:

A

8-10 seconds

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19
Q

What is given if adenosine is contraindicated:

A

Verapamil

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20
Q

State ONE serious interaction with verapamil:

A

With beta-blockers

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21
Q

State the classes of anti-arryhthmic drugs:

A

Class 1: membrane stabilising (lidocaine, fleicanide) Class 2: beta-blockers (incl sotalol)
Class 3: amiodarone
Class 4: CCBs (includes verapamil)

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22
Q

What is the initial loading dose for amiodarone:

A

200 mg TDS for one week, 200 mg BD for one week and then 200 mg OD as maintenance

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23
Q

State some side effects of amiodarone:

A

Constipation, corneal deposits, hypothyroidism, photosensitivity, hypotension, taste altered, Corneal microdeposits – if vision impaired or optic neuropathy occurs, amiodarone must be stopped to prevent blindness
Thyroid function – can cause hypo/hyperthyroidism
Hepatotoxicity – if severe liver dysfunction or if signs of liver disease occurs
Pulmonary toxicity – new or progressive shortness of breath or cough develops

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24
Q

What is the monitoring requirements for amiodarone:

A

Thyroid before and every 6 months
Lfts before and every 6 months
Serum potassium before treatment
Chest x-ray before treatment Annual eye test

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25
Q

Common significant interactions for amiodarone

A

Amiodarone + grapefruit juice = increase plasma amiodarone concs
Amiodarone + (warfarin (phenytoin) (digoxin)
Amiodarone + statins = increased risk of myopathy
Amiodarone + (quinolones) (macrolides) (TCAs) (SSRIs) (Lithium) (chloroquime, mefloquine) (sulpride, pimozide, amisulpride) = QT prolongation, increased risk of ventricular arrhtymia

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26
Q

If patient is taking amiodarone with concomitant sofofbuvir, daclatasvir, simeprevir, ledipasvir:

A

Recognise signs of bradycardia and heart block and spot – SOB, light headedness, palpitations. Fainting, unusual tiredness, chest pain = seek urgent help

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27
Q

What is digoxin:

A

Narrow therapeutic cardiac glycoside drug Therapeutic levels 1-2 mcg/L
Blood samples taken 6 hours after a dose

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28
Q

What are the dose adjustments for digoxin due to interactions:

A

Reduce dose by half with concurrent use of amiodarone, dronedarone and quinine

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29
Q

What are the signs of digoxin toxicity?

A

Bradycardia, nausea, vomiting, diarrhoea, abdominal pain, rash, blurred or yellow vision, Hypokalaemia, hypercalcaemia, hypoxia, hypomagnesemia

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30
Q

What is the maximum daily grams a female can take tranexamic acid:

A

4g

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31
Q

What can be given prior to general or orthopaedic surgery for prophylaxis:

A

Low molecular weight heparin

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32
Q

What is preferred in patients with renal impairment:

A

Heparin (unfractionated)

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33
Q

Which anticoagulant is preferred for patient undergoing bariatric, abdominal, thoracic, cardiac, fragility, hip surgery:

A

Fondaparinux sodium
Pharmacological prohyplaxis should be carried on:
for 7 days post-surgery
28 days post major cancer surgery in abdomen 30 days post spinal surgery

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34
Q

What is the thromboembolism prophylaxis in pregnancy:

A

Low molecular weight heparin (tinzaparin, enoxaparin, dalteparin) Treatment stopped during onset of labour

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35
Q

What is the antidote for low molecular weight heparins:

A

Protamine sulphate

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36
Q

What should a patient receive after suspecting stroke:

A

Aspirin or clopidogrel

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37
Q

What is the acute management of acute ischaemic stroke:

A

Alteplase given within 4.5 hours of symptoms onset
Treatment with aspirin initiated 24 hours after thrombolysis (or clopidogrel)

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38
Q

What is the long term management following a TIA or ischaemic stroke:

A

Clopidogrel
Or M/R dipyridamole
Or aspirin
Statin should also be initiated 48 hours after stroke symptom onset

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39
Q

What is the long term management of intracerebral haemorrhage:

A

Avoid aspirin, anticoagulants and statins - NSAIDS increase blood pressure

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40
Q

What is low dose aspirin used for:

A

75 mg – secondary prevention of CVD

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41
Q

What is the prescribing information for dipyridamole?

