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mpharm stage 3 > cardiovascular system > Flashcards

cardiovascular system Flashcards

1
Q

what are the 4 different valves

A

mitral
tricuspid
aortic
pulmonary valves

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2
Q

examples of antihypertensives

A

ACE inhibitors
ARBs
beta blockers
CCB
diuretics

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3
Q

examples of anticoagulants:

A

aspirin
clopidogrel
warfarin
DOACs

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4
Q

examples of lipid lowering agents:

A

statins
fibrates
ezetimibe

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5
Q

examples of anti anginal agents:

A

GTN
beta blockers
CCB

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6
Q

examples of heart failure meds:

A

ACE inhibitors
beta blockers
diuretics
valsartan

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7
Q

atherosclerosis

A

build up of fat/plaque in arteries

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8
Q

symptoms of hypertension:

A

1) irregular beat
2)fatigue
3) vision
4)chest pain
5) difficulty breathing

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9
Q

how might nsaids be harmful ?

A

can cause fluid retention and decrease renal function

causing blood pressure to increase

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10
Q

examples of drugs to avoid if have high bp

A

1)nsaids
2)nasal decongestants
3) recreational
4) oegesterone containing preparations
5) migraine meds
6)antidepressant
7) corticosteroids
8) cyclosporin

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11
Q

what are the 3 different types of hypertension ?

A

1) primary- high bp not from medical condition (obesity,diet)

2) secondary- high bp due to medical condition

3) resistant- high bp that is not easily controlled even with bp treatment.

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12
Q

what types of drugs are used to treat hypertension ? (8)

A

1) ACEi
2)ARBs
3)CCB
4)Diuretics
5) renin inhibitors
6)beta blockers
7) alpha blockers

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13
Q

ACE inhibitors:
-examples
-moa
-side effects
-and other info and monitoring

A

Examples: Ramipril, enalapril

moa:
1)Causes vasodilation by inhibiting angiotensin II.
2) Less and angiotensin II and inhibition of the breakdown of bradykinin causes vasodilation.

side effects:
1) dry cough
2) hyperkalaemia
3) dizziness
4) GI irritation

other info: ramipril can cause dry cough, so can change to ARB.
- take dose at night to avoid hypotension when starting.

monitor: bp and K+ levels, renal function.

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14
Q

ARBs:
-examples
-moa
-side effects
-and other info and monitoring

A

Examples: Losartan, valsartan

moa:
1)Bind to angiotensin II type 1 receptor.
2)Preventing angiotensin II from binding to receptor.
3)causing blood vessels to constrict, decreasing bp.

side effects:
Dizziness, headache, arrythmia, cough, diarrhoea

other info: kidney function monitoring
potassium and creatine monitoring

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15
Q

CCBs:
-examples
-moa
-side effects
-and other info and monitoring

A

examples: Amlodipine, felodipine, diltiazem, verapamil

moa:
1)bind to L-type volted gated calcium channels,
2) blocking inward movement of calcium,
3)causing blood vessels to relax and lowers bp.

side effects:
constipation
dizziness
headache
nausea

other info: avoid grapefruit juice with verapamil and diltiazem.

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16
Q

Diuretics:
-examples
-moa
-side effects
-and other info and monitoring

A

examples: hydrochlorothiazide, furosemide, Spironolactone

moa:
1) reduce bp by increasing sodium and water content secreted in urine.
2) This is done by reducing the amount of sodium and water reabsorbed by the kidneys.
3) increasing the amount of sodium and water in urine. lowering bp.

side effects:
dehydration, electrolyte imbalance, hypokalaemia, gout

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17
Q

Renin inhibitors:
-examples
-moa
-side effects
-and other info and monitoring

A

example: aliskiren
moa:
1) reduces production of angiotensin II and aldosterone
2) causing blood vessels to constrict
reducing bp.

side effects: dizziness, diarrhoea, electrolyte imbalance, cough

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18
Q

Alpha blockers:
-examples
-moa
-side effects
-and other info and monitoring

A

examples: doxazosin, prazosin

moa:
1) preventing norepinephrine from tightening muscles in arterial walls and vessels.
2) causing blood vessels to relax, lowering bp.

side effects: dizziness, headache, nausea, postural hypotension, drowsiness, tremor.

