Cardiovascular question Flashcards
Mr F Ruty, has come into practice to visit you today for his annual poly pharmacy medication review. You take this time to remind Mr F Ruty about important interactions with certain medications he is taking.
Which of the following medications below would you remind Mr F Ruty to avoid drinking grapefruit juice?
A-Apixaban
B-Bisoprolol
C-Simvastatin
D-Warfarin
C-Simvastatin
Which of the following beta-blockers has a long duration of action?
A-Sotalol
B-Metoprolol
C-Acebutol
D-Nadolol
D-Nadolol
Mr P just been discharged after a successful hip replacement operation. He has been discharged with Rivaroxaban 10mg 1 OD for prophylaxis of VTE.
How long would you expect Mr P to take the Rivaroxaban for?
A-14 days
B-21 days
C-28 days
D-35 days
D-35 days / 5 weeks
Upon asking Ms O when she last used her GTN tablets, she informed you it was about 1 month ago when she overdone it in the garden but didn’t think they worked as well as when she first opened the bottle and used some 3 months ago. She proudly tells you that she carries them around with her all the time and shows you. Looking at the label on the opened bottle you can see that this was dispensed on the 19/12/19. You take this opportunity to remind Ms O how important it is to discard GTN SL after a period of time once they have been opened.
When should the GTN SL tablets be discarded once they are in use?
A-1week
B-2 weeks
C-4 weeks
D-8 weeks
D- 8 weeks
Must be stored in a bottle with the cap tightly closed and given a new supply 8 weeks after opening.
Mr P has come into the pharmacy to hand in a prescription for Isosorbide Mononitrate 40mg 1 BD. He mentions that he was a bit confused as when best to take them. The doctor advised that they should be taken a little differently to normal twice daily medications and asks if you could clarify on when best to take them.
When should the second dose of Isosorbide Mononitrate be taken?
A-After 4 hours
B-After 6 hours
C-After 8 hours
D-After 12 hours
C- After 8 hours
What electrolyte disturbance would be most likely to occur with co-administration of Candesartan and Spironolactone?
A-Hypokalaemia
B-Hyperkalaemia
C-Hyponatraemia
D-Hypermagnesaemia
A- Hyperkalaemia
Spironolactone is a potassium sparing diuretic
Candesartan reduces excretion of potassium
Which of the following is classed as a “Loop Diuretic”?
A-Bumetanide
B-Amiloride
C-Metolazone
D-Bendroflumethiazide
A- Bumetanide
Mrs L has been in cold temperatures due to the winter season. She works as a lawyer and is also currently under a lot of stress. Due to this, it’s causing her blood vessels to go into spasm and is restricting blood flow to her fingers.
What drug can be used to treat her symptoms?
A-Aspirin
B-Simvastatin
C-Nifedipine
D-Bisoprolol
C- Nifedipine
Raynaud’s
Mr B comes in to collect his usual monthly prescription. Upon talking to him, he mentions that he has noticed that his urine appears to be of a blue colour sometimes. He wonders if it is related to that new water tablet he was started on.
Which of the following drugs below could blue urine be associated with?
A-Metolazone
B-Xipamide
C-Amiloride
D-Triamterene
D- Triamterene
Urine may look slightly blue in some lights
Some beta-blockers are classed as “Cardio-selective”. These beta-blockers predominantly work on the B1 receptors in the heart.
Which of the following beta-blockers is NOT classed as “cardio-selective”?
A-Atenolol
B-Metoprolol
C-Nebivolol
D-Propranolol
D- Propranolol
You are discussing with the nursing team the number of patients who are coming into the surgery to get their INR tested due to being on warfarin. As part of a measure to try and reduce this you identify a cohort of patients who are eligible and willing to switch over to a DOAC.
One of the nurses asks what a patients INR should ideally be if they are to switch over to Apixaban from Warfarin straight away?
Apixaban and Dabigatran: Start when INR < 2
Edoxaban: Start when INR < 2.5
Rivaroxaban: Start when INR < 3
Which of the drugs below, used for the treatment of stable angina can cause serious skin, mucosal and eye ulceration, including gastrointestinal ulcers?
A-Atenolol
B-Bisoprolol
C-Nicorandil
D-Verapamil
C- Nicorandil
Stop treatment if ulceration occurs and consider an alternative
Ms G has been diagnosed as having Angina. You are counselling her on the use of the GTN spray which has been prescribed. If Ms G is experiencing symptoms of angina and uses the GTN spray.
