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GPhC Exam Revison > Cardiovascular System > Flashcards

Cardiovascular System Flashcards

1
Q

What is atrial fibrillation?

A

Irregular electrical signals in the heart

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2
Q

Which wave is absent on an ECG during AF?

A

P wave

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3
Q

What is the difference between rate and rhythm control in AF?

A

Rate control: controls ventricular rate

Rhythm control: controls/maintains sinus rhythm of the heart

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4
Q

What is the immediate management of a haemodynamically unstable patient with AF?

A

Immediate electrical cardioversion

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5
Q

What determines whether you treat a patient for rate or rhythm control in an acute AF presentation (if <48h)?

A

Rhythm control needed if patient is symptomatic/has reversible AF and can include cardioversion or pharmacological

Rate control preferred if rhythm not appropriate

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6
Q

What drugs are involved in rate controlling AF (>48h)?

A

B-blockers (not sotalol)
Rate limiting CCBs
Digoxin (esp. in HF patients)

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7
Q

Which type of control is preferred if AF has been present for more than 48h?

A

Rate control

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8
Q

What are the pharmacological drugs used if a patient presents with AF <48h and cardioversion is not suitable?

A

Flecainide (no IHD)
Amiodarone (with IHD)

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9
Q

Why are b-blockers and rate-limiting CCBs never given together?

A

Because there is a risk of severe bradycardia and death

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10
Q

In which type of patients is digoxin recommended in?

A

Patients living sedentary lifestyles, or if they have heart failure

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11
Q

Which drugs are used as self-treatment if a patient has infrequent episodes of AF (also known as ‘pill in picket’)?

A

Flecainide
Propafenone

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12
Q

What must be done if a patient presents with AF for >48h, and requires rhythm control?

A

3 weeks of anticoagulation, then electrocardioversion, then anticoagulation for a further 4 weeks after

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13
Q

What does the CHA2DS2VASc tool measure? When should treatment be initiated?

A

It is a tool to measure the risk of stroke in a patient

1 or 0 = aspirin/no therapy needed
>2 = warfarin/DOAC

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14
Q

Which tool measures the risk of bleeding?

A

HAS-BLED (or ORBIT)

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15
Q

What is the treatment for pulseless/unstable ventricular tachycardia?

A

Pulseless: resuscitation/CPR

Unstable: IV amiodarone or cardioversion

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16
Q

What is the treatment for stable ventricular tachycardia?

A

IV amiodarone, but can also use flecainide/propafenone

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17
Q

What is the maintenance treatment for patients with high risk of cardiac arrest?

A

Cardioverter defibrillator implant
B-blocker

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18
Q

What is the treatment for torsade de pointes?

A

Magnesium sulphate

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19
Q

What is the treatment for paroxysmal supraventricular tachycardia?

A

Iv adenosine 6mg
Alternatively IV verapamil

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20
Q

Why is amiodarone only given once daily?

A

Because it gas a very long half life that can extend to several weeks

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21
Q

What specific side effects can amiodarone cause?

A

Reversible corneal micro-deposits
Optic neuropathy
Photoxicity
Slate-grey skin

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22
Q

What symptoms should patients taking amiodarone report?

A

Night glares
Impaired vision/blindness
Burning skin/erythema

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23
Q

What can SOB/coughing with amiodarone use implicate?

A

Pulmonary toxicity (usually reversible)

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24
Q

Since amiodarone contains iodine, what can this cause?

A

Hypo or hyperthyroidism

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25
Q

What monitoring is required with amiodarone?

A

Annual eye test
Chest X-ray
LFTs every 6 months
TSH
BP, ECG
Serum potassium

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26
Q

Which specific fruit juice should be avoided with amiodarone?

A

Grapefruit juice as this is enzyme inhibiting which can cause amiodarone toxicity

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27
Q

What type of drug is digoxin?

A

It is a cardiac glycoside by increasing the hearts contraction and reducing conductivity in AV node

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28
Q

What are the therapeutic levels of digoxin and when should samples be taken?

