Cardiovascular Flashcards
When do thiazide and related diuretics lose effectiveness?
When CrCl is less than 30ml/min
How long should anticoagulation be continued after a provoked and unprovoked DVT or PE?
provoked = 3 months (3 to 6 months for those with active cancer)
unprovoked = beyond 3 months (beyond 6 months for those with active cancer)
What is the CrCl value in which you should AVOID each DOAC?
Apixaban, edoxaban and rivaroxaban - CrCl less than 15ml/min
Dabigatran - CrCl less than 30ml/min
What is the dosage adjustment of edoxaban if CrCl between 15-50ml/min
30mg OD
Missed dose advice with dabigatran
If a dose is more than 6 hours late, the missed dose should not be taken and the next dose should be taken at the normal time.
What patient characteristics could warrant the use of reduced dose of apixaban?
Age 80 years and over
body weight 60kg or less
Serum creatinine 133micromol/L or over
What are common interactions of warfarin?
Cranberry juice
Pomegranate juice (increases INR)
Direct acting antivirals
Alcohol (decreases anticoagulant effect)
SSRIs and NSAIDs (severe, increased risk of bleeding)
Miconazole
What are common interaction with statins?
Grapefruit juice
Amlodipine (increased risk of myopathy, max dose of 20mg simvastatin)
Clarithromycin
Which statin is used with caution in Asians?
What adjustments can be made?
Rosuvastatin
use 5-20mg only, dose to be increased gradually
What are the key side effects of nitrates?
flushing, headache, and postural hypotension
How to avoid building tolerance to nitrates?
Transdermal patches they should be left off for 8–12 hours (usually overnight) in each 24 hours
Modified release and conventional preparations - second dose should be given after 8 hours (instead of 12).
These aim to increase the nitrate free interval.
Counselling advice with short acting nitrates such as GTN?
to repeat the dose after 5 minutes if the pain has not gone
to call an emergency ambulance if the pain has not gone 5 minutes after taking a second dose
When using GTN spray sit down as dizziness can occur, spray under tongue and mouth should be closed immediately after
What medications can be prescribed for someone with stable angina?
Short acting nitrates to manage acute attacks
Drugs for secondary prevention of CVD (aspirin 75mg daily, ACEi, statins)
For long term prevention of chest pains in angina: beta-blocker or CCB (rate-limiting or dihydropyridines)
What medication can be prescribed for treatment of stable angina if first-line meds not tolerated?
Long-acting nitrate, ivabradine, nicorandil or ranolazine.
When should ivabradine be discontinued?
Resting heart rate below 50bpm
(monitor for bradycardia)
What is normal heart rate?
60-100 beats per min
What are common side-effects of calcium channel blockers?
Flushing
Peripheral oedema
Headaches
Dizziness
Gingival hyperplasia (uncommon)
What is a key side-effect of nicorandil?
Can cause serious skin, mucosal and eye ulceration.
Can cause GI ulcers.
Stop treatment if ulceration occurs.
What are the dose adjustments of ramipril in renal impairment?
Max daily dose 5mg if CrCl 30-60ml/min
Max initial dose is 1.25mg if CrCl is less than 30ml/min
What are the 4 pillars of heart failure with reduced ejection fraction?
ACEi/ARB (max tolerate dose, titrate quick)
Beta-blocker (‘start low, go slow’)
MRAs e.g. spironolactone or eplerenone
SGLT2i
+Loop diuretics for sympotamtic relief (oedema)
Which beta-blockers are licensed for heart failure?
Bisoprolol
Carvedilol
Nebivolol
Which calcium channel blockers can be used if HF with reduced ejection fraction?
amlodipine
What dosage adjustments need to be made if amiodarone and eplerenone are used together?
Amiodarone and inhibitors of CYP enzymes increase the exposure to Eplerenone, so the max dose will be 25mg OD
What medications should be used as part of DAPT when patient has STEMI with primary PCI
Aspirin + prasugrel
Aspirin + clopidogrel if patient already taking oral anticoagulant