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Chapter 2 Cardiology > Conditions > Flashcards

Conditions Flashcards

1
Q

what is ARRHYTMia and how are they detected

A

abnormal rate and rhytm of heart caused by an obstruction in the electrical conduction in the heart
Detected via ECG

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2
Q

symptoms of arrthymias

A

breathlessness, chest discomfort, stroke, palpitations, syncope

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3
Q

how is the risk of stroke assessed in those who have atrial fibrillation

A

CHAD2DS2Vasc score

MEN= 1 WOMEN=2

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4
Q

How is the risk of stroke managed in af

A

anticoagulants- doacs

2nd line warfarin

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5
Q

How is the risk of bleeding assessed in AF

A

ORBIT score

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6
Q

what is acute AF and how is the life threatening and non-threatening sytoms treated

A

acute means it is new onset of AF
life-threateniing- emergency electrical conversion (electrical shock)
non-life threatening= pharmacological cardioversion e.g amiodarone , flecanide and beta blockers
if under 48hrs can give rate or rhytm control
if over 48 hrs onset or it is uncertain then give rate control

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7
Q

What is paroxysmal AF?

A

episodes of AF Athat stops within 7 days usually within 48 hrs without any treatment
pt only takes medications when symptoms occur

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8
Q

What are the causes arrthymias

A

aging, hypertrension, heart conditions, cardiomyopathy

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9
Q

what is cardioversion

A

restores sinus rhythm of the heart

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10
Q

which parenteral anticoagulant is given to patients with acute (new onset) AF who are recieving no anticoagulation and are waiting for the appropriate anticoagulant to be started

A

heparin

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11
Q

first line and second line anticoagulation for af

A

DOACS E.G apixaban and edoxaban are first line

if ci e.g due to renal impairment use warfarin

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12
Q

supraventricular arrthymia drugs

A

verapamil, adenoside, cardiac glycosides

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13
Q

ventricular arrthymia drugs

A

Lidocaine sotalol

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14
Q

what class are amiodarone and sotalol in the vaughan william classification for arrthytmic drugs

A

class 3, sotalol is also class 2

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15
Q

which is first line for arrthymias= rate or rhythm control

What are the exceptions

A

Rate control except when
atrial flutter suitable for ablation strategy- use heat or cold energy to block electrical activity
AF with reversible cause e.g MI, Hyperthyroidism, PE, caffine/ alcohol
heart failure caused by AF
or if rthym control is more appropriate

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16
Q

drugs that are used for rate control in af

DIVED BETA

A

beta blockers (not sotolol)
rate limiting calcium channel blocker e.g verapamil and diltiazem
digoxin *monnotherfapy only considered for initial rate control in patients with non paroxysmal af and other drugs unsuitable.
digoxin also used if patient has congestive heart failure

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17
Q

Which drug combinations can be used if monotheray doensnt work for rate control for AF
BB and DD

A

Beta blocker
digoxin
Diltiazem

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18
Q

what drugs are used for rhythm control

FABrhythmS;PD

A 
beta blockers (not sotalol) as first line
flecanide (avoid in heart disease)
amiodarone
propafenone (avoid in heart disease)
dronedarone
sotalol (beta blocker but not first line
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19
Q

What are the two types of cardioversion

A

pharmacological: flecanide and amiodarone-if they have structural or ischaemic heart disease
electrical: electric shocl

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20
Q

why is antoicoagulant given before cardioversion if stroke is over 48 hrs and how many weeks before and how long is it conrinued for after
If it is not possibke to be given before- what should be done/used instead

A

The prcodeure of electrical cardioversion can spread around the blood clot whihc can go to the brain and cause a dtroke. anticoag should be given 3 weeks before cardioversion to avoid this and continued for 4 weeks after
if not possible give heparin immediatly then cardioversion

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21
Q

what does CHA2DS2-VASC score

A 
congedstive heart failure=1
hypertension=1
age equal and over 75 years=2
age 65-74=1
diabetes mellitus=1
Stroke/TIA. thrombo-embolism=
Vascular disease=1
Sex Female=1
vascular disease includes previous MI, PAD or aortic plaque
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22
Q

what score of CHA2D2SVAS2C SCORE reqiures anticoagulation

A

2 and above

AN2COAGULANTS

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23
Q

what does ORBIT stand for

A 
Older than 74yrs=1
Reduced haemoglobin (history of anemia)=2
Bleeding history e.g gi bleed, intracranial bleed or haemorrhage stroke=2
Inadequate renal function (GFR<60)=1
Treatment with antiplatelet=1
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24
Q

What do the different ORBIT scores mean in terms of risk of bleeding

A

0-2 low risk
3 medium risk
4-7 high risk

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25
Q

what does HASBLED stand for

A 
hypertension (160/90) 1
abnormal liver or kidney function 1
stroke 2
bleeding history 1
lacible inr 1
elderly (over 65) 1
drug treatment- antiplatelet or nsaid / alcohol 1-2
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26
Q

what is torsades de pointes

A

type of arrthymia where the heart beats in an irregualr way usually too fast so not enough oxygen is being pumped around the body resulting in blackouts, faininting and deaths

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27
Q

Which rhythm control drugs should be avoided in heart disease

A

Propagenone and flecanide

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28
Q

What are the triggers for torades de pointes

A

stress, strenous exercise, sudden noise, hypokaleamia, bradycardia and drugs such as sotalol

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29
Q

what is the treatment for torsades de pointes

A

IV magnesium sulphate

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30
Q

which drugs can cause QTC Prolongation

ABCDDE

A 
Anti-arrthymics e.g amiodarone, sotalol, flecanide
antiBiotics
antispsyChotics
antiDepressants
Diuretics
antiEmetics- ondansetron
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31
Q

what is the dose for amiodarone

A

200mg tds 1 week then 200mg bd for a week then 200mg od

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32
Q

amiodarone s/e

ami is a photosensitive BITCH

A 
Photosensitivity = grey slate skin so use at least spf 30
bradycardia
Interstitial lung disease
thyroid dysfunction= contains iodine
corneal- occular
hepatic
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33
Q

c/i of amiodarone

A

iodine sensitivity

thyroid function

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34
Q

monitoring of amiodarone

A 
TFT 6 MONTHS
LFT
Potassium
chest x ray
annual eye tests
ECG with IV use
Blood pressure
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35
Q

what pt counselling associated with amiodarone

A

shield from sunlight- wear sunscreen
seek medical attention if have follwoing s/e= SOB, lightheadness, palipitations, fainting, unusual tiredeness, chest pain

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36
Q

amiodarone drug interactions

A

QT prolongation
statin- increased risk of myopathy
lityhium- increased risk of arrthymia
increased plasma conc with warfarin, digoxin, ciclosporin and phenyoin

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37
Q

what is the therapeutic range for amiodarone

A

1-2.

above 1.5 is increased toxicity

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38
Q

MOA of digoxin

A

increases force of myocardial contraction and decreases HR by reducing conductivity in atrio-ventricular node.

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39
Q

digoxin dose for atrial fibrillation maintenance

A

125-250mg od- loading dose required

62.5-125mcg od- no loading dose required used for heart failure sinus rhthym

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40
Q

is digoxin excreted renally or hepatically

A

reanlly

reduce dose in elderly

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41
Q

if a patient is on digoxin and has nausea what can you do to the dose

A

half dose of digoxin because it has long half life

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42
Q

why can you switch between formualtions of digoxin

A

different formulations have different bioavailablities and has a narrow therapeutic range

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43
Q

what is the therapeutic range for digoxin

A

1-2mcg/L

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44
Q

What is the toxic range for digoxin

A

1.5mcg/L-3MCG/L

increases progressively through this range

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45
Q

whys hould the digoxin range in elderly be reduced

A

more suseptible to toxicity

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46
Q

Digoxin predisposes to which electrolyte disturbances

A

hypokalaemia
hypomagnesia
hypercalcaemia
hypoxia

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47
Q

what d given to prevent hypokalaemia in digoxin

A

k spaing diuretics or k supplements

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48
Q

what steps hsould be taken if digoxin toxicity occurs

A

withdraw digoxin

if life threatening use digifab- digoxin specific antibody fragments

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49
Q

what the signs of digoxin toxicity

A

yellow vision
arrthymias
cardiac construction disorder
dizziness, nausea etc

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50
Q

monitoring requirements for digoxin

A

Plama-digoxin conc= taken 6 hrs after a dose
serum electrolytes
renal function- reduce in renal impairement

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51
Q

drug interactions with digoxin

CRASED

A 
renal excreted= NDSAIDS, ARBS/ACEI
enzyme inducers- reduced digoxin conc
enzyme inhibitors- increase digocin conc
Decreased potassium e.g diuretics, theophylline, steroids
CCCB
RIFAMPICIN
AMIODARONE
ST JOHNS WORT
ERYTHROMYCIN
DIURETICS
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52
Q

antifibrolytiic drugs

A

tranexamic acid- inihibits fibrolysis

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53
Q

uses of antifibrolytics and doses

A

prevents bleeding e.g surgery or dental extraction
management of menorrhagia 1g tds for up to 4 days max 4g a day and start when menstration starts
herediatry angioedema, epistaxis (nose bleeds) , general fibrolysis and thromboltic overdose,
epistaxis- 1g tds for 7 days
fibrinolysis 1-1.5g 2-3 times a day

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54
Q

which patients are at high risk of VTE

A 
BMI over 28
contraceptives- HRT COC
Low mobility
malignnat disease e.g cancer
pregnancy
dehydration
over 60 years
family history of vte
thrombophilic disorder
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55
Q

what is used for pharmacological prophylaxis (unconfirmed) in DVT and PE

A

LMWH
Unfractionated heparin
Fondaparinux
DOACS

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56
Q

what pharmacological treatment is used for DVT and PE

A

1st line Rivaroxaban, apixaban
pregnant : LMWH / Heparin
Alternative LMWH for 5 days follwed by dabigatran/ edoxaban
renally impaired 15-50 offer either apixaban rivaroxaban or lmwh for 5 days follwed by rivaroxban or apixaban

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57
Q

when should you not use mechanical prophylaxis of DVT/PE for a pt in hospital

A

acute stroke, peripherfal arterial disease, peripheral neuropathy, severe leg oedema or local conditions e.g gangrenen or dermatitis

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58
Q

What anticoagulants and when are they given to patients undergoing orthopeadic surgery

A

Offer pharmacological prophylaxis for patiets undergoing surgery within 14 hrs of admission or before
use LMWH
unfractioned heparin preferred in patinets with renal impairment or increased risk of bleeding

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59
Q

which surgeries should fondaparinux be given for VTE and how long post surgey

A

hip/knee replacement, hip fracture, G.I Bariatric or day surgery procedures
7 days or until patient is mobile

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60
Q

when are DOACS used as pharmacological thromboprophylaxis

A

elective hip/knee replacement after LMWH or low dose aspirin

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61
Q

when shounld unfractionated heparins be used as pharmacological thromboprophylaxis

A

renal cleareance 15-50ml/min or increased bleeding risk

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62
Q

which anticoagulants can be used in pregnancy and why

A

heparins are safe as they dont cross the placenta
lmwh preferred due to lower risk of osteoporosis abd heparin induced thrombocytopenia (low platelets)
lmwh are eliminated more rapidly in pregnancy so may need to adjust the dose

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63
Q

for a confirmed dvt or pe how long should anticoagulant be given for

A

at least 3 -6 months for active cancer

3 months otherwise

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64
Q

for provoked e.g due to pregnancy or contraception dvt and PE how long is anticoagulant treatment

A

3 months

3-6 months active cancer

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65
Q

unprovoked DVT or PE how long is the duration of anticoagulation treatment

A

Over 3 months

active cancer for over 6 months

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66
Q

in patients who has dvt or pe decline anticoagulant treatment which medication should be used

A

aspirin or another antiplatelet

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67
Q

what is the most common side effect of heparins and lmwh and what do we do to reverse it

A

Haemorrhage if it occurs then withdraw

protamine sulphate is the antidote but only partially revserses effects of lmwh

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68
Q

what are the three different types strokes

HIT

A

Haemorrhagic stroke
ischaemic stroke
transient ischaemic stroke

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69
Q

What are the symptoms of stroke

A 
FAST
face drop
arm weakness
slurred speech
time to act- call 999
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70
Q

how is haemorrhagic stroke treated

A

surgey (avoid all meds)

and treat the hypetension

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71
Q

how is TIA treated initially

A

give aspirin 300mg immediately with ppi if dsypepsia and arrange urgent care within 24 hrs
clopidogrel -unlicensed 75mg if intolerant of aspirin

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72
Q

what is the initial management for ischaemic stroke

A

alteplase if within 4-5 hrs of stroke symptoms and intracranial haemorrhage has been excluded OR
aspirin 300mg or clopidrogrel 75mg within 24hrs of symproms onset

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73
Q

when is anticoagulant given in stroke

A

long term managememt if the patient has AF, DVT or thrombosis

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74
Q

Long term management of stroke- tia/ ischaemic stroke

CLAAS

A

Clopidogrel 75mg OD OR
MR dipyramidole 200mg BD + aspirin 75mg OD OR
MR dipyramidole 200mg BD if the above contraindicated
Lifestyle
Anticoagulant/Warfarin if af dvt or thrombosis instead of antiplatelets
Antihypertensives - keep bp below 130/80 but avoid BB because increases the risk of stroke
Statins 48hrs after stroke- high intensity atorv 20-80mg

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75
Q

a patient has a TIA in a pharmacy do you give 300mg or call 999

A

If the patient has a haemorrhagic stroke, aspirin will make them bleed even more
need to determine what type of stroke it is and need to do this by a scan in a hospital

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76
Q

name the caourmarins and phenindiones and how long it takes for them to be fully efefctive

A

warfarin, acenocoumarol and phenindione
takes 48-72hrs to get full effect
warfarin is drug of choice
different streghths

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77
Q

name the different strengths of warfarin and their colours

A

0.5 white
1mg brown
3mg blue
5mg pink

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78
Q

what are the mhra warnings associated with warfarin

A

pts with renal disease are more likely to get calciphylaxis whihc is a painful rash that needs to be referred to the GP
miconazole- daktarin oral gel causes bleeding e.g unexplained bruising, nose bleeds, blood in urine- stop and seek medical advice

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79
Q

Whar is the antidote for warfarin

A

phytomendione

vitamin k1

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80
Q

which foods and drinks should be avoided when taking warfarin

A

cranberry juice
Pomegranate juice increases INR
avoid diet change- liver sprouts, brocoli, green tea, salalds and leafy green vegetables
alcohol- heavy drinking decreases effects of warfarin

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81
Q

why cant warfarin be given in pregnancy

A

Teratogenic especially in 1st and 3rd trimester
crosses placenta leading to fetal abnormalities
risk of haemorrhage due to vitamin k deficiency

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82
Q

which conditions require an INR value of 2.5

MORE IMPORTSNAT TO LEARN THIS CARD THAN 2.5 CARD

A 
treatment DVT or PE
AF
Cardioversion
dilated cardiomyopathy 
mitral stenosis regurgitation 
myocardial infarction
acute arterial embolism
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83
Q

whihch conditions requires an INR of 3.5

MORE IMPORTSNAT TO LEARN THIS CARD THAN 2.5 CARD

A

reccurent dvt/pe
mechanical prosthetic heart valves
if within 0.5 it is satifactory

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84
Q

if pt has major bleed on warfarin

A

STOP WARFARIN

phytomendione by slow iv injection and/or dried prothrombin complex/ fresh frozen plama (less effective)

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85
Q

if patient has inr over 8 and minor bleeding what should you do

A

stop warfarin
phytomendione slow iv injection. repeat dose of vit k if inr still high sfter 24hrs
restart inr when under 5

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86
Q

if patient has inr over 8 but no bleeding

A

stop warfarin
iv phytomindione by mouth whihc is unliscend. repeat vit k if inr still high after 24 hrs
restart when inr under 5

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87
Q

if pt has inr between 5-8 and minor bleed

A

stop warfarin
phytomiodione by slow iv injection
restart inr when below 5

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88
Q

if patient has inr between 5-8 and no bleed what should be done

A

withold warfarin for 1 to 2 doses

reduce subsequent maintenance doses

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89
Q

when is phytomendione given by slow iv

A

major bleed

minor bleeds inr 5 upwards

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90
Q

when is phytomindione iv given by mouth

A

no bleeding but inr over 8

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91
Q

what are the drug intercations assocaited with warfarin

A

enzyme inducers decrease the effects
enzyme inhibitors , benzafibrates and amiodarone increase the effect
aspirin increases the risk of bleeding

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92
Q

whihc has a higher risk of bleeding
Clopidogrel and warfarin OR
Aspirin and warfarin

A

clopidogrel and warfarin

can use together but should reduce the amount of time together or withold antiplatelet whilst taking warfarin

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93
Q

what is the difference between heparin and lmwh

A

heparin
intiates anticoagulation rapidly but for a short amount of time- used for pts with increased risk of bleeding becaus eyou can stop it very quickly by stopping infusion
LMWH
Doesn’t cross placenta so can be used in pregnancy
preferred over heparin because it is very effective and less risk of heparin induced thrombocytopenia and osetoporisis
longer cation and given once daily
doesnt require monitoring
20,000 unit/ml syringe licensed for extended treatmnet and prophylaxis of VT in patinets with solid tumors

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94
Q

moa of antiplatelets

A

decrease platelet aggregation and inhibit thrombus formation in the arterial circulation

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95
Q

is aspirin used in primary or secondary prevention of cvd

A

secondary

give ppi if high risk of bleeding

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96
Q

indication of dipyridamole

A

prophylaxis of thromboembolism assocaietd with prosthetic heart valves
mr for secondary prevntion of ischaemic stroke and tia- 200mg bd with food

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97
Q

what is the important prescriiing and dispensing information associated with dipyridamole

A

should be dispensed in its original container- pack contains desicant and any remaining caps should be discarded 6 weeks after opening the pack

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98
Q

when are doacs preffered to warfarin in AF

A

Non valvular AF e.g due to thyroid dsyfunction etc. DOACS preferred
stenosis and problem with valves are valvular AF where warfarin is more suitable

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99
Q

when do you give anticoagulant for prevention of stroke

A

diabetes, hypertension , previous MI, stroke/TIA, age equal to or above 75years
use chadvasc score

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100
Q

which parameters require dose reduction in DOACS?

ABCD

A

age= equal to or above 80
body weight under 61/60kg
Crcl=15-50
drugs e.g verapamil, amiodarone, erthyromycin, ciclosporin

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101
Q

What drug is contra-indicated in antiphospholipid syndrome?

A

doacs because this condition creates an immune response whihc creates antibodies which makes blood clot increases the risk of recurrent thrombotic events

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102
Q

Which doac is given in heart attacks- ACS and dose

A

Rivaroxaban at 2.5mg BD

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103
Q

what dose is rivaroxaban given at for stroke prophylaxis

A

20mg OD

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104
Q

What dose is rivaroxaban given at for VTE prophylaxis

A

10mg OD

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105
Q

What dose is apixaban given at for VTE prophylaxis

A

2.5mg BD

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106
Q

What dose is apixaban given at for stroke prophylaxis

A

5mg BD

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107
Q

How many times daily are each of the DOACS given

A

Once a day
Rivaroxaban
Edoxaban

Twice a day
Apixaban
Dabigatran

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108
Q

what needs to be monitored when giving doacs

A

kidneys

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109
Q

do all doacs have patient alert cards

A

yes

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110
Q

moa of dabigaTran

A

direct thrombin inhibitor with a rapid onset of action

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111
Q

apiXAban EdoXAban and rivaroXAban moa

A

direct and reversible inhibitors of factor Xa

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112
Q

which doac does not have an antidote

A

edoxaban

edoxaban has no ban

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113
Q

what is the antidote for dabigatran

A

idarucizumab

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114
Q

what is the antidote for apixaban

A

anadexanet alfa

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115
Q

what is the antidote for rivaroxaban

A

Andexanet Alfa

116
Q

what are the indications doacs

A

prophylaxis of stroke and systemic embolism in non valvular AF
secondary prevention of DVT and PE
Prevention of VTE in hip or knee replacement
rivaroxaban for atherosclerotic events in ACS

117
Q

what is the mOA of warfarin

A

inhibits vitamin K by dreasing clotting factors II, VII, IX and X

118
Q

what is the mhra advice surrounding rivaroxaban dosing

A

15mg and 20mg has to be given with food

119
Q

when should dose of 5mg BD of apixaban for stroke prophylaxis be reduced to 2.5mg BD
ABCC

A 
2 of the following (creatinine count as the same point)
age over or equal to 80
body weight equal to or over 60kg
creatinine equal to or over 133
creatinine clearance of 15-50
120
Q

what is the normal dosing for warfarin

A

initially 4-10mg then maintain at 3-9mg taken at the same time daily

121
Q

what is the dose of dabigatran given for prophylaxis of VTE after knee replacement

A

110mg for 1-4 hours after surgery then 220mg OD for 10 days

122
Q

What dose of dabigatran is given for prophylaxis of stroke and when should it be reduced

A

150mg BD
if pt over or equal to 80 years old reduce to 110mg BD

on verapamil
or crcl=30-50ml/min
75-79 years old reduce dose to 110-150mg BD

123
Q

when is dose of edoxaban dose reduced

A

erythromycin, ciclosporin, ketoconazole and dronedarone
or weight less than 61kg
or crcl=15-50

124
Q

what is the cautionary label given with edoxaban and apixaban
Label 10

A

read the additional information given with this medicine

125
Q

what is the cautionary label given with dabigatran

label 10 and 25

A

read the additional information given with this medicine

swallow this medicine whole- do not chew or crush

126
Q

what strenth tabelts do dabigatran come in

A

75mg, 110mg, 150mg caps

127
Q

what strength does apixaban come in

A

2.5mg and 5mg

128
Q

what strength tabelts does rivaroxaban come in

A

2.5mg, 10mg, 15mg, 25mg

129
Q

what strength tabelts does edoxaban come in

A

15mg, 30mg, 60mg

130
Q

Contraindications of anticoagulants

A

dont give to anticoagulants together
confitions with risk factors of bleeding
antiphospholipid syndrome
switching between rivaroxaban and warfarin

131
Q

when tranxexamic acid is given p med what is indication, age and duration

A

4 days
merrhagia
18 and over

132
Q

what are the red flags for tranxeminc acid and where would you refer them to

A

increased risk of dvt with contraceptive
colour vision chnage or viusual impairment - discontinue
leg, arms swollen or red are signs of dvt so refer to hospital
coughing up blood or anaphylactic reaction

133
Q

when is tranexamic acid contra-indicated

A

epilepsy, DVT, PE, irregular periods, renal problems, pregnancy

134
Q

non-modifiable risks of CVD

A 
over 50 starts to increase
ove 85 particular risk
south asian
men
family history
135
Q

what is the difference between QRISK 2 and QRISK 3 and what does it do

A

Incrased risk of CKD, lupus, migraine, steroid use, atypical antipsychotics, mental illness, erectile dysfunction
estimates 10 year risk

136
Q

what does JBS3 measure

A

estimates lifetime risk of cvd risk

137
Q

what is ASSIGN

A

assign estimates 10 year risk

138
Q

What QRISK score elicits starting a statin

A

equal to or above 10%

139
Q

what are the exemptions to the cardiovascular risk assessments

A 
pts with
diabetets type 1
established cvd
CKD
Familial hypercholesterimia
equal to or over 85 years old esp if they spoke
140
Q

what are the drugs given in primary prevention of CVD

A

Antihypertensives if over 140/90

low dose statin 20mg atorv

141
Q

causes of hyperlipidemia

A

hypothyroidism
antipychotics, immunosuppressant , corticosteroids
diabetes

142
Q

what is a high intensity statin and examples

A

a statin that reduces ldl by 40%

atorv and rosuvastatin and 80mg simvastatin are high intensity

143
Q

what statin and dose should be used for primary prevntion of cvd

A

atorvastatin 20mg

144
Q

what is second line to statins for hypercholesterolemia

A

either start ezetimibe or use both ezetimibe and statin

can then use fibrats, bile acid sequestrant or nicotinic acid after talking to specialist

145
Q

when are fenofibrates used

A

fenofibrate are better at reducing triglycerides than statins

146
Q

why should statins and fibrates not be used together

A

increased of rhabdomylisis- breakdown of mucsle

147
Q

what should be monitored when starting statins

A 
lipid profile
liver enzymes and 3 and 12 months in
cK
Hba1c/ fasting blood glucose and 3 months in
hypothyroidism
renal function
148
Q

why should statins and gemfibrozil not be used together

A

considerable risk of rhabdomylysis

149
Q

what is the moa of statin

A

inhibits the HMG CoA reductase which is found in the liver and produces cholesterol

150
Q

why is statin drug of choice over fenofibrate

A

statins reduce risk of heart attack and total mortality

151
Q

which statins are safe to give in breastfeeding and pregnancy

A

None as its teratogenic - discontine three months before starting to concieve
contraception needed during treatment and 1 month afterwards

152
Q

patient and carer advice given to patients for statin

A

unexplained muscle pain tenderness and weakness

153
Q

whichh statins can be given at any time of day

A

atorvastatin

rosuvavstatin

154
Q

what is the max dose of simvastatin can be given with amlodipine, amiodarone or ranolazine and what is the risk

A

20mg- when given with amlodipine its like doubling the dose so increases the risk of rhabdomylysis

155
Q

When to stop statins when measuring lft and CK levels

A

3 times the upper limit of LFT

5 times the upper limit of CK

156
Q

important interacctions with statins

A

enzyme inducers and inhibitors

157
Q

what is the max dose of simvassttain taht cna be given with fibrates

A

10mg

158
Q

what is the max dose that can be given of atorvastatin with ciclosporin

A

10mg

159
Q

what is the max dose of rosouvastatin that can be given with clopidogrel

A

20mg

160
Q

what is the highest dose of fluvastatin

A

80mg

161
Q

what is the highest dose of prvastatin that cna be given

A

40mg

162
Q

what is the highest dose of Rosuvastatin that can be given

A

40mg

163
Q

is prvaastatin low, medium or high statin

A

all strengths are low

164
Q

which statins and doses are medium intensity

A

20, 40mg Simvastatin
10mg atorvastatin
80mg fluvastatin
5mg rosouvastatin

165
Q

what are the two types of heart failure and what the differences

A

acute heart failure- sudden symptoms so emergency

chronic heart failure- symptoms ongoing

166
Q

what are the symptoms of heart failure

A 
SOB
Persistent coughing/wheezing
ankle swelling
reduced exercise tolerance
chest pain
palpitations
risk greater in smokers, men and increases with age
167
Q

what causes heart failure

A 
CHD especially MI
Hypertension
heart valve
Cardiomyopathy
arrythmias
excess drugs, alcohol
thyroid dysfunvction, severe anaemia leading to reduced cardiac output
168
Q

how is heart failure diagnosed

A

physical examination- pulse enlarged herat, fluid retention

blood tets- measure BNP or NT-proBNP. They both increase in heart failure

169
Q

when should pt report weight changes with heart failure

A

1.5-2kg in 2 days report to GP

170
Q

what does heart failure mean

A

not enough blood is going into and out of the heart so it doenst function properly

171
Q

which medications are used in heart failure with reduced ejection ( which is most common type of HR and what I will be examined on)
ACBD

A

optimise dose of ACEI/ARB then add beta blocker if needed or vice versa
better to start with acei if diabeteic or fluid overload or BB if angina

if symptoms persist then add MRA e.g spironolactone

If patient is afro-Caribbean or therer is another reason pt can’t take ACEI or ARB then use hydralazine and Nitrate

specialist advice if none of this worksqho can add sacubitril, ivabradine, digoxin or hydralazine and nitrate

ACEI/ARB
BB
CCB- only amlodipine
Diuretics e.g loop, MRA e.g spironolactone

172
Q

Which beta blockers are used in herat failure

A

nebivolol, bisporolol, carvedilol

173
Q

when are loop diuretics used in heart failure

when are thiazide like diuretics used in heart failure

A

thiazides ae used for mild fluid retention and eGFR is over 30
loop diuretics is used to relieve breathlessness and oedema

174
Q

whihc MRA are liscensed for heart failure

A

eplerenone, spironolactone

175
Q

which vaccines should be offered to patients who have heart failure and how often

A

Influenza and pneumococcal vaccines annually

176
Q

which drugs should be stopped/avoided in heart failure because they worsen it

A

NSAIDS-increase sodium retention , CCB unless amlodipine

177
Q

which acei are licensed for HF

A

Perindopril, ramipril, captopril, enalapril, lisinopril, quinapril, fosinopril

178
Q

if a patient has COPD/diabetes/erectile dysfunction/ PVD or was old and they had HF
do you give a beta blocker

A

yes because the benefits outweigh the risk

179
Q

whihc ARBs can be used in heart failure

A

candasartan, losartan, valsartan

180
Q

what are the second line add on treatments for HF

A

Aldosterone antagonists e.g spironolatone, epelerone

dapaglifozin/empaglifozin 10mg od

181
Q

what are the three types of acs

A

NSTEMI
STEMI
Unstable angina

182
Q

What is ACS physiology

A

plaque ruptures in a coronary artery that causes a partical or complete blocakage of the artery. the obstruction restricts the blood supply to the heart-lack of oxygen leads to ischaemia (chest pain). Angina is often the first sign
If obstruction is extensive heart muscle starts to die causing myocardial infarction

183
Q

What are the symptoms of angina

A

tight sharp stabbing dull and heavy chest pain
radiates to left arm neck, back, jaw
triggered by exertion and stress
stops within few minutes of lying down

184
Q

difference between unstable and stable angina

A

stable= predictable due to exercise/stress and stops on resting
unstable angina= unpredicable so occurs whilst resting, longer and recurring, chest pain more severe

185
Q

what is the initial management of ACS in hospital

A 
GTN Sublinfual/buccal tablets
IV Opioids e.g morphine ASAP
aspirin 300mg alt clopidogrel ASAP
oxygen If needed
insulin if hyperglycaemia glucose over 11mmol/L
186
Q

what is secondary management of patients STEMI or NSTEMI

A

Cardiac rehab- lifestyle
ACEI/ARB
BB or verapamil/diltiazem
Dual antiplatelet therapy- aspirin and clopidogrel for 12 months OR
Triple therapy - aspirin, clopidogrel and rivaroxaban if the the patine has really high cardiac biomarkers
Statin

187
Q

what are the common side effcts of nitrates

A

ypertensio, fkushing, headaches

188
Q

gtn spray length of action

A

quick acting- 20-30 minutes

189
Q

when should a patient be switched from gtn spray to gtn tablets

A

if using spray moe than twice a week, need the tablet

300mcg tablet most appropriate when first used. alternatively can use the aerosol spray

190
Q

wich form of gtn can be used if longer duration of action is required

A

transdermal patches

however tolerance can grow

191
Q

prophylaxis of angina using gtn- what is the dose

A

1 tablet before activity

1-2 sprays under the tongue

192
Q

treatment of angina using gtn- dose

A

Sublingual tablets 1 tablet repeated at 5 min interval if required. if not resolved after three doses call 999
spray 1-2 doses under tongue for either prophylaxis or treatment
one patch changed every 24hrs

193
Q

moa and role of nitrates

A

potent coronary vasodilators but main benefit is reduction in venous return which reduces left ventricular work.

193
Q

moa and role of nitrates

A

potent coronary vasodilators but main benefit is reduction in venous return which reduces left ventricular work.

194
Q

isosorbide dinitrate

A

active sublingually effective in patients requiring infrequently
effective by mouth even though slow onset
effect persist for a few hours

195
Q

difference in dosage between dinitrate MR preps and mononitrate MR preparations

A

mononitrate is given once a day

dinitrate is given twice a day- has a duration of 12 hours

196
Q

isosorbide mononitrate IV glyceryl trinitrate/iv isosorbide dinitrate
when is one used over the other

A

isosorbide mononitrate- angina prophylaxis

IV glyceryl trinitrate/iv isosorbide dinitrate-vfor severe symptoms or sublingual can’t be used

197
Q

what is the main caution associated with nitrates and how can it be prevented?

A

tolerance
take isosorbide mononitrate MR tabs because it is once daily
for twice daily tablets- take the second dose after 6-8 hrs not 12 hrs to allow for a nitrate period
leave patch off for 8-12 hrs- overnight in each 24 hrs

198
Q

what strengths do GTN sublingual tablets come in and what are the dispensing and storage requirements

A 
300mcg
500mcg
600mcg
tablets supplied in glass container not over 100 tabs
closed with foil line cap
no cotton wool wadding
discard after 8 weeks
rectal ointment discarded 8 weeks after opening
199
Q

how do you take gtn tablets or spray- when what dose etc

A

take before exertion e.g before exercising
take when required
dose: 1 tablet or 1-2 sprays. no more than 3 at any one time
take sitting down due to postural hypotension
1st dose wait 5 mins
2nd dose wait 5 mins
3rd dose wait 5 mins
chest pain persists call 990

200
Q

three types of blood pressure

A

home done at home using automatic machine
clinic in drs or hospital
ambulatory- 24 hr monitoring

201
Q

what is established cvd

A 
CVD is a general term for conditions affecting the heart or blood vessels
-stroke/tia
mi
angina
pad
202
Q

what are the target organs

A

heart
brain
kidney (CKD)
eye (retinopathy)

organs investigated if blood pressure is high
e.g ventricular hypertrophy, CKD, hypertensive retinopathy, increased urine albumin: creatinine ratio

203
Q

What is the definition of the different stages of hypertension
both stage 1 and 2 have to have both clinic and ambulatory readings

A 
stage 1 hypertension
clinic BP= >140/90-160/100
home/ambulatory=>135/85
stage 2 hypertension
clinic BP 160-100mm/hg- 180/120
home/ambulatory 150/95mmHg
stage 3 hypertension
clinic systolic BP= >180 or
diastolic >120
high blood pressure at repeated clinic encounters- persistent hypertension
204
Q

what is accelerated hypertension aka

malignant hypertension

A

severe increase in bp to over 180/120 and most often over 220/120
signs include
-retinal haemorrhage
papilloedema- swelling optic nerve
usually associated with target organ damage

205
Q

Overview of hypertension diagnosis

A

no hypertension and nor organ damage= measure clinic bp every 5 years and more frequently if close to 140/90
no hypertension but target organ damage= investigate causes further
high bp offer ambulatory or home to confirm diagnosis
investigate and assess cvd risk

206
Q

when is medication given or not given for stage one persisitent hypertension

A 
If she is under 80 and has one of the follwing:
target organ dammage e.g ckd
established cvd
renal disease
Diabetes 
qrisk 10 and above
lifestyle advice
If over 80:
drug treatment and advice
if under 40 yrs:
investigate secondary causes of hypertension 
if under 60
estimated cvd qrisk
offer lifestyle advice and drug Treatment
207
Q

do you always treat stage 2 hypertension with medciation

A

medication no matter age

208
Q

if stage 3 or severe hypertension how do you treat

A

IV antihypertensives

209
Q

same day specialist refferal for pts with hypertension 180/120 and above with any of the follwing signs:?

A

retinal haemorrhage
papilloedema- accelerated hypertension
life threatening symptoms- new confusion , chest pain, signs of heart failure pr acute kidney injury
suspected phaeochromocytoma e.g postural hypotension, headache, palpitations, abdo pain, pallor, diaphoresis

210
Q

if pt has 180/120 or over and dont have any of the warning signs what investigatiomns/monitoring/drug treatment should be used

A

carry out investigations for target organ dmage asap
if therer is damamge then start antihypertensive treatment immediately without results of further bp tetst
if no damage then repeat clininc bp 7 days later

211
Q

is BB contra-indicated indecompensated - severe-, HF or unstable angina- yeds or no

A

yes

212
Q

what are the drug classes for antihypertensives used in order

A 
acei/arb
ccb
Thiazide like diuretic
low dose spironolactone
beta blocker/alpha blocker
213
Q

if an african man aged 80 has diabetes, which antihypertensive is used firdst line

A

acei or arb

214
Q

If ccb is not tolerfated due to oedema or heart failure

A

offer thiazide like diuretic

use indapamide or chlotriazdone over bendroflumethazide -unless pt is already on bendro

215
Q

Cautions for ACE I

A

Afro-car
severe renal carribbean
Pregnancy/breast feeding
aliskiren egfr under 60 or diabetic angioedema

216
Q

side effects assocaited withe ace inhibitors

A

angioedema
cough
hyperkalaemia

217
Q

Cautions for ARB

A

Afro-car
severe renal carribbean
Pregnancy/breast feeding
aliskiren egfr under 60 or diabetic angioedema

218
Q

Side effects associated with arb

A

hyperkaleamia

angiooedema

219
Q

cautions associated with with CCB

A

Oedema
HF except amlodipine
unstable angina/ decompensated hf

220
Q

side effect of ccb

A

oedema

221
Q

cautions for thiazide diuretics and thiazide like diuretics

A

diabetes
gout
egfr under 30
addisons

222
Q

sid eeffects assocaited with thiazide /like diuretics

A

hypokalaemia
hyperuricaemia
hypercalcaemia
hyponatraemia

223
Q

what are the cautions associated spironolactone

A

addisons

hyperkalaemia

224
Q

what are the side effects associated with spironolactone

A

gynaecomastia

hyperkalaemia

225
Q

what are the cautions associated with beta blockers

A

asthmatics
copd
unstable hf

226
Q

what aew the side effects asocaited with beta blockers

A

bradycardia

227
Q

what are the cautions associated with alpha blockers

A

history of syncope in benign prostatic hyoerplasia or posturaL hypotension

228
Q

what are the side effects associated with alpha blockers

A

orthostatic hypotension- laying flat standing always hypo

229
Q

what age diffrentiates between giving an acei/arb or a ccb as first line treatment in hypertension

A

55 years ol

230
Q

what is step 4 of antihypertensive treatment

A

low dose spironolactone if potassium is equal to or under 4.5
alpha blocker or beta blocker if blood potassium level is over 4.5

231
Q

what is the first line and other treatments for antihypertensive treatment in type 1 diabetics

A 
acei/arb first line
BB
CCB- long acting prep e.g MR nifedipine or amlodipine (standard)
Diuretics in combo with bb
not stepwise just use as monotherapy
232
Q

what is first second and third line treatment for hypertension in pregnant women

A

1st line oral labetalol
2nd Line MR Nifedipine
3rd line IV Methyldopa= stopped 2 days after giving birth

233
Q

What is the initial, maintenance and max dose of labetalol given in pregnancy

A

Adult dose; initially BD, dose to be increased in intervals of 14 days
usual dose 200mg BD Increased if necessary to 800mg daily in 2 divided doses
maximum of 2.4g per day

234
Q

Is labetalol taken with food or without food

A

with food

235
Q

how should higher doses e.g 800mg of labetalol be divided

A

3-4 divided doses

236
Q 
What are the targets thresholds for starting antihypertensive for: (clinic)
Pregnancy
Renal disease (CKD)
renal disease and diabetes 
type 1 diabetes with albuminuria or clinical features that increase the risk of ckd
type 1 diabetes
under 80
80 or over
A 
Pregnancy = over 140/90
Renal disease (CKD)= over 140/90
renal disease and diabetes = over 130/80
type 1 diabetes with albuminuria or clinical features that increase the risk of ckd= equal to or over 130/80
type 1 diabetes= equal to and over 135/85
under 80= equal to or above 140/90
80 or over = equal to or above  150/90
237
Q

what is the moa of beta blockers

A

bloc adrenoreceptors in the heart bronchi, pancreas liver and peripheral vasculature- blood vessels outside the heart
slow the heart and can depress the myocardium
beta blockers are all equally effective

238
Q

where are the b1 and b2 receptors in the body

A 
b1=heart (one heart)
b2 lungs (2 lungs)
239
Q

Which BB cause less bradycardia and less coldness on extremities
ICE PACO

A 
Intrinsic sympathomimetic activity= ability of bb to stimulate and also block adrenergic receptors
Pindolol
acebutolol
Celiprolol
Oxprenolol
240
Q

what is the benefit of water soluble bb and examples

CANS (water cans) NA A

A

Water soluble bb are less likely to enter the brain therefore cause less sleep disturbance and nightmares
excreted by the kidneys- dosage reduction necessary in renal impairment
Celiprolol
Atenolol
Nadolol
Sotalol

241
Q

what is the difference between cardio selective BB and other BB and examples
BE A MAN NE AE

A 
less effect on bronchi receptors
lesser effect on airway resistance
selective but not specific
used in well controlled asthma if no alternative
Bisoprolol
Atenolol
Metoprolol
Acebutolol
Nebivolol
242
Q

How often are short acting vs long acting BB administered and which BB are long acting
BACN A AN

A 
Short duration of action 
given two- three times a day
MR given once for hypertension
Long action give
Bisoprolol
Atenolol
Celiprolol
Nadolol
243
Q

What are the side effect of beta blockers

A 
fatigue
coldness of extremities
sleep disturbances
bradycardia
hypotension
hypo/hyperglycaemia- 
masks hypoglycaemia
BB can interfere with the metabolism of carbohydrates causing hypoglycaemia or hyperglycaemia in patients with or without diabetes, they can also interfere with metabolic and autonomic responses to hypoglycaemia, thereby masking symptoms such as tachycardia
244
Q

can BB be given to patients with asthma

A

precipitates bronchospasm- avoid in pts with history of asthma
given to pts with well controlled asthma/copd if no alt
for co-existing conditions e.g HF or MI
Give cardio selective BB with caution
Atenolol, bisoprolol, metoprolol, nebivolol and acebutolol- have less effects on B2 receptors therefore cardioselective but not cardiospecific

245
Q

are beta blockers contra-indicated in diabetics

A

no

use with caution- cardioselectivity preferred
affects carbs metabolism in pts with and without diabetes
avoid in pts with frequent episodes of hypoglycaemia

246
Q

which type of BB is preffered in both diabetics and asthmatics

A

cardioselective BB

247
Q

What are some of the uses of beta blockers

A 
hypertension
angiina
mi
arrthymia
hf
anxieety- ptopranolol
migraine -propranolol
glaicoma
thyrotoxicosis- propranolol
248
Q

what are the contra-indications of BB

A 
asthma/copd
marked bradycardia
prinzmetal's angina
2nd/3rd degree av block
uncontrolled heart failure
249
Q

What are the cautions associated with BB

A

1st degree av block
symptoms of thyrotoxicosis and hypoglycaemia may be masked
verapamil and diltiazem
may reduce response to adrenaline

250
Q

What are the cautions associated with BB

A

1st degree av block
symptoms of thyrotoxicosis and hypoglycaemia may be masked
verapamil and diltiazem
may reduce response to adrenaline

251
Q

what severe adr does IV verapamil have with BB

A

hypotension and bradycardia

252
Q

what are the three classes of CCB

A

Dihydropyridines
Phenylaklyamines
Benzothiazepines

253
Q

example of dipyramidines and moa

A

amlodipine, nifedipine, lacidinpine, felodipine
relax sm- vasodilatory effect
no anti-arrthymic affect

254
Q

example and moa of phenylalkylamines CCB

A 
verapamil 
treat hypertension, angina and arrhinias
very inotropic CCB (Can slow HR down very low)
minimal vasodilatory effect compare to dihydropyridines
causes constipation
cardiac depressant
may precipitate heart failure
do not use with beta blocker
255
Q

moa and example of benzothiazepine CCB

A

diltiazem
cardiac depressant and vasodilatory effects
intermediate between classes
effective in angina
longer acting formulations used in hypertension
less -ve inotropic effect than verapamil
caution with bb due to bradycardia

256
Q

CCB in unstable angina

A

ccb DO NOT REDUCE THE RISK OF mi IN UNSTABLE ANGINA
Verapamil and diltiazem should be reserved for pts resistant to treatment with BB
Sudden withdrawal of CCB can exacerbate angina

257
Q

what is the prescribing and dispensing information associated with diltiazem

A

prescribed by brand

different MR preps containing ove r60mg may not have the sam effect

258
Q

nicorandil indications and where it exerts its action

A

long and short term treatment of angina
arterial and venous vasodilatory effects
L channel activator with nitrate component
other drugs ivabradine and ranolazine

259
Q

side effects to CCB

A 
Dizziness
flushing
Headaches
Postural hypotension
GI disorders
ankle swelling
skin reactions
sudden withdrawal of CCB may exacerbate myocardial ischaemia
260
Q

moa, indications and examples of thiazide and related diuretics

A

inhibit sodium reabsorption in the beginning distal convulated tubule
acts within 1-2 hrs of oral admin and effects last for 12-24 hrs
give in mooring to avoid diuresis overnight which can affect sleep
indication- lower doses reduce bp
higher doses used for oedema due to CHF- More biochemical effects than lower doses - K, Na, uric acid, glucose, lipids with little advantage on bp
examples
Bendroflumethiazide- mild to moderate HF or hypertension
Chlortalidone- long duration of action and may be given on alt days
indapamide- lowers bp with less effects on electrolytes and less aggrabation of diabetes

261
Q

contra-indications of thiazide and related diuretics

A

hypokalaemia, hyponatraemia, hypercalcaemia and Addison’s disease- low levels of sodium and high levels of potassium

262
Q

cautions associated with thiazides and relate diuretics

A

hypokalaemia- loop and thiazides but higher with thiazides
hypokalaemia dangerous in CVD or cardiac glycosides
K sparing diuretics of potassium supplements can be used
in hepatic failure, hypokalaemia can lead to encephalopathy, particularly in alcoholic cirrhosis
elderly more susceptible to s/e- give lower dose
not use on long term basis sue to gravitational oedema- responds to increased movement, raising legs and support stockings
can exacerbate diabetes and gout due to the hyperuricaemia and hyperglycaemia

263
Q

s/e of thiazide and related diuretics

A

constipation. electrolyre imbalance, headache, postural hypotension, skin reactions

264
Q

should thiazide and related diuretics be used in pregnancy

A

thiazides and related diuretics should not be used to treat gestational hypertension
may cause neonatal thrombocytopenia, bone marrow suppression, jaundice, electrolyte imbalances

265
Q

can thiazide and thiazide like diuretics be used in renal and hepatic impairement

A

caution in severe hepatic disease

ineffective if egfr under 30 so should be avoided

266
Q

moa and examples of loop diuretics

A

inhibits reabsorption from the acsending loop of henel- powerfule diuretics
used in pulmonary oedema duw to left ventricular heart failure and in CHF
Stronger diuretics than thiazides and can be used for resistant oedema
can exacerbate diabetes (but hyperglycaemia less likely than with thiazides) and gout
examples- furosemide and bumetanide
both act within 1hr or oral admin and in similar activity
diuresis is complete within 6 hrs so can be given twice a day without interfering with sleep

267
Q

contra-indications associated with loop diuretics

A

renal failure, hypokalaemia, severe hyponatraemia, liver cirrhosisi
higher dose or rapid I.V admin loop diuretics may cause tinitus and deafness
renal impairemment

268
Q

what colour can furosemide and triamterene color urine

A

blue

269
Q

which are the strong k sparring/ aldosterone antagonists

A

eplerone
spironolactone
k supplements must not be given with aldosterone antagonists

270
Q

examples of weak k sparing diuretics and aldosterone antagonists

A

amiloride
tiamterene
potassium supplements must not be given with potassium sparing diuretics
k sparing diuretics and acei can cause severe hyperkaelaemia

271
Q

what is the main side effcet associated with spironolactone

A

gynaecomastica

272
Q

other diuretics and thier indications

A

combo diuretic therapy
mannitol- osmotic diuretic used to treat cerbral oedema and raised ocular pressure
mercurial diuretics- effective but hardly used due to nephrotoxicity
acetazolamide (carbonic anhydrase inhibitor\0- weak diuretic used for mountain sickness prophylaxis
eye drops of dorzolamide and brinzolamide inhibit formation of aqueous humour and used in glauccoma

273
Q

moa and indications of ACEI

A

inhibit conversion of angiotensin 1 to angiotensin 2

Indications - heart failure, hypertension, diabetic neuropathy , prophylaxis of CV events

274
Q

Contra-indications associated with ACEI

A

In combo with aliskiren contraindicated in pts with diabetes and pts with egfr under 60

275
Q

cautions associated with ACEI

A

Afro-caribbean
Concomitant diuretics
frugs that cause hypotension e.g diuretics

276
Q

Use of ACEI in heart failure

A

used in heart failure with beta blockers
can be used in stable and unstable heart filure
discontinue k sparing diuretics and k supplements bedfore starting ACEI due to risk of hyperkalaemia- low dose spironolactone can be used but closely monitored
profound first dose hypotension with pts with heart failure already taking a high dose loop diuretic e.g furosemide 80mg or more so take at night sitting down

277
Q

when should ACEI be administered under specialist supervision

A 
sevre hf
pts recieving high dose diuretic
unstable heart failure
hyponatraemia
hypotension
CKD
Hypovolaemia
reciving aliskiren
renovascular disease
278
Q

whar are the main side effects associated with ACEI

A 
angiooedema- may be delayed and more common in afro-caribbean
angina pectoris
constipation
G.I
Electrolyte imbalance
persistent dry cough
alopecia
skin reactions
279
Q

REnal impairement assocaited with ACEI

A

renal functions and electrolytes before starting acei
hyperkalaemia
acei cause renalimpairement in elderly
concommitant use with NSAIDS or k sparing diuretics due to hyperkalemia
avoid in renovascular disease

280
Q

Contra-indications of ACEI

A

acei and aliskiren contraindicated if egfr under 60 or diabetes
discontinue if marked heaptic enzyme or jaundice occur

281
Q

Cautions, monitoting, preganncy, directions for admin assocaited with ACEI

A

Monitor: renal function electrolytes
directions for admin: first dose at bedtime
renal impairement- caution start low and adjust
prenancy: avoid- affects fetal and neonatal bp and renal function also skull defects reported
avoid during dialysis to prevent anaphylactic reactions

282
Q

ARB examples, indications, use in pregnancy / rnal impairment and eldelry

A

Less likely to give dru cough- does not inhibit break down of bradykinin and other kinins
used when ACEI contrindicatied or not tolerated
avoid in preganancy and use with caustion in rnal impairememnt or elderly

283
Q

what are the side effects associated with ARB

A

Hypotension dizziness and hyperkalaemia

284
Q

name the renin inhibitor, indication and caution

A

inhibits renin directly- renin converts angiotensisn to angiotensin 1
aliskiren is licensed for treatment of hypertension alone or in combo with other antihypertensives
ACEI and Aliskiren should not be given together due to increased risk of hyperkalaemia, hypotension or renal impairement compared to a single drug
example; aliskiren

285
Q

How long after taking digoxin should a blood assay be taken

A

6 hrs

Chapter 2 Cardiology (1 decks)

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