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Victor BNF Notes > Cardiovascular System Part 1 > Flashcards

Cardiovascular System Part 1 Flashcards

1
Q

What are Arrhythmias

A

Irregular/abnormal heartbeat

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2
Q

Anti-arrhythmic drugs: Membrane Stabilising Drugs

A
  • Disopyramide
  • Lidocaine
  • Flecainide (not in asthma and severe COPD, ischaemic heart disease
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3
Q

Anti-arrhythmic drugs: Beta Blockers

A
  • Propranolol
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4
Q

Anti-arrhythmic drugs: K+ Channel Blockers

A
  • Amiodarone (4 weeks before and 12 weeks after electrical cardioversion to increase success)
  • Sotalol
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5
Q

Anti-arrhythmic drugs: Ca+ Channel Blockers

A
  • Verapamil
  • Diltiazem (unlicensed)
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6
Q

Anti-arrhythmic drugs: Other

A
  • Adenosine
  • Digoxin
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7
Q

3 Types of Arrhythmias

A
  • Arterial Fibrillation
  • Ventricular Arrhythmias
  • Paroxysmal Supraventicular Arrhythmias
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8
Q

What is Arterial Fibrillation

A

Abnormal, disorganised electrical signals fired causing the atria to quiver or fibrillate

Rapid irregular heartbeat

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9
Q

Arterial Fibrillation symptoms

A
  • heart palpitations
  • dizziness
  • shortness of breath
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10
Q

Arterial Fibrillation complications

A
  • stroke
  • heart failure
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11
Q

What is
Cardioversion

A

Restoring sinus rhythm, using electrical or drug methods

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12
Q

Cardioversion cautions

A
  • Can’t give medication if symptoms are longer than 48 hours (due to increased risk of stroke)
  • Use electrical if over 48 hour symptoms
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13
Q

Cardioversion treatment

A
  • Wait until fully anti-coagulated for 3 weeks, then continue with cardioversion
  • If haemodynamically unstable, use electrical
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14
Q

Arterial Fibrillation Acute New-onset presentation treatment

With Life Threatening Haemodynamic Instability (unstable blood pressure)

A

If Life Threatening haemodynamic instability (unstable blood pressure):

  • Electrical Cardioversion
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15
Q

Arterial Fibrillation Acute New-onset presentation treatment

Without Life Threatening Haemodynamic Instability (unstable blood pressure)

A

Without life threatening haemodynamic:

— Within 48 hours: Electrical / Amiodarone

— Later than 48 hours:
Verapamil/Beta-Blocker

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16
Q

Acute Arterial Fibrillation Maintenance Drug Treatment

A

First Line:
Beta-blockers- Bisoprolol / Propranolol
(not Sotalol, as can prolonge QT interval)

Second Line:
Beta-blocker + Digoxin

Third line:
Oral Anti-arrythmatic drug: Amiodarone

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17
Q

What is Arterial Flutter

A

It is when heart is short circuited, causing upper chambers to pump rapidly

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18
Q

CHA
Tool (Stroke Prevention)

A

C - Chronic Heart Failure / Left Ventricular Dysfunction

H - Hypertension

A - Age 75+

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19
Q

DS Tool (Stroke Prevention)

A

D - Diabetes Mellitus

S - Stroke / Transient ischemic attack / Venous Thromboembolism History

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20
Q

VAS Tool (Stroke Prevention)

A

V - Vascular Disease

A - 65 to 74 years

S - Sex Category FEMALE

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21
Q

Stroke Prevention Tool Scoring Treatment

A

> 2: Anticoagulant

< 2: Low Risk

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22
Q

New (non-acute) Onset Arterial Fibrillation treatment

A

Parental Anticoagulant

(Low molecular weight heparin)

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23
Q

Diagnosed (non-acute) Arterial Fibrillation treatment

A

Anticoagulant
- Vitamin K Antagonist
(Warfarin)

  • Non Vitamin K Antagonist (NOAC)
    (Apixaban, Rivaroxaban)
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24
Q

Ventricular Tachycardia Treatment:

  • Pulseless / Fibrillation
  • Non- Sustained
A

Pulseless / Fibrillation:

— Defibrillation + CPR

Non-Sustained:

— Beta Blocker

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25
Q

Ventricular Tachycardia Treatment:

Unstable and Stable Sustained Ventricular Tachycardia

A

Unstable sustained ventricular tachycardia:

— Cardioversion

— Amiodarone + Cardioversion

Stable sustained ventricular tachycardia:

— IV Anti-arrhythmic (Amiodarone)

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26
Q

Maintenance treatment for ventricular tachycardia

A

— Cardioverter defibrillator implant

— maybe + Sotalol or Beta Blocker + Amiodarone

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27
Q

Prolonged QT Interval Treatment

A

Magnesium Sulphate

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28
Q

Prolonged QT Interval Causes

A

Sotalol, Hypokalaemia, Bradycardia

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29
Q

Anti-Arrhythmic Drugs: Class III Anti-Arrhythmic

A

Amiodarone

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30
Q

Amiodarone Dose

A

200mg TDS daily for 7 days

then…

200mg BD for 7 days

then…

200mg OD maintenance

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31
Q

Amiadarone side effects: Eyes

A

— Corneal micro deposites (night glares when driving)

— optic neuropathy
(stop if vision impaired)

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32
Q

Amiadarone side effects: Skin

A

— Phototoxicity (burning)
— Slate grey skin

(use high spf sunscreen)

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33
Q

Amiadarone side effects: Nerves

A

— Peripheral Neuropathy (nerve pain)

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34
Q

Amiadarone side effects: Lungs

A

— Pneumonitis

— Pulmonary Fibrosis

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35
Q

Amiadarone side effects: Liver

A

— Hepatoxicity

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36
Q

Amiadarone side effects: Thyroid Dysfunction

A

— Hyperthyroidis (Carbimazole)

— Hypothyroidism (Levothyroxine)

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37
Q

Amiodarone Monitoring

A
  • Annual eye test
  • chest x-ray
  • liver function tests every 6 months
  • Monitor (thyroid stimulating hormone, T3, T4)
  • Blood Pressure and ECG
  • Serum Potassium
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38
Q

Why is Amiodarone dangerous with Interactions

A

Long half-life (50 days):
Therefore, danger of post stopping interactions.

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39
Q

Amiodarone and Grapefruit

A

May increase amount of amiodarone in the body

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40
Q

Amiodarone and Warfarin, Phenytoin and Digoxin

A

Warfarin
- inhibits warfarin metabolism, associated with major bleeding during warfarin therapy

Phenytoin
- may alter the blood levels of both medications

Digoxin
- inhibit P-glycoprotein system and increase serum levels of digoxin

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41
Q

Amiodarone and Statins

A

inhibition of the metabolising enzyme by amiodarone, leading to an excess of statin.

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42
Q

Amiodarone and beta-blockers and ccb

A

increased risk of AV block and myocardial depression

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43
Q

Amiodarone interaction, increasing QT interval and risk of ventricular arrhythmia

A

Quinolones, macrolides, TCAs, SSRIs, Lithium, Antiphsycotics

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44
Q

Digoxin Mode of Action

A

Increases force myocardial contraction, reduces conductivity in AV node,

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45
Q

Digoxin Monitoring

A

Non, unless toxicity or renal impairment

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46
Q

Digoxin Doses

A
  • Loading dose required due to long half life
  • Arterial Flutter and Non-Paroxysmal AF in sedentary patients
    —125-250 mcg
  • Worsening/Severe heart failure
    — 62.5-125mcg
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47
Q

Signs of Digoxin Toxicity

A
  • Bradycardia
  • Nausea/Vomiting
  • Diarrhoea
  • Abdominal Pain
  • Blurred/Yellow Vision
  • Confusion
  • Rash
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48
Q

Digoxin Toxicity Treatment

A
  • Withdraw (correct electrolyte imbalance)
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49
Q

Digoxin Interactions: Creased

A

C CB (verapamil)
R ifampicin
A miodarone
S t Johns Wort
E rythromycin
D iuretics

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50
Q

Digoxin Interaction: CCB

A

Increases serum concentration of Digoxin

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51
Q

Digoxin Interaction: Rifampicin

A

Reduces digoxin serum levels

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52
Q

Digoxin Interaction: Amiodarone

A

increases serum digoxin levels

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53
Q

Digoxin Interaction: St Johns Wort

A

Reduce efficacy of Digoxin

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54
Q

Digoxin Interaction: Erythromycin

A

increase serum levels of digoxin

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55
Q

Digoxin Interaction: Diuretics

A

3x times likely increase of digoxin toxicity

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56
Q

Tranexamic Acid Mode of Action and Use

A

Used to control bleeding

Dose this by:

occupying the necessary binding sites which prevents the dissolution of fibrin, thereby stabilising the clot and preventing haemorrhage

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57
Q

What is tranexamic acid usually prescribed for

A

heavy periods and nose bleeds

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58
Q

Coagulation factor Deficiency Treatment

A

Vitamin K

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59
Q

What is Subarachnoid Haemorrhage

A

Bleeding in space surrounding brain

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60
Q

Subarachnoid Haemorrhage Treatment

A

Surgery

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61
Q

Blocked Catheter and Line Treatment

A

UROKINASE

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62
Q

Urokinase Mode of Action

A

activates plasminogen to plasmin, which in turn degrades fibrin clots

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63
Q

What are the two types of Venous Thromboembolism

A
  • Deep Vein Thrombosis
  • Pulmonary Embolism
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64
Q

What is Deep Vein Thrombosis

A

Blood clot in deep vein, usually in one leg

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65
Q

What is Pulmonary Embolism

A

Detachment of blood clot, travels to lugs and blocks the pulmonary artery

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66
Q

VTE Risk Assessment

A
  • Immobility
  • BMI >30
  • Malignant Disease (presence of cancer cells)
  • 60+ years
  • History / Genetic
  • thrombophilic disorders (easy blood clot forming)
  • HRT / Contraception
  • Pregnancy
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67
Q

Mechanical VTE Prophylaxis

A

Stockings
(usually for scheduled surgery patients)

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68
Q

Pharmacological VTE Prophylaxis

A

Parenteral Anticoagulants

  • LMW Heparin (unfractionated heparin in renal failure, due to short half life)
  • Fondaparinux

VT Antagonist Anticoagulant
- Warfarin

Non-VK Antagonist Oral Anticoagulant
- Edoxaban

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69
Q

Duration of VTE treatment due to surgery

A

General Surgery
- 5-7 days or until sufficient mobility

Major Cancer, Abdomen or Pelvis Surgery
- 28 Days

Knee/Hip Surgery
- extended duration

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70
Q

VTE in Pregnancy

A

Heparin/Low molecular weight heparin

  • lower risk of osteoporosis and heparin-induced thrombocytopenia
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71
Q

What drug class are Heparins

A

Parenteral Anticoagulants

72
Q

2 types of Heparin

A
  • low molecular heparin
  • unfractionated heparin
73
Q

Unfranctionated Heparins Mode of Actions

A

activates antithrombin

74
Q

Low Molecular Weight Heparin Mode of Action

A

inactivates factor Xa

75
Q

Unfractionated Heparin

A
  • Short duration of action
  • used if:
    — high risk of bleeding
    — renal impairment
  • essential to measure APTT (how long it takes to clot)
76
Q

Low Molecular Weight Heparin

A

Enoxaparin, Dalteparin

  • longer duration of action
  • used if:
    — osteoporosis
    — heparin-induced thrombocytopeonia
77
Q

Side Effects of Heparin

A
  • Haemorrhage (stop heparin, use Protamine)
  • Hyperkalaemia (reduces aldosterone secretion)
  • Osteoporosis
  • Heparin-Induced Thrombocytopoenia (low platelet count)
78
Q

Other parental Anticoagulants

A

Argatroban
Hirudin
Epoprostenol

79
Q

White Warfarin

80
Q

Brown Warfarin

81
Q

Blue Warfarin

82
Q

Pink Warfarin

83
Q

Dose of Warfarin

A

5mg initially, monitor every 1-2 days

  • Maintenance dose: 3 to 9 mg daily
84
Q

Isolated Calf DVT warfarin treatment

A

VTE is limited to lower limbs

Warfarin for 6 weeks

85
Q

Provoked VTE

A

VTE with a cause

Warfarin every 3 months

86
Q

Unprovoked VTE

A

Warfarin at least 3 months

87
Q

Monitoring of Warfarin

A

INR International Normalised Ration

every 3 months once stable

88
Q

Normal INR Levels

A

1.1 or below

89
Q

If a person has VTE, target INR levels are:

90
Q

If a person has recurrent VTE, target INR levels are:

91
Q

Warfarin yellow booklet

A

Booklet explaining treatment, and allows for treatment record keeping

92
Q

What is an anticoagulant alert card

A

Safety card that provides appropriate details of their treatment

93
Q

Warfarin and Direct Acting antiviral

A

changes INR, affects efficacy o warfarin

Monitor INR

94
Q

Warfarin and Daktarin (miconazole gel:fridge)

A

miconazole inhibits enzymes, increasing effects of anticoagulant

95
Q

Stop warfarin when…

A

Sign of bleeding or blood in urine

96
Q

Side Effects of Warfarin

A
  • Bleeding
    (antidote for bleeding, Vitamin K)
  • Calciphylaxis: painful rash
    (calcium accumulates in small blood vessels of the fat and skin tissues)
    — Risk factor of Calciphylaxis: end stage renal disease
97
Q

If INR is 5 to 8 and no bleeding

A
  • stop taking for 1 to 2 doses
  • reduce dose
  • measure INR in 2 to 3 days
98
Q

If INR is 5 to 8 plus minor bleeding

A
  • Stop warfarin
  • IV Vitamin K
  • restart when INR is below 5
99
Q

If INR is above 8 and no bleeding

A
  • stop warfarin
  • oral vitamin k
  • restart when INR is below 5
100
Q

If INR above 8 and minor bleeding

A
  • stop warfarin
  • IV Vitamin K
  • restart warfarin when INR is below 5
101
Q

Warfarine and Elective Surgery

A
  • stop Warfarin 5 days before surgery
  • Oral vit K for 1 day id INR 1.5 and above
  • Restart warfarin next day
102
Q

Warfarin and Emergency Surgery

A
  • Try to delay for 6 to 12 hours
  • While taking IV Vit K and dried prothrombin complex
103
Q

Anticoagulant and High risk of bleeding with surgery

A

Start low molecular heparin 48 hours after surgery

104
Q

Novel Oral Anticoagulants (NOACs)

A

Inhibit specific clotting factors, e.g thrombin or factor Xa

105
Q

Examples of NOACs

A
  • Apixaban
  • Edoxaban
  • Rivaroxaban
    (Direct factor Xa inhibitors)
  • Dabigatran
    (direct thrombin inhibitor (4 months expiry))
106
Q

Advantages of NOACs over Warfarin

A
  • rarely causes bleeding
  • no monitoring requirements
107
Q

What is an Ischaemic Stroke

A

Blood clot obstructing supply

transient ischaemic attack:
- mini strokes

108
Q

Haemorrhagic Stroke

A

Weak blood vessel in vein bursts

intracerebral haemorrhage

109
Q

Transient Ischaemic Stroke Management (mini)

A

Dipyridamole and Aspirin

110
Q

Ischaemic Stroke Mangament

A

Clopidogrel

(in arterial fibrillation related stroke, review for anticoagulant)

111
Q

Both Transient ischaemic and normal ischaemic stroke mangement

A

Statin

treat hypertension (not with beta blocker)
- unless beta blocker already used for another condition

112
Q

Intracerbral Haemorrhage treatment

A

avoid Aspirin, Statins and Anticoagulants
— because they increase bleeding risk

treat hypertension, but avoid hypo perfusion (reduced blood flow)

113
Q

Antiplatelet drugs mode of action

A

Decrease platelet aggregation and inhibits thrombus formation in the arterial circulation

114
Q

Examples of Antiplatelet medication

A
  • Aspirin
  • Clopidogrel
  • Dipyridamole
  • Prasugrel
  • Ticagrelor
115
Q

Aspirin dose for secondary prevention of CVD/event

A

75 mg daily

116
Q

When is Clopidogrel used

A
  • following acute coronary syndromes
    (conditions related to sudden reduction in blood flow to heart)
  • following Percutaneous coronary intervention (PCI) (non-surgical procedure to widen or unlock narrowed or blocked coronary artery)
117
Q

When to use Dipyridamole

A

secondary prevention of strokes (take 30 to 60 mins before food)

Persantin Retard Capsules have special container (6 week expiry)

118
Q

Stages of Hypertension

A

Normal: 120/80
Stage 1: 140/90
Stage 2: 160/100
Stage 3: 180/110

119
Q

When to start pharmacological management of hypertension: Stage 1 and 2

A

Stage 1:
Only treat if below 80 with
- diabetes CVD, CVD risk of 20%, renal disease, CKD, retinotherapy, left ventricular hypertrophy)

Stage 2:
Treat all

120
Q

Stage 3 management scenarios

A

Hypertensive Emergency with acute target organ damage

  • IV bp reduction
  • reduce organ perfusion (fluid leak to organ)

Hypertensive Urgency without target organ damage

  • oral bp reduction over 24 to 48 hours
121
Q

Hypertension mangement rule

A

always titrate up doses before moving to another line

122
Q

1st Line Hypertension management

A

If under 55 and not afro/carib with type 2 diabetes
— ACEi

if above 55 or afro/carib or can’t handle cough with type 2 diabetes
— ARB (candesartan and losartan)

if pregnant avoid both ARB and ACEi, and don’t give both at the same time

Above 55, no diabetes or afro/carib
— CCB (amlodipine, diltiazem, felodipine)
— If CCB not tolerated due to oedema, give thiazide like diuretic (indapamide)

123
Q

2nd Line Hypertension Management

A

Make sure medication and lifestyle adherence

If already receiving ARB/ACEi add CCB or Thiazide like diuretic

If already receiving CCB/Thiazide like diuretic add ACEi or ARB

124
Q

3rd Line Hypertension managment

A

ACEi/ARB
+
CCB
+
Thiazide like diuretic

125
Q

4th Line Resistant Hypertension management

A

confirm high BP using ambulatory BP monitoring

add fourth antihypertension drug

126
Q

4th Line Resistant Hypertension management: how to choose 4th medication

A

if a patient has Low Potassium (≤ 4.5 mmol/L):

  • low-dose spironolactone

(caution with reduced glomerular filtration rate due to hyperkalemia risk.
Monitor sodium, potassium, and renal function at initiation and regularly thereafter)

If a patient has High Potassium (> 4.5 mmol/L):

alpha-blocker
- Doxazosin

Beta-blocker
- Atenolol
- Bisoprolol
- Propranolol

(Monitor potassium levels and adjust treatment as needed)

127
Q

Under 80 BP Targets

A

140/90 or less

130/90 or less
in atherosclerotic CVD and diabetes with kidney disease

128
Q

Over 80 BP Target

A

150/90 or less

129
Q

Renal Disease BP Targets

A

140/90 or less

130/80 or less if CDK, diabetes, proteinuria >1g

130
Q

Diabetes BP Targets

A

140/80 or less

130/80 or less if complications of diabetes

131
Q

Pregnant BP Targets

A

150/100 or less

140/90 or less if chronic hypertension, target organ damage or given birth

132
Q

Angiotensin-Converting Enzyme Inhibitor (ACEi) mode of action

A

Inhibits the conversion of angiotensin 1 to angiotensin 2

133
Q

Angiotensin 2 receptor blockers mode of action

A

blocks angiotensin 2 receptor, does not inhibit the breakdown of bradykinin

(alternative to ACEi if coughing or afro/carib)

134
Q

ACEi Doses

A

Taken OD and first dose is at bedtime

Captopril only ACEi with BD dose

Perindopril 30-60mins before food

135
Q

Side Effects of ACEi

A
  • persistant dry cough
  • hyperkalaemia (higher risk in renal impairment and diabetes)
136
Q

Side Effects of ACEi Part 2

A
  • Anaphylactoid reaction (similar to anaphylaxis)
  • Oral ulcer
  • taste disturbance
  • hypoglycaemia
137
Q

Pregnancy and ACEi

A

Avoid ACEi

138
Q

ACEi Renal Effects

A
  • Renoprotective (as it inhibits angiotensin 2)
  • Nephrotoxicity (drop in renal perfusion pressure and then decrease in glomerular filtration)
139
Q

ACEi Hepatic Effects

A
  • Cholestatic jaundice
  • hepatic failure
  • liver transaminases increase (protein in liver helping with function)

stop taking if liver transaminases are 3x normal (normal is <65) or jaundice

140
Q

ACEi Interaction that Increase chance of hyperkalaemia

A
  • Aiskeren
  • ARB
  • K+ sparing diuretics
  • Aldosterone Antagonists
141
Q

ACEi interaction that increases nephrotoxicity and reduces eGFR

A
  • NSAIDs (afferent arteriole constriction
142
Q

ACEi interaction that increases hypotension

A
  • Diuretics (volume depletion = low blood pressure)
143
Q

ACEi interaction that produces renal impairment, hyperkalaemia and hypotension

A
  • ARB
  • Renin inhibitor

(avoid ACEi and ARB in diabetic nephropathy)

144
Q

Angiotensin-11 Receptor Blockers (ARB) Mode of Action

A

Blocks angiotensin 2 recepto. Does not inhibit the breakdown of bradykinin

145
Q

Centrally Acting Anti-hypertensives Mode of Action

A

alpha2-adrenoceptor stimulation in the brain stem.

146
Q

Centrally Acting Anti-hypertensives examples

A
  • Methyldopa (side effects: nausea and dizziness)
  • Clonidine (side effects: sleepy, dry mouth, erection problems)
  • Moxonidine (side effects: dry mouth, sedation, oedema)
147
Q

Hydralazine antihypertensive mode of action and side effects

A

arteriolar dilator acting directly on the smooth muscle of arterioles, resulting in reduced peripheral vascular resistance and reduced blood pressure.

Side Effects: loss of apetite, tachycardia, nausea, fluid retention

148
Q

Minoxidil antihypertensive mode of action and side effects

A

opens adenosine triphosphate‐sensitive potassium channels in vascular smooth muscle cells, resulting in vasodilation

Side effects: fluid retention, tachycardia , extra hair growth

149
Q

Alpha Blockers Antihypertensive Mode of Action

A
  • keep a hormone called norepinephrine from tightening the muscles in the walls of smaller arteries and veins.
  • therefore, the blood vessels remain open and relaxed.
150
Q

Alpha Blocker Examples

A
  • Prazosin
  • Terazosin
  • Indoramin
151
Q

Beta-Adrenorecptor Blockers (beta blocker) mode of action

A

block beta adrenoreceptor in the heart, peripheral vasculature, bronchi, pancreas and liver

152
Q

Examples of Beta blockers

A
  • atenolol
  • bisoprorol
  • propranolol
153
Q

Esmolol (Beta Blocker)

A
  • Esmolol (hypertension in peroperative period-surgical time- as it has a short half life)
154
Q

Labetalol (Beta blocker)

A
  • Labetolol (hypertension in pregnancy, but hepatoxic)
155
Q

Sotalol (beta blocker)

A
  • Sotalol (class 3 anti-arrhythmic)
156
Q

Types of Beta Blockers- 4 types

A
  • Intrinsic sympathomimetic activity
  • Water-soluble
  • Cardio-selective
  • OD Dosing
157
Q

Intrinsic sympathomimetic activity Beta Blockers (ice PACO)

A

P indolol
A cebutalol
C eliprolol
O xprenolol

  • less bradycardia
  • less cold extremities
158
Q

Water Soluble Beta Blockers (water CANS)

A

C eliprolol
A tenolol
N adolol
S otalol

  • less likely to cross BBB
  • less sleep disturbances
    (reduce dose in renal impairment)
159
Q

Cardio Selective Beta blockers (Be A Man)

A

B isoprolol
A tenolol
M etoprolol
A ceubutol
N ebivolol

  • less bronchospasm
160
Q

OD Dosing beta blocker (BACoN)

A

B isoprolol
A tenolol
C eliprolol
N adolol

  • long duration of action
161
Q

Side Effects of Beta blockers

A
  • bradycardia
  • hypotension
  • hyperglycaemia (reduces insulin release)
162
Q

Contra-indications of beta blockers

A
  • Asthma (causes bronchospasm)
  • Worsening unstable heart failure
  • Second/degree heart block
  • Severe hypotension and bradycardia
163
Q

Beta blocker interactions

A

Verapamil Injection
- causes asystole (heart stops beating) and hypotension

Thiazide Like Diuretic
- hyperglycaemia (avoid in diabetes and risk of diabetes)

164
Q

Calcium Chanel Blockers (CCB)

A

blocks calcium channels to reduce force of contraction conductivity and vascular tone

165
Q

Digydropyridine CCB examples

A
  • Amlodipine
  • Felodipine
  • Lercanidipine
  • Lacidipine
  • Nifedipine (same S/R brand)
166
Q

CCB Side effects

A
  • ankle swelling
  • flushing
  • headaches
167
Q

Rate Limiting CCB examples

A
  • Verapamil (causes constipation, only CCB for arrhythmias)
  • Diltiazem (keep brand if >60mg)
168
Q

CCB Interactions

A

avoid grapefruit juice
(it increases CCB concentrations)

169
Q

What is a phaechromocytoma

A

tumour in adrenal gland, causing increase in hormone production (epinephrine and norepinephrine)

170
Q

Phaechromocytoma treatment

A
  • surgery
  • if cancerous chemo and radio
  • alpha blocker (phenoxybenzamine)
    — blunts the effects of catecholamines released from the tumor)
171
Q

What is a Hypertensive Crisis

A

Sudden onset of high blood pressure usually =>180/120

172
Q

Hypotension and Shock

A

low bp can cause damage to organs, leading to shock.

173
Q

Vasoconstrictor Sympathomimetics mode of action

A

raises blood pressure for short period by acting on alpha-adrenergic receptors to constrict peripheral blood vessels

174
Q

Hypotension induced shock treatment

A

Vasoconstrictor Sympathomimetics
- epinephrine
- noradrenaline
- phenylephrine (longer lasting bp rise)

175
Q

Side effects of Vasoconstrictor Sympathomimetics

A
  • reduced perfusion to vital organs

Victor BNF Notes (25 decks)

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