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Cardiovascular Medicine > Cardiovascular Drugs > Flashcards

Cardiovascular Drugs Flashcards

1
Q

Antiplatelet drugs - Aspirin irreversibly acetylates … …-…, preventing production of thromboxane A2, thereby inhibiting platelet . Used in low dose for secondary prevention following MI, TIA/Stroke and for patients with angina or peripheral vascular disease. May have a role in primary prevention.

A

Aspirin irreversibly acetylates cycle-oxygenate, preventing production of thromboxane A2, thereby inhibiting platelet aggregation. Used in low dose for secondary prevention following MI, TIA/Stroke and for patients with angina or peripheral vascular disease. May have a role in primary prevention.
ADP receptor antagonists (e.g. clopidogrel, prasugrel, ticagrelor) also block platelet aggregation, but may cause less gastric irritation. They have a role if truly intolerant of aspirin; with aspirin after coronary stent insertion; and in acute coronary syndrome. Glycoprotein IIb/IIIa antagonists (E.g. tirofiban) have a role in unstable angina/MI.

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2
Q

ADP receptor antagonists (e.g. clopidogrel, prasugrel, ticagrelor) also block platelet aggregation, but may cause less … irritation. They have a role if truly intolerant of …; with … after coronary stent insertion; and in acute coronary syndrome. Glycoprotein IIb/IIIa antagonists (E.g. tirofiban) have a role in unstable angina/MI.

A

ADP receptor antagonists (e.g. clopidogrel, prasugrel, ticagrelor) also block platelet aggregation, but may cause less gastric irritation. They have a role if truly intolerant of aspirin; with aspirin after coronary stent insertion; and in acute coronary syndrome. Glycoprotein IIb/IIIa antagonists (E.g. tirofiban) have a role in unstable angina/MI.

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3
Q

What is acute coronary syndrome? (ACS)

A

A spectrum of conditions - unstable angina, NSTEMI, STEMI
Reduction of blood through coronary arteries
Usually after atherosclerotic plaque rupture

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4
Q

Treatment aims of ACS:

A 
Reduce cardiac ischaemia:
- Revascularisation
- Thrombolysis
- Medical management 
Reduce myocardial oxygen demand
Prevent recurrence (Secondary prevention)
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5
Q

ACS - immediate management

A

Oxygen, nitrates, anti-emetics,
Anti platelet loading
Fondaparinux/LMWH

MONA - morphine, oxygen, nitrates, aspirin

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6
Q

What long term management and secondary prevention would you expect an ACS patient to be discharged home with?

A

Long term management and secondary prevention
• DAPT - Aspirin + Clopidogrel/Prasugrel/Ticagrelor • ACE-inhibitors/ARB’s
• Beta-blockers
• Statins
• GTN spray
• Lifestyleadvice

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7
Q

Aspirin - what is the loading dose?

A

300mg

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8
Q

Aspirin - what is the maintenance dose?

A

75mg OD

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9
Q

Aspirin should be taken with ….

A

Food

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10
Q

What is clopidogrel loading dose?

A

300 or 600mg as per ESC

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11
Q

What is the maintenance dose for clopidogrel?

A

75mg OD

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12
Q

How long is clopidogrel usually given following MI?

A

About a year

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13
Q

Ticagrelor loading dose?

A

180mg STAT

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14
Q

Ticagrelor maintenance dose?

A

90mg BD

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15
Q

Side effect of ticagrelor?

A

SOB

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16
Q

Side effect of prasugrel?

A

GI bleeding

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17
Q

Loading dose for prasugrel?

A

60mg STAT

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18
Q

Prasugrel maintenance dose

>60kg =, <60kg or over 75yrs =

A

> 60 kg = 10mg OD

<60 kg or over 75yrs = 5mg OD

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19
Q

Contraindications for ticagrelor:

A

Active bleeding, history of intracranial haemorrhage

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20
Q

Contraindications for prasugrel:

A

History of stroke or TIA, active bleeding

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21
Q

Beta-blockers - how do they work on the SA node? And how do they lower BP?

A

Slow the SA node - slow heart rate allows left ventricle to fill completely and lowers heart workload - also dilate arteries = lower blood pressure

22
Q

Contraindications and cautions for beta blockers

A

In history of asthma and obstructive airway disease
In 2nd and 3rd degree heart block
Unstable heart failure

23
Q

Side effects of beta blockers

A 
Fatigue
Cold hands/feet
Nightmares/sleep disturbances
Breathing difficulties in asthmatics
Bradycardia
Masks symptoms of hypoglycaemia
Do not stop taking without doctor’s advice as you can get rebound tachycardia
24
Q

Why should you not stop taking beta blockers without doctor’s advice?

A

Chance of rebound tachycardia

25
Q

…. should be used within 24 hours following an MI in patients with ventricular enlargement due to a poorer prognosis

A

ACE inhibitors should be used within 24 hours following an MI in patients with ventricular enlargement due to a poorer prognosis

26
Q

With ACEi, it is important to monitor what?