A

1-2mcg/L, 6h after dose

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29
Q

Why do patients need to be given a loading dose of digoxin initially?

A

Because it has a long half-life

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30
Q

What determines the dose of digoxin?

A

Renal function of patient since digoxin is renally cleared

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31
Q

Which specific electrolyte must be corrected before starting a patient on digoxin?

A

Potassium, since hypokalaemia can predispose the patient to digoxin toxicity

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32
Q

What are the signs of digoxin toxicity?

A

SLOW AND SICK

Bradycardia
N+V
Blurred or yellow vision
Confusion
Rash

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33
Q

Which antifibrinolytic is used in menorrhagia?

A

Tranexamic acid

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34
Q

What is the dose of tranexamic acid? What is the max. daily dose?

A

1g TDS for up to 4 days
Max. 4g a day

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35
Q

What are the symptoms of a DVT?

A

Swelling, tenderness of leg
Skin changes
Vein distention

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36
Q

What are the symptoms of a PE?

A

SOB
Chest pain
Coughing blood

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37
Q

When is mechanical VTE prophylaxis given?

A

If patient has undergone major trauma, or undergoing minor surgery

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38
Q

When is pharmacological VTE prophylaxis given?

A

If patient is undergoing general or orthopaedic surgery

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39
Q

Which parenteral anticoagulants are given for pharmacological prophylaxis?

A

Unfractionated heparin if renally impaired
Heparin
Fondaparinux

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40
Q

When are DOACs given as VTE prophylaxis?

A

After knee/hip replacement surgery
Treatment/prevention of recurrent VTE (mainly edoxaban used)

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41
Q

What is given (and for how long) for patients undergoing elective hip surgery requiring VTE prophylaxis?

A

LMWH for 10 days
Aspirin for 28 days

ALTERNATIVELY

LMWH for 28 days + stockings until discharge

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42
Q

What is given (and for how long) for patients undergoing elective knee surgery requiring VTE prophylaxis?

A

Aspirin for 14 days

ALTERNATIVELY

LMWH for 14 days + stockings till discharge

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43
Q

What is the treatment of a confirmed DVT?

A

DOAC + LMWH or unfractionated heparin if renally impaired for at least 5 days and INR being 2 for at least 24h

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44
Q

Which DOACs are usually given in a renally impaired patient?

A

Apixaban
Rivaroxiban

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45
Q

Which anticoagulant is recommended in pregnancy related VTE?

A

LMWH, e.g. dalteparin, enoxaparin, tinzaparin

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46
Q

Which type of heparin has the longest duaryion of action?

A

LMWH

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47
Q

Why are unfractionated heparins the preferred choice for those at high risk of bleeding?

A

Because it has a short duration of action, so its effects can be reversed by just stopping the infusion

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48
Q

What are some examples of LMWH? What route are these given?

A

Tinzaparin
Enoxaparin
Dalteparin

They are given as subcutaneous injections

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49
Q

Which specific electrolyte should you monitor if a patient is receiving a heparin for >7 days?

A

Potassium (risk of hyperkalaemia)

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50
Q

How long does warfarin take to exert its effects?

A

48-72h

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51
Q

What are the colours of warfarin tablets and what are their strengths?

A

White = 0.5
Brown = 1mg
Blue = 3mg
Pink = 5mg

(Remember WBBP)

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52
Q

What are the target INRs for VTE, and for recurrent VTE?

A

2.5 = treatment
3.5 = recurrent

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53
Q

What is painful itchy skin associated with warfarin a sign of?

A

Calciphylaxis - must report

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54
Q

What should you do if a patient has a major bleed and are taking warfarin?

A

Stop warfarin
Give IV phytomenadione

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55
Q

What is the INR target to restart warfarin after having a bleed?

A

<5

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56
Q

What should you do if the patients INR if 5-8, with no bleeding?

