Cardiovascular drugs 1

Question 1

What are the risk factors for atrial fibrillation?

Answer 1

Hypertension
Valvular heart disease
Coronary artery disease
Cardiomyopathy
Congenital heart disease
Previous cardiac surgery
Pericarditis
Lung disease - PE, pneumonia, COPD
Hyperthyroidism
Alcohol

Question 2

How is AF classified?

Answer 2

Lone AF
Paroxysmal
Persistent
Permanent

Question 3

What are the clinical features of AF?

Answer 3

Asymptomatic
Palpitations
SOB
Chest pain
Syncope
Pre-syncope
Heart failure

Question 4

What are the 3 broad ways of treating AF?

Answer 4

Rate control
Rhythm control
Anticoagulation

Question 5

When is rhythm controlled preferred over rate control?

Answer 5

Symptom improved
Younger patient
Heart failure related to AF
Adequacy of rate control

Question 6

What are the rate control drugs for acute AF without heart failure?

Answer 6

1st line: Beta blocker or Calcium channel blocker

2nd line: add digoxin

Question 7

What are the rate control drugs for acute AF with heart failure?

Answer 7

1st line: digoxin and amiodarone

2nd line: add amiodarone

Question 8

What are the rate control drugs for permanent or paroxysmal AF?

Answer 8

1st line: beta blocker or CCB

2nd line: add digoxin

Question 9

What are the rhythm control drugs for acute cardio version and a normal heart?

Answer 9

Flecainide

Sotalol

Question 10

What are the rhythm control drugs for acute cardio version with an abnormal heart?

Answer 10

Amiodarone

Question 11

What are the rhythm control drugs to maintain sinus rhythm in a normal heart?

Answer 11

Flecainide

Sotalol

Question 12

What are the rhyththm control drugs to maintain sinus rhythm in an abnormal heart?

Answer 12

Amiodarone

Question 13

What are the 3 types of beta blockers?

Answer 13

Non-cardioselective
Cardioselective
Vasodilatory

Question 14

Give examples of non cardioselective beta blockers

Answer 14

Propanolol
Carvedilol
Sotalol

Question 15

Give examples of cardioselective beta blockers

Answer 15

Atenolol
Bisoprolol
Esmolol
Metoprolol
Nebivolol

Question 16

Give examples of vasodilatory beta blockers

Answer 16

Labetalol

Carvedilol

Question 17

Give examples of rate limiting calcium channel blockers

Answer 17

Verapamil

Diltiazem

Question 18

Give examples of dihydropyridine calcium Chanel blockers

Answer 18

Amlodipine
Nifedipine
Felodipine
Lercanidipine
Nimodipine

Question 19

What risk factors are included in the ChadsVaSc score?

Answer 19

Congestive HF = 1
Hypertension = 1
Age >75 = 2
Diabetes = 1
Stroke = 2
Vascular disease = 1
Age 65-74 = 1
Sex (female) = 1

Question 20

What is included in the HAS-BLED score?

Answer 20

Hypertension = 1
Abnormal renal / liver function = 1 point for each
Stroke = 1
Bleeding = 1
Labile INRs = 1
Elderly = 1
Drugs / alcohol = 1 point each

Question 21

What is the HAS-BLED score?

Answer 21

1 year risk of bleeding with AF and anticoagulation

Question 22

What are some non-pharmaceutical treatments of AF?

Answer 22

Radiofrequency catheter or cryo-ablation

Left atrial appendage occlusion

Question 23

What drug treatments are given for stroke?

Answer 23

Fibrinolysis
Antithrombotics
Aspirin
Clopidogrel
Warfarin or DOACs
Lipid modification
Treat hypertension

Question 24

Give examples of secondary causes of raised lipids

Answer 24

Excess alcohol
Uncontrolled diabetes
Hypothyroidism
Liver disease
Nephrotic syndrome

Question 25

When should patients be referred to lipid specialist?

Answer 25

Total serum cholesterol > 7.5mmol/l + family history of premature CAD Total serum cholesterol >9mmol/l

Question 26

How do PCSK9i work?

Answer 26

PRALUENT binds to PCSK9 which inhibits binding of PCSK9 to LDLR. This increases number of LDLRs available to clear LDL which lowers LDL-C levels

Question 27

Give examples of PCSK9i drugs

Answer 27

Alirocumab | Evolocumab

Question 28

What drug classes are used to treat heart failure?

Answer 28

``` Diuretics ACE inhibitors Beta blockers Aldosterone antagonists ARBs Hydralazine / nitrates Digoxin ```

Question 29

Give an example of a loop diuretic

Answer 29

Furosemide

Question 30

Give an example of a thiazide diuretic

Answer 30

Bendroflumethiazide

Question 31

What type of diuretic is metolazone?

Answer 31

Thiazide like

Question 32

Give examples of K+ sparing diuretics

Answer 32

Spironolactone | Amiloride

Question 33

Give examples of ACE inhibitors

Answer 33

``` Ramipril Lisinopril Enalapril Perindopril Captopril ```

Question 34

Give examples of ARBs

Answer 34

Losartan Candersartan Valsartan

Question 35

When is ivabradine recommended?

Answer 35

With / instead of beta blocker if HR is too high

Question 36

When is hydralazine + nitrate recommended?

Answer 36

If ACEi / ARB are not tolerated or contraindicated or in those of African origin

Question 37

When is sacubitril recommended?

Answer 37

NYHA II-III symptoms and LVEF ≤35% and already taking stable dose of ACEi or ARB

Question 38

What are some alternative therapies for HF?

Answer 38

Coronary revascularisation Cardiac resynchronisation therapy Cardiac transplantation