A

MR caps should be discarded after 6 weeks of opening

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42
Q

What are signs and the advice if patient gets heparin-induced thrombocytopenia:

A

30% reduction in of platelet count, thrombosis, skin allergy
Heparin should be stopped and alternative anticoagulant commenced. Such as danaparoid

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43
Q

What sis the risk of hyperkalaemia with unfractionated or LMWH:

A

Inhibition of aldosterone secretion can result in hyperkalaemia
Patients with diabetes, chronic renal failure, acidosis, raised plasma potassium or those taking potassium sparring drugs are more susceptible

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44
Q

State the MHRA warning of warfarin sodium:

A

Warfarin use may lead to calciphylaxis which is a painful skin rash
Most commonly observed in patients with known risk factors such as end stage renal disease

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45
Q

What is defined as Stage 1 hypertension:

A

Clinical BP of 140/90 or higher
Or Home BP of 135/85 or higher

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46
Q

What is defined as Stage 2 hypertension:

A

Clinical BP of 160/100 or higher
Or Home BP of 150/95 or higher

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47
Q

How long should an antihypertensive medication be taken for before determining the effectiveness of it:

A

4 weeks

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48
Q

What is the stages of treatment for hypertension in a patient under 55 years old:

A

1) ACE OR ARB
2) ACE OR ARB + CCB/Thiazide like diuretic
Note: offer TLD if evidence of heart failure
3) ACE OR ARB + CCB/Thiazide like diuretic
4) Add low dose spironolactone if potassium level is 4.5mmol/litre or less OR add alpha
blocker/beta-blocker if potassium level is greater than 4.5mmol/litre

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49
Q

antihypertension treatment For patients over 55, and patients of any age who are of African or Carribean family origin:

A

1) CCB
2) CCB + ACE/ARB or TLD
3) CCB + ACE/ARB + TLD

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50
Q

What target clinical BP is recommended for a patient aged 80+:

A

150/ 90 mmhg

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51
Q

What is the target Home BP for a patient aged 80+:

A

145/85 mmhg or lower

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52
Q

Which age range is isolated systolic hypertension common in:

A

Patients over 60

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53
Q

What is the clinical target BP recommended for patients with diabetes:

A

Below 140/80 mmg
Or 130/80 if kidney, eye or cerebrovascular disease also present

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54
Q

What is the treatment for diabetic nephropathy:

A

ACE or ARB

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55
Q

What is the antihypertensive treatment during pregnancy:

A

1) Labetalol
2) Nifedipine 3) Methyldopa

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56
Q

If a woman has been taking methyldopa when should she restart her usual antihypertensive medication after birth and WHY:

A

Within 2 days of the birth = due to risk of depression

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57
Q

What does NICE define pre-eclampsia as:

A

New onset of hypertension (over 140mmHg systolic or diastolic over 90) and co-existence of1 or more of the following new onset conditions:
CKS, diabetes, autoimmune disease, chronic hypertension (one of high-risk factors)
Two or more moderate factors: first pregnancy, aged 40+, pregnancy interval of more than 10 years, BMI of 35+, family history, multiple pregnancy

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58
Q

What should woman take if they have pre-eclampsia and from when?

A

Aspirin OD from 12 weeks until birth

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59
Q

What is antihypertensive treatment in postnatal period if a women wishes to breastfeed:

A

Enalapril

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60
Q

What is antihypertensive treatment in postnatal period if a black-african women wishes to breastfeed:

A

Nifedipine or amlodipine if had it before

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61
Q

What should you advise to a female breastfeeding during taking antihypertensive medication after birth:

A

Monitor baby for signs of hypotension: drowsiness, lethargy, pallor, cold peripheries or poor feeding

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62
Q

What is given to females with pre-eclampsia where birth is considered within 7 days and for what indication:

A

IM betamethasone for foetal maturation

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63
Q

State 2 side effects of hydralazine hcl if given alone

A

Can cause tachycardia and fluid retention

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64
Q

State a disadvantage of taking clonidine hcl:

A

Sudden withdrawal of treatment can cause severe rebound hypertension. withdraw slowly

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65
Q

How doe ACE work:

A

Inhibits conversion of angiotensin 1 to angiotensin 2

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66
Q

State one side effect of ACE inhibitors with patients on impaired renal function:

A

Hyperkalaemia

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67
Q

ACE + NSAIDs =

A

renal damage

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68
Q

State one common side effect of ACE:

A

Dry cough – refer to gp to change to ARB

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69
Q

State one serious side effect of ACE:

A

Angiodema

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70
Q

State one serious side effect of CCB:

A

Swelling of ankles - oedema

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71
Q

ACE + ARB =

A

not recommended due to risk of hyperkalaemia

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72
Q

What is the max dos of methyldopa for adult in g:

A

3g
Monitor blood counts and LFTs before treatment and intervals during first 6-12 weeks and if unexplained fever occurs

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73
Q

Which betablockers have intrinsic sympathomimetic activities, (causing less bradycardia, and cause less coldness of extremities):

A

Celiprolol, pindolol, acebutolol, oxprenolol

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74
Q

Which beta-blockers are most water soluble:

A

Atenolol, celiprolol, nadolol, sotalol = less likely to enter brain and thus less likely to cause nightmares and less sleep disturbance

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75
Q

Where is water soluble BB excreted:

A

Kidneys

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76
Q

Which condition is BB contraindicated in and why:

A

Asthma due to risk of precipitating bronchospasm

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77
Q

Which ACE has to be taken twice daily:

A

Captopril

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78
Q

Which ACE has directions to be taken 30-60 mins before food:

A

Perindopril

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79
Q

State cardio-selective beta-blockers:

A

Atenolol, bisoprolol, metoprolol nebivolol, acebutolol

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80
Q

State one side effect of using beta-blockers in angina:

A

Sudden abrupt withdrawal can cause exacerbation of angina and so gradual reduction of dose is required

81
Q

BETA-BLOCKERS + VERAPAMIL =

A

precipitate heart failure

82
Q

State one side effect of sotalol:

A

Can induce torsa de pointes/ prolong QT interval

83
Q

Which BB is licensed for stable mild to moderate heart failure in patients over 70:

A

Nebivolol

84
Q

Which 2 BB can reduce mortality in any grade of stable heart failure:

A

Bisoprolol, carvedilol

85
Q

Which BB can reverse symptoms of clinical thyrotoxicosis within 4 days:

A

Propranolol

86
Q

State some side effects of BB

A

Bradycardia, confusion, depression, heart failure, erectile dysfunction, rash, sleep disorders, diarrhoea, nausea, dizziness

87
Q

What do you monitor while patient is taking BB:

A

Lung function

88
Q

State one common side effect of verapamil:

A

Constipation, principate heart failure, exacerbate conduction disorders, hypotension + not given with BETA BLOCKERS

89
Q

What is verapamil:

A

Highly negatively ionotropic CCB

90
Q

State common side effects of CCBs:

A

Peripheral oedema, gingival hyperplasia, dizziness, nausea, rash, tachycardia, palpitations

91
Q

State symptoms of CCB poisoning:

A

Nausea, vomiting, dizziness, agitation, confusion, coma, metabolic acidosis, hyperglycaemia in severe poisoning

92
Q

Which CCB can be used for chronic anal fissure: (unlicensed use)

A

Diltiazem hcl

93
Q

State the side effect if diltiazem taken as overdose|:

A

Profound cardiac depressant effect causing hypotension and arrythmias, complete heart block and asystole

94
Q

What is the prescribing info for diltiazem:

A

Diltiazem of more than 60 mg should be prescribed via brand name

95
Q

Which CCB can inhibit labour:

A

Lacidipine

96
Q

What does Nifedipine be prescribed by:

A

Brand name

97
Q

Which syndrome is verapamil contraindicated in:

A

Wolff-parkinson-white syndrome

98
Q

Which conditions is thiazides and related diuretics cautioned in:

A

Gout, diabetes, hyperaldosteronism

99
Q

What electrolyte disturbance can occur with thiazide and related diuretics:

A

Hypokalaemia – loss of potassium ions

100
Q

What is seldom necessary to take when thiazides are used in treatment for hypertension:

A

Potassium supplements / potassium sparring diuretic

101
Q

Which conditions can thiazides and related diuretics exacerbate:

A

Diabetes, gout and systemic lupus erythematosus

102
Q

What are the common aside effects of thiazides and related diuretics:

A

Alkalosis hypochloraemia, constipation, diarrhoea, postural hypertension, urticaria

103
Q

What eGFR is classed as thiazides and related diuretics as ineffective:

A

Less than 30 and thus should be avoided

104
Q

Which diuretic can be used if eGFR is less than 30:

A

Metolazone but has risk of excessive diuresis

105
Q

What is side effect of Bendroflumethiazide:

A

Blood disorder, cholestasis, gout, hyperglycaemia, oedema, rash, SCARs

106
Q

State MHRA warning for patients taking hydrochlorothiazide:

A

Increased risk of non-melanoma skin cancer = report any skin lesion / moles changes Limit exposure to sun light and UV rays and use sun protection

107
Q

When are thiazides best taken:

A

On a morning

108
Q

ACE + ALISKIREN

A

contraindicated in patients with diabetes

109
Q

What are the ACE inhibitors cautions:

A

Diabetes may lower blood glucose
First dose hypotension especially in patients taking high doses of diuretics, on low sodium diet, dialysis, dehydrated or with heat failure

110
Q

State some common side effects of ACE inhibitors

A

Alopecia, angina, dry cough, angioedema (more common in black africans), headache, hypotension, syncope, dizziness, diarrhoea, rhinitis, taste altered, myalgia, tinnitus, vertigo Hyperkalaemia common with those with impaired renal function

111
Q

State some more serious side effects that ACE inhibitors can cause:

A

Cholestatic jaundice, hepatitis, fulminant hepatic necrosis, hepatic failure

112
Q

Is ACE inhibitors safe in pregnancy:

A

No, as can cause adversely foetal and neonatal blood pressure drop adrenal function and skull defects, oligohydramnios

113
Q

Which ACE can be crushed and suspended into water immediately before use:

A

Enalapril

114
Q

State some side effects of ramipril:

A

Muscle spasms. GI, increased risk of infection, asthma exacerbated, depressed, libido decreased, hyperkalaemia, angioedema (swelling)

115
Q

State side effects of ARBS:

A

Abdominal pain, hypotension, hyperkalaemia, postural hypotension, vertigo

116
Q

Are ACE nephroprotective or nephrotoxic?

A

Nephroprotective in CKD
Nephrotoxic in AKI

117
Q

State the drugs that has to be avoided in AKI:

A

Diuretic
ACE
Metformin
NSAIDs Pioglitazone

118
Q

Patient is recently started on hydralazine for severe hypertension. Patient is complaining of unexplained weight loss, arthritis. What do you do?

A

Refer to GP as patient is showing symptoms of systemic lupus erythematosus

119
Q

Which medicine owes risk of contact sensitisation of hands?

A

Phenoxybenzamine hcl

120
Q

What has to be given to all patients who are at risk of CVD:

A

Low dose atorvastatin

121
Q

A patient is a Type 1 diabetic, which lipid-regulating medicine should also be commenced:

A

Atorvastatin

122
Q

What drug can be given to patients over the age of 85 to reduce risk of non-fatal myocardial infarction:

A

Low-dose atorvastatin

123
Q

Name two bile acid sequestrants:

A

Colestyramine and colestipol

124
Q

If statins are contra-indicated in which medicines can be given (and for familial hypertriglyceridemia):

A

Ezetimibe, colestyramine and colestipol

125
Q

Which two PCSKY9 inhibitors can be used if cholesterol remains above target levels despite other tolerated lipid lowering therapy being used:

A

Alirocumab and evolocumab

126
Q

What statin dose should be used as secondary prevention of CVD:

A

Atorvastatin 80 mg

127
Q

Which statin should be avoided in secondary prevention due to risk of myopathy:

A

Simvastatin

128
Q

What should be checked 3 months after starting treatment with a high intensity statin:

A

Total cholesterol
HDL cholesterol
Non-HDL cholesterol
NICE recommends aiming for reduction non-hdl in 40% and JBS3 recommends below 2.5mmol/L

129
Q

Which class of medicines should be considered if a patient had CVD and is presenting symptoms of depression:

A

SSRIs

130
Q

Define chronic heart failure:

A

Progressive clinical syndrome caused by structural or functional abnormalities of the heart resulting in in reduced cardiac output

131
Q

State symptoms of heart failure:

A

Shortness of breath
Persistent coughing or wheezing Ankle swelling
Reduced exercise intolerance
Fatigue
Oedema and Risk of heart failure is greater in men, smokers and diabetic patients and increases with age

132
Q

When a patient has heart failure, what weight increase within 2 days is a big concern and would be classed as a red flag to refer to GP or heart specialist:

A

Report any weight gain of 1.5-2kg in 2 days

133
Q

Which 2 vaccinations is recommended for patients with heart failure:

A

Annual flu
Annual vaccination against pneumococcal disease

134
Q

Drug treatment for heart failure:

A

1) ACE + BB (bisoprolol, caervedilol, nebivolol)
Or ARB if ACE contraindicated (candersartan, losartan, valsartan)
2) Aldosterone antagonist (spironolactone, eplenerone)
3) Hydralazine + nitrate given to those patients tat have ACE+BB CI

135
Q

What egFR are diuretics can be used for heart failure:

A

Egfr more than 30 ml

136
Q

Which loop diuretics can be used in heart failure:

A

Furosemide, bumetanide, torasemide

137
Q

Which ARBs are licensed for heart failure if ACE are CI:

A

Candersartan, losartan, valsartan

138
Q

Which statin dose reduced in Asian patients:

A

Rosuvastatin

139
Q

Patient is taking colesevelam, what 2 advice would you give to patient:

A

Do not take other medicines at same time
Drug can cause fat-soluble vitamin deficiency so take ADEK vitamins as supplement or get them prescribed
Take other drugs 1 hour before (or 4 hours for colesevelam) or 4 hours after bile acid sequestran

140
Q

How do bile acid sequestrants work:

A

Bind bile acids, preventing their reabsorption, promotes hepatic conversion

141
Q

How does ezetimibe work:

A

Inhibits intestinal absorption of cholesterol

142
Q

How do fibrates work

A

Decreases serum triglycerides

143
Q

What should be corrected before patient starts taking a fibrate – lipid modifying drugs:

A

Correct hypothyroidism before initiating treatment

144
Q

How do statins work:

A

Inhibits HMG COA reductase, enzyme involved in cholesterol synthesis, especially in liver

145
Q

State common side effects fo statins:

A

Dizziness, diarrhoea, constipation, myalgia, sleep disorders,
pancreatitis,

146
Q

State patient advice for taking statin

A

Report unexplained muscle pain, tenderness, weakness Dyspnoea, cough and weight loss = interstitial lung disease

147
Q

A female patient has been taking simvastatin and has come to the GP to seek advice as she would like to get pregnant. What do you advise:

A

Statins avoided in pregnancy
Discontinue 3. Months before trying to conceive

148
Q

Monitoring requirements for statins:

A

Full lipid profile, triglyceride concentrations, TSH,renal function
LFTs before treatment, 3 months and at 12 months
Creatine kinase measured in patients who have had unexplained muscle pain
If measurement is more than 5 times the measurement should be repeated after. 7days Fasting blood glucose or HBA1C before and then after 3 months

149
Q

What condition can atorvastatin cause as a side effect:

A

Hyperglycaemia

150
Q

State side effect of atorvastatin:

A

Hyperglycaemia, epistaxis, muscle pain, tinnitus, vertigo

151
Q

State treatment of acute attack for stable angina:

A

Sublingual GTN spray

152
Q

For long term prevention of chest pain in patients with stable angina:

A

1) BB (metoprolol, atenolol, bisoprolol, propranolol) first line
2) Rate limiting CCB (diltiazem, verapamil)
3) If above contraindicated, then BB + CCB given
4) Lon acting nitrate (ivabradine, nicorandil, ranolazine) if BB + CCB contraindicated

153
Q

Which CCB is effective in Prinz mentals angina:

A

Amlodipine

154
Q

All patients with stable angina due to atherosclerotic disease should be given:

A

Low dose aspirin + statin (+ ACE in those with diabetes)

155
Q

You are working as a GP pharmacist and measuring a patients HR. The patients HR is 49 what do you do. This is a new medication – ivabradine:

A

Discontinue as signs of bradycardia. Discontinue if HR falls below 50 BPM

156
Q

State some serious side effects of nicorandil:

A

Serious skin, mucosal, eye, gi ulceration. Stop treatment.

