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Inori Pre Reg > CV > Flashcards

CV Flashcards

1
Q

What’s the 2 methods for prophylaxis management?

A 
Pharmacological
Mechanical (IPU intermittent pneumotic compression stockings
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2
Q

When is mechanical vte prophylaxis contraindicated?

A

Peripheral arterial disease
Peripheral neuropathy
Severe leg oedema
Local conditions e. G. Gangrene, dermatitis

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3
Q

When would you use fondeparinux for vte prophylaxis?

A

When having abdominal and cardiac surgeries

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4
Q

How long would you have vte prophylaxis after the surgery?

A

More than 7 days usually or until sufficient mobility
28 days for abdominal cancer
30 days for spine surgery

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5
Q

What’s the vte prophylaxis plan for elective THR?

A

LMWH for 10 days followed by low dose aspirin for a further 28days
Or
LMWH for 28 days + mechanical stocking TED until discharge
Or
Rivaroxaban

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6
Q

What’s the VTE prophylaxis plan for TKR?

A 
Low dose aspirin for 14 day
Or
LMWH for 14 days + TED until discharge
Or
Rivaroxaban
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7
Q

What’s the bridging process?

A

Give heparin and warfarin for at least 5 days or until the INR is over 2 for at least 24hrs,

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8
Q

How would you give warfarin if
Need for rapid acting
For AF
For immediate effect

A

5 or 10mg od for 2dsys and the base on INR

Achieve anticoag in 3to4wks via 1 to 2mg od, then base on inr

Use heparin/LMWH for bridging, usually heparin

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9
Q 
How long would you take warfarin for
Isolated calf DVT
Provoked VTE
Unprovoked DVT or PE
Recurrent DVT/PE
AF
Heart valve?
A

6wks

3 months

3motnhs or 6 months to long term possibility

Long term for last 3

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10
Q

What to do if a surgery is going to take place and pt is taking warfarin?

A

If elective, stop 5 days before surgery

Phytomenadione day before if inr is over 1.5

Bridging LMWH if high risk

If emergency, delay 6 to 12hrs + Phytomenadione

If emergency, no delay then prothrombin + Phytomenadione

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11
Q

Why is LMWH preferred more than heparin?

A

Lower risk of osteoporosis and thrombocytopenia

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12
Q

What’s the specific antidote for LMWH?

A

Protaminesulfate

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13
Q

Other than ACS, what can cause an increase in troponium?

A

Sepsis

Inflammatory disease

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14
Q

What’s the MHRA warning on nicorandil?

And another warning?

A

MHRA gives a second line risk of ulcer complications on mouth, skin, eye and GI

Do not drive until it is established that performance is not impaired

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15
Q

In a hypertensive emergency, by how much do you have to reduce your BP? Within what hors?

A

20-25% within 24hrs

Hypertensive emergency is high BP with organ damage.

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16
Q

What happens if you reduce BP too rapidly?

A

Hypotension crisis leading to cerebral infarction, blindness, deterioration in renal function, MI

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17
Q

How to manage hypertensive emergency?

A

Sodium nitroprusside (unlicensed)
Nicardipine
Labetalol
Hydralazibe

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18
Q

How to manage hypertensive urgency?

A

High BP over 180/110 without organ damage

Lavetalol
CCB
Amlodioibe, felodipine

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19
Q

How do you treat hypotension shock?

A

Volume replacement if haemorrhage, sepsis but Not in cardiac shock

Use of sympathomimetics inotropes like adrenaline, dopamine but Not in haemodynamically stable pts as can cause cardiogenic shock

Vasoconstrictor e. G. Noradrenaline, norepinephrine

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20
Q

What antihypertensive drugs are not advised to be used together?

A

BBs and diuretics

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21
Q

For pts over 55 it African origin, who has high risk of Hf, what’s first line?

A

Thiazide like diuretics

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22
Q

What’s the normal BP?

A

120/80

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23
Q

What to do if BP is 140/90?

