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Medication > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Furosemide (Lasix)

A

DC: Loop Diuretics

I:

  • Oedema associated with heart failure, liver cirrhosis;
  • Severe hypercalcaemia

D:
- 20-40mg BD. Max dose 1g daily

M:

  • Urate levels
  • Renal function
  • Electrolytes
  • Weight
  • Cardiovascular risk factors
  • Dizziness
  • Fluid intake, hydration levels
  • Signs of ototoxicity

C:

  • Taken mane, if BD, second dose at lunchtime
  • You will feel dizzy, get up gradually.

PP:

  • Electrolyte disturbances
  • Could potentially precipitate gout
  • Ototoxicity more likely with IV
  • Contraindicated in severe sodium and fluid depletion. If use with potassium lowering drugs, risk of hypokalaemia.
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2
Q

Glyceryl Trinitrate

A

DC: Nitrate

I:

  • Treatment and prevention of angina
  • Acute heart failure and unstable angina

D:

  • Tablets: half to one tablet prn every 3-4 hours.
  • Spray: 400mcg to 800mcg prn. If prevention: 5-10 min before exercising

M:

  • Frequency of angina attacks
  • Worsening of heart failure
  • HR, BP
  • Dosing period (patch free periods)

C:

  • Dizzy! Use it during an episode or before exercising.
  • Sit down or lie down before using the tablet/spray.
  • Spray to sublingual tab under the tongue. If it does not get relief after 3-4 minutes, put another one in and call the ambulance.
  • For tablet: spit out what’s left to prevent headaches (active orally therefore reduce systemic absorption by spitting it out)
  • For sprays: require to prime the spray 5 times if its new, 1 time if you haven’t used it for 7 days.

PP:

  • NITRATE FREE PERIOD
  • Isosorbide mononitrate has the same counselling. But dosing of 30mg to 60mg D (Max 120mg) and swallow whole.
  • Avoid treatment with PDE5 drugs!
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3
Q

Indapamide

A

DC: Thiazide like diuretics

I:

  • HT
  • Oedema associated with heart failure and liver cirrhosis

D:

  • 1.25-2.5mg daily.
  • CR: 1.5 D

M:

  • Improvement of symptoms (heart failure)
  • Weight, cardiovascular risk factors
  • Exercise intolerance, SOB
  • Electrolytes
  • Renal function
  • Serum urate
  • BP
  • BGL
  • Adherence

C:

  • Dizzy + weakness
  • if CR then swallow whole
  • Mild diuretic, therefore may make you go urinate more.

PP:

  • Could precipitate gout
  • Could worsen diabetes
  • Ensure good hydration as could increase risk of renal failure
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4
Q

Lifestyle changes

A
  • Weigh yourself! Especially in heart failure patients. Weigh yourself after you urinate in the morning every single day.
  • Keep track of your weight and liaise closely with your cardiologist.
  • Diet. Reduce sodium intake and maintain good healthy clean diet.
  • Fluid restriction if necessary. If not the maintain well hydrated.
  • Exercise! At least 30 minutes for most days of the week.
  • Measure BP regularly.
  • Reduce smoking
  • Reduce alcohol
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5
Q

Verapamil

A

DC: Non-dihydropyridine calcium channel blocker

I:

  • HT
  • Angina
  • SVT
  • AF
  • Prophylaxis of cluster headache

D:

  • 80mg to 160mg BD to TDS
  • CR: 180mg to 240mg D

M:

  • BP
  • HR, ECG
  • Cardiovascular risk
  • Frequency of angina attack
  • Gingival hyperplasia
  • Severe constipation
  • Peripheral oedema
  • Renal function
  • Dizziness
  • Palpitations

C:

  • Verapamil increase the effects of alcohol. You may be more easily affected by alcohol and the effects would last longer.
  • Dizziness, flushing, decrease heart rate and mild swelling of limbs.
  • Regular dental check up while on this medication
  • If experience severe constipation, talk to the doctor.
  • Do not stop this medication abruptly.
  • It can interact with some over the counter medication and prescription medication. Therefore, ask pharmacist and doctor before initiating any medication.

PP:
- It is contraindicated with dabigatran.

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6
Q

Propranolol

A

DC: Beta blockers

I:

  • HT
  • Angina
  • MI
  • Prevention of migraine
  • Essential tremor

D:

  • 20mg to 40mg BD or TDS
  • Max 120mg to 320mg daily in 2-3 doses

M:

  • BP
  • HR
  • BGL
  • Asthma
  • Adherence
  • Cardiovascular risk factors
  • Improvement of symptoms (if used for tremor or migraine)
  • LFT
  • Thyroid function

C:

  • Do not stop this medication abruptly
  • Dizzy and tired! Get up gradually. Do not drive or operate machinery
  • May also cause cold fingers and sleep disturbances. If severe and affecting, talk to doctor.
  • Lifestyle

PP:

  • Could mask signs of hyperthyroidism and also diabetes
  • May worsen peripheral circulation.
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7
Q

Simvastatin

A

DC: Statin (HMG CoA reductase inhibitor)

I:

  • Hypercholesterolaemia
  • High risk of coronary heart disease

D:

  • 10-40mg daily
  • Maximum 80mg daily (indicated only for high risk of coronary heart disease)

M:

  • Cholesterol levels: LDL, HDL, Triglycerides, total cholesterol levels
  • LFT
  • Renal function
  • BGL
  • Creatine kinase
  • Cardiovascular risk factors: exercise, weight, diet
  • Myopathy

C:

  • Avoid grapefruit juice
  • May experience mild headache, abdominal discomfort.
  • If experience muscle pain and yellowing of skin, dark urine, pale stool tell doctor.
  • Lifestyle

PP:

  • Zocor
  • Change doses when taking amino Darren, digoxin, diltiazem, verapamil, amlodipine and nicotinic acid.
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8
Q

Fenofibrate

A

DC: Fibrates

I:

  • Severe hypertriglyceridaemia with risk of pancreatitis
  • Hypercholesterolaemia
  • Mixed hyper+dyslipidaemia associated with diabetes

D:

  • 145mg daily.
  • for 48mg and 96mg, it is used when patient has renal failure.

M:

  • Cholesterol levels: LDL, HDL, Triglycerides, Total cholesterol
  • Cardiovascular risk factors
  • LFT
  • Renal function
  • Signs of myopathy
  • FBE (due to leukopenia)
  • Signs of photosensitivity

C:

  • Avoid sun exposure.
  • May cause mild GI upset
  • Tell doctor if experience muscle pain or weakness, yellowing of skin and whites of the eyes, dark stool, pale urine.
  • Lifestyle

PP:

  • Renal and liver function important
  • Require to check blood count too.
  • Gemfibrozil is 600mg BD, best taken before food.
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9
Q

Sildenafil

A

DC: PDE5 inhibitor (Phosphodiesterase 5 inhibitor)

I:

  • Pulmonary hypertension
  • Erectile dysfunction

D:

  • 50mg to 100mg prn (Max 1 dose daily)
  • 20mg TDS for pulmonary arterial HT

M:

  • BP
  • Improvement of symptoms
  • Excessive dizziness
  • Concurrent medications (CI in nitrates and precaution for BP lowering drugs)
  • Vision changes
  • Loss of hearing
  • Duration of erection
  • Cardiovascular risk factors
  • LFT

C:

  • Dizziness! Some people may experience flushing and headache. Do not drive or operate machine. Paracetamol may help.
  • If erection last for more than 2 hours, come in pharmacy to get pseudoephedrine. If more than 3-4 hours then go emergency room.
  • Only allowed to take 1 tablet in 24 hours.
  • Doesn’t matter with or without food, but works faster without food. Take it 30 minutes before sexual activity.
  • If develop changes in vision (Could cause blue tinge or blurred vision) or loss of hearing, tell your doctor immediately.
  • Be aware of excessive dizziness and faintness when you are also taking BP lowering medications.

PP:

  • If require more than 2 doses in a week, may use tadalafil to help out.
  • Vardenafil prolongs QT interval. And could cause nausea.
  • If using Sildenafil for HT, nose bleed is a common side effect.
  • May induce migraine (vasodilation)
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10
Q

Ivabradine

A

DC: Antianginal

I:

  • Stable angina
  • Stable chronic heart failure
  • (Require heart rate to be >70bpm)

D:

  • 5mg BD
  • May be 2.5m to 7.5mg BD

M:

  • Cardiovascular risk factors
  • HR, ECG
  • BP
  • LFT
  • Vision changes
  • Angina frequency

C: 5, 12 ,18

  • Swallow whole with food
  • Could interact with different medication, therefore ask Dr or pharmacist before initiating anything new
  • May affect mental alertness and vision such as increase bright areas and blurred vision. Generally temporary and will disappear after 2 months. Do not drive or operate machinery.
  • Avoid grapefruit juice.
  • Tell doctor if pulse rate is slow (Develop SOB, fatigue, dizzy) as your dose may require adjusting.
  • Lifestyle

PP:

  • Coralan 5mg and 7.5mg 56 tablets
  • This medication commonly cause luminous effect and bradycardia
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11
Q

Amiodarone

A

DC: Antiarrhythmics

I:
- Prevention and treatment of severe tachyarrhythmias refract to other treatment: SVT, AF and atrial flutter

D:

  • 200mg TDS for 1 week, then 200mg BD for 1 week, then 200mg D thereafter
  • Maintenance of 100mg to 200mg D, could go up to 400mg D

M:

  • BP, HR, ECG
  • Thyroid function
  • Chest x-ray, pulmonary function
  • Regular eye check
  • Electrolytes
  • Cardiovascular risk factors
  • TDM
  • FBC

C: 5,8,18

  • May experience nausea, vomiting initially, taste disturbances, skin pigmentation changes.
  • May interact with a lot of different medications. Consult doctor or pharmacist before initiating anything new
  • Avoid sun exposure
  • Avoid grapefruit juice
  • If develop any vision changes, SOB, cough, worsening of heart symptoms, muscle weakness, weight loss, jaundice, tell doctor
  • You may require regular blood test, chest X-ray and ECG while you’re on this medication
  • Lifestyle

PP:
- Amiodarone contains iodine. Could affect thyroid tests and also could increase risk of hypo or hyperthyroidism.

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12
Q

Nicorandil

A

Dr: Antianginal (Venous and arterial dilation)

I:
- Prevention and treatment of angina

D:
- 5mg BD could increase to 10-20mg BD.

M:

  • Clinical effect; improvement of angina symptoms
  • Frequency of angina attack
  • BP
  • Cardiovascular risk factors
  • Excessive dizziness
  • Signs of wound or ulcer

C: 16

  • Dizzy and headache! Do not drive or operate machine, stand up slowly. Generally when new medication or increase in dose
  • Monitor for wounds or slow healing ulceration.

PP:

  • Ikorel
  • Treatment with PDE5 is contraindicated.
  • Keep on hand angina spray.
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13
Q

Perhexiline

A

Dr: Antianginal

I:
- Angina refractory to surgical procedure and other drugs

D:

  • 200mg D until metaboliser status known
  • Maintenance 100-250mg daily

M:

  • Improvement of angina
  • Frequency of angina attack
  • BP
  • Cardiovascular risk factors
  • LFT
  • TDM
  • Peripheral neurophathy
  • BGL

C: 16

  • You may require regular blood test while you’re on this medication
  • Tell your doctor if you experience weakness, weight loss or feel pins and needles or numbness on your fingers or toes.
  • Dizzy! Do not drive or operate machinery.

PP:

  • Pexsig 100mg
  • It could cause hepatotoxicity and peripheral neuropathy
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14
Q

Clonidine

A

Dr: Alpha 2 and imidazoline receptor agonist

I:

  • HT
  • ADHD
  • Menopausal flushing
  • Adjunct in opioid withdrawal

D:

  • HT: 50-100mcg BD could increase to 100-200mcg D. (Max around 150-300mcg D)
  • Menopausal flushing: 25mcg BD, up to 75mcg BD
  • ADHD: 50mcg nocte, up to 300mcg daily in 2-3 doses.

