CARDIOVASCULAR Flashcards

Question

WARFARIN- SURGERY MINOR PROCEDURES, LOW RISK OF BLEEDING? INR LESS THAN , restart within.. PROCEDURES RISK OF SEVERE BLEEDING? Stop warfarin... INR GREATER THAN Thromboembolism risk... EMERGENCY SURGERY? Can be delayed... Can't be delayed..

Answer 1

MINOR PROCEDURES, LOW RISK OF BLEEDING? INR<2.5 Restart within 24hrs of op PROCEDURES RISK OF SEVERE BLEEDING? Stop warfarin 5 days before INR equal to/>1.5? Give vitamin K day before surgery High risk of thromboembolism? Bridge with LMWH, stop LMWH 24hrs before surgery, restart LMWH 48hrs after EMERGENCY SURGERY? Can be delayed by 6-12 hrs? Give IV vitamin K CAN'T be delayed by 6-12hrs? IV vitamin K+dried prothrombin complex

Answer 2

APIXABAN? 10mg BD for 7 days-> 5mg BD RIVAROXABAN? 15mg BD for 3 weeks-> 20mg OD, should be taken with food DABIGATRAN? 150mg BD aged 18-74 110-150mg BD, aged 75-79 110mg BD, aged 80+ EDOXABAN? 60mg OD, 30mg OD if <61kg

Answer 3

ALL HEPARINS? Avoid in heparin-induced thrombocytopenia Can cause hyperkalaemia Haemorrhage- treat with PROTAMINE SULPHATE (used for unfractionated heparin) UNFRACTIONATED HEPARIN? Quick initiation+elimination- ideal in high bleeding risk (monitor APTT) Higher risk of heparin-induced thrombocytopenia than LMWH Preferred in renal impairment LMWH? Preferred in pregnancy

Answer 4

HAEMORRHAGIC? Manage bp+avoid statins ISCHAEMIC? TIA/ACTUAL STROKE Initial Management w/ Aspirin Long-term Management?

Answer 5

HAEMORRHAGIC? Manage bp+avoid statins ISCHAEMIC? TIA/ACTUAL STROKE Initial management w/ aspirin TIA: 300mg OD till diagnosis established Ischaemic: 300mg OD for 14 days, then alteplase (given in 4.5hrs) Long-term Management? 1st line: Clopidogrel 75mg OD 2nd line: MR Dipyridamole+Aspirin 3rd line: MR Dipyramidole alone (or Aspirin alone) START HIGH-INTENSITY STATIN 48HRS AFTER STROKE MANAGE HYPERTENSION TO ACHIEVE <130/80 AVOID BETA-BLOCKERS

Answer 6

STAGE 1? 140/90-160/100mmHg (clinic) AND 135/85-149/94mmHg (ambulatory) <80 with kd, diabetes, CVD, >10%risk CVD 10 years? drug treatment <60 w/ <10% risk of CVD in 10 years? consider drug treatment+lifestyle advice >80 with bp>150/90mmHg? drug treatment+lifestyle STAGE 2? 160/100-180/120mmHg (clinic) AND >150/95mmHg (ambulatory) Treat all patients STAGE 3? >180/120mmHg Medical emergency

Answer 7

PATIENTS <55/TYPE 2 DM? Step 1? ACE-I OR ARB* Step 2? ACE-I/ARB+ CCB OR TLD Step 3? ACE-I/ARB+ CCB + TLD Step 4? Potassium <4.5mmol/L= low dose spironolactone Potassium >4.5mmol/L= alpha/beta-blocker *type 2 diabetes+afro-caribbean? ARB>ACE-i preferred

Answer 8

Step 1? CCB Step 2? CCB+ ACEi/ARB Step 3? same same ACE-I/ARB+ CCB + TLD Step 4? Potassium <4.5mmol/L= low dose spironolactone Potassium >4.5mmol/L= alpha/beta-blocker

Answer 9

``` Cough (ARB instead) Hyperkalaemia Hepatic failure Angioedema Renal impairment Dizziness & headaches ``` ARB: Candesartan/Irbesartan/Losaratan Same S-Es as ACE-i, except cough and angioedema!

Answer 10

INCREASED.. Risk of renal failure- ARBs, K-sparing diuretics, NSAIDs Hyperkalaemia- Heparin, ARBs, NSAIds, K-sparing diuretics, b-blockers Volume depletion- Diuretics Plasma levels of lithium

Answer 11

CARDIO-SELECTIVE? less likely to cause bronchospasms BAtMAN Bisoprolol, Atenolol, Metoprolol, Acebutolol & Nebivolol WATER-SOLUBLE? less likely to cross BBB-> less nightmares Water CANS Celiprolol, Atenolol, Nadolol & Sotalol INTRINSIN SYMPATHOMIMETIC B-BLOCKERS? less likely to cause cold extremities Ice PACO Pindolol, Acebutolol, Celiprolol & Oxprenolol

Answer 12

BRADYCARDIA/HF (avoid amiodarone/digoxin) MASKS EFFECTS OF HYPOGLYCAEMIA 'Can induce diabetes' hypergly? BRONCHOSPASMS-> contraindicated in asthmatic patients INTERACTIONS- digoxin, heart block+ any hypotensive drug! ANY HEART DRUG, BRADYCARDIA RISK?

Answer 13

Dihydropyridine? Amlodipine, Felodipine, Lacidipine, Lercanidipine & Nifedipine Rate-limiting? Diltiazem & Verapamil ``` SIDE-EFFECTS? Dizziness Gingival Hyperplasia- enlarged gums flushing/headaches/ankle swelling: more so in dihydro Complete AV block- more so in R-L ```

Answer 14

High risk of developing pre-eclampsia? Kidney disaese/diabetes/autoimmune disease/hypertension TAKE ASPIRIN FROM WEEK 12 TILL BIRTH Blood pressure> 140/90mmHg? Labetalol, L? Nifedipine MR, L? Methyldopa

Answer 15

<80years? 140/90mmHg (clinical) | 135/85 (ambulatory) >80years? 150/90mmHg (clinical) | 145/85 (ambulatory) Type 2? Clinical same as above Renal Disease? 140/90mmHg (clinical) Pregnancy/Type 1 Diabetes? 135/85mmHg (clinical)

Answer 16

Total cholesterol? 5 or below HDL (good cholesterol)? 1 or greater LDL (bad cholesterol)? 3 or below Non-HDL (bad cholesterol)? 4 or below Triglycerides? 2.3 or below

Answer 17

``` When to offer lipid-lowering agents? <85 w/ >10% 10-year CVD risk Type 2 diabetes w/ >10% 10-year CVD risk ALL Type 1 diabetes: >40years Diabetes>10 years Established nephropathy CKD Familial Hypercholesterolaemia ```

Answer 18

Time of day? Atorvastatin/Rosuvastatin-any time of day Other 3- ON, cholesterol produced at night, highest Atorvastatin strongest dose? Atorvastatin 80mg- used in secondary prevention (e.g. had a heart attack) Hypothyroidism? Manage BEFORE starting statin High risk of diabetes? Measure FBG/HbA1C BEFORE starting statin Repeat after 3 months

Answer 19

MYOPATHY+RHABDOMYOLYSIS-> muscle toxicity- seek medical advice if they develop muscle symptoms (pain/tenderness/weakness) INTERSTITIAL LUNG DISEASE-> seek medical attention if patients develop dyspnoea/cough/weight loss TERATOGENIC-> statins should be avoided in pregnancy (discontinue 3 months before conceiving)

Answer 20

CYP450 enzyme inducer? (rifampin, phenytoin, phenobarbital) -Reduces conc. of statin CYP450 enzyme inhibitor? (erythromycin, ketoconazole, diltiazem, colchicine) - Increases conc of statin-> increased risk of rhabdomyolysis - Patients prescribed macrolides-> stop taking statin during treatment - Avoid drinking grapefruit juice ``` Fusidic acid (oral, X cream)? -Stop statin during treatment-> restart 7 days after last dose ```

Answer 21

AMIODARONE+SIMVASTATIN? 20mg AMLODIPINE+SIMVASTATIN? 20mg DILTIAZEM/VERAPAMIL+SIMVASTATIN? 20mg TICAGRELOR+SIMVASTATIN? 40mg CICLOSPORIN+ATORVASTATIN? 10mg TIPRANAVIR+ATORVASTATIN? 10mg SIMVA+FIBRATES 10MG