A

Omit 1-2 doses of warfarin and reduce maintenance dose.
Measure INR after 2-3 days

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57
Q

What should the patient do if they are taking warfarin and are due for an elective surgery?

A

Stop warfarin 5 days before elective surgery

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58
Q

Which specific NOAC is in a special container? What is its expiry date once opened?

A

Dabigatran - 4 month expiry

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59
Q

What is the difference between an ischaemic and haemorrhagic stroke?

A

Ischaemic: loss of oxygen to brain due to a blood clot

Haemorrhagic: a weak vessel in the brain bursting

60
Q

What are the symptoms of a stroke?

A

Remember FAST

Facial drooping
Arms dropping
Slurred speech
Time

61
Q

What is the long term management of stroke?

A

Lifestyle advice
High intensity statin
Clopidogrel 75mg OD
OR MR dipyridamole 200mg + aspirin 75mg
Anticoagulant therapy 14 days after acute event

62
Q

What are examples of antiplatelets?

A

Clopidogrel
Aspirin
Prasugrel
DOACs
Ticagrelor

63
Q

What is given in an acute ischaemic event?

A

Alteplase or tenectaplase within 4.5h

64
Q

What is given in an acute haemorrhagic event?

A

Surgery
Vitamin K/fresh frozen plasma to reverse bleeding

65
Q

What is the hypertension pathway for a Caucasian person who is <55yrs old, or has T2DM?

A

Step 1: ACEi or ARB
Step 2: ACEi or ARB + CCB or thiazide
Step 3: ACEi or ARB + CCB + thiazide
Step 4: Low dose spironolactone, or a/b blockers

66
Q

What is the hypertension pathway for a black patient, or >55yrs old, or without T2DM?

A

Step 1: CCB
Step 2: CCB + ACEi or ARB or thiazide
Step 3: CCB + ACEi or ARB + thiazide
Step 4: low dose spironolactone, or a/b blockers

67
Q

What is the cut off point for potassium levels to initiate spironolactone in hypertension?

A

Only give if K+ levels are <4.5mmol/L

68
Q

What is the recommended daily salt intake?

A

<6g a day (or 100mmol)

69
Q

What is the normal BP target for an adult in a clinical setting?

A

<140/90mmHg

70
Q

When should you offer ABPM or HBPM in a clinical setting?

A

If the patient has a BP reading of 140/90mmHg - 179/119mmHg

71
Q

What is classified as stage 1 hypertension?

A

If their ABPM/HBPM is 135/85mmHg-149/94mmHg

72
Q

When should you refer a patient to a same-day clinic who has come in for a BP reading?

A

If their BP is >180/120mmHg

73
Q

What is classified as stage 2 hypertension?

A

If their ABPM/HBPM is >150/95mmHg

74
Q

What are the BP targets for a T1DM and T2DM patient?

A

T1DM: <135/85mmHg

T2DM: <140/90mmHg

75
Q

What is the target BP for a patient >80 years old?

A

<150/90mmHg

76
Q

Why is the first dose of an ACEi taken a night?

A

To avoid first dose hypotension

77
Q

What should you do if a patient develops a dry cough whilst on an ACEi?

A

Switch to an ARB

78
Q

Which specific side effect is more common in black people taking an ACEi?

A

Angiodema

79
Q

Which specific electrolyte should be monitored whilst on an ACEi?

A

K+, because ACEi can cause risk of hyperkalaemia

80
Q

Which drugs if given with an ACEi can increase the risk of an AKI?

A

Remember DAMN drugs
Diuretics
ACEi/ARB
Metformin
NSAIDs

81
Q

Which hepatic effects can be caused by ACEi, and hence must stop its use?

A

Cholestatic jaundice
If liver transaminases are x3 normal of baseline

82
Q

What are some other side effects o ACEi?

A

Hypoglycaemia
Mouth ulcers
Taste disturbances

83
Q

Which specific drug is unlicensed for the use of gestational hypertension?

A

Methyldopa

84
Q

Which drug is given in severe resistant hypertension?