M:

  • BP
  • BGL
  • Mood changes or depressive thoughts
  • Renal function
  • Withdrawal symptoms
  • excessive dizziness

C: 1,9,16

  • Dizziness! Do not drive or operate machine. Stand up slowly
  • Drowsiness! Do not drive or operate machine. Increase the effect of drowsiness do not drink alcohol.
  • Do not stop this medication abruptly.

PP:

  • Catapres comes in 100mcg and 150mcg
  • Common side effect is depression, causes hypo in diabetic patients.
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15
Q

Flecanide

A

Dr: Class 1 antiarrhythmics

I:

  • Treatment and prevention of severe tachyarrhythmias that is refractory to other treatment
  • SVT
  • Maintenance therapy after cardioversion

D:

  • 50mg BD to 100mg BD
  • Max 400mg D

M:

  • BP, HR, ECG
  • Cardiovascular risk factors: weight, smoking, exercise, diet
  • Electrolytes
  • Worsening of heart symptoms
  • LFT

C: 9,12

  • Do not stop this medication abruptly.
  • It could cause dizziness, blurred vision, sensitive to light, headaches and nausea

PP:

  • Patient required to be healthy when on this medication as it could worsen heart failure.
  • It could also worsen arrhythmias
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16
Q

Moxonidine

A

Dr: Centrally acting alpha 2 and imidazoline agonist

I:
- HT

D:

  • 200mcg to 400mcg daily
  • Max 600mcg daily in 2 doses

M:

  • BP
  • HR
  • Cardiovascular risk factors
  • Excessive dizziness
  • Renal function

C: 1,9,12,16

  • Drowsiness, dizziness. Do not drive or operate machinery. Avoid alcohol as could increase effects of alochol.
  • Do not stop this medication abruptly.
  • May experience mild headache and dry mouth
  • Takes around 2 weeks to reduce blood pressure effectively.

PP:
- If dry mouth, chew on sugarless gum or sweets or use a saliva substitute.

17
Q

Enoxaparin

A

Dr: Low Molecular Weight Heparin

I:

  • Treatment and prevention of VTE
  • Treatment of acute STEMI, non STEMI, and angina
  • Treatment of pulmonary embolism

D:

  • Prevention: 40mg D, if CrCl <30mL/min then 20mg D
  • Treatment: 1mg/kg BD or 1.5mg/kg D

M:

  • Bleeding risk
  • Cardiovascular risk factors
  • APTT
  • BP
  • FBC (HIT - Heparin induced thrombocytopenia)
  • Electrolytes
  • LFT
  • Antifactor Xa

C:

  • Tell your doctor if you develop any signs of bleeding (nosebleed, black tarry stools, unexplained bleed or bruise) during or after treatment.
  • Injection around the tummy
  • Rotate sites
  • Subcut
  • Don’t rub the area

PP:

  • It could cause HIT
  • Require to monitor antifactor Xa. Could tell bleeding risks. But regular monitoring does not reduce bleeding risk
18
Q

Rivaroxaban

A

Dr: Factor Xa inhibitors

I:

  • Prevention of VTE following elective hip or knee surgery
  • Treatment of acute VTE and prevention of subsequent VTE
  • Non - valvular AF and high risk of storke or systemic embolism

D:

  • Prevention: 10-20mg daily
  • Treatment: 15mg BD then change to 20mg D

M:

  • Bleeding risk
  • Cardiovascular risk factors
  • Renal function
  • Liver function
  • FBC
  • BP

C:

  • Keep a calendar to mark off your dose.
  • Take this medication at the same time each day.
  • Take with food
  • Tell your doctor or pharmacist before starting any new medication
  • Tell your dentist, podiatrist, physiotherapist, chiropractor that you are on this medication
  • If you experience any signs of bleeding such as unexplained bleeding or bruising, pink, red, brown urine or dark, red stools. Tell your doctor immediately.

PP:
- For Apixaban it could cause thrombocytopenia.

Medication (7 decks)

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