Cardiovascular Part 10 Flashcards
What is the initial loading dose for amiodarone?
200mg TDS for 7 days
200mg BD for 7 days
200mg OD maintenance dose
What is the contraindication for adenosine?
Asthma - bronchospams
What drug enhances the effects of adenosine?
Dipyridamole
- dipyridamole increases exposure of adenosine
What drug blocks the effects of adenosine?
Theophylline
What are the adverse effects associated with adenosine?
chest pain
bronchospasm
transient flushing
can enhance conduction down accessory pathways, resulting in increased ventricular rate (e.g. WPW syndrome)
How do you treat paroxysmal supraventricular tachycardia?
1st line: reflux vagal stimulation - immersing face in ice-cold water, carotid sinus massage, Valsalva manoeuvre
2nd line: IV adenosine, if contraindicated = IV verapamil
Recurrent episodes: catheter ablation/ diltiazem/ verapamil/ sotalol/ flecainide/ propafenone
What are the adverse effects associated with ivabradine?
Visual effects, particular luminous phenomena, are common
headache
bradycardia
heart block
What type of treatment is preferred for AF when onset of symptoms is more than 48hrs?
Rate control
What class of drugs should be avoided in suspected concomitant acute decompensated HF with AF?
CCB
How do you treat AF with rate control?
1st line: BB (not stall)
2nd line: Rate limiting CCB
3rd line: Digoxin - only for initial rate control in patients with non-paroxysmal AF who are predominantly sedentary or when rate-limiting drugs are unsuitable
If monotherapy fails = consider 2 drugs from above
If this fails = rhythm control
If ventricular function diminished (LVEF <40%) = BB + digoxin preferred
How do you treat an acute presentation of AF for heamodynamically stable patients?
IV BB
OR
Verapamil if LVEF > or equal to 40%
How do you maintain sinus rhythm post-cardioversion?
1st line: standard BB
2nd line: anti-arrhythmic drugs - amiodarone, flecainide, propafenone
When should flecainide and propafenone be avoided?
Ischaemia or structural heart disease
For patients with left ventricular impairment or heart failure: consider amiodarone
- 2nd line would be considered dronedarone in patients with persistent or paroxysmal AF
How can you treat episodes of symptomatic paroxysmal AF using rhythm control?
‘pill in pocket’
How do you treat bradycardia post-MI (arrhythmias after MI)
Particularly if complicated by hypotension
Atropine sulfate
Failed to respond: adrenaline
What is the VTE prophylaxis dose rivaroxaban following knee replacement?
10 mg once daily for 2 weeks, to be started 6–10 hours after surgery.
What is the eGFR limit for flecainide?
If eGFR <35ml/min - reduce dose to maximum of 100mg daily
What is a serious risk of SGLT2?
Fournier’s gangrene - redness and swelling around genitals and fever
When are troponin I levels taken?
troponin I levels are taken immediately after chest pain is experienced and then after 12 hours to identify if the patients troponin levels have decreased
When heart muscle is damage, troponin leaks into blood stream and levels increase
Which thiazide or thiazide related diuretic can be used in eGFR less than 30ml/min?
Metolazone
Which type of CCB is vasocilatory adverse effects more associated with?
dihydropyridine calcium-channel blockers
Flushing, headaches, postural hypotension, ankle swelling
Which lipid are fenofibrates best at lowering?
Triglyceride
What monitoring is required when starts ACEi, ARB or mineralcorticoid receptor antagonist in HF?
1-2 weeks after starting treatment and at east dose increment then every 3 months then every 6 months:
Potassium
Sodium
Renal function
What is monitored when BBs are initiated?
HR
BP
What is the initial furosemide dose for patients with HF and preserved ejection fraction?
Furosemide 80mg
What is the management of an NSTEMI?
300mg ASAP
Fondapabruinx
Reperfusion (PCI or fibrinolysis) therapy OR medicines management
Medication management:
- ticagrelor + aspirin (if high risk bleeding - clopidogrel + aspirin)
Which beta blockers are licensed for AF?
Atenolol, acebutaolol, propranolol, metaprolol, nadolol, oxprenolol
