Cardiovascular Part 6 Flashcards
What is the secondary prevention of cardiovascular disease - acute coronary syndrome (STEMI, NSTEMI, stable angina)?
Aspirin 75mg daily + 2nd antiplatelet for 12 months
Options:
- clopidogrel 75mg daily
- Prasugrel 5 mg once daily (10 mg if body weight is 60 kg or more and the patient is under the age of 75)
- Ticagrelor 90 mg twice daily for up to 12 months (reduced to 60 mg twice daily if treatment is extended beyond 12 months)
What must you discontinue in heart failure before introducing an ACEi?
Potassium supplements or potassium-sparing diuretics due to the risk of hyperkalemia
However, low-dose spironolactone can be used but monitor potassium closely
What is the secondary prevention of cardiovascular disease - peripheral arterial disease (PAD)?
Clopidogrel 70mg is preferred for the preventions of occlusive vascular events
If contraindicated, low-dose aspirin
For those at high risk of ischaemic events and low risk of bleeding - specialists recommended rivaroxaban 2.5mg BD + aspirin
What is the secondary prevention of cardiovascular disease - Percutaneous coronary intervention?
Those with stable coronary arterial disease undergoing PCI
- Aspirin and clopidogrel 75mg for 6 months
if high risk of bleeding = 1-3 month treatment
high ischaemia risk but no bleeding complications = up to 36 months
Patients with what condition are more susceptible to hyperkalemia with an ACEi?
Patients with diabetic nephropathy should not be given ACEi and ARB
What is the interaction between lithium and furosemide?
Furosemide increases concentration of lithium = lithium toxicity
Side effects: Vomiting, diarrhoea, muscle weakness, tremor, confusion
What are the electrolyte imbalances with furosemide?
Hyponatraemia
Hypomagnesaemia
Hypokalaemia
Hypocalcaemia
What are other ADRs of furosemide other than electrolyte imbalances?
Ototoxicity
Hypotension
Metabolic acidosis
Renal impairment from dehydration and direct toxic effect
Hyperglycaemia but less common than with thiazides
What are the main drugs that furosemide interacts with?
Lithium
Digoxin
Amiodarone
Citalopram
Quinine
Macrolide antibiotics
What conditions can loop diuretics exacerbate?
Diabetes
Gout
Which diuretic is used for cerebral oedema and raised intra-ocular pressure?
Mannitol
What is the treatment for secondary prevention of an MI?
- anti-platelet therapy (aspirin longterm and ticagrelor for 12 months)
- ACEi
- BB
- Statin
What is the management of AF maintenance?
1st RATE CONTROL:
- beta blocker (not sotalol)
- RL CCB
- Digoxin for non-paroxysmal AF (preferred for those with sedentary lifestyles)
2nd RHYTHM CONTROL
- pharmacological cardioversion: amiodarone, flecainide (if not structural heart disease), sotaolol
Reduce stroke:
- CHAD2DS2VASc if score more than 2 in women and more than 1 in men
- Warfarin or DOAC
What is CHAD2DS2VASc score?
A tool to assess a person’s stroke risk
What drugs does clopidogrel interact with?
Reduced antiplatelet effects:
Carbamazepine
Cimetidine
Chloramphenicol
Ciprofloxacin
Erythromycin
Fluconazole
Omeprazole
The antiplatelet effect enhances the anticoagulant effect – increased risk of bleeding:
Warfarin - avoid
Which OTC painkiller should you avoid with ACEi/ARBs?
Ibuprofen - increased risk of hyperkalaemia especially when given with spironolactone or eplerenone
What is the interaction between SSRI and rivaroxaban?
Increased risk of bleeding - severe interaction
Do amiodarone and simvastatin interact?
yes - increased risk of muscle side effects because amiodarone increases exposure of simvastatin
What drink interacts with amlodipine?
Grapefruit juice
What is the maximum atorvastatin dose with ciclosporin?
Atorvastatin 10mg