Answer 22

EZETIMIBE? Statins+fibrates= increased risk of rhabdomyolysis FIBRATES? Bezofibrate/Ciprofibrate/Fenofibrate/Gemfibrozil Myotoxicity in renal impairment LFTs/3 months for the first year Statins+fibrates= increased risk of muscle related side-effects

Answer 23

? Build up of atherosclerotic plaques which restrict arteries, reducing blood supply and oxygen to the heart

Answer 24

INITIAL TREATMENT? - Can be taken prophylactically/when symptoms arise - GTN dose to be taken at 5mins intervals - If symptoms haven't resolved after third dose: medical emergency LONG-TERM PREVENTION? 1st line: beta-blocker (R-L ccb if contra) 2nd line: b-blocker +normalCCB (amlodipine, lacidipine, etc) NEVER B-B+R-L CCB 3rd line: long-acting nitrate- nicorandil/ivabradine/ranolazine Nicorandil can cause GI+mucosal ulceration ``` Angina further advice? Healthy lifestyle measures 75mg aspirin low dose statin (not secondary prevention) ```

Answer 25

SUBLINGUAL TABLETS DISCARD? -Discard 8 weeks after opening bottle TOLERANCE? - Patients should have nitrate free period to prevent tolerance - Second dose of nitrate, give 8hrs after first dose (not 12), 16hrs nitrate-free blood (8am, 4pm...) - Transdermal use: leave patch off for 8-12hrs SIDE-EFFECTS? - Dizziness - Flushing - Headaches -Elderly, caution!

Answer 26

``` MAJOR RISK FACTORS? Family history Hypertension Hypercholesterolaemia Diabetes Smoking ``` All syndromes- similar in initial/secondary treatment

Answer 27

STEMI- Primary PCI (coronary reperfusion therapy) should be delivered ASAP within 2hrs P.S . All 3 syndromes started on secondary prevention

Answer 28

LOADING DOSE ASPIRIN 300mg PAIN RELIEF: GTN/IV morphine O2 if needed Monitor all patients for hyperglycaemia, >11mmol/L? Insulin!-> dose-adjusted infusion NSTEMI/UNSTABLE ANGINA/STEMI DIFFERENCE? -UNSTABLE ANGINA- PARTIAL blockage of artery -NSTEMI- PARTIAL blockage of artery+myocardial necrosis (dead cardiomyocytes->elevated cardiac troponin values) ST zone of ECG is not elevated -STEMI- COMPLETE blockage of artery causing myocardial necrosis ST zone of ECG is elevated non-ST vs st-elevated myocardial infarction!

Answer 29

Give heparin if PCI is done through radial access | Long-term management? Prasugrel- secondary anti-platelet

Answer 30

DUAL, ACE, B-B & S DUAL ANTIPLATELET THERAPY? lifelong aspirin 75mg 12 months: clopidogrel, prasugrel (preferred if PCI), ticagrelor ACE-i? ARB if ACE-i is contraindicated B-BLOCKER? Discontinue after 12months in patients with LVEF STATIN? Atorvastatin 80mg, high strength *only difference is STEMI needs PCI! Patients with NSTEMI might consider PCI to prevent future MI

Answer 31

``` SOB Persistent cough/wheezing Ankle swelling Reduced exercise tolerance Fatigue ```

Answer 32

1st LINE? ACEi+B-blocker Start at low dose+titrate up slowly to max. ARB instead if ACE-I an L (licensed only- candesartan/losartan/valsartan) Hydralazine+nitrate if both ACE-i & ARB an L (common in African/Caribbean origin) SPIRO AFTER HYDRALAZINE+NITRATE! SYMPTOMS PERSIST? Add aldosterone antagonist- spironolactone/eplerenone (previous MI/HF?) SYMPTOMS PERSIST 2? Add amiodarone/digoxin/sacubitril w/ valsartan/ivabradine/dapagliflozin Dapagliflozin has water loss side-effect, chronic HF excess fluid Digoxin for patients in sinus rhythm in worsening/severe HF LOOP DIURETICS PURPOSE? Relieve breathlessness/oedema in fluid retention, furosemide/bumetanide/torasemide DIGOXIN HF LOADING DOSE? 62.5-125mcg OD

Answer 33

Water retention in the system Pulmonary- lungs Peripheral- rest of the body (ankle swelling)