A

Offer lifestyle advice

Only treat if under 80 with target organ damage, 10yr CVD risk is over 20, renal disease, diabetic

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24
Q

When do you start Hypertension treatment no exception?

A

When BP 160/100

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25
Q

What’s the target BP for under 80 with atherosclerotic CVD?

A

130/80

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26
Q

What’s the target BP in renal disease?

A

Below 140/90

Below 130/80 if CKD, diabetes, proteinuria of more than 1g in 24hrs (consider ACEi/ARB if proteinuria exist)

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27
Q

What’s the target BP in diabetes?

A

140/90

130/80 if complications with eye, kidney, or cerebrovascular disease

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28
Q

Target BP for pregnant lady?

A

150/100

140/90 if target organ damage or given birth

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29
Q

Hypertension treatment for pregnant ladies?

A 
Labetalol = hepatotoxic but first linr
Methyldopa = stop 2 days after birth
Mr nifedipine (unlicensed)
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30
Q

ACEi is taken OD except which drug

A

Captopril BD

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31
Q

Special way of taking perindopril?

A

Take 30-60mins before food

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32
Q

Higher risk of Hyperkalaemia when taking ACEi in what condition?

A

Renal impairment and diabetes

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33
Q

What kind of anaphylaxis shock does ACEi cause?

A

Angiodema

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34
Q

What drugs can cause acute kidney injury?

A

Diuretics
ACEi /ARBs
Metformin
NSAIDS

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35
Q

What hepatic effect does ACEi have?

A

Can cause jaundice, hepatic failure

Stop ACEi if liver transaminases is 3x normal or jaundice occurs

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36
Q

What side effects does ACEi cause?

A

Oral ulcer, taste disturbance and hypoglycaemia

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37
Q

Which drugs are centrally acting antihypertensives?

A

Methyldopa
Clonidine
Monoxidine

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38
Q

Side effect of Methyldopa?

A

Drowsiness so careful driving

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39
Q

Side effect of Clonidine?

A

Flushing

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40
Q

What drugs are vasodilator antihypertensives?

A

Hydralazine

Minoxidil

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41
Q

Side effect of hydralazine?

A

Fluid retention, tachycardia

Don’t use monotheraoy, always as adjunct e as on its own it can Cause the above side effect

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42
Q

Side effect of minoxidil?

A

Tachycardia, fluid retention and increase cardiac output

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43
Q

Side effects of BBs?

A

Bradycardia
Hypotention
Affected carbohydrate metabolism (hypo or hyperglycaemia)
Masks symptoms of Hypoglycaemia such as tremor, tachycardia

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44
Q

Who cannot use BBs?

A

Asthma as it can cause bronchospasm (eye drops can as well)

Worsening unstable HF and heart block pts as BBs can depress the myocardium

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45
Q

Interaction between verapamil and BBs?

A

With verapamil injection, asystole and hypotention

Also a risk of participating HF when used together in established ischaemia heart disease

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46
Q

Interaction between thiazide like diuretics and BBs?

A

Hyperglycaemia so avoid in diabetes

COC and corticosteroids too

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47
Q

What’s advice regarding nifedipine dispensing?

A

Maintain the same Mr brand

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48
Q

What’s the overdose symptons of BBs?

A

Light-headedness, dizziness, syncope, bradycardia, hypotention

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49
Q

Side effects of CCBs?

A

Ankle swelling,

Vasodilation side effects such as flushing, headaches (becomes less after a dew days)

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50
Q

When should you avoid rate limiting CCBs?

A

In HF bc they can further depress cardiac function and execerbate HF

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51
Q

Side effect of verapamil?

A

Constipation

Only CCB licensed for arrhythmia

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52
Q

Dispensing caution on diltiazem

A

Maintain on same brand when doses over 60mg

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53
Q

Food interaction with CCB?

A

Grapefruit juice works as an enzyme inhibitor and increases CCB conc.

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54
Q

MHRA warning on hydrochlorothiazide?

A

Dose dependent increased risk of non melanoma skin cancer esp if long term
Limit exposure to sunlight and examine suspicious moles

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55
Q

Who cannot take propafenone?

A

Asthma, severe COPD

Structural/ischaemia disease

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56
Q

Why can you not give rhythm control after 48hrs of onset?

A

Increased risk of stroke

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57
Q

What to do if ot us life threatening haemodynamically unstable?

A

Electrical cardioversion

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58
Q

What to give for paroxysmal and symptomatic afib?

A

Ventricular or rhythm control live BB or antiarrthmic drugs

Pill in poker like flecanide or propafenone is infrequent paroxysmal afib

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59
Q

How to treat atrila flutter?

A

Similar treatment as Afib but catheter ablation more suitable

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60
Q

What to give in pulse less or fibrillation?

A

Immediate defibrillation + CPR

IV amiodarone is given refractory to defibrillation

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61
Q

What to give in unstable sustained ventricular tachycardia?

A

Direct current cardioversion

If this fails, give IV amiodarone and repeat direct current

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62
Q

What to give in stable sustained ventricular tachycardia?

A

IV antiarrthmic drug (amiodarone preferred)

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63
Q

What to give in non sustained ventricular trlachycardia?

A

Bb

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64
Q

Maintainance treatment for pts at high risk of cardiac arrest?

A

Most pts nerd cardiovascular defibrillator implant

Some pts also require a drug; sotalol, BB alone or BB with amiodarone

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65
Q

What is torsade de pointes?

A

Prolonged QT interval

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66
Q

Treatment of torsade de pointes?

A

Magnesium sulphate

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67
Q

What causes torsade de pointes?

A

Sotalol and other drugs that prolong QT interval
Hypokalaemia
Bradycardia

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68
Q

How to manage paroxysmal superventriculat tachycardia?

A

Terminates spontaneously or with reflex vagal nerve stimulation e.g. Immersing face in ice, carotid sinus massage

2nd line is IV adenosine

3rd line is IV verapamil

If haemodynamically unstable = direct current cardioversion

If recurrent=catheter ablation or drugs e.g. Verapamil, diltiazem, BBs, flecanide or propafenone

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69
Q

IV adenosine is contra indicated against?

A

Cops asthma

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70
Q

Amiodarone has an extremely long half life, how long?

A

Up to 50 days

So danger of interactions several months after stopping

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71
Q

Grapefruit act as an inducer or inhibitor to amiodarone?

A

Inhibitor

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72
Q

Is amiodarone an inhibitor or inducer?

A

Inhibitor

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73
Q

Interaction between digoxin and amiodarone?

A

Half dose of digoxin

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74
Q

Interaction between amiodarone and stations?

A

Increased risk of myopathy

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75
Q

Interaction between amiodarone and BBs?

A

Bradycardia, AV block and myocardial depression

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76
Q

Interaction between rate limiting CCBs and amiodarone?

A

Bradycardia, AV block and myocardial depression

77
Q

What drugs contribute to QT prolongation?

A 
Quinolones
Macrolides
TCAs
SSRIs
Lithium
Quinine
Hydroxychloroquinr
Antimalatials
Antiosychotics
78
Q

Digoxin’s therapeutic levels? When to take it?

A

1-2mcg/l
6hrs after dose

Regular monitoring is not required during maintenance unless toxicity suspected or in renal impairment

79
Q

Digoxin dose for atrial flutter and non paroxysmal AF in sedentary pts?

A

125-250mcg

80
Q

Digoxin dose for Worsening or severe heart failure?

A

62.5-125mcg

81
Q

What electrolyte imbalance increase the risk of digoxin toxicity

A 
Hypokalaemia
Hypomagnesium 
Hypoxia
Hyoercalcaemia
Renal imapirment
82
Q

What drug has the potential to increase plasma digoxin and predispose toxicity?

A

Amiodarone so half digoxin dose
Rate limiting CCBs
Enzyme inhibitors

83
Q

Main digoxin drug interactions?

A

CRASED

CCBs rate limiting
Rifampicin
Amiodarone
St John's wort
Erythromycin 
Diuretics
84
Q

How to recognise stroke/TIA outside of hospital?

A

FAST
F=face = may droop on one side, not able to smile, mouth or eye dropped
A=arms=cannot be lifted or keep them lifted bc of weakness or numbness
S=speech=slurred speech
T=time to call 999

85
Q

How to recognise stroke/TIA in hospitals?

A

Use of online tool ROSIER
Recognition of Stroke In the Emergency Room

Has there been LOC or syncope?
Any seizures activity?

FAS symptoms
Visual field defects

86
Q

What’s TIA?

A

Mini stroke which resolves within 24hrs

87
Q

Initial management of TIA?

A

Aspirin 300mg stat
If C/I even if with PPI, clopidogrel 75mg OD but unlicensed

Investigation required within 24hrs

88
Q

Long term treatment of TIA?

A

Clopidogrel 75mg OD
If C/I dipyridamole MR + aspirin + PPI
If aspirin also C/I = dipyridamole MR only

89
Q

Dose of dipyridamole?

A

MR200mg BD preferably with food

90
Q

Side effects of dipyridamole?

A

Diarrhoea, headache, hot flush, hypotention, nausea

91
Q

Storing info on dipyridamole?

A

Should be dispensed in OP as desiccant and any remains should be discarded 6wks after opening

92
Q

Initial management of ischaemia stroke?

A

Alteplase within 4.5hrs
Aspirin 300mg within 24hrs of thrombolysis or within 48hrs if not receiving thrombolysis
Clopidogrel if C/I unlicensed

Anticoagulation if at high risk of VTE

93
Q

AF pt who had TIA, what to do with their Anticoagulants?

A

Stop Anticoagulant for 7days and substitute with aspirin

94
Q

Why hypertention treatment only in emergency (if hypertensive crisis) with pts who just had a TIA?

A

Can cause decreased cerebral perfusion

95
Q

Dose of alteplase?

A

900mg/kg over 60mins

96
Q

Side effect of alteplase?

A

Risk of haemorrhage if serious bleeding stop use

Anaphylaxis

97
Q

What’s HF?

A

Structural or functional abnormalities of the heart, resulting in reduced cardiac output

Normally the left ventricule loses its ability to contract normally leading to reduced EF but sometimes it loses the ability to relax and this leads to a normal EF

98
Q

How to manage fatigue in HF?

A

IV iron if confirmed anaemia

Oral Iron isn’t absorbed well in HF

99
Q

What is NT proBNP?

A

N terminal Pro B type natriunetic peptide is produced in the heart and released when the heart is working hard

Measured when HF is suspected

100
Q

Refer pt if there NT proBNP value is over?

A

400ng

101
Q

What kind of pts have reduced NT proBNP?

A

Obesitiy
African
Treatment with diuretics, ACEi ARB, BBs, mineralcorticoid receptor antagonist

102
Q

What kind of pts have increased NT proBNP?

A 
Over 70
Tachycardia
COPD
Diabetes
Liver cirrhosis
Exercise
Renal dysfunction
103
Q

After how long is HF considered to be stable of chronic?

A

When symptoms remain unchanged for at least a month

104
Q

What’s the normal range of EF?

A

55% - 65%

105
Q

How to calculate EF?

A

Amount of blood pumped out /amount of blood in chamber

106
Q

Non drug treatment of Hf?

A 
Cardiac rehabilitation like exercise and diet
Limit fluid intake to no more than 2L
Daily weight check
Reduced salt intake
Reduce alcohol consumption
107
Q

Why dose rate limiting CCBs need to be avoided in HF?

A

They reduce cardiac contractility

108
Q

How does loop diuretics work?

A

Act in the limb of the loop of Henle

Inhibits the NaKCL Co transporter to increase excretion of Na, K and Cl

109
Q

How does thiazide diuretics work?

A

Act on the proximal part of the distal tubule

Inhibits the NACL Co transporter thus increases excretion of Na and urine volume

110
Q

How does potassium sparing diuretics work?

A

Act on the distal convoluted tubule either by aldosterone antagonism (aldosterone antagonists like spironolactone and eplerenone) or direct inhibitor of epithelial sodium channell (amiloride)

111
Q

Side effects of loop diuretics?

A 
Fluid imbalance
Electrolyte imbalance (Hypokalaemia, Hyppnatraemic, hypochloride)
Hypotention
Rash
Hyperglycaemia
Raised serum creatinine
Headache
Dizziness
Tinnitus, deafness
Blood dyscrasia
112
Q

Side effects of thiazide diuretics?

A 
Electrolyte depletion like hypokalaemia, Hypomagnesium, this results in arrhythmia
Postural hypotention
Hyperuricaia
Hyperglycaemka
Impaired renal function
Impaired exercise tolerance
Erectile dysfunction (unknown mechanism)
Skin rash
Thrombocytopaenia
113
Q

Specific side effect of bumetanide?

A

Gynecomastia

114
Q

Side effects of k sparing diuretics?

A 
Hyperkalaemia
Hyponatraemia
GI disturbances
Hypotention
Dry mouth
Confusion
Rash
115
Q

1st line in HF treatment?

A

ACEi/ARB and beta blocker

up titrate to minimum tolerated doses

116
Q

Which ARB are licensed for HF?

A

Candesartan

Valsartan

117
Q

Which BBs are recommended for all grades if LVSD?

A

LSVD is an impairment of left ventricular performance

Bisoprolol
Cardevilol

118
Q

What’s recommended for mild to moderate HF over 70?

A

Nebivolol

119
Q

2nd line HF treatment? And when to add it

A

If still symptomatic and LVEF is below 35%

Add MR antagonist, spironolactone

120
Q

3rd line treamtnet of Hf is able to tolerate ACEi?

A

Enreresto (ARNI) to replace ACEi if still symptomatic and LVEF is below 35 %

121
Q

3rd line treatment if sinus rhythm and HR is over 75bpm

A

Ivabradine

122
Q

4th line treatment?

A

Digoxin

Or a heart transplantation

123
Q

Rampirl dose for HF?

A

1.25-10mg

124
Q

thiazide diuretics are ineffective if?

A

Renal failure below 30

125
Q

For fluid overload, for symptomatic treatment of Hf, what should be added?

A

Loop diuretics or thiazide for mild HF

126
Q

How to manage dose of ACEi for HF treatment?

A

Titrate every 2wks to highest tolerated dose

127
Q

Monitoring ACEi in HF?

A

Urea and electrolytes, BP within 2wks of titration

Max 50% rise in Cris acceptable. If more, reduce or stop

128
Q

ACEi is contra indicated in?

A

Bilateral renal artery stenosis
Renal disease
Pregnancy

129
Q

What does entresto contain?

A

Valsartan and sabcutiril

130
Q

Side effects of entresto?

A

Symptomatic hypotention
Hyperkalaemia
Renal impairment

131
Q

When can you start entresto?

A

Use 36hrs post ACEi or 1 day post ARB

132
Q

Entresto is contra indicated in?

A

Pts with serum K level of over 5.4
Known history of angiodema related to previous ACEi or ARB therapy
Hereditary or idiopathic angiodema
Severe hepatic impairment, biliary cirrhosis and cholestasis
2nd and 3rd trimester of Preganancy

133
Q

Side effects of BB?

A 
Fatigue
Bradycardia
AV block
Postural hypotention
Bronchispasm
Vasoconstriction
Cold extremities
CNS effects (headache, dizziness)
Sleep disturbance = nightmare
Masks Hypoglycaemia
134
Q

Dose advice on BBs for HF?

A

Gradually titrate up to maximum tolerated dose, titrate every 2wks
Do not stop suddenly

135
Q

Monitoring for BB in HF?

A

Urea and electrolytes
HR
BP
Within 2wks of titration

136
Q

Dose of spironolactone? Eplerenone?

A

25-50mg OD

25-50mg OD

137
Q

Typical combination of drugs in HF treatment?

A

ACEi /ARB + BBs + MRAs + diuretics

138
Q

General advice about HF treatment drugs?

A

Avoid NSAIDs as can lead to fluid retention
Low salt diet advised
Caution if taking aspirin unless indicated

139
Q

Dose of Ivabradine for HF?

A

5-7.5mg BD

140
Q

Side effects of Ivabradine?

A 
Phosphenes (bright illuminations in the periphery of the visual field)
Blurred vision
Bradycardia
AV block
AF
BP change
Headache
Dizziness
141
Q

Ivabradine is C/I in?

A

AF
Pregnancy as teratogenic
Enzyme inducer and inhibitors

142
Q

Dose advice on Ivabradine?

A

Titrate every 2wks

If HR below 50 bpm 2.5mg BD

If HR 50-60 bpm 5mg BD

If HR over 60bpm 7.5mgBF

143
Q

Dose of Ivabradine for over 75?

A

2.5mg BD

144
Q

How to load digoxin in HF? Then it’s maintenance dose?

A

Load with 500mcg BD Then OD

Maintenance is 65mcg if creatine over 200, 125mcg if creatine below 200

145
Q

Signs and symptoms of Hf congestion?

A 
Increased breathlessness
Fatigur
Weight gain of over 1kg in 3 days
Tachycaedia
Pulmonary oedema
146
Q

Dose of furosemide for HF? Bumetanide?

A

40mg up to 240mg is persistent

1mg up to 5mg if persistent

147
Q

Equivalent dose of furosemide and bumetanide?

A

40mg=1mg

148
Q

Who requires primary prevention of CV?

A

Type 1 diabetes
Type 2 diabetes only if CVD risk is over 10%
Anyone if 10yr QRISK score is over 10%
CKD or albuminuria
Hypercholestrrolaemia
85yr and above to reduce risk of non fatal MI

149
Q

QRISK 2 calculation is unsuitable in which pts bc of them being already at high CV risk?

A 
Type 1 diabetes
Established CV
Over 85
CKD eGFR below 60
Familial Hypercholestrrolaemia
150
Q

What level of cholesterol will lead to diagnosis of hyperlipidaemia?

A

Over 6nmol/L of total cholesterol

151
Q

Target total cholesterol levels?

A

Below 5mmol /L for healthy adults

Below 4mmol/L for high risk adults

152
Q

Target level of LDL?

A

Below 3mmol/L for healthy adultd

Below 2mmol/L for high risk adults

153
Q

Target level if HDL?

A

Over 1mmol/L = higher the better

154
Q

Target level of triglycerides?

A

Below 1.7mmol/L

155
Q

What drugs can cause hyperlipidaemia?

A

Antiosychotics
Immunosuporessants
Corticosterouds
Antiretrovirals (HIV drugs)

156
Q

Conditions that cause hyperlipidaemia?

A 
Hypothyroidism
Liver or kidney disease
DM
Family history of it
Lifestyle factors like smoking, excessive alcohol cobsumption
Obesity and a poor fatty diet
157
Q

How does statins work?

A

Lowers LDL by the liver via inhibition if HMG Coa reductase

Indirectly reduces triglycerides and increase HDL

158
Q

Digoxin’s serum conc. Level?

A

1.5-3mcg/L

159
Q

What’s a weak k sparing diuretic?

A

Amiloride

160
Q

Secondary prevention dose of atirvastatin?

A

80mg

161
Q

MHRA warning on simvastatin?

A

High risk of myopathy
=only give if high risk of CV complications or severe Hypercholestrrolaemia and treatment goals not achieved at lower dose

162
Q

What’s first line for treating Hypercholestrrolaemia and moderate hypertriglyceridaemia?

A

Statins

163
Q

2nd line for severe Hypercholestrrolaemia or hyperglyceridaemis if not controlled by max dose of 1st line?

A

Add ezetimibe

164
Q

What to add if triglycerides remain high even after LDL cholesterol conc. Has been reduced adequately?

A

Fibrate to statin

Or Fibrate alone if statin c/I

165
Q

Whats the criteria of being a high intensity statin?

A

Defined as a dose at which a reduction in LDL cholesterol of greater than 40% is achieved

166
Q

General steps of hyperlipidaemia?

A

Statin
Ezetimibe
Fibrates
Bile acid sequestant like colestyramine

167
Q

What increases the risk of myopathy when Co administered with statin?

A

Ezetimibe, Fibrates esp gemfibrozil

Concomitant fusidic acid, restart statin 7days after last dose

168
Q

Side effects of statins?

A

Rhabdomyolysis
Interstitial lung disease
= report short breath, cough, weight loss
Diabetes - statins can raise HBA1C or blood glucose levels

169
Q

Monitoring requirements for statins?

A 
Baseline lipid profile
Renal function
Thyroid function
HBA1C if high risk of developing diabetes
Liver
170
Q

When to discontinue to statins?

A

Creatine kinase x5

Liver transaminases x3

171
Q

Max dose of statin when taken with fibrates?

A

10mg

172
Q

Max dose of statin is 20mg when taken with?

A

Amiodarone
Amlodioine
Diltiazem
Verapamil

173
Q

Max dose of atirvastatin when taken with ciclosporin?

A

10mg

174
Q

Dose of rosuvastatin when taken with clopidogrel?

A

Initially 5mg then max 20mg

175
Q

Statin and Preganancy, advice?

A

Statins are teratogenic
Need effective contraception during and 1month after stopping
Stop taking 3 months before conceiving and restart after BF finished

176
Q

How does ezetimibe work?

A

Reduce blood cholesterol by inhibiting the absorption of cholesterol by the small intestine

177
Q

How does fibrates work?

A

Lowers blood triglyceride levels by reducing the lover’s production of VLDL (the triglyceride carrying particle that circulates in the body) and by speeding up the removal of triglycerides from the blood

178
Q

All fibrates are used in combo with statins apart from?

A

Gemfibrozil which should not be used with statins as high risk of myopathy

179
Q

How does specialist Bile acid sequentstrants work?

A

Binds to Bile acid preventing its reabsorption which promotes the conversion of cholesterol into Bile acids q

180
Q

Important interactions of Bile acid sequestant?

A

Impairs absorption of fat soluble vitamins ADEK and other drugs so take other drugs 1hr before (4hrs for colevesrlam) or 4hrs after Bile acid sequentstrants

181
Q

Important interactions of Bile acid sequestant?

A

Impairs absorption of fat soluble vitamins ADEK and other drugs so take other drugs 1hr before (4hrs for colevesrlam) or 4hrs after Bile acid sequentstrants

182
Q

What’s used to determine bleeding risk?

A 
Has-bled (has been validated for warfarin but not for DOACs)
H=hypertention (over 160)
A=abnormal renal or liver (1 point each)
S=stroke
B=bleeding
L=labile INRs
E=elderly over 65
D=drugs or alcohol (1 point each)

0-2 low rusk
Over 3 is high risk of bleeding

183
Q

Side effects of warfarin?

A

Bleeding
Painful skin rash
Blue/purple toe syndrome

184
Q

What juice increases the effect of warfarin?

A

Cranberry and pomegranate

185
Q

Which statins increase the effect of warfarin?

A

Fluvastatin and rosuvastatin

186
Q

Warfarin tab colours

A

0.5 - white
1 - brown
3 - blue
5 - pink

187
Q

What conditions does thiazide diuretics exacerbate?

A

Diabetes, gout and lupus

188
Q

Reduce initial dose of Ivabradine if?

A

concurrent use of moderate CYP3A4 inhibitors (except diltiazem, erythromycin and verapamil where concurrent use is contraindicated).

Inori Pre Reg (22 decks)

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