cardiovascular system Flashcards
what are the 4 different valves
triscupid
mitral
aortic
pulmonary valves
examples of antihypertensives
ACE inhibitors
ARBs
beta blockers
CCB
diuretics
examples of anticoagulants:
aspirin
clopidogrel
warfarin
DOACs
examples of lipid lowering agents:
statins
fibrates
ezetimibe
examples of anti anginal agents:
GTN
beta blockers
CCB
examples of heart failure meds:
ACE inhibitors
beta blockers
diuretics
valsartan
atherosclerosis
build up of fat/plaque in arteries
symptoms of hypertension:
1) irregular beat
2)fatigue
3) vision
4)chest pain
5) difficulty breathing
how might nsaids be harmful ?
can cause fluid retention and decrease renal function
causing blood pressure to increase
examples of drugs to avoid if have high bp
1)nsaids
2)nasal decongestants
3) recreational
4) oegesterone containing preparations
5) migraine meds
6)antidepressant
7) corticosteroids
8) cyclosporin
what are the 3 different types of hypertension ?
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.
what types of drugs are used to treat hypertension ? (8)
1) ACEi
2)ARBs
3)CCB
4)Diuretics
5) renin inhibitors
6)beta blockers
7) alpha blockers
ACE inhibitors:
-examples
-moa
-side effects
-and other info and monitoring
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.
ARBs:
-examples
-moa
-side effects
-and other info and monitoring
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 relax, decreasing bp.
side effects:
Dizziness, headache, arrythmia, cough, diarrhoea
other info: kidney function monitoring
potassium and creatine monitoring
CCBs:
-examples
-moa
-side effects
-and other info and monitoring
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.
Diuretics:
-examples
-moa
-side effects
-and other info and monitoring
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
Renin inhibitors:
-examples
-moa
-side effects
-and other info and monitoring
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
Alpha blockers:
-examples
-moa
-side effects
-and other info and monitoring
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.
Beta blockers:
-examples
-moa
-side effects
-and other info and monitoring
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
what level is “hypertensive emergency/crisis” ?
180/120mmHg or higher
symptoms:
shortness of breath
nose bleeds
severe headache
what is severe hypertension level ?
180/110mmHg or higher
and if there is no damage of target organs, then this is “hypertensive urgency”.
what is pre-eclampsia ?
high bp during pregnancy
and high amount of protein in urine.
symptoms: severe headache
blurry vision
vomit
pain below ribs
what are the different types of LDL percentage reduction targets ?
1) 20-30%
2) 31-40%
3) more than 40%
what is recommended for 20-30% LDL reduction
Fluvastatin- 20-40mg
pravastatin-10-40 mg
simvastatin- 10 mg
daily
what is recommended for 31-40% LDL reduction
Fluvastatin- 80mg
simvastatin- 10-40mg
atorvastatin-10 mg
rosuvastatin: 5 mg
what is recommended for 40% + LDL reduction
simvastatin: 80mg
atorvastatin: 20-80 mg
rosuvastatin: 10-40mg
primary and secondary preventation/treatment
for high cholesterol
Primary: 20mg atorvastatin
Secondary: 80mg atorvastatin
initial dose of 20mg if they have CKD
what is given for primary hypercholesterolaemia
Ezetimibe
- especially if statins are not well tolerated.
- and given if LDL levels are not well controlled after taking statins
example of bile sequestrants to treat high cholesterol ?
and moa
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
ezetimibe mechanism of action and side effects
- inhibit absorption of cholesterol by small intestine
side effects: diarrhoea, stomach pain, nausea, headache, dizziness.
symptoms of stable angina
breathlessness
chest heaviness
tachycardia
sweating
how to treat angina
GTN sublingual
B-blockers
CCBs
K+ channel activators
long acting nitrates
For secondary prevention: Antiplatelets, high intensity statins, ACE inhibitors.
GTN
examples
moa
side effects
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.
Why is ACS risky ?
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.
Troponin I risk of MI
low risk: less than 0.1 mcg/L
medium: 0.1-0.6
high: 0.6 +
Troponin T risk of MI
normal levels: less than 14ng/L
medium: 14-100
high: 100+
Summary of stemi treatment
1) oxygen, nitrates, opiods
2) aspirin, thrombolytics (alteplase)
3) Anticoagulants
4) aspirin, B-blocker, ACEi, statin
side effects of thrombolytics ?
1) nausea
2) vomit
3) bleeding
4) low bp
5)allergy/anaphylaxis
moa of thrombolytics :
Activate plasminogen, which is converted into plasmin
plasmin breaks down fibrin
causing blood clots to dissolve and break up
Treatment for unstable angina and NSTEMI ?
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.
symptoms of pulmonary congestion
Breathlessness, basal crackles, frothy sputum, gasping
symptoms of peripheral congestion
Ankle oedema
bowel oedema
anorexia
symptoms of reduced perfusion
Fatigue, confusion, renal failure, tachycardia, cold hands n feet.
diagnosis tests for HF
physcial exam
chest x ray
echocardiography
ECgs
Treatment for chronic HF
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.
What ACEis are used for HF
Enalapril
catopril
ramipril
What B blockers are used for HF
Bisoprolol
carvedilol
What ARbs are used for Hf
losartan
valsartan
candesartan
Bendroflumethazide side effects HF (thiazide loop dieuretic)
constipation, diarrhoea, dizziness, headache, nausea, vomit
Furosemide side effects HF (loop dieuretic)
headaches, dizziness, nausea, vomit, dry mouth,
Digoxin side effects HF (cardiac glycoside)
Dizziness, diarrhoea, nausea, vomit, blurred vision, skin rash
Sacubritil valsartan HF
increased fluid retention, lower bp, dry cough,
Spironolactone side effects
Dizziness, nausea, vommit, muscle cramps
Arrthymia ?
abnormal electrical activity of the heart
symotoms of arrthymia
dizzines
chest pain
fatigue
shortness of breath
palpitation
What is used to treat atrial cardia if there is LV dysfunction ?
Sotalol or amiodarone
What is the most common arrthymia
Atrial fibrillation AF
Drugs used to treat rate control for AF
Beta blocker
CCB (diltiazem or verapamil).
digoxin mono therapy (if they do little exercise).
Amiodarone side effects ?
cough
dizziness
nausea
vomit
fever
painful breathing
tremor
moa of amiodarone
1) Blocks K+ channel
2) slows down electrical impulse conduction of heart.
3) causing an increase in the duration of action potential
4) stabilising heart rhythm
What is used to treat long term rhythm control for AF
Adenosine (first line): AV nodal blocker
CCBs
B blockers
What is the “pill in the pocket” strategy for AF
infraquent paroxysmal AF
then tablet is taken (fleicainide or propaferone).
What is venous thromboembolism
blood clot in vein
What is non pharmalogical VTE treatment
1) Anti embolism (compression) stockings
2) Foot impulse devices ( people with heart related or skin related problems cant use)
3) other pneumatic compression devices
What is pharmalogical VTE prophylaxis
Fondaparinux (LMWH)
or unfractioned heparin infusion
it is a low molecular weight heparin
Advantages of adminstering LMWH for VTE prohpylaxis
1) once a day admin
2) does not require anticoagulant monitoring
3) lower risk of induced heparin thrombocytopenia.
Symptoms of deep vein thrombosis (DVT)
1) pain and sweelin in one leg
2) increased temp in affected area
3) Redness
4) heavy ache
Symtpms of pulmonary embolism (PE)
1) chest pain
2) shortness of breath
3) coughing blood
4) faint
What is alteplase for
To treat haemodynamically unstable PE
when bp decreases and it is more difficult to stay oxygenated.
Advanatages of apixaban and rivaroxaban over edoxaban and dabigatran
The first two don’t require treatment with parental anticoagulant at first, but the other two require 5 days of parenteral anticoagulant treatment beforehand.
what is a stroke
interruption of blood flow to brain
what are the 2 different types of strokes
Ischaemic and haemorrhagic
symptoms of stroke
facial weakness
Arm leg weakness
disturbed speech
visual problem
dizziness
headache
What is the difference between apolipoprotein a1 and B
a1 major component of HDL
B major component of LDL
what is thrombotic and embolic stroke ( types of ischemic stroke)
Thrombotic : caused by atherosclerosis
Embolic: when clot or debris from else where travel through circulatory system.
What is a transient iscahemic attack (TIA)
Temporary disruption in blood supply to brain
causing ischaemia from lack of oxygen supply
mini stroke
What is a haemorrhagic stroke
caused by rupture of blood vessels, causing an expanding haematoma to form
What are the 2 types of haemorrhagic stroke
intracerebral and subarachnoid
treatment and testing for acute stroke ?
CAT scan and CT scan
Iscahemic stroke treatment
Aspirin 300 mg/day for 2 weeks
then clopidogrel 75mg
for secondary prevention statins can be given
should be started 48 hrs after stroke
secondary prevention of TIA
Antiplatelet therapy
clopidorgrel 75mg
MR dipyridamole 200mg x2 a day if clopidogrel or aspirin not tolerated
Haemorrhagic stroke treatment
anticoagulant therapy stopped for 10-14 days
Nimodipine can be given for cerebral vasospasm in SAH
How to hands only CPR
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
How to do CPR with rescue breaths (adults)
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.
How to do CPR for child over 1yrs old
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
How to do CPR for under 1yr old
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