Answer 34

THIAZIDE? BIt- Bendroflumethiazide, Indapamide Inhibits sodium reabsorption at the beginning of the distal convoluted tubule Lasts up to 24hrs- needs to be given AM to avoid sleep L LOOP? FBT- Furosemide, Bumetanide, Torasemide Inhibits reabsorption from the ascending limb of the loop of Henle Used in pulmonary oedema due to left ventricular failure Lasts 6hrs, can give BD, no L on sleep

Answer 35

POTASSIUM-SPARING DIURETICS? AT- Amiloride, Triamterene (blue urine) Prevents sodium reabsorption in the distal tubule collecting duct ALDOSTERONE ANTAGONISTS (P-S A)? Spironolactone, Epleronone Inhibits potassium secretion in the distal tubule collecting duct Stopped if person becomes dehydrated- vomiting/diarrhoea MUST NOT TAKE WITH K+ supplements

Answer 36

ALL? Induce hyponatraemia+hypomagnesaemia LOOP+THIAZIDE? Hypokalaemia Exacerbates diabetes+exacerbates gout (both loop only) Hypotension K+-SPARING? Hyperkalaemia Change in libido Breast pain/tenderness

Answer 37

Loop+Thiazide? hypokalaemia inducing drugs Thiazide? avoid NSAIDs, but low-dose aspirin calm K+sparing? hyperkalaemia inducing drugs Loop+Aminoglycosides? nephrotoxicity/ototoxicity (gent) Spironolactone/Loop+Lithium? reduces lihtium secretion (renal)

Answer 38

OCCLUSIVE VASCULAR DISEASE? - Normally caused by atherosclerosis - Reduced risk with health lifestyle, statins & antiplatelets VASOSPASTIC VASCULAR DISEASE? (Raynaud's) - Avoid exposure to cold+smoking cessation - Further treatment? NIFEDIPINE!

Answer 39

At least 2 of: >/=80years >/=133 Cr = 60kg

Answer 40

Parenteral anticoag for 5 days

Answer 41

B-blocker+Digoxin is key!

Answer 42

Patients with heart disease/heart failure

Answer 43

reduces risk of toxicity

Answer 44

amiodarone

Answer 45

48-72 HOURS!