157
Q

Less brady cardia, less coldness of extremities: ICE PACO

A

Pindolol
Acebutolol
Celiprolol
Oxprenolol

158
Q

Water soluble, less likely to cross through blood brain barrier, less nightmares and sleep disturbances Water CANS:

A

Celiprolol
Atenolol
Nadolol Sotalol

159
Q

Cardio selective, BE A MAN:

A

Bisoprolol
Atenolol
Metoprolol
Acebutolol Nebivolol

160
Q

Once daily dosing, long duration of action:

A

Bisoprolol
Atenolol
Celiprolol
Nadolol

161
Q

What are the usual cholesterol targets:

A

<5mmol/L total cholesterol for HEALTHY adults <4mmol/L total cholesterol for high risk adults
<3mmol/L LDL for HEALTHY adults <2mmol/L for high risk adult

162
Q

Hyperlipidaemia diagnosis =

A

6mmol/L total cholesterol

163
Q

Which drugs can cause hyperlipidaemia:

A

Antipsychotics, immunosuppressants, corticosteroids and antiretrovirals (HIV) drugs

164
Q

All statins besides ONE, must be taken at night due to cholesterol synthesis greater at night:

A

Atorvastatin

165
Q

There is an increases risk of myopathy with:

A

concomitant statin + ezitimibe/fibrates, especially gemfibrozil
concomitant fusidic acid (oral) + statin. Restart statin 7 days after last dose as increased risk of rhabdomyolysis

166
Q

Which drugs can increase statin levels = increased risk of myopathy:

A

Amidarone, grapefruit juice, CCB, itraconzole, ciclosporin

167
Q

Clarithoymcin + Statin =

A

stop statin for durartion of antibiotic course

168
Q

What is the max dose of simvastatin + amiodarone/amlodipine/diltiazem/verapamil:

A

20 mg

169
Q

State a caution of nitrates:

A

Tolerance

170
Q

How long does GTN sublingual spray/tablet last:

A

20-30 mins

171
Q

What is the expiry for sublingual GTN spray/tablets?

A

8 weeks after opening

172
Q

GTN rule steps:

A

Take 1st dose under tongue and wait 5 mins
Take 2nd dose and wait 5 mins
Take 3rd dose and wait 5 mins
If pain is still present – call 99 medical emergency

173
Q

If tolerance is suspected for nitrates:

A

Leave patches off for 8-12 hours
Take second dose after 8 hours not 12 hours for isosorbide mononitrate and MR isosorbide dinitrate
MR isosorbide mononitrate taken once daily only

174
Q

Avoid abrupt withdrawal of nitrates + CCB

A

= worsens angina

175
Q

Step management of unstable angina/NSTEMI:

A

A. Oxygen if there is hypoxia
B. Nitrates for ischameic pain. (GTN/IV buccal GTN/ IV isosorbide dinitrate
If still pain IV Morphine/diamorphine + metoclopramide
C. Aspiring 300 mg + clopidogrel 300 mg or ticagerelor
D. Heparin unfractionated or LMWH or fodaparin sodium
E. Statin + ACE + Aspirin + Beta-blocker = long term management
Clopidogrel for 4 weeks = STEMI
Clopidogrel for 12 months = NSTEMI/unstable angina

176
Q

Which aldosterone antagonist Is licensed following an MI in those with LVEF of heart failure:

A

Epelrenone

177
Q

State treatment of cardiac arrest / cardiopulmonary resuscitation:

A

IV adrenaline 1 in 1000 (1mg) every 3-5 minutes
IV amiodarone can be considered if there is ventricular fibrillation

178
Q

How long does it take for thiazides and related diuretics to work and DOA:

A

1-2 hours and Duration Of Action is 12 -24 hours

179
Q

Which thiazide like diuretic is claimed to reduce blood pressure with less metabolic disturbance, particularly less aggravation of diabetes:

A

Indapamide

180
Q

What can loop diuretic exacerbate:

A

Gout / diabetes (hyperglycaemias less likely with thiazides) Furosemide and bumetanide act within 1 hour. Can be given BD

181
Q

Which thiazide can be given on alternate days for oedema:

A

Chlortalidone

182
Q

What electrolyte balances can loop diuretics cause:

A

Hypokalaemia
Hyponatraemia
Hypomagnesemia
Hypocalcaemia BUT hypercalcaemia in thiazides and related diuretics

183
Q

What colour does triamterene turn urine:

A

Blue

184
Q

State potassium-sparring diuretics:

A

Amiloride and triamterene
Side effects is HYPERKALAEMIA thus avoid with ACE/ARB/K+ supplements/aldosterone antagonist

185
Q

State some side effects of aldosterone antagonists: (spironolactone/eplerenone)

A

Gynaecomastia, change in libido, hyperkalaemia, increase in gout, hyponatraemia

186
Q

What is the treatment of life threatening new onset atrial fibrillation

A

emergency electrical cardioversion.

187
Q

What is the treatment for non-life threatening af

A

If not life-threatening, pharmacological or electrical
cardioversion should be considered. Ventricular rate
can be controlled with a standard beta-blocker (not
sotalol), rate-limiting calcium channel blocker such as
diltiazem or verapamil as monotherapy. If
monotherapy fail, a combination of two drugs
including a beta-blocker, digoxin, or diltiazem can be
used.

188
Q

How is sinus rhythm restored post cardio version

A

with a standard beta-blocker. Alternatively, sotalol,
flecainide, propafenone, or amiodarone may be
considered.

189
Q

What are the INR targets with warfarin

A

1.1 or below in healthy people
* 2.5 for most indications
* 3.5 for recurrent DVT or PE

190
Q

How long does it take for the effects of warfarin to fully develop

A

Take at least 48 to 72 hours for the anticoagulant
effect to develop fully.

191
Q

How long is warfarin taken for

A
  • 6 weeks for isolated calf-vein DVT
  • 3 months for venous thromboembolism provoked
    by surgery or other transient risk factor (e.g.
    combined oral contraceptive use, pregnancy,
    plaster cast)
  • at least 3 months for unprovoked proximal DVT or
    PE; may be required long-term
192
Q

What are the tablet colours for warfarin

A

Brown tablets = 1mg
Blue tablets = 3mg
Pink tablets = 5mg

193
Q

What is the first line treatment for heart failure with reduced ejection fraction

A

ace inhibitor and a beta blocker
aldosterone antagonist can be added

194
Q

What is the first line treatment for heart failure with preserved ejection fraction

A

diuretic and refer to specialist

195
Q

How is acute angina managed

A

Acute attacks of stable angina should be managed
with sublingual glyceryl trinitrate; sublingual glyceryl
trinitrate can be taken immediately before performing
activities known to bring on an attack. If attacks occur
more than twice a week, regular drug therapy is
required.

196
Q

How is stable angina managed

A

Patients with stable angina should be given a betablocker or a calcium-channel blocker. Addition of a
long-acting nitrate, ivabradine, nicorandil, or
ranolazine can be considered.

197
Q

What is given in the treatment of a stemi

A

Aspirin – to limit clot size and allow blood flow
* Morphine – relieve pain and anxiety
* Metoclopramide – to relive nausea from morphine
* Oxygen – to ease laboured breathing
* Nitrate – vasodilator to ease blood flow
* LMWH – anticoagulant to prevent clot growth

198
Q

Discuss tolerance and nitrates

A

Developing tolerance reduces therapeutic effects of
nitrates. A nitrate free period of 4 to 12 hours each
day usually maintains effectiveness. Conventional
formulations of isosorbide mononitrate should not
usually be given more than twice daily unless small
doses are used; modified-release formulations of
isosorbide mononitrate should only be given once
daily, and used in this way do not produce tolerance

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