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19
Q

Beta blockers:
-examples
-moa
-side effects
-and other info and monitoring

A

examples:
bisoprolol, propranolol, carvedilol, atenolol

moa:
1) block the release and effects of adrenaline and noradrenaline
2) causing heart rate to slow down, lowering bp.
- can widen blood vessels increasing blood flow
- can block angiotensin II, reducing bp.

side effects:
Nausea
dizziness
fatigue
constipation
diarrhoea
hypotension
bradycardia

other info: dont take if asthma

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20
Q

what level is “hypertensive emergency/crisis” ?

A

180/120mmHg or higher

symptoms:
shortness of breath
nose bleeds
severe headache

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21
Q

what is severe hypertension level ?

A

180/110mmHg or higher

and if there is no damage of target organs, then this is “hypertensive urgency”.

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22
Q

what is pre-eclampsia ?

A

high bp during pregnancy
and high amount of protein in urine.

symptoms: severe headache
blurry vision
vomit
pain below ribs

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23
Q

what are the different types of LDL percentage reduction targets ?

A

1) 20-30%

2) 31-40%

3) more than 40%

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24
Q

what is recommended for 20-30% LDL reduction

A

Fluvastatin- 20-40mg
pravastatin-10-40 mg
simvastatin- 10 mg

daily

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25
Q

what is recommended for 31-40% LDL reduction

A

Fluvastatin- 80mg
simvastatin- 10-40mg
atorvastatin-10 mg
rosuvastatin: 5 mg

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26
Q

what is recommended for 40% + LDL reduction

A

simvastatin: 80mg
atorvastatin: 20-80 mg
rosuvastatin: 10-40mg

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27
Q

primary and secondary preventation/treatment

for high cholesterol

A

Primary: 20mg atorvastatin

Secondary: 80mg atorvastatin
initial dose of 20mg if they have CKD

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28
Q

what is given for primary hypercholesterolaemia

A

Ezetimibe
- especially if statins are not well tolerated.
- and given if LDL levels are not well controlled after taking statins

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29
Q

example of bile sequestrants to treat high cholesterol ?

and moa

A

colestipol

mechanism of action:
- binds to bile acid, preventing bile acid from being reabsorbed.
- so bile acid secreted in faeces

  • this increases the amount of cholesterol converted into bile acids
  • increases number of LDL receptors
  • decreasing LDL cholesterol
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30
Q

ezetimibe mechanism of action and side effects

A
  • inhibit absorption of cholesterol by small intestine

side effects: diarrhoea, stomach pain, nausea, headache, dizziness.

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31
Q

symptoms of stable angina

A

breathlessness
chest heaviness
tachycardia
sweating

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32
Q

how to treat angina

A

GTN sublingual

B-blockers
CCBs
K+ channel activators
long acting nitrates

For secondary prevention: Antiplatelets, high intensity statins, ACE inhibitors.

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33
Q

GTN
examples
moa
side effects

A

Examples: Glytrin, minitran

its a nitrate, vasodilator

Side effects: headache, dizziness, nausea, vomit

moa:

1) nitroglycerin is converted into nitroxide.
2) nitro oxide then activates guanylyl cyclase, causing conversion of GTP to cGMP. causing blood vessels to widen.

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34
Q

Why is ACS risky ?

A

Acute coronary syndrome

  • plaque becomes unstable and ruptures, causing its lipid cores to become exposed.
  • platelets then attach to these cores forming a thrombus
  • thrombus can then cause blockage of coronary artery.
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35
Q

Troponin I risk of MI

A

low risk: less than 0.1 mcg/L

medium: 0.1-0.6

high: 0.6 +

36
Q

Troponin T risk of MI

A

normal levels: less than 14ng/L
medium: 14-100
high: 100+

37
Q

Summary of stemi treatment

A

1) oxygen, nitrates, opiods

2) aspirin, thrombolytics (alteplase)

3) Anticoagulants

4) aspirin, B-blocker, ACEi, statin

38
Q

side effects of thrombolytics ?

A

1) nausea
2) vomit
3) bleeding
4) low bp
5)allergy/anaphylaxis

39
Q

moa of thrombolytics :

A

Activate plasminogen, which is converted into plasmin

plasmin breaks down fibrin

causing blood clots to dissolve and break up

40
Q

Treatment for unstable angina and NSTEMI ?

A

1) antiplatelets and antithrombin
- 300mg aspirin or clopidogrel if allergic to aspirin

2) Anticoagulant: Fondaparinux, if creatine below 265ul/L then heparin is given instead.

41
Q

symptoms of pulmonary congestion

A

Breathlessness, basal crackles, frothy sputum, gasping

42
Q

symptoms of peripheral congestion

A

Ankle oedema
bowel oedema
anorexia

43
Q

symptoms of reduced perfusion

A

Fatigue, confusion, renal failure, tachycardia, cold hands n feet.

44
Q

diagnosis tests for HF

A

physcial exam
chest x ray
echocardiography
ECgs

45
Q

Treatment for chronic HF

A

First line: ACE inhibitors and beta blocker
if not tolerated, then long acting nitrate and hydralazine is given instead.

but beta blockers may cause pulmonary oedema, if so then loop diueretics used instead, or dose of b blockers lowered.

46
Q

What ACEis are used for HF

A

Enalapril
catopril
ramipril

47
Q

What B blockers are used for HF

A

Bisoprolol
carvedilol

48
Q

What ARbs are used for Hf

A

losartan
valsartan
candesartan

49
Q

Bendroflumethazide side effects HF (thiazide loop dieuretic)

A

constipation, diarrhoea, dizziness, headache, nausea, vomit

50
Q

Furosemide side effects HF (loop dieuretic)

A

headaches, dizziness, nausea, vomit, dry mouth,

51
Q

Digoxin side effects HF (cardiac glycoside)

A

Dizziness, diarrhoea, nausea, vomit, blurred vision, skin rash

52
Q

Sacubritil valsartan HF

A

increased fluid retention, lower bp, dry cough,

53
Q

Spironolactone side effects

A

Dizziness, nausea, vommit, muscle cramps

54
Q

Arrthymia ?

A

abnormal electrical activity of the heart

55
Q

symotoms of arrthymia

A

dizzines
chest pain
fatigue
shortness of breath
palpitation

56
Q

What is used to treat atrial cardia if there is LV dysfunction ?

A

Sotalol or amiodarone

57
Q

What is the most common arrthymia

A

Atrial fibrillation AF

58
Q

Drugs used to treat rate control for AF

A

Beta blocker
CCB (diltiazem or verapamil).
digoxin mono therapy (if they do little exercise).

59
Q

Amiodarone side effects ?

A

cough
dizziness
nausea
vomit
fever
painful breathing
tremor

60
Q

moa of amiodarone

A

1) Blocks K+ channel

2) causes repolarisation of heart muscle during the 3rd phase of cardiac action potential.

3) causing an increase in the duration of action potential

4) rhythm returns to normal level

61
Q

What is used to treat long term rhythm control for AF

A

Adenosine (first line): AV nodal blocker
CCBs
B blockers

62
Q

What is the “pill in the pocket” strategy for AF

A

infraquent paroxysmal AF

then tablet is taken (fleicainide or propaferone).

63
Q

What is venous thromboembolism

A

blood clot in vein

64
Q

What is non pharmalogical VTE prophylaxis

A

1) Anti embolism (compression) stockings

2) Foot impulse devices ( people with heart related or skin related problems cant use)

3) other pneumatic compression devices

65
Q

What is pharmalogical VTE prophylaxis

A

Fondaparinux (LMWH)

or unfractioned heparin infusion

it is a low molecular weight heparin

66
Q

Advantages of adminstering LMWH for VTE prohpylaxis

A

1) once a day admin

2) does not require anticoagulant monitoring

3) lower risk of induced heparin thrombocytopenia.

67
Q

Symptoms of deep vein thrombosis (DVT)

A

1) pain and sweelin in one leg

2) increased temp in affected area

3) Redness

4) heavy ache

68
Q

Symtpms of pulmonary embolism (PE)

A

1) chest pain
2) shortness of breath
3) coughing blood
4) faint

69
Q

What is alteplase for

A

To treat haemodynamically unstable PE

when bp decreases and it is more difficult to stay oxygenated.

70
Q

Advanatages of apixaban and rivaroxaban over edoxaban and dabigatran

A

The first two don’t require treatment with parental anticoagulant at first, but the other two require 5 days of parenteral anticoagulant treatment beforehand.

71
Q

what is a stroke

A

interruption of blood flow to brain

72
Q

what are the 2 different types of strokes

A

Ischaemic and haemorrhagic

73
Q

symptoms of stroke

A

facial weakness
Arm leg weakness
disturbed speech
visual problem
dizziness
headache

74
Q

What is the difference between apolipoprotein a1 and B

A

a1 major component of HDL

B major component of LDL

75
Q

what is thrombotic and embolic stroke ( types of ischemic stroke)

A

Thrombotic : caused by atherosclerosis

Embolic: when clot or debris from else where travel through circulatory system.

76
Q

What is a transient iscahemic attack (TIA)

A

Temporary disruption in blood supply to brain

causing ischaemia from lack of oxygen supply

mini stroke

77
Q

What is a haemorrhagic stroke

A

caused by rupture of blood vessels, causing an expanding haematoma to form

78
Q

What are the 2 types of haemorrhagic stroke

A

intracerebral and subarachnoid

79
Q

treatment and testing for acute stroke ?

A

CAT scan and CT scan

80
Q

Iscahemic stroke treatment

A

Aspirin 300 mg/day for 2 weeks

then clopidogrel 75mg

for secondary prevention statins can be given
should be started 48 hrs after stroke

81
Q

secondary prevention of TIA

A

Antiplatelet therapy

clopidorgrel 75mg

MR dipyridamole 200mg x2 a day if clopidogrel or aspirin not tolerated

82
Q

Haemorrhagic stroke treatment

A

anticoagulant therapy stopped for 10-14 days

Nimodipine can be given for cerebral vasospasm in SAH

83
Q

How to hands only CPR

A

1) place heel of hand on breast bone at centre of chest, place other hand on top and interlock fingers

2) position shoulders above hands

3) using body weight press down by 5-6cm on chest

4) keep hands on chest and release compression, allow chest to return to original position

5) repeat at rate of 100-120 per minute

84
Q

How to do CPR with rescue breaths (adults)

A

1) place heel of hand on centre of chest, place other hand on top and press 5-6cm down at a rate of 100-120 compressions per min.

2) After 30 compressions give 2 rescue breaths

3) tilt head gently and lift chin up with 2 fingers, pinch nose, seal mouth over their mouth, and blow into their mouth for a second. Check that their chest rises. then give 2 rescue breaths

4) continue with 30:2 ration until they recover.

85
Q

How to do CPR for child over 1yrs old

A

1) open airway by placing one hand on forehead and tilting head back and lifting chin. remove visible obstruction from mouth or nose.

2) pinch nose. seal mouth over their mouth and blow, check if chest rises. give 5 rescue breaths

3) place heel of one hand on centre of chest, and push down by 5cm

4) after 30 compressions give 2 breaths.

5) Continue with 30:2 ratio until they recover

86
Q

How to do CPR for under 1yr old

A

1) open airway by placing one hand on their forehead and tilt head back and lift chin

2) place mouth over their mouth and nose, and blow, check chest rises. Give 5 rescue breaths

3) place 2 fingers in the middle of the chest and push down by 4cm

4) 30 compressions, then 2 breaths

5) Continue with 30:2 ratio until they recover

87
Q
A

mpharm stage 3 (4 decks)

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