Cardiovascular Drugs

Question 0

What’s the 48 hour rule in AF

Answer 0

48 hour rule onset, need to think about the risk of thrombosis - focus should now be now on rate control, try to prevent any clots that have formed

Question 1

Treatment of AF

Answer 1

Flecaindie - Na channel blocker, prolongs cardiac action potential. Slows conduction via the bundle of His (contraindicated in coronary artery disease)

Question 2

AF in elderly patients - no other co-conditions

Answer 2

Rate control. Anti coagulation. Unlikely to have a structurally normal heart. First time beta-block or CCB (without heart failure)

Question 3

What scoring system is used for anticoagulation

Answer 3

CHADSVaS score

Question 4

How does warfarin work?

Answer 4

Warfarin inhibits vitamin K dependent factors in the coagulation cascade. By factors……. Side effect can cause bleeding

Question 5

What factor does heparin effect?

Answer 5

Factors Xa

Question 6

Elderly man that came in AF with heart failure. How do you treat?

Answer 6

Digoxin, Amiodarone

Question 7

How does Digoxin work?

Answer 7

Inhibits membrane bound Na-K ATPase. Increases intracellular calcium. Increases force of myocardial contraction (positive ionotropic effect). Positive ionotropic effect (AV node effects + vagal stimulation + sympathetic inhibition)

Question 8

AF, high pulse, low BP. Treatment?

Answer 8

DC Cardioversion

Question 9

AF, pregnant, intermittent palpitations, pulse 142, BP 120/70. Treatment?

Answer 9

Rate control / Anticoagulation

Question 10

What’s a caution of warfarin in pregnancy?

Answer 10

Warfarin is teratogenic in pregnancy

Question 11

Old. Stroke. BP >180/110. Treatment?

Answer 11

CCB - Amlodipine

Question 12

45, Caucasian, BP 158/99. Treatment

Answer 12

ACE inhibitor

Question 13

54, BPH (benign prostatic hypertrophy), persistently elevated BP. Treatment?

Answer 13

Alpha blocker - all over in prostate, heart, blood vessel

Question 14

Equation for BP

Answer 14

BP = CO x TPR (total peripheral resistance)

Question 15

76, stroke, HTN, 3/7 of SOB on exertion. White frothy sputum. Treatment?

Answer 15

Presentation of Acute HF. Diuretic - Frusimide (loop diuretic- inhibits sodium, potassium co transporter from the ascending loop of henlè. This reduces preloads, reducing the pressure on the heart). Sit him up! Oxygen.

Question 16

76, Amlodipine, Indapamide and Atorvastatin is treated for a chest infection recently. 5/7 after treatment starts he develops muscle aches and pains

Answer 16

Satin induced myopathy, caused by clarithromycin as it causes enzyme inhibition

Question 17

Rhythm control in AF - treatment of Cardioversion or sinus rhythm

Answer 17

Flecanide, Sotalol

Question 18

Rhythm control AF, Cardioversion or sinus rhythm in an ABNORMAL HEART

Answer 18

Amiodarone