A

Hydralazine

85
Q

What are some examples of alpha-blockers which can be give as a last step in hypertension if K+ levels are >4.5mmol/L?

A

Doxazosin
Prazosin

86
Q

Where are B1 and B2 receptors found in the body?

A

B1: heart, kidney, fat cells

B2: lungs, arteries of skeletal muscles

87
Q

Which type of b-blockers have less side effects of bradycardia/coldness of extremities?

A

ISA B-blockers

88
Q

Which b-blockers can cause less sleep disturbances and nightmares?

A

Remember ANS
Atenolol
Nadolol
Sotalol

89
Q

Which b-blockers are cardio-selective, and hence cause less bronchospasms?

A

Remember Be A MAN
Bisoprolol
Atenolol
Metorpolol
Acebutalol
Nebivolol

90
Q

Which b-blockers are taken once daily due to their long duration of action?

A

Remember BACoN
Bisoprolol
Atenolol
Celiprolol
Nadolol

91
Q

What are some side effects of b-blockers?

A

Bradycardia
Hypotension
Hyperglycaemia
Masking symptoms of hypoglycaemia

92
Q

What are some common side effects of dihydropyridine CCBs?

A

Ankle swelling
Flushing
Headaches

93
Q

Which 2 CCBs are known as rate-limiting?

A

Verapamil
Diltiazem

94
Q

Why should diltiazem always be prescribed by brand if it is >60mg?

A

Because different MR preparations may not have the same clinical effect

95
Q

Which specific fruit juice should you avoid with CCBs?

A

Grapefruit juice, because it is enzyme inhibiting so can cause increased CCB concentrations

96
Q

What is given during a hypertensive crisis?

A

IV sodium nitroprusside

97
Q

Which drugs are used to treat pulmonary hypertension?

A

Sildenafil
Tadalafil
Oliprost

98
Q

Which vasoconstricting sympathomimetics are used in shock/hypotension?

A

Atropine
Noradrenaline
Phenylephrine

99
Q

What are symptoms of heart failure?

A

SOB
Persistent coughing/wheezing
Reduced exercise tolerance
Fatigue
Weight gain due to fluid build up

100
Q

What is the difference between reduced ejection fraction and preserved ejection fraction?

A

Reduced ejection fraction: when left ventricle loses its ability to contract, so ejection is only 40%

Preserved ejection fraction: left ventricle cannot relax normally so output is normal/slightly reduced

101
Q

Which types of CCBs should always be avoided in HF patients?

A

Rate-limiting CCBs - verapamil, diltiazem
Short acting CCBs - nifedipine

102
Q

What are the 2 first line treatment drugs which are used in HF?

A

B-blockers and ACEi/ARB

103
Q

Which b-blockers are license din HF patients?

A

Bisoprolol
Carvedilol
Nebivolol

104
Q

What others drugs can be added if 1st line treatment in HF is not suitable, or symptoms worsen?

A

Eplerenone
Spironolactone
Ivabradine
Digoxin
Amiodarone

105
Q

What drugs can be used for HF patients to help with oedema related symptoms?

A

Loop diuretics, e.g. furosemide, bumetanide

106
Q

What monitoring is required for HF patients?

A

K+, Na+
Renal function
BP
Weight
HR
Symptom control

107
Q

When is primary CVD prevention offered in patients?

A

If their QRISK2 score is >10%

108
Q

What is the diagnosis for hyperlipidaemia?

A

If total cholesterol is >6mmol/L, or triglycerides are >1.7mmol/L

109
Q

When are fenofibrates used to reduce cholesterol levels?

A

If triglyceride levels remain high even after LDL levels reduced

110
Q

What should be added if cholesterol levels are still high despite being on the highest dose of statin?

A

Add ezetimibe

111
Q

Which enzyme do statins inhibit?

A

HMG-CoA

112
Q

Why are statins taken at night?