Answer 46

TRUE | idarucizumab

Answer 47

UNDER 80? 140/90 clinical, 135/85 amb OVER 80? 150/90 clinical, 145/85 amb

Answer 48

``` DARK URINE/ABDOMINAL DISCOMFORT SOB SORE THROAT BRUISING MOUTH ULCERS ```

Answer 49

5mg | 20mg

Answer 50

Mannitol cerebral oedema high intracranial pressure

Answer 51

CRANBERRY JUICE

Answer 52

SPINACH & KALE CONTAINING VITAMIN K

Answer 53

Sinus rhythm? Use electrical or pharmacological. | Pharmacological- Flecainide or amiodarone

Answer 54

AF> 48 hours? Electrical cardioversion's preferred. - Patient must be fully anticoagulated for at least 3 weeks - Give oral anticoagulation- +4weeks at least after cardioversion

Answer 55

Drug treatment post-cardioversion? (rhythm control) - Standard beta blocker (1st line) (NOT SOTALOL) - SPAF (Sotalol, Propafenone, Amiodarone or Flecainide) - Amiodarone, can be started 4 weeks before and continued up to 12 months after electrical cardioversion, increase success of procedure

Answer 56

Ventricular rhythm? (rate-control) | Standad beta-blocker

Answer 57

Symptoms persist/standard B-B not appropriate? | SPAF (Sotalol, Propafenone, Amiodarone or Flecainide)

Answer 58

Symptomatic paroxysmal AF? | 'Pill-in-the-pocket'- Flecainide/Propafenone PRN

Answer 59

RATE? | B-blocker/R-L CCB, temporary

Answer 60

RESTORATION? Direct current cardioversion- rapid control needed Pharmacological cardioversion Catheter ablation- recurrent atrial flutter

Answer 61

STILL NEED TO ENSURE? Patient has been anticoagulated for 3 weeks if flutter has lasted longer >48hrs Assess stroke risk

Answer 62

ELECTIVE HIP REPLACEMENT? - LMWH for 10 days AND THEN 75mg aspirin for 28 days - LMWH for 28 days+stockings till discharge - Rivaroxaban- 10mg OD 5 weeks

Answer 63

ELECTIVE KNEE REPLACEMENT? - 75mg aspirin for 14 days - LMWH for 14 days+stockings till discharge - Rivaroxaban General medical patients, high risk of VTE- pharmacological prophylaxis for at least 7 days OR mechanical till mobile

Answer 64

MECHANICAL? -Continued until mobility/discharge PHARMACOLOGICAL? - LWMH common - Unfractionated heparin preferred in renal impairment - Fondaparinux, lower limb immob Continue for at least 7 days post-surgery/till mobility However, 28 days after major cancer surgery in abdomen 30 days in spinal surgery

Answer 65

PHARMACOLOGICAL? - LWMH common - Unfractionated heparin preferred in renal impairment - Fondaparinux, lower limb immob Continue for at least 7 days post-surgery/till mobility However, 28 days after major cancer surgery in abdomen 30 days in spinal surgery

Answer 66

Spontaneous? | Terminate ekhla

Answer 67

Reflex vagal stimulation? | Valsalva manouevre/face-in-cold water (ECG monitoring though)

Answer 68

L? IV Adenosine, L? IV Verapamil (but avoid in patients, recent b-blockers, risk of brady/hypotension)

Answer 69

Recurrent symptoms? Catheter ablation (terminate faulty electrical pathways from sections of heart)

Answer 70

Preventing future episodes? B-blocker/R-L CCB

Answer 71

Pulseless ventricular tachycardia OR ventricular fibrillation? RESUSCITATION

Answer 72

Unstable sustained ventricular tachycardia? | Direct current cardioversion. L? Give IV amiodarone. L? Repeat current cardioversion

Answer 73

Stable ventricular tachycardia? IV amiodarone, L? Direct current cardioversion Non-sustained ventricular tachycardia- b-blocker

Answer 74

Patients high risk of cardiac arrest? Implantable cardioverter defib Add b-blockers/amiodarone (combined with standard b-blocker)

Answer 75

Can be drug induced/caused by severe hypokalaemia/severe bradycardia? Amiodarone, sotalol, macrolide, haloperidol, SSRI, TCA, antifungals

Answer 76

Self-limiting, but if recurrent? | Can lead to impaired consciousness

Answer 77

No control? | Ventricular fibrillation--> death

Answer 78

TREATMENT? IV magnesium sulphate B-blocker (NOT sotalol) and atrial/ventricular pacing may be considered

Answer 79

AVOID-- anti-arrythmics- prolong QT interval- worsens condition

Answer 80

BISOPROLOL CARVEDILOL NEBIVOLOL

Answer 81

K+ NA+ BP RENAL before treatment 1-2 weeks after starting at each dose increment. Target hit/maximum tolerated dose is achieved, monitor monthly for 3 months and then at least every 6 months, and if the patient becomes acutely unwell.

Answer 82

MINOR PROCEDURES, LOW RISK OF BLEEDING? INR<2.5 Restart within 24hrs of op PROCEDURES RISK OF SEVERE BLEEDING? Stop warfarin 3-5 days before INR equal to/>1.5? Give vitamin K day before surgery High risk of thromboembolism? Bridge with LMWH, stop LMWH 24hrs before surgery, restart LMWH 48hrs after EMERGENCY SURGERY? Can be delayed by 6-12 hrs? Give IV vitamin K CAN'T be delayed by 6-12hrs? IV vitamin K+dried prothrombin complex

Answer 83

Advice from the MHRA: there is an increased risk of myopathy associated with high-dose (80 mg) simvastatin. The 80 mg dose should be considered only in patients with severe hypercholesterolaemia and high risk of cardiovascular complications who have not achieved their treatment goals on lower doses, when the benefits are expected to outweigh the potential risks.

Answer 84

BUT POMEGRANATE AND CRANBERRY :) INHIBITOR

Answer 85

HIGH BLEEDING RISK

Answer 86

``` Old age (74+) Reduced haemoglobin- +2 (<13 mg/dL in men and <12 mg/dL in women) Bleeding history- +2 Insufficient kidney function (eGFR<60) Tx w/ antiplatelets ``` REDUCED HAEMOGLOBIN/BLEEDING GET +2 EACH

Answer 87

ANDAXANET ALFA

Answer 88

IDARUCIZUMAB

Answer 89

Initially 80 mg daily in 1–2 divided doses, then increased to 160–320 mg daily in 2 divided doses, dose to be increased gradually at intervals of 2–3 days.

Answer 90

nosebleed lasts longer than 10 to 15 minutes

Answer 91

1.5 mg/kg every 24 hours until adequate oral anticoagulation established.

Answer 92

MHRA/CHM advice: Hydrochlorothiazide: risk of non-melanoma skin cancer, particularly in long-term use (November 2018)

Answer 93

The black triangle symbol identifies newly licensed medicines that require additional monitoring by the European Medicines Agency. Such medicines include new active substances, biosimilar medicines, and medicines that the European Medicines Agency consider require additional monitoring. The black triangle symbol also appears in the Patient Information Leaflets for relevant medicines, with a brief explanation of what it means. Products usually retain a black triangle for 5 years, but this can be extended if required. Spontaneous reporting is particularly valuable for recognising possible new hazards rapidly. For medicines showing the black triangle symbol, the MHRA asks that all suspected reactions (including those considered not to be serious) are reported through the Yellow Card Scheme. An adverse reaction should be reported even if it is not certain that the drug has caused it, or if the reaction is well recognised, or if other drugs have been given at the same time. surveillance lol

Answer 94

One ‘5’ patch to be applied to chest or upper arm; replace every 24 hours, siting replacement patch on different area, dose to be adjusted according to response.

Answer 95

GIVE WARFARIN

Answer 96

RELIEVES OEDEMA, SWELLING SO ELDERLY, SWELLING CAN'T TAKE CCB? GIVE THIAZIDE!

Answer 97

Distal DVT? 6 weeks Proximal DVT/PE? At least 3 months (3-6m for active cancer) Provoked DVT/PE? Stop at 3 months if the provoking factor resolved Unprovoked DVT/PE? 3 months+ Recurrent DVT/PE? Long-term

Answer 98

ATENOLOL BISOPROLOL CELIPROLOL NADOLOL

Answer 99

FOLLOWING KNEE SURGERY? 2 WEEKS FOLLOWING HIP SURGERY? 5 WEEKS

Answer 100

NICORANDIL

Answer 101

30-60MINS BEFORE FOOD

Answer 102

VOMITING TIRED RAPID BREATHING SEIZURES LFT/WCC raised NOT muscle aches WCC raised? body fighting infection! :(

Answer 103

Amiodarone Quinine Dronedarone Dilt Verap?

Answer 104

hypokalaemia hypomagnesaemia hypercalcaemia hypoxia

Answer 105

Dabigatran, NOACs have a risk!

Answer 106

Prevention of cardiovascular events in a COPD patient who has previously had a myocardial infarction

Answer 107

Stop warfarin; give phytomenadione (vitamin K1) by slow IV injection; repeat dose of phytomenadione if INR still too high after 24 hours; restart warfarin when INR <5.0

Answer 108

INR >8.0, minor bleeding—stop warfarin sodium; give phytomenadione (vitamin K1) by slow intravenous injection; repeat dose of phytomenadione if INR still too high after 24 hours; restart warfarin sodium when INR <5.0 INR >8.0, no bleeding—stop warfarin sodium; give phytomenadione (vitamin K1) by mouth using the intravenous preparation orally [unlicensed use]; repeat dose of phytomenadione if INR still too high after 24 hours; restart warfarin when INR <5.0

Answer 109

3.5 RECURRENT DVT/PE, has score above 2 mechanical prosthetic heart valve

Answer 110

The standard formulations containing 60mg diltiazem hydrochloride are licensed as generics and there is no requirement for brand name dispensing. Different versions of modified-release preparations containing more than 60mg diltiazem hydrochloride may not have the same clinical effect. To avoid confusion between these different formulations of diltiazem, prescribers should specify the brand to be dispensed.

Answer 111

IV OR SC | NEVER IM

Answer 112

PRESCRIBE BY BRAND

Answer 113

aminoglycosides/glycopeptides>>>> linezolid

Answer 114

ciclosporin macrloides grapefruit juice NOT? azithromycin (macrolide, but no interaction)

Answer 115

Nimodipine, smooth muscle relaxant effect, use confined to following haemorrhage

Answer 116

stop 2 days before birth, risk of depression

Answer 117

18+ | but pharmacist supervision? 12+

Answer 118

``` corticosteroids carbocisteine doacs antiplatelets warfarin nsaid ssris ```

Answer 119

usually 7 28 days cancer 30 days spinal

Answer 120

amiodarone adrenaline lidocaine epinephrine

Answer 121

B-blockers are contraindicated Give diltiazem or verapamil! amlodipine might be decent

Answer 122

Sacubitril/Valsartan

Answer 123

Patients should be encouraged to weigh themselves daily at a set time of day and to report any weight gain of more than 1.5–2.0 kg in 2 days to their GP or heart failure specialist.

Answer 124

buprenorphine

Answer 125

Answer: B (A 5-day course of a single antibiotic.) Adults with low-severity community-acquired pneumonia are prescribed a 5-day course of a single antibiotic. Pneumonia is usually caused by bacteria and should be treated with antibiotic therapy. A 5-day course of a single antibiotic is usually an effective treatment for diagnosed low-severity community-acquired pneumonia unless symptoms do not improve. Prescribing a 5-day course will ensure that antibiotic therapy is not given for longer than necessary, and will contribute to effective antimicrobial stewardship. Healthcare professionals should give people advice on seeking further help if their symptoms do not show signs of improving after 3 days of antibiotic therapy.

Answer 126

Answer: D {20mg once a day) - CrCI >50ml/min: 20mg - Manufacturer advises reduce dose to 15 mg once daily if creatinine clearance 15-49 ml/minute.

Answer 127

IMIPRAMIEN MOST ANTIMUSCARINIC

Answer 128

EDOXABAN - Rivaroxaban: The MHRA has received a small number of reports suggesting a lack of efficacy (thromboembolic events) in patients taking 15 mg or 20 mg rivaroxaban tablets on an empty stomach. Healthcare professionals are advised to remind patients to take rivaroxaban 15 mg or 20 mg tablets with food. - Apixaban dosing is twice a day and may affect compliance

Answer 129

Sotalol may prolong the QT interval, and it occasionally causes life threatening ventricular arrhythmias (important: manufacturer advises particular care is required to avoid hypokalaemia in patients taking sotalol—electrolyte disturbances, particularly hypokalaemia and hypomagnesaemia should be corrected before sotalol started and during use).

Answer 130

Brain natriuretic peptide

Answer 131

Faecal calprotectin

Answer 132

Rivaroxaban

Answer 133

Lithium /Haloperidol /Macrolides /Venlafaxine /Citalopram /Amiadorone

Answer 134

10mg BD 7 days, 5mg BD maintain

Answer 135

SLEEPINESS! insomnia can coccur yikes

Answer 136

ST JOHN WORT, INDUCER, LESS WARFARIN, CLOT, LETSS EFFECTIV!

Answer 137

HYPOTENSION TACHYCARDIA HEADACHE DIZZINESS

Answer 138

dose reduce DB?

Answer 139

no interaction

Answer 140

BISOPROLOL BOYO

Answer 141

Manufacturer advises max. 10 mg daily with concurrent use of bezafibrate or ciprofibrate. Manufacturer advises max. 20 mg daily with concurrent use of amiodarone, amlodipine, or ranolazine. Manufacturer advises reduce dose with concurrent use of some moderate inhibitors of CYP3A4 (max. 20 mg daily with verapamil and diltiazem). Manufacturer advises max. 40 mg daily with concurrent use of lomitapide or ticagrelor. Manufacturer advises max. 20 mg daily with concurrent use of elbasvir with grazoprevir. Manufacturer advises usual max. 20 mg daily with concurrent use of bempedoic acid or bempedoic acid with ezetimibe; max. dose 40 mg daily in patients with severe hypercholesterolaemia and at high risk of cardiovascular complications.

Answer 142

hypertensive crisis, 14 days MAOI gap, etc

Answer 143

CONSIDER ADDITIONAL DRUG GLIPTIN BEST

Answer 144

DAQ Droanderone Amiodarone Quinine

Answer 145

6 HOURS AFTER!!!!

Answer 146

WARFARIN!!

Answer 147

ATORVASTATIN- 20MG, 40MG, 80MG ROSUVASTATIN- 10MG, 20MG, 40MG SIMVASTATIN- 80MG

Answer 148

HYPONATARAMIEA+HYPOMAGNESAEMIA