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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

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
MOA of BB
Block beta adrenoceptors in the heart, pancreas , liver and blood vessels outside the heart They slow the heart and can depress the myocardium
26
Which beta blockers are found in the lungs?
B2
27
Which BB are found in the heart?
B1
28
What is ISA activity
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
Examples of BB that will not cause extreme coldness of extremities and less bradycardia
ICE PACO Pindolol Acebutol Celiprolol Oxprenolol
30
What are examples of water soluble beta blockers
CANS Celiprolol Atenolol Nadolol Sotalol
31
Examples of cardioselective BB
Be a man Bisoprolol Atenolol Metoprolol Acebutol Nebivolol
32
Example of Non cardioselective BB
Sotalol
33
Examples of long duration Beta blockers
BACN Bisoprolol Atenolol Celiprolol Nadolol
34
Side effect of BB
Mask symptoms of hypoglycaemia Cause hypoglycaemia or hyperglycaemia Hypotension Bradycardia Sleep disturbance with nightmares Coldness of extremities (less common with ISA) Fatigue
35
What BB should be offered to diabetic and asthmatic pat?
Cardioselective Be a man
36
Some of the uses of beta blockers
See BNF
37
Contraindications of BB
Asthma, COPD and bronchospasm- give cardioselective if no alternative Marked bradycardia Prinzmetal's Angina 2nd and 3rd degree AV block Uncontrolled HF
38
BB Cautions
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
Important interaction of BB
IV verapamil and bradycardia Risk of hypotension and bradycardia
40
List examples of Dihydropyridines CCB
Amlodipine Nifedipine( maintain same brand for MR) Lercanidipine Lacidipine and felodipine
41
MOA of dihydropyridine CCB
Relax vascular smooth muscle Have no antiarrhythmic property
42
Example of phenylalkamines
Verapamil
43
Facts about Verapamil
Used to treat hypertension, angina and arrhythmia Highly negatively ionotropic Minimal vasodilatory effect Cause constipation Has profound cardio depressant effect
44
Example of benzothiazepine
Diltiazem
45
Facts about Diltiazem
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
Prescribing and dispensing information for Diltiazem
MR preparation containing more than 60 g Diltiazem may not have the same clinical effect Prescribers should prescribe by brand to prevent confusion
47
Facts about Nicorandil
Licensed for long term tx of angina Has both arterial and Venous vasodilatory effects Potassium Channel activator with nitrate component
48
Examples of anti-Anginal drugs
Ivabradine and ranolazine
49
Side effects of CCBs
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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