How long after administering the first dose should Ms G wait before administering a second dose if required?
A-1 minute
B-2 minutes
C-3 minutes
D-5 minutes
D- 5 minutes
Mrs P, presents to you a prescription for Perindopril 4mg tablets. She informs you; she has just been diagnosed with having hypertension and has been put onto these tablets.
What is the most accurate counselling advice to give to Mrs P, regarding Perindopril tablets?
A-Take with or just after food, or a meal
B-Take this medicine when your stomach is empty. This means an hour before food or 2 hours after food
C-Take 30 to 60 minutes before food
D-The first dose should preferably be given in the morning
C- Take 30-60 minutes before food
Better absorption
Aspirin should not be given to children under the age of 16 due to the risk of developing Reye’s syndrome.
Which ONE of the following signs and symptoms is least likely to occur?
A-Vomiting
B-Seizures
C-Muscle aches
D-Raised white cell count
E-Delirium
C- Muscle aches
Reye’s syndrome symptoms: Persistent, effortless vomiting, loss of energy and seizures. Delirium occurs as the condition progresses
Mr W requires a 1-week course of H. Pylori eradication therapy previously diagnosed by their GP. He is allergic to penicillin (urticarial rash). His other medications include:
-Clopidogrel 75mg once a day
-Aspirin 75mg once a day
-Bisoprolol 2.5mg once a day
-Ramipril 5mg once a day
Which of the following regimes is most appropriate for Mr W’s eradication therapy?
A-Esomeprazole 20mg twice a day, Clarithromycin 250mg twice a day, Metronidazole 400mg twice a day
B-Lansoprazole 30mg twice a day, Clarithromycin 250mg twice a day, Metronidazole 400mg twice a day
C-Omeprazole 20mg twice a day, Clarithromycin 250mg twice a day, Metronidazole 400mg twice a day
D-Pantoprazole 40mg twice a day, Amoxicillin 1g twice a day, Clarithromycin 500mg twice a day
B- Lansoprazole 30mg BD, Clarithromycin 250mg BD, Metronidazole 400mg BD
Omeprazole and Clopidogrel interaction = risk of thrombosis
Allergic to penicillin
Esomeprazole is not a H.Pylori treatment
What agent is used to reverse the effects of Dabigatran ?
A-Idarucizumab
B-Flumazenil
C-Naloxone
D-Phytomeniadone
E-Protamine
A- Idarucizumab
Post-operatively, Mr C is returned to the ward with an epidural catheter in situ for his pain relief. In the evening, as Mr C is eating and drinking, he is prescribed all of his usual medications, as well as the post-operative medications, as per below.
Which ONE of the following drugs should be omitted in order to have the greatest reduction in risk of complications associated with the insertion of an epidural catheter?
A-Candesartan
B-Levothyroxine
C-Dabigatran
D-Gliclazide
E-Dalteparin
E- Dabigatran
NOACs carry a risk of causing epidural haematoma (collection of blood in between skull and dura matter)
You have recently qualified as an independent prescribing pharmacist and your competency is in acute stroke and transient ischaemic attacks.
Which of the following is the most appropriate use of aspirin?
A-Prevention of cardiovascular events in a healthy 25-year-old made with a strong history of early-onset heart disease
B-Prevention of cardiovascular events in a COPD patient who has previously had a myocardial infarction
C-Prevention of cardiovascular events in a diabetic patient who has not already had a cardiovascular event
D-As an enteric coated tablet in patients with a history of gastric ulcer
B- Prevention of cardiovascular events in a COPD patient who has previously had an MI
As the patient has had a recent MI event they are at a much higher risk of another event compared to someone who has not had any events, regardless of their co-morbidities
Mr ARB is a 47-year-old, Afro-Caribbean man who has had ambulatory blood pressure monitoring with an average of 155/95 mmHg.
Which of the following medicine should be initiated for the treatment of his hypertension.
A-Losartan 50mg daily
B-Nifedipine 60mg daily
C-Amlodipine 10mg daily
D-Perindopril 8mg daily
C- Amlodipine 10 mg daily
CCB most appropriate for Afro-Caribbean origin patients
What is the recommended salt intake per day?
6g
Is Warfarin suitable in Pregnancy and Breast feeding?
