Cardiovascular Flashcards by Lily Rendall

What is the mechanism of action of Aspirin?

Aspirin is an NSAID that irreversibly inhibits COX-1 (and COX-2), producing prostaglandins.
It is an acetylating agent and attaches an acetylene group to the active site of a COX enzyme.

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When would Aspirin be prescribed?

Aspirin can be used to alleviate arthritic and menstrual pain or reduce fever.
It also prevents blood clotting so is useful for patients with atherosclerosis or angina due to CHD.

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What is the mechanism of action of Amlodipine?

Amlodipine inhibits calcium ion influx across the plasma membrane, causing vasodilation and reduction in peripheral vascular resistance, lowering blood pressure.
It increases the supply of blood and oxygen to the heart whilst reducing its workload.

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When would Amlodipine be prescribed?

Amlodipine is prescribed to treat angina and prevent attacks of chest pain. It is also used to reduce blood pressure.

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What is the mechanism of action of Ramipril?

Ramipril inhibits ACE, reducing the conversion of angiotensin I to angiotensin II, and consequently that of aldosterone.
This reduces sodium and water retention, which lowers blood pressure.

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When would Ramipril be prescribed?

Hypertension (first line)
Heart failure
Secondary prevention after MI

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What is the mechanism of action of Losartan?

Losartan inhibits angiotensin II receptors, meaning blood vessels relax and blood pressure lowers.

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When would Losartan be prescribed?

To treat high blood pressure.

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What is the mechanism of action of Bisoprolol?

Bisoprolol is a beta blocker that inhibits renin secretion, therefore blocking the RAAS.

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When would Bisoprolol be prescribed?

To treat heart failure and high blood pressure.

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What is the mechanism of action of Atenolol?

Atenolol binds to beta-1 adrenergic receptors which blocks the release of adrenaline and noradrenaline. This slows the heart rate.

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When would Atenolol be prescribed?

What patients would not typically be prescribed Atenolol?

To treat arrhythmias and angina.

It is not usually given to those with asthma.

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What is the mechanism of action of Propranolol?

Propranolol inhibits renin release and blocks the RAAS. This in turn blocks the action of epinephrine and norepinephrine

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When would Propranolol be prescribed?

What patients would not typically be prescribed Propranolol?

To treat arrhythmia and angina, and can be used to help control the symptoms of an overactive thyroid gland.

It is not given to patients with respiratory diseases, especially those with asthma.

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What is the mechanism of action of Metoprolol?

Metoprolol inhibits beta-1 adrenergic receptors which leads to a decrease in heart rate.

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When would Metoprolol be prescribed?

To treat the rapid heart rate in those with angina, arrhythmias and hyperthyroidism.

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What is the mechanism of action of Furosemide?

Furosemide increase the excretion of Na+ and water by the kidneys by inhibiting their reabsorption.

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When would Furosemide be prescribed?

To treat oedema in patients with heart failure, and some lung/liver/kidney disorders.

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What drug classification does Aspirin belong to?

NSAIDs

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What drug classification does Amlodipine belong to?

Calcium Channel Blockers

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What drug classification does Ramipril and Lisinopril belong to?

ACE Inhibitors

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What drug classification does Losartan belong to?

Angiotensin II Receptor Blockers (ARBs)

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What drug classification does Furosemide belong to?

Loop Diuretics

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What is the mechanism of action of Clopidogrel?

What other common drug has the same mechanism?

Clopidogrel is an antiplatelet that inhibits P2Y12 receptors, inhibiting ADP binding to platelet receptors.

Ticagrelor has the same mechanism.

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What drug classification does Clopidogrel and Ticagrelor belong to?

Antiplatelets

What is Ramipril the first-line drug for? Which patients are exempt from this? And what do they get first-line alternatively?

Hypertension Afro-Caribbean patients should receive CCB as a first-line treatment for hypertension

In what situation is Ramipril contraindicated?

Pregnancy

Give examples of adverse effects of Ramipril and Lisinopril?

- Persistent dry cough - Renal dysfunction - Angioedema

What is the mechanism of action of Amlodipine?

Blocks K+ channels therefore prolonging the refractory period Also effective at blocking Na+, having a high affinity for inactivated channels

When would Amlodipine be prescribed?

Arrhythmias, particularly when other drugs are ineffective or contra-indicated

What is the first line treatment for hypertension in a patient under 55 years old?

Use an ACE-inhibitor Swap to an ARB if ACEi not tolerated

What is the first line treatment of hypertension in a patient that is older than 55?

DHP calcium channel blockers

What is the first line treatment of hypertension in patients of African or Caribbean ethnicity?

DHP calcium channel blockers

What is the second line treatment of hypertension?

Combining calcium channel blockers and ACE-inhibitors / ARBs

What is the third line treatment of hypertension?

Adding a thiazide-like diuretic to the ACEi / ARB and/or CCBs already being taken

What is the fourth line treatment of hypertension when blood potassium levels are less than 4.5mmol/L ?

Add spironolactone to other medications being taken

What is the fourth line of treatment of hypertension when blood potassium levels are higher than 4.5mmol/L ?

You increase the amount of thiazide-like diuretics being prescribed

What other drugs can be given as a fourth line treatment for hypertension when blood potassium levels are less then 4.5mmol/L ?

Alpha blockers - such as doxacosin Beta blockers - such as atenolol

What are the 4 pillars of therapy in heart failure?

- Angiotensin receptor-neprilysin inhibitors (ARNIs) - Beta blockers - Mineralcorticoid receptor antagonists (MRAs) - Sodium-glucose co-transporter 2 inhibitors (SGLT2i)

What is quadruple therapy (specifically in relation to heart failure) ?

Using a combination of 4 drug classes to manage heart failure

What two drugs can be used to improve the symptoms of heart failure?

- Digoxin - Frusemide

How should beta blockers be given in heart failure?

Started on a low dose and getting up-titrated to the highest dose that can be tolerated

When is a combination of hydralazine and nitrates used in heart failure?

When ACEi or ARBs are not tolerated

What SGLT2i inhibitor is commonly used in heart failure?

Ivabradine

What is the immediate treatment for stable angina?

GTN spray / tablets

What is the recommended long term treatment for stable angina? What should you do if this is not tolerated?

Beta blockers - BB If beta blockers not tolerated, give patient a calcium channel blocker - CCB

What lifestyle advice is given to patients with stable angina? Name at least 3

- smoking cessation - diet and exercise advice - reducing alcohol consumption - reducing BMI if possible

What are the three As of the secondary prevention of angina?

Aspirin Atorvastatin ACE inhibitors

What surgical method is often offered to patients with proximal or extensive disease on CTCA?

Percutaneous Coronary Intervention - PCI

What surgical method is offered to patients with severe stenosis?

Coronary Artery Bypass Graft - CABG

What is the first line management of acute DVT?

Anticoagulants First line is Apixaban OR Rivaroxaban

If recommended first line treatment for acute DVT is not suitable, what should be given to the patient?

Low molecular weight heparin (LMWH) followed by: Dabigatran / Edoxaban OR A vitamin K antagonist

What is the recommended secondary prevention for DVT?

Long term anticoagulation - a DOAC, LMWH

How long should secondary prevention of a provoke DVT with reversible factors be given for?

At least 3 months

How long should secondary prevention of a provoked DVT with irreversible factors be given for?

3 to 6 months or as lifelong treatment

How long should secondary prevention of an unprovoked DVT be given for?

3 to 6 months or as lifelong treatment

What are the recommended treatment options of a ischaemic stroke?

Thrombolysis - up to 4 and a half hours from symptom onset A thrombectomy - up to 6 hours from symptom onset

What are the recommended treatment options for a haemorrhagic stroke?

Supportive measures

What is the secondary prevention measure of an embolic stroke?

Aspirin / Warfarin

What is the best secondary prevention measure associated with strokes?

Control of risk factors - diabetes, hypertension etc

What should patients with AF be given depending on their risk score?

Warfarin

What is the recommended management of an acute PE?

Anticoagulation - Apixaban or Rivaroxaban

What should be given if the recommended management of an acute PE is not suitable?

Give LMWH followed by either: Dabigatran / Edoxaban OR a vitamin K antagonist

What are the 3 long term anticoagulation drugs for a PE?

Warfarin A DOAC - Apixaban, Rivaroxaban LMWH

How long should secondary prevention measures be given to a patient presenting with a PE?

At least 3 months If needed, 3-6 months or as a lifelong treatment

What may be given to patients with acute aortic regurgitation?

Vasodilators and inotropes

What type of drug can be useful in the management of chronic severe AR and heart failure?

ACE-inhibitors

What can we give to patients with Marfan’s in the hopes of slowing aortic dilation?

Beta blockers

What is indicated in symptomatic AR patients?

Valve replacement surgery

What would indicate a valve replacement surgery in asymptomatic AR patients?

Deteriorating left ventricle function

In mitral regurgitation patients who develop heart failure, what 2 drugs would we likely prescribe?

Diuretics or ACE-inhibitors

What 3 procedures can be done to manage mitral regurgitation?

Valve repair surgery Valve replacement surgery Open heart surgery

What is used in mitral regurgitation patients who cannot tolerate surgery?

Mitraclip

What drugs are given in the medical therapy of mitral stenosis?

Diuretics

What cardiac arrhythmia is commonly treated in mitral stenosis management?

Atrial fibrillation

What surgical procedure is used on patients with mitral stenosis?

Valve replacement surgery

In the case that surgery is not tolerated, what procedure is given to mitral stenosis patients?

A balloon valvuloplasty

What is given to ectopic atrial tachycardia patients with troublesome symptoms?

Beta blockers

What should you advise ectopic atrial tachycardia patients to avoid?

Stimulants - caffeine, cigarettes

What are the 3 main steps of stable SVT management? What is the potential 4th step?

1. The valsalva manoeuvre 2. A carotid sinus massage 3. IV adenosine or verapamil 4. DCCV may be required if above fails

What 2 drugs are used in the management of stable SVT? How are they administered?

Adenosine or Verapamil Intravenously

What is the preferred long term treatment of paroxysmal SVT in young patients?

Radiofrequency ablation

What are the 3 most common drugs used in the long term management of paroxysmal SVT in older patients?

Amiodarone Beta blockers Calcium channel blockers

What class of drugs are used to manage stable ventricular tachycardia? Give 2 examples

Anti-arrhythmic Amiodarone or Lignocaine

If medical therapy fails to manage stable VT what can then be used?

Direct Current Cardioversion

How is unstable VT with a pulse managed?

Direct Current Cardioversion

How is pulseless VT managed?

Defibrillation

What may be the first treatment of VF?

CPR

What should be used alongside CPR in the initial treatment of VF?

A defibrillator

After the 3rd (and/or 5th) defib shock what should be administered to patients?

IV Amiodarone

What other procedures can be considered in the treatment of VF?

Coronary angiography Catheter ablation

What should be used in the long term management of VF?

An implantable cardioverter defibrillator (ICD)

What should be carried out in patients with life-threatening haemodynamic instability?

Emergency electrical cardioversion

What drug should be offered at initial presentation of atrial fibrillation?

Heparin

What are the 3 drugs that can be used for rate control in patients with AF?

Beta blockers - atenolol Calcium channel blockers - diltiazem Digoxin (only in sedentary patients)

What procedure can be used in the rate control of AF?

AV node ablation

What 3 drugs can be given in the long term medical rhythm control of AF?

Beta blockers - first line Dronedarone - second line Amiodarone - heart failure patients

For patients with paroxysmal AF may be prescribed which drug as a ´pill-in-the-pocket´approach? What does this mean?

Flecanide It is taken only when they feel symptoms begin to arise

What are the 2 most commonly used drugs for long term anticoagulation in patients with AF?

Warfarin DOACs

What is typically used in the management of symptomatic acute paroxysm?

Cardioversion Most commonly Direct Current Cardioversion (DCCV) as this is a defib

What should be given to patients who have had atrial flutter for more than 1 or 2 days? How long should this be given?

Anticoagulants - 3 week course

What is typically used for the management of recurrent atrial flutter?

Catheter Ablation

What 2 types of drug can be used in the case of recurrent atrial flutter if required?

Beta blockers or class III anti-arrhythmetics

What 2 drugs are commonly used in the treatment of a STEMI?

Aspirin and Clopidogrel

What 2 types of drugs are given intravenously in the early treatment of a STEMI?

Anti-emetics Analgesia (morphine)

When should oxygen be given to a STEMI patient?

If they are hypoxic

What procedure should be carried out for a STEMI within 120 minutes of symptom onset? What should be used if this is not possible?

Primary angioplasty If not possible - thrombolysis

What is a primary angioplasty and when should it be used?

A procedure in which a catheter is inserted into a blocked artery and inserts a stent through the use of a small balloon for expansion It should be used in the treatment of a STEMI

What type of drugs are used in NSTEMI patients to inhibit the coagulation cascade?

Antithrombotic drugs

What is the preferred first agent in dual-anti platelet therapy for a NSTEMI?

Clopidogrel

What is the most common procedure used in the treatment of a NSTEMI?

Coronary Angiography

What are the 4 phases of cardiac rehabilitation?

1. In-patient care 2. The early post discharge period 3. A structured exercise programme 4. A long term maintenance of physical activity and healthy lifestyle

What lifestyle advice can be given for the secondary prevention of acute coronary syndrome?

Smoking cessation!! Eating well Reducing alcohol consumption Controlling risk factors (diabetes, bp, cholesterol levels etc)

What 4 types of medications can be used in the secondary prevention of ACS?

Aspirin ACE inhibitors Beta blockers Statins