Cardiovascular Flashcards
Name 2 cardiovascular prostaglandins
Epoprostenol and iloprost
What drugs are alpha and beta blockers?
Carvedilol and labetolol
Which beta blockers are less likely to cause sleep disturbance and why.
Water soluble. Sotalol, nadolol, atenolol, celiprolol
Which beta blockers also partially stimulate the receptors? What is their advantage?
Acebutolol, celiprolol, oxprenolol, pindolol.
Less bradycardia and cold extremities.
In what cases will cardioselective beta blockers be preferred? Which are these?
Common hypoglycemic attacks. Asthma.
Acebutolol, atenolol, bisorolol, celiprolol, esmolol, metoprolol, nebivolol
Allocate the antiarrhythmic drugs to their classes
Class 1a: disopyramide
Class 1b: lidocaine
Class 1c: flecainide and propafenone
Class III: amiodarone and dronedarone
Adenosine (other)
When are class 1c antiarrhythmics used, and not used?
“pill in the pocket” for paroxysmal AF. not in structural heart disease
How will sympathomimetics act upon the cardiovascular system? Give examples.
Increase blood pressure/vasoconstriction.
Ionotropic: dopamine, dobutamine.
Metarominol, midodrine, noradrenaline, adrenaline, phenylephrine
What is hydralazine indicated for?
Heart failure and hypertension
Minoxidil is an antihypertensive - what else can it be used for?
Alopecia
What drugs are used for hypertension in phaeochromocytoma? Which has more problems?
Alpha blockers - phenoxybenzamine and phentolamine. Phenoxybenzamine causes sensitisation on handling and troublesome side effects such as dizziness, fatigue, nasal congestion and reflex tachycardia.
Moxisylyte, naftidrofuryl oxalate and pentoxyfylline are what drugs for what conditions?
Peripheral vasodilator for vascular disease and raynauds syndrome.
How does guanethidine work?
Peripheral antiadrenergic. Prevents NA release. No effect on supine blood pressure but can cause postural hypotension (for resistant hypertension)
What should be monitored with milrinone?
ECG, HR, BP, fluid and electrolytes, renal function, platelets
What is tranexamic acid used for?
Haemorrhage. Anti fibrinolytic.
Name the antihaemorrhagic monoclonal antibody
Emicizumab
What 3 products can be used in major bleeding with warfarin
Phytomenadione. Then dried prothrombin complex or fresh frozen plasma.
What different coagulation proteins are available?
VIIa, VIII, IX, XIII (and with inhibitor bypassing fraction), fibrinogen, protein c complex
Which calcium channel blocker is used for a different indication than the rest and for what?
Nimodipine is used for ischemic neurological defects in subarrachnoid haemorrhage
Which calcium channel blockers can be used in angina?
Nicardipine and nifedipine
How do NOACs exert their action?
FACTOR XA inhibitors. Prevent prothrombin to thrombin and increase clotting time.
What is bivalirudin and when is it used.
Thrombin inhibitor. In heparin induced thrombocytopenia.
Name the 2 tissue plasminogen activators?
Alteplase and tenecteplase
What should be monitored with cangrelor and ticagrelor?
Renal impairment with ACS
When should a person having elective surgery stop their clopidogrel?
7 days before
What do centrally acting antihypertensives have in common?
Drowsiness, slow withdrawal.
When are potassium sparing diuretics used and when is their risk highest?
Oedema or to preserve potassium with loop/thiazides. Hyperkalaemia high risk with renal impairment.
Which diuretic can colour your urine?
Triamterene
What class is indapamide?
Thiazide like
What classes of antihypertensives should not be used together and why? Which are sometimes combined?
ACEIs/ARBs/renin inhibitor due to high potassium, low BP and renal impairment. Sometimes an ACEI will be given with valsarta and candesartan. Don’t give any with k sparing.
What tests should be done with endothelin receptor antagonists?
Haemoglobin at 1 month and 6m. Liver function.
How does colestyramine interact with drugs?
Should not be given 1h before or 4-6 hours after
What 5 classes of drugs are used in hyperlipidaemia.
Bile acid sequestrants, cholesterol absorption inhibitors, fibrates, nicotinic acid derivatives, statins
What is ranolazine used in
Angina
In what instance should nicorandil be stopped?
Skin/mucosal/eye ulceration
What cardiovascular drug can also be used for anal fissure?
Glyceryl trinitrate
What should be reviewed in AF patients and how often?
Anticoagulation, Stoke and bleeding risk annually
What control technique is preferred if onset of arrythmias are more than 48 hours?
Rate
What drugs are used in pharmacological cardioversion and when are they preferred?
IV amiodarone (preferred if structural heart disease) or flecainide
When is electrical cardioversion given?
If present for over 48 hours and patient should be anticoagulated for t least 3 weeks
What drugs can be used in rate control and when are they preferred?
Beta blockers - not sotalol
Diltiazem
Verapamil - only monotherapy
Digoxin - sedentary (HR should not fall below 60bpm), congestive heart failure, C/I with accessory conductive pathway disorders
B blockers and digoxin if diminished ventricular function
What drugs can be used post cardioversion for rhythm control?
