Cardiovascular Part 9 Flashcards
Which drugs should be avoided in heart failure with reduced ejection fraction?
Rate limiting CCBs
Short-acting dihydropyridines - nifedipine or nicardipine
They reduce cardiac contractility
Which class of drugs turns your urine blue?
ENaC blockers e.g. Triamterene amiloride
Indication: used with thiazide or loop diuretics as an alternative to K supplementation
- Never give with aldosterone antagonists (spironolactone/ eplerenone)
How do you treat fluid overload in HF?
Used to relieve breathlessness and oedema
Typically with Loop diuretics e.g. furosemide, bumetanide, torasemide
Thiazides only of benefit in patients with mild fluid retention and an eGFR of >30ml/min
How is chronic heart failure with reduced ejection fraction treated?
1st line: ACEi/ARB +BB (bisoprolol, carvedilol, nebivolol)
2nd line: mineral corticosteroid receptor antagonist - spironolactone/ eplerenone (add-on therapy)
If intolerant of ACEi AND ARB: consider hydralazine + nitrate (esp in African Caribbean with moderate-severe HF)
3rd line: Amiodarone, digoxin, sacubitril with valsartan, ivabradine, empagliflozin, dapagliflozin
digoxin is recommended in sinus rhythm
Which ARBs are licensed for heart failure?
Candasartan, Losartan, Valsartan
What is the ADRs of spironolactone?
HYPERkaemia
HYPOnatraemia
HYPERchloraemic acidosis
HYPERtrichosis
Gynaecomastia
Change in libido
SCARS severe cutaneous adverse rxns
AKI
What are the main interactions of spironolactone?
ACEi/ARB
Lithium
Digoxin
NSAIDs
What is the interaction between isosorbide mononitrate and sildenafil?
Increased risk of hypotension - severe interaction avoid
How is MR isosorbide mononitrate taken?
OD
When should you stop the use of isosorbide mononitrate in the elderly?
If prescribed a long-acting nitrate with persistent postural hypotension - recurrent drop in systolic BP less than or equal to 20mmHg
What are some ADRs of isosorbide mononitrate?
FLushing
Dizziness
Hypotension
Headache
Tachycardia
Hypersensitivity
Circulation collapse
What are the statin doses for primary prevention?
Atorvastatin 20mg
Simvastatin 40mg
What are the modifiable risk factors for ACS?
Smoking
Obesity
HTN
Hyperlipidaemia
T2DM
What are the non-modifiable risk factors for ACS?
Increasing age
Male
Family history of ischaemia heart disease
What is the management of an NSTEMI?
Antiplatelet - aspirin 300mg and tricagrelor/pasugrel for 12 months
Anticoagulant - fondaparinux, UFH, LMWH
BB
Consider glycoprotein llb/llla antagonist (eptifibatide or trifiban) for those scheduled for angiography
Coronary angiography within 96 hours of admission
What condition is nifedipine used first line for?
Raynaud’s syndrome - impact on blood circulation
Can cause painful vasospasm in response to cold or stress
Brand must be specified
Which drug works by inhibiting the intestinal absorption of cholesterol?
Ezetimibe
What is the target blood pressure for a pregnant woman?
135/85mmHg
What is the interaction between CCBs and Alpha-blockers?
Enhanced hypotensive effect and increases risk of first dose hypotension
What is the maximum infusion rate for furosemide?
4mg/minute