A

Because cholesterol synthesis is greater at night, so treatment will be more effective

113
Q

Which specific side effects should patients taking statins report?

A

Muscle weakness, pain or tenderness

114
Q

What monitoring is required for a patient taking a statin?

A

LFTs
TFTs
Renal function
Baseline lipid profile
HbA1c

115
Q

When should a statin be discontinued?

A

If creatine kinase is x5 normal level, or liver transaminases are x3 normal level

116
Q

Which class of antibiotic would require the patient to stop taking their statin during treatment?

A

Macrolides

117
Q

What should a patient do if they are prescribed fusidic acid if they are taking a statin?

A

Must stop taking their statin during treatment and restarted 7 days after last dose

118
Q

What is the max dose of rosuvastatin if taken with clopidogrel?

A

20mg

119
Q

Which vitamins may not be absorbed if a patient takes a bile sequestrant?

A

Fat-soluble vitamins (ADEK), and folic acid

120
Q

What are some example of bile sequestrants?

A

Colesevelam
Colestyramine

121
Q

What is the dose of bempedoic acid?

A

180mg OD

122
Q

What can precipitate stable angina?

A

Physical exercise
Emotional stress

123
Q

What is used to relieve acute angina attacks?

A

GTN spray

124
Q

How is GTN spray/tablets taken?

A

When required or before angina-inducing activity

125
Q

How long after the first GTN dose can a patient repeat another dose?

A

5 minutes (max. 3 times in 1 sitting)

126
Q

What is the expiry of GTN sublingual tablets?

A

8 weeks (special container)

127
Q

What drugs can be given for stable angina prophylaxis?

A

MR Isosorbide dinitrate
Isosorbide mononitrate
B-blockers
CCB
Ivabradine
Ranolazine
Nicorandil

128
Q

Which drug has the risk of causing mucosal ulceration?

A

Nicorandil, stop drug if this occurs

129
Q

What can be done to reduce tolerance of long-acting transdermal nitrate preparations?

A

Avoid wearing the patch overnight
2nd dose can be taken 8h after 1st dose
Take isosorbide mononitrate OD

130
Q

What are some side effects of nitrate preparations for angina?

A

Worsening angina (if abruptly stopped)
Flushing
Throbbing headache
Heartburn

131
Q

Which type of ACS requires a PCI or reperfusion intervention?

A

A STEMI (heart attack)

132
Q

What is given during an acute ACS event (I.E. in ambulance)?

A

Remember MONA
Morphine 5mg IV
Oxygen
Nitrates
Aspirin 300mg loading dose

133
Q

What is given for the long term treatment of an ACS event?

A

Remember ABAS
Dual antiplatelet therapy (aspirin lifelong + clopidogrel 75mg 12 months)
B-blocker
ACEi
Statin (high dose)

+ PPI as GI protection

134
Q

Which antiplatelet is given within 12h of onset for a STEMI?

A

Prasugrel 60mg as loading dose

135
Q

How many compressions/min are given during cardiac arrest?

A

100 compressions per minute

136
Q

Which loop diuretic is the most potent?

A

Bumetanide

137
Q

Why are diuretics taken in the morning?

A

To avoid sleep disruption/night time waking to go toilet

138
Q

Which diuretic can colour urine blue?

A

Triamterene

139
Q

How do diuretics work?

A

They inhibit sodium/water reabsorption, so more is urinated out and which relieved oedema

140
Q

Why can loop diuretics be given twice a day?

A

Because they have a shorter duration of action (6h)

141
Q

Why should you avoid loop diuretics in patients with BPH?

A

Because loops can cause acute urinary retention

142
Q

Which type of diuretic should you avoid if a patient has hypercalcaemia?

A

Thiazides

143
Q

Which type of diuretic is given if a patient is experiencing hypokalaemia?

A

Potassium sparing diuretics, e.g. spironolactone

144
Q

What is an example of an osmotic diuretic?

A

Mannitol

145
Q
A

GPhC Exam Revison (5 decks)

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