B blocker
Sotalol
Felcainide/Propafenone - not if ischemic or structural heart disease, pill in the pocket if infrequent symptomatic paroxysmal
Aminodarone - 4w before and 12m after, left ventricular impairment or HF
Dronedarone - paroxysmal or persistent
What does CHA2-DS2-VASc measure?
Risk of stroke using risk factors; prior ischemic stroke, TIA, thromboembolic event, heart failure, left ventricular systolic dysfunction, vascular disease, diabetes, hypertension, female, over 65. Score of 0 in men or 1 in women do not require anticoagulation.
When can NOACs be used for AF anticoagulation?
Non valvular
What should flecainide and propefanone be prescribed with for atrial flutter?
Beta blocker, Verapamil or diltiazem
What should flecainide and propefanone be prescribed with for atrial flutter?
Beta blocker, Verapamil or diltiazem
What are the treatment stages for paroxysmal supra ventricular tachycardia?
Vagal stimulation
Adenosine - below maybe preferred in asthma
IV Verapamil - avoid in recent beta blocker
What can cause torsade de points?
Drugs, hypokaleamia, severe bradycardia, genetics
What drugs shouldn’t be used in torsade de points?
Anti arrythmic and Sotalol
When is disopyramide used in arrythmias?
After MI. But impairs contractility and has antimuscarinic effect (no glaucoma or prostatic hyperplasia.)
What should be adjusted with concurrent use with amiodarone?
Flecainide - reduce dose by half
Digoxin - reduce dose by half (also with Dronedarone and quinine)
What serious adverse effects are caused by amiodarone and Dronedarone?
Corneal micro deposits
Thyroid disorder
Hepatitoxicity - advise to recognise abdominal pain, anorexia, jaundice, nausea, fever, malaise, itching, dark urine
Pulmonary toxicity - SOB/cough (also with Dronedarone)
Photosensitivity - sheild from sun even several months after
Bradycardia and heart block with antivirals
Liver injury and heart failure (odoema, dyspnoea) also in dronedarone
What monitoring is done for amiodarone?
Thyroid function before and 6m. Raised t3 and t4 with very low tsh suggests thyrotoxicosis
Liver function before and 6m.
Serum potassium and xray before.
What monitoring is done with Dronedarone?
ECG every 6m.
Serum creatinine before and 7d. Again if raised andstop if continues.
Liver function before, 1w, monthly for 6m, 3m
What electrolyte imbalances should be corrected before sotalol use
Prolong qt interval and causes life threatening ventricular arrythmias so correct hypokaleamia and hypomagnesemia
What measures are used in suspected digoxin toxicity?
Atropine
Correction of electrolytes
Digoxin specific antibody - if lifethreatening associated with ventricular arrythmias or Brady arrythmias unresponsive to the above
At what plasma concentration is digitalis toxicity most likely?
1.5 - 3 mcg/L
What is the mechanism of action of digoxin
Increases the force of myocardial contraction and reduces conductivity within the AV node
Digoxin levels should be monitored - true or false
False. Only if problems suspected or renal impairment. Take at least 6 hours after dose.
In what side effects should tranexanic acid be discontinued?
Colour vision changes and visual impairment
What are the risk factors considered in hospital for VTE?
Anticipated to have substantial reduction in mobility, obese, malignant disease, history of VTE, thrombophillic disorder, over 60 years.
What prophylaxis of VTE is considered for surgical patients.
Mechanical. Pharmacological if general or ortho.
When are the different anticoagulants preferred?
LMWH suitable for all types of surgery.
Unfractionated heparin if renal failures.
Fondaparinux for hip/knee replacement, hip fracture, bariatric, and day surgery.
Oral following hip /knee replacement
How long should pharmacological prophylaxis continue following general surgery compared to major cancer surgery?
5 - 7 days in general. 28 in major cancer.
How is VTE treated?
LMWH or Unfractionated. Warfarin started at the same time and heparin continued for at least 5 days and until INR above 2 for 24 hours.
Which heparin is preferred in pregnancy and what must be considered?
LMWH have lower risk of osteoporosis and thrombocytopenia but are eliminated more rapidly so dosage must be altered for dalteparin , enoxaparin and tinzaparin
What should be done if haemorrhage occurs on parenteral anticoagulants?
Usually sufficient to just withdraw but protamine can be used for rapid reversal
What should be given in suspected TIA?
Aspirin. Or clopidogrel.
What should be given acutely following ischemic stroke?
Alteplase if within 4.5 hours for thrombolysis. Aspirin following this within 24 hours. Or within 48 hours if not receiving thrombolysis (or clopidogrel).
When are anticoagulants recommended following stroke?
Parenteral if symptomatic or high risk of VTE. After cardio embolic stroke with AF. Substitute with aspriirn for 7 days when experiencing disabling stroke.
What long term treatment is given following stroke?
Clopidogrel or
MR dipyridamole +aspirin or
MR dipyridamole or
Aspirin
Review warfarin/anticoagulant if AF
Statin 48 hours after onset
Antihypertensives for target under 130/80 (not beta blockers)