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308: Clinical pharmacology and therapeutics > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Risk factors for atrial fibrillation

A

Hypertension

Cardiomyopathy

Coronary heart disease

Valvular heart disease

Previous cardiac surgery

pericarditis

Lung diseases: PE, COPD, pneumonia

Hyperthyroidism

Alcohol

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2
Q

Classifications of atrial fibrillation

A

Lone

Paroxysmal= <7 days

Persistent= >7 days

Permanent= >7 days, not stopped by cardioversion or > 1 year without cardioversion indicated

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3
Q

Clinical features of AF

A

Asymptomatic

Palpitations

SOB

Chest pain

Syncope

Pre-syncope

Heart failure

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4
Q

Rate vs rhythm control for AF

A

Control rhythm

  • If onset <48 hours
  • In younger patients
  • If there is heart failure
  • If symptoms improve

If onset >48 hours
- Control rate

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5
Q

Rate control of acute AF without heart failure

A

First line
Beta blocker/ Ca2+ channel blocker
- Bisoprolol
- Diltiazem, verapamil

Second line
- Add digoxin

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6
Q

Rate control of acute AF with heart failure

A

First- Digoxin/ Amiodarone

Second line- Amiodarone

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7
Q

Rate control of permanent or paroxysmal AF

A

Beta blocker OR CCB

second line- add digoxin

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8
Q

Rhythm control of AF

- Acute

A

Normal heart

  • Flecainide
  • Sotalol

Abnormal heart
- Amiodarone

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9
Q

Rhythm control of AF

- Maintaining sinus rhythm

A

Normal heart

  • Flecainide
  • Sotalol

Abnormal heart
- Amiodarone

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10
Q

Non cardio-selective beta blockers

A

Propanolol
Carvedilol
Sotalol

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11
Q

Cardio-selective beta blockers

A

Atenolol

  • 90% is renally cleared
  • Contraindicated in renal disease

Bisoprolol

Esmolol

Metoprolol

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12
Q

Vasodilatory beta blockers

A

Labetalol

Carbedilol

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13
Q

Rate limiting CCB examples

A

Verapamil

Dilitiazem

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14
Q

Dihydropyridine CCB examples

A

L-type CCB

Almodipine

Nifedipine

Nimodipine

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15
Q

CHA(2)DS(2) VaSc

A

Score that estimates the risk of someone with AF, developing a stroke.

C- Congestive heart failure
H- Hypertension
A(2)- >75=2
D- Diabetes
S(2)- Previous stroke, TIV or TE= 2

V= vascular disease
A- Age 65-74
Sc- female (sex)

Treat with warfarin if score >2.

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16
Q

HAS-BLED score

A

Calculates the risk of bleeding if on anticoagulation with AF.

H- Hypertension
A- Abnormal renal/liver function (1 point each)
S- Previous stroke

B- Bleeding history
L- Labile INR
E- Elderly
D- Drug/ Alcohol (1 point each)

> 3= significant risk of bleeding.

17
Q

Lipid modification in stroke

A

Consider referral if
- Serum cholesterol> 7.5 + family history of CHD

  • Serum cholesterol >9
Atorvastatin
for primary intervention
- >10% risk of developing CVD in 10 years
- T1 DM
- CKD

For secondary intervention
- Previous stroke or MI

18
Q

Lifestyle treatment of heart failure

A

Exercise

Decrease alcohol consumption

Smoking cessation

19
Q

Diuretics and heart failure

A

Beneficially in relieving symptoms
- Decreases cardiac preload

Examples

  • Loop: furosemide, bemetanide
  • K sparing: spironolactonne, amiloride
  • Thiazides: bendroflumethiazide, metolazone
20
Q

Other AF treatments

A

Radiofrequency/ Cryo-ablaton

Left atrial appendage occlusion

21
Q

Pcsk9 inhibitors

A

Pcsk9 receptor binding degrades cholesterol receptors on the liver
- Inhibiting this means= more cholesterol receptors= less circulating cholesterol

Drug is indicated for complicated hypercholesterolaemia

22
Q

Warfarin-Aspirin interaction

A

Aspirin can displace warfarin from plasma albumin
- Warfarin is highly bound to albumin

Displacement of 1-2% warfarin can double/triple its concentration
= Great risk of bleeding

23
Q

Liver metabolism in elderly

A

Decreased liver volume and blood flow
= Decreased first pass metabolism= decreased enzyme activity

= Decreased clearance of drugs

24
Q

Excretion of drugs in elderly

A

Decreases renal function

  • GFR declines by 1% from 40
  • Drugs renal excreted by >60%= affected by Renal function reduction
25
Q

Examples of drugs primarily excerpted by kidneys

A

Digoxin

Atenolol

Stotalol

Lithium

Allopurinol

26
Q

Lithium toxicity

A

Excreted mainly in kidneys

Early toxicity

  • Tremor
  • Agitation
  • Twitching

Late

  • Coma
  • Fits
  • Arrhythmia
  • Renal failure
27
Q

Morphine metabolism

A

Phase 2 metabolism

  • Conjugation
  • More potent after conjugation

308: Clinical pharmacology and therapeutics (13 decks)

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