PREGNANCY -
Should not be given in the first trimester.
Crosses the placenta with risk of congenital malformations.
Babies of mothers taking warfarin at the time of delivery need to be offered immediate IM Vitamin K1
BREASTFEEDING- Not present in milk, Risk of haemorrhage which is increased by Vit K deficiency
Mr GTN has been complaining of chest pain and has been diagnosed with angina. He has a previous diagnosis of type 2 diabetes mellitus. Mr GTN has been complaining of severe headaches, which he has not experienced before.
Which one of the following medicines is most likely to be causing the headaches?
A-Aspirin
B-Enalapril
C-Rosuvastatin
D-Gliclazide
E-Isosorbide mononitrate
E- Isosorbide mononitrate
Common side effects of nitrates include dizziness, postural hypotension and throbbing headache
Mr Y is a 54-year-old man who was admitted to hospital 3 days ago with a diagnosis of heart failure. The medical team decide to start him on digoxin and after an oral loading dose he is maintained on 125 micrograms daily. Mr Y requires a blood test to assess his plasma digoxin concentration.
When is the most appropriate time to sample Mr Y’s blood to monitor his digoxin levels?
A-At least 8 hours after an oral dose has been administered
B-Between 2-3 hours after an oral dose has been administered
C-At least 6 hours after an oral dose has been administered
D-Immediately after an oral dose has been administered
E- Thirty minutes after an oral dose has been administered
C- At least 6 hours after an oral dose has been administered
Note- toxicity increased by electrolyte disturbances
Mrs SF who suffers from heart failure has recently been admitted to hospital due to poor symptom control. Her recent U&Es are as follows:
-Potassium
3.6 mmol/L (3.5-5.3)
-Urea
9.2 mmol/L (2.5-7.8)
-Creatinine
150 mmol/L (44-80)
-Sodium
145 mmol/L (133-146)
On the ward, she complains to you of nausea and her vision is a little blurred. Looking at the observation chart you note her BP is 120/68 and pulse rate of 54.
Which of the following drugs she is prescribed is the most likely to be contributing to this clinical picture?
A-Bumetanide 2mg OM
B-Bisoprolol 1.25mg OD
C-Digoxin 125mcg OD
D-Ramipril 5mg OD
E-Spironolactone 12.5mg OD
C- Digoxin
Symptoms of Digoxin overdose
Mr VF has been commenced on amiodarone in hospital for ventricular fibrillation. He comes to your community pharmacy 2 weeks after discharge to get a further supply. He complains that he is feeling tired and that his stools have changed from a dark brown to clay-coloured and wonders if this could be caused by the amiodarone.
What is the most appropriate advice for this patient?
A-The symptoms described are not known to be caused by amiodarone
B-Stop taking the amiodarone immediately and see the GP as soon as possible
C-He should see the GP as the dose of amiodarone may need to be increased
D-He should see the GP as the dose of amiodarone may need to be decreased
E-He is experiencing a side effect of amiodarone but may want to speak to the GP about an alternative but keep taking the amiodarone until then
B- Stop taking the amiodarone immediately and see the GP
Hepatotoxicity may occur on this medicine
Mr P is an 80-year-old man with a past medical history of atrial fibrillation and stroke. He has been on warfarin for approximately 3 years and is on a stable dose. Last month he suffered a seizure and was admitted to hospital where he was prescribed an anti-epileptic drug. Today his INR is 1.6 (target 2.5).
Which of the following drugs is most likely to be responsible for the decrease in his INR?
A-Phenytoin
B-Clobazam
C-Gabapentin
D-Pregabalin
E-Sodium Valproate
A- Phenytoin
Phenytoin is an enzyme inducer and will INDUCE the metabolism of warfarin and therefore reduce its effectiveness and decrease the INR
CRAPGPS
Mrs W is an 81-year-old lady who is being treated for chronic heart failure. She has recently been prescribed new medication following a medication review with her heart failure nurse at the hospital. She tells you that ever since starting the medication, her hands and feet are feeling very cold, especially her fingers and toes. This happens especially at night and she can’t seem to keep them warm.
Which of the following medication could be causing these symptoms?
A-Carvedilol
B-Verapamil
C-Diltiazem
D-Amlodipine
E-Bendroflumethiazide
A- Carvedilol
Beta blockers are associated with fatigue, coldness of the extremities and sleep disturbances
What is the max dose of Ramipril in a patient with CrCl between 30-60 ml/min
5mg
What are the colours of warfarin tablets
1mg BROWN
3mg BLUE
5mg PINK
Mrs D comes into the pharmacy asking about her sore leg. You ask her if you can take a look in the consultation room. You see that it is inflamed and red. Mrs D states that it is stiff and hot to touch she also states she has recently been to Malaysia for a holiday. She also takes the combined oral contraceptive pill.
Which of the following is the most appropriate advice to give?
A-Mrs D should take aspirin 300mg
B- Mrs D should take a regular anti-inflammatory such as ibuprofen 400mg to help with the inflammation
C-Mrs D should make a non-urgent GP appointment
D-Mrs D should rest and keep her leg elevated to help reduce the inflammation
E- Mrs D should seek immediate medical attention
E- Mrs D should seek immediate medical attention
Symptoms are indicative of a DVT
Taking the combined oral contraceptive pill increases risk of VTE
Mrs R is a 75-year-old patient with a past medical history of atrial fibrillation and stroke. She has been on warfarin for about 2 years and has been on a stable dose. Last month, however, she suffered a seizure and was admitted to hospital where she was prescribed an antiepileptic. Today her INR is 1.6 (target 2.5)
Which of the following drugs is most likely to be responsible for the decrease in her INR?
A-Carbamazepine
B-Diazepam
C-Gabapentin
D-Pregabalin
E-Valproate
A- Carbamazepine
Carbamazepine is an enzyme inducer
It will induce the metabolism of warfarin = reducing warfarin effect
Mr S is a 71-year-old patient with hypertension and chronic heart failure. His current medication is as follows:
-Digoxin 125mcg daily
-Ramipril 5mg daily
-Bisoprolol 2.5mg daily
-Bumetanide 2mg daily
-Atorvastatin 80mg at NIGHT
-Vitamin D3 1000 units daily
Which of his medications listed above is most likely to predispose Mr S to digoxin toxicity?
A-Ramipril 10mg
B-Bumetanide 2mg
C-Bisoprolol 2.5mg
D-Atorvastatin 40mg
E-Vitamin D3 1000 units
B- Bumetanide
Loop diuretic = can cause hypokalemia which predisposes to digoxin toxicity
Mrs M, a 75-year-old female, calls the pharmacy and complains of feeling dizzy and off-balance. She has also noticed a yellow tint in her vision. She mentions that she started a new tablet not long ago. You check the PMR and see the following:
-Evacal D3 tablet – ONE twice a day
-Digoxin 125 mcg tablets – ONE daily
-Bumetanide 1mg tablets – HALF ONCE a day
Which of the following is the most likely to cause for Mrs M’s visual disturbance?
A-Hypokalaemia
B-Hyperkalaemia
C-Hypernatraemia
D-Hypercalcaemia
E- Hyponatraemia
A- Hypokalaemia
Hypokalemia can increase the risk of digoxin toxicity
Mr AF has just been commenced on a new medication from his cardiologist. He has been informed that he will need to attend his GP every 6 months so that his TFTs can be checked.
Which drug below is this monitoring requirement most likely be applicable to?
A-Digoxin
B-Sotalol
C-Valsartan
D-Amiodarone
D- Amiodarone
When is Aspirin started for women at risk of pre-eclampsia in pregnancy
From 12 weeks
What are the side effects of Nicorandil
Skin, mucosal and eye ulceration. Including GI ulcers which may progress to perforation and fistulas
Which one of the following diuretics is associated with gynecomastia?
A-Furosemide
B-Bumetanide
C-Bendroflumethiazide
D-Eplerenone
B- Bumetanide
How long can you keep Dipyridamole M/R capsules fpr?
Dipyridamole should always be kept in its original container and discarded 6 weeks after opening
Which of the beta-blockers below is not classed as water soluble?
A-Atenolol
B-Celiprolol
C-Nadolol
D-Bisoprolol
D- Bisoprolol
Is there a link between gout and diuretics?
Diuretics may increase the risk of gout and gout flares because they raise uric acid levels in the blood
What electrolyte disturbance would be most likely to occur with co-administration of Trimethoprim and Amiloride?
A-Hypokalaemia
B-Hyperkalaemia
C-Hyponatraemia
D-Hypernatraemia
B- Hyperkalaemia
