Cardiovascular drugs 1

Question 1

Atrial fibrillation- pathophysiology

Answer 1

Chaotic atrial electrical activity

Fibrosis and loss of atrial muscle mass related to:

• ageing
• chamber dilatation
• inflammation
• genetic

Question 2

AF risk factors

Answer 2

Hypertension

Valvular heart disease

Coronary artery disease

Cardiomyopathy

Congenital heart disease

Previous cardiac surgery

Pericarditis

Lung disease- PE, pneumonia, COPD

Hyperthyroidism

Alcohol

Question 3

AF classification

Answer 3

Lone AF

Paroxysmal (<7 days)

Persistent (>7 days)

Permanent (>7 days ± cardioversion)

Question 4

AF clinical features

Answer 4

Asymptomatic

Palpitations

SOB

Chest pain

Pre-syncope

Heart failure

Question 5

AF treatment

Answer 5

Rate control

Rhythm control

Anticoagulation

Question 6

When rhythm control is prefered

Answer 6

Symptom improvement

Younger patient

Heart failure related to AF

Adequacy of rate control

Question 7

Rate control

• acute
• without heart failure

Answer 7

1st line

• beta blocker OR
• CCB (diltiazem, verapamil)

2nd line
- add digoxin

Question 8

Rate control

• acute
• heart failure

Answer 8

1st line

• digoxin
• amiodarone

2nd line
- amiodarone

Question 9

Rate control

• permanent
• paroxysmal

Answer 9

1st line

• beta blocker OR
• CCB

2nd line
- add digoxin

Question 10

Rate control

• acute cardioversion
• normal heart

Answer 10

Flecainide

Sotalol

Question 11

Rate control

• acute cardioversion
• abnormal heart

Answer 11

Amiodarone

Question 12

Rate control

• maintain sinus rhythm
• normal heart

Answer 12

Flecainide

Sotalol

Question 13

Rate control

• maintain sinus rhythm
• abnormal heart

Answer 13

Amiodarone

Question 14

Non cardioselective beta blockers

Answer 14

Propanolol

Carvedilol

Sotalol

Question 15

Cardioselective beta blockers

Answer 15

Atenolol

Bisoprolol

Esmolol

Metoprolol

Question 16

Vasodilatory beta blockers

Answer 16

Labetolol

Carvedilol

Question 17

Rate limiting calcium channel blockers

Answer 17

Verapamil

Diltiazem

Question 18

Dihydropyridine CCB

Answer 18

Amlodipine

Nifedipine

Nimodipine

Question 19

Stroke drug treatment

Answer 19

Fibrinolysis

Antithrombotics

• aspirin
• clopidogrel
• warfarin or DOACs

Lipid modification

Treat hypertension

Question 20

Lipid modification

Answer 20

For primary and secondary prevention

Exclude secondary causes of increase lipids

Question 21

Lipid modification

- primary prevention

Answer 21

Offer atorvastatin for primary prevention of CVD

• people who have 10% of greater 10 year risk of developing CVD
• adults with T1DM
• people with chronic kidney disease

Question 22

Lipid modification

- secondary prevention

Answer 22

Offer atorvastatin in any patient who has had a stroke or MI

Question 23

Heart failure treatment aims

Answer 23

Relieve symptoms

Reduce mortality

Question 24

HF treatment

Answer 24

Lifestyle measures

• exercise
• decrease alcohol
• smoking cessation

Drugs

Devices

Surgery

Question 25

Loop diuretics

Answer 25

Furosemide

Question 26

Thiazide diuretics

Answer 26

Bendroflumethiazide Metolazone (thiazide like)

Question 27

K+ sparing diuretics

Answer 27

Spironolactone Amiloride

Question 28

HF ACE inhibitors

Answer 28

Increase life expectancy vs placebo Effect more marked in patients with more severe LV dysfunction Benefit for all NYHA classes Reduces risk of hospitalisation

Question 29

ACE inhibitors

Answer 29

Ramipril Lisinopril Enalapril Perindopril Captopril

Question 30

HF ARBs

Answer 30

Losartan, candestartan, valsartan Reduces mortality Some date of QOL, symptom control Used in patients who cannot tolerate ACEi

Question 31

HF beta blockers

Answer 31

Increase life expectancy vs placebo All NYHA classes Reduces hospitalisation

Question 32

HF- spironolactone

Answer 32

Patients with severe heart failure Increases life expectancy Reduces hospital admission Low dose

Question 33

Chronic HF- ivabradine

Answer 33

Used with or in place of beta blocker if heart rate too high (>75bpm)

Question 34

Chronic HF- hydrazaline and nitrate

Answer 34

Used if ACEi/ ARB not tolerate or contraindicated or in people of African origin

Question 35

Other HF therapy

Answer 35

Coronary revascularisation Cardiac resynchronisation therapy Cardiac transplantation