CV Drug Councilling

Question 1

Aspirin COUNCILLING

Answer 1

• GI: nausea, bleeds (prophylactic PPI)
• Bronchospasm - 20% asthmatics
• Children: Reye’s syndrome
• Gout (cant leAp)
• Ototoxic
• Anticoagulants: bleed
• Antidepressants: bleed [SSRI, Venlafaxin SSNRI - inhibit 5HT from PLTs)
• Cytotoxic drugs : low excretion of methotrexate

Question 2

ACEi COUNCILLING

Answer 2

• Dry Cough 1/10
• First-dose hypotention (start at night)
• +Diuretics/ RAAS – enhances hypotensive effects
• HYPERkalaemia (CI +K supplements/ drugs)
• Angioedema (stop)/ CI Hx
• Teratogenic
• Hepatic impairment: max 2.5mg
• Renal impairment
  
  • Stop if Cr inc>30%/ eGFR dec>25%
  • GFR 30-60 mac 5mg (<30 start 1.25, max 5)
• CI Renovascular disease
• CI Valvular stenosis
• +Lithium toxicity
• +Ciclosporin ARF
• +NAIDS (reduce efficacy)

Question 3

ARBs COUNCILLING

Answer 3

• First-dose hypotention (start at night)
• +Diuretics/ RAAS – enhances hypotensive effects
• HYPERkalaemia (CI +K supplements/ drugs)
• Angioedema (stop)/ CI Hx
• Teratogenic
• Renal impairment (stop if Cr >inc>30%/ eGFR dec>25%)
• CI Renovascular disease
• CI Valvular stenosis
• +Lithium toxicity
• +Digoxin fluctuations (candesartan)

Question 4

Aldosterone antag COUNCILLING

Answer 4

• HYPERkalaemia (low K diet)
  
  • CI K+ >4.5 (hyperK = >5.5)
  • Risk: ACEi/ ARBs/ supplements
• CI Addison’s disease
• Renal (anuria) (CI, Cr >220half, >310stop)
• Hepatic failure (CI, stop)
• Gynaecomastia (spironolactone progesterone effects)
• Menstrual irregularities

Question 5

B blocker COUNCILLING

Answer 5

• Bradycardia (CI 2/3HB, sick sinus)
• Hypotension (CI uncontrolled HF)
• Cold-extreminies (CI Reynauds, PVD)
• Bronchospasm (CI asthma)
• Sleep disturbance, nightmares (water-soluble)
• CI +Verapamil (severe brady)
• +Thiazide (insulin resistance, monitor)

Question 6

CCB COUNCILLING

Answer 6

• Non-DHP: Bradycardia (CI 2/3HB, sick sinus)
• Hypotension (CI uncontrolled HF)
• GI (Verapamil: Constipation)
• Flushing
• Ