Cardiovascular Part 2 Flashcards
What are some common calcium channel blocker side effects?
Ankle swelling
Flushing
Palpitations
Bradycardia (rate-limiting)
Hypotension
Dizziness
Gingival hyperplasia
Headache
What is the prescribing pathway for stable angina (myocardial ischaemia)?
1st line: BB
- Bisoprolol, propranolol, metaprolol, atenolol
2nd line: Rate-limiting CCB
- Verapamil or diltazium
3rd line: BB & CCB
4th line: Nitrate with BB/ CCB OR as monotherapy
- Ivabradine, nicroandil, ranolazine
How do you protect against cardiovascular events in patients with stable angina?
Low dose aspirin
Statin
Consider ACEi especially in diabetic patients
What are the common side effects for Ranolzine?
Asthenia
Constipation
Vomiting
Head
Can you use ranolzine in renal impairment?
Avoid if CrCl <30ml/min
Caution in CrCl between 30-80ml/min
What are some important contraindications for Ivabradine?
Do not initiate for angina if HR <70
Do not initiate for heart failure if HR <75
2nd and 3rd degree heart block
Severe hypotension
What are the common side effects of ivrabradine?
Arrthymias
Atrioventricular block
Dizziness
Headache
Hypertension
Vision disorders
What are the common side effects of Nicorandil?
Can cause serious skin, mucosal and eye ulcerations including GI ulcers - discontinue treatment
Asthenia
Dizziness
Haemorrhage
Headache
Nausea
Vasodilation
Vomiting
If max. dose statin fails to control statin, what would be the recommendation?
Max dose statin + ezetimibe
Can a patient be prescribed a statin and a fibrate?
It increases the risk of muscle-related side effects and rhabdomyolysis therefore, it must be done under specialist supervision
Which fibrate must not be used with statins?
Gemfibrozil - increases risk of rhabdomyolysis considerably
What drug management should you consider for patients with primary heterozygous familial hypercholesterolemia whose LDL-cholesterol is not controlled on maximum tolerated lipid-lowering therapy?
Alirocumab
Evolocumab
What should you measure if a patient is experiencing muscle side effects with statins?
creatine kinase concentrations
What symptoms should you seek medical attention for if developed with a statin?
dyspnoea
cough
weight loss
All signs of interstitial lung disease (scarring of the lungs)
What is the contraception requirements for statins?
Adequate contraception is required during treatment and for one month after
Must be stopped 3 months before attempting to conceive as teratogenic
Which liver function test may prompt discontinuation of statins?
If serum transaminases are more than 3 times the upper limit of the reference range
What factor increases the risk of rhabdomyolysis with statins?
Hypothyroidism
What are the main symptoms of heart failure
SOB
Persistent cough or wheezing
Ankle swelling
Reduced exercise tolerance
Fatigue
What are the risk factors of heart failure?
Men
Diabetes
Smokers
Increased age
African-Caribbean patients with hypertension
Coronary heart disease
What are the complications of heart failure?
AF
CKD
Depression
Cachexia
Sexual dysfunction
Sudden cardiac death