A

Renal function and electrolytes

27
Q

Side effects of ACEi

A

Postural hypotension - advised take at night initially
Loss of taste/appetite
Persistent dry cough

28
Q

Statins - side effects

A 
Muscle pain - must be reported to GP or cardiac rehab team
Headache 
Nausea, vomiting and abdominal pain
Alcohol - avoid high intake
Avoid grapefruit
29
Q

What to avoid when taking statins?

A

High alcohol intake and grapefruit

30
Q

Target cholesterol levels: total cholesterol

A

≤ 5

31
Q

Target cholesterol levels: Non-HDL cholesterol

A

≤ 4

32
Q

Target cholesterol levels: Triglycerides

A

≤ 2.3

33
Q

Target cholesterol levels: LDL cholesterol

A

≤ 3

34
Q

Target cholesterol levels: HDL cholesterol

A

≥ 1

35
Q

What cholesterol is ‘bad’?

A

LDL

36
Q

Why is it advised to avoid grapefruit with statins?

A

Can cause the statin to stay in your body for longer, causing statin level to increase in blood and increases possibility of side effects

37
Q

How do nitrates help in angina?

A

Dilation of veins and collaterals - decreased oxygen demand of the heart and increasing coronary flow

38
Q

How do nitrates help in HF?

A

Dilation of conduit arteries, dilation of veins leads to reduced left ventricular end diastolic pressure, reduced wall stress and a reduction of mitral regurgitation

39
Q

ACS - nitrate effect

A

Dilation of conduit arteries, dilation of collaterals, antiaggregant effects leading to increased oxygen supply

40
Q

Reasons for using nitrates…

A

To relieve or prevent expected chest pain (GTN)

To prevent regular chest pain (nitrate tablets/patches)

41
Q

Side effects of nitrates:

A

Flushing, headache, dizziness, postural hypotension

42
Q

Does the headache with nitrates improve, stay the same, or get worse over time?

A

Usually reduces and becomes less severe over time

43
Q

What particular medications have an interaction with nitrates?

A

Medication for erectile dysfunction i.e. Sildenafil, verdenafil, tadalafil - causing significant drop in BP

44
Q

This patient is suffering from paroxysmal atrial fibrillation. In the absence of other cardiovascular co-morbidities, this patient can be managed with ….

A

This patient is suffering from paroxysmal atrial fibrillation. In the absence of other cardiovascular co-morbidities, this patient can be managed with flecainide.

45
Q

Which of the following best describes the pharmacological mechanism of aspirin?

A Irreversible inhibition of cyclooxygenase
B Direct inhibition of thrombin
C Inhibition of the adenosine diphosphate (ADP) receptor
D Potentiates the action of anti-thrombin III to inhibit factor Xa
E Inhibition of the glycoprotein IIb/IIIa receptor

A

Aspirin is commonly used in patients with, or at risk, of ischaemic heart disease. It works through irreversible inhibition of cyclooxygenase.

46
Q

Direct inhibition of thrombin. …

A

Direct inhibition of thrombin. Dabigatran

47
Q

C: Inhibition of the adenosine diphosphate (ADP) receptor. …

A

C: Inhibition of the adenosine diphosphate (ADP) receptor. Clopidogrel

48
Q

D: Potentiates the action of anti-thrombin III to inhibit factor Xa.

A

Low molecular weight heparin.

49
Q

Which of the following is not a recognised adverse-effect of amiodarone?

A    Hypothyroidism
B	Hyperthyroidism
C	Interstitial pneumonitis
D    Interstitial nephritis 
E	Hepatotoxicity
A

All of the above are considered direct adverse-effects of amiodarone, except interstitial nephritis.

50
Q

Which of the following statements is false regarding aortic regurgitation?

A It may be caused by connective tissue diseases (e.g. Marfan’s disease)
B Acutely it may cause haemodynamic compromise
C Quincke’s sign refers to pulsation of nail beds
D It causes a pansystolic machinery murmur
E Müller’s sign refers to pulsation of uvula

A

Aortic regurgitation causes an early diastolic murmur that is heard loudest at the left sternal edge.
A pan systolic murmur may be heard in mitral regurgitation and with an interventricular septal defect. The latter may occur following a myocardial infarction with ischaemia to the interventricular septum or may be due to a congenital heart defect.

51
Q

Warfarin is one of the older indirect anticoagulants. Warfarin works on the vitamin K-dependent clotting factors (II, VII, IX, X) through the ..

A

Warfarin is one of the older indirect anticoagulants. Warfarin works on the vitamin K-dependent clotting factors (II, VII, IX, X) through the inhibition of vitamin K reductase.

52
Q

Which of the following is not a recognised adverse-effect of amiodarone?

Hypothyroidism
Hyperthyroidism
Interstitial pneumonitis
Interstitial nephritis
Hepatotoxicity
A

All of the above are considered direct adverse-effects of amiodarone, except interstitial nephritis.

Cardiovascular Medicine (28 decks)

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