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cardiovascular system 1 > Cardiovascular 4 > Flashcards

Cardiovascular 4 Flashcards

1
Q

State the drugs used in hypertension

A

ACDDB
Ace/ARB
CCB
Thiazide diuretics
Low dose spironolactone
Beta blockers

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2
Q

What antihypertensive is preferred for adults of black African origin

A

ARBs

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3
Q

What antihypertensive should be offered to all patients with diabetes regardless of origin and age

A

ACEi/ARbs

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4
Q

State what antihypertensive is suitable for patients that are unable to tolerate CCB due to oedema or heart failure

A

THIAZIDE LIKE DIURETICS eg Indapamide over Bendroflumethazide(Thiazide diuretics)

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5
Q

State when to avoid /use with caution ACE inhibitors and ARB in HTN

A

Afro-Caribbean unless diabetic
Severe renal disease
Pregnancy and BF
Angioedema
Aliskiren with EGFR <60 or- diabetic- Avoid

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6
Q

What are the side effects of ACE inhibitors

A

Angioedema
Cough
Hyperkalaemia
Alopecia
GI
Hypotension
Sleep disorders
Taste altered
Tinnitus

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7
Q

What are the side effects of ARBs

A

Hyperkalaemia
Angioedema
Abdominal pain
Renal impairment
Cough
Diarrhoea
Dizziness
Nausea
Back pain

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8
Q

State when to avoid CCB in HTN

A

Oedema
Heart failure except amlodipine
Unstable Angina-CI
, uncontrolled HF
Cardiogenic shock- CI
Significant aortic stenosis- CI

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9
Q

What’s the side effect of CCB

A

Oedema
Skin reactions
Drowsiness dizziness
Flushing
Headache
Tachycardia
Vomiting
Nausea
Palpitations

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10
Q

State when to avoid /caution Thiazide like diuretics

A

Diabetes- caution
Gout- Caution
Egfr <30
Addison disease- Avoid
Hyponatraemia - avoid
Refractory hypokalaemia- avoid
Hypercalcaemia-Avoid

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11
Q

Side effect Thiazide diuretics

A

Hypokalaemia
Hyperuricaemia
Hypercalcaemia
Hyponatraemia
Hyperglycaemia
Postural hypotension
Erectile dysfunction

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12
Q

State when to avoid spironolactone

A

Addison’s Disease
Hyperkaelamia
Anuria

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13
Q

Side effect of spironolactone

A

Hyperkalaemia
Gyneacomastia

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14
Q

State when to avoid BB in HTN

A

COPD
Asthma
Unstable HF

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15
Q

Side effect of BB

A

Bradycardia

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16
Q

State when to avoid alpha blocker in HTN

A

Hx of syncope in BPH or postural hypotension

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17
Q

Side effect of alpha blocker

A

Orthostatic hypotension

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18
Q

Drug tx for HTN with type 1 Diabetes

A

First line- ACEi/ARB
BB
CCB( only long acting eg Nifidipine or amlodipine)
Diuretics ( low dose in combination) with BB

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19
Q

What’s the target clinical BP in renal disease

A

<140/90 or < 130/80 in patients with CKD and diabetes or if urine:albumin exceeds 70mg/mmol

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20
Q

What is the first line tx of HTN in pregnancy

A

Labetolol

21
Q

2nd line tx of HTN in pregnancy

A

MR nifidipine(unlicensed)

22
Q

3rd line tx of HTN in pregnancy

A

Methyldopa (unlicensed)
Stop methyldopa 2days after birth and continue with regular HTN tx

23
Q

Drug used to tx severe HTN in pregnancy

A

IV magnesium

24
Q

What’s the dose of Labetolol in pregnancy

A

Initially 100mg BD , increased at intervals of 14days

Usual dose = 200mg BD , increased up to 800mg daily in 2 divided doses
To be taken with food
Higher doses tobe given in 2-3 divided doses
Max 2.4g/day

25
Q

MOA of BB

A

Block beta adrenoceptors in the heart, pancreas , liver and blood vessels outside the heart
They slow the heart and can depress the myocardium

26
Q

Which beta blockers are found in the lungs?

A

B2

27
Q

Which BB are found in the heart?

A

B1

28
Q

What is ISA activity

A

Intrinsic Sympathometic Activity is the ability of a beta blockers to stimulate and block adrenergic receptors
ISA causes less bradycardia and less coldness of extremities

29
Q

Examples of BB that will not cause extreme coldness of extremities and less bradycardia

A

ICE PACO
Pindolol
Acebutol
Celiprolol
Oxprenolol

30
Q

What are examples of water soluble beta blockers

A

CANS
Celiprolol
Atenolol
Nadolol
Sotalol

31
Q

Examples of cardioselective BB

A

Be a man
Bisoprolol
Atenolol
Metoprolol
Acebutol
Nebivolol

32
Q

Example of Non cardioselective BB

A

Sotalol

33
Q

Examples of long duration Beta blockers

A

BACN
Bisoprolol
Atenolol
Celiprolol
Nadolol

34
Q

Side effect of BB

A

Mask symptoms of hypoglycaemia
Cause hypoglycaemia or hyperglycaemia
Hypotension
Bradycardia
Sleep disturbance with nightmares
Coldness of extremities (less common with ISA)
Fatigue

35
Q

What BB should be offered to diabetic and asthmatic pat?

A

Cardioselective
Be a man

36
Q

Some of the uses of beta blockers

A

See BNF

37
Q

Contraindications of BB

A

Asthma, COPD and bronchospasm- give cardioselective if no alternative
Marked bradycardia
Prinzmetal’s Angina
2nd and 3rd degree AV block
Uncontrolled HF

38
Q

BB Cautions

A

Diabetes
Ist degree AV block
Symptoms of thyrotoxicosis and hypoglycaemia may be masked
Verapamil and Diltiazem can cause AV block
May reduce response to adrenaline

39
Q

Important interaction of BB

A

IV verapamil and bradycardia
Risk of hypotension and bradycardia

40
Q

List examples of Dihydropyridines CCB

A

Amlodipine
Nifedipine( maintain same brand for MR)
Lercanidipine
Lacidipine and felodipine

41
Q

MOA of dihydropyridine CCB

A

Relax vascular smooth muscle
Have no antiarrhythmic property

42
Q

Example of phenylalkamines

A

Verapamil

43
Q

Facts about Verapamil

A

Used to treat hypertension, angina and arrhythmia
Highly negatively ionotropic
Minimal vasodilatory effect
Cause constipation
Has profound cardio depressant effect

44
Q

Example of benzothiazepine

A

Diltiazem

45
Q

Facts about Diltiazem

A

Have both cardiac depressant and vasodilatory effects
Effective in most form of Angina
Long acting formulations used for HTN
May be used for patients in whom BB are contraindicated or ineffective
Less negative ionotropic effect than Verapamil
Use with caution with BB because of risk of bradycardia

46
Q

Prescribing and dispensing information for Diltiazem

A

MR preparation containing more than 60 g Diltiazem may not have the same clinical effect
Prescribers should prescribe by brand to prevent confusion

47
Q

Facts about Nicorandil

A

Licensed for long term tx of angina
Has both arterial and Venous vasodilatory effects
Potassium Channel activator with nitrate component

48
Q

Examples of anti-Anginal drugs

A

Ivabradine and ranolazine

49
Q

Side effects of CCBs

A

Dizziness
Flushing
Headache
Postural hypotension
Gastro intestinal disorder
Ankle Swelling
Skin reactions
Sudden withdrawal of CCB may exacerbate myocardial Ischaemia

cardiovascular system 1 (42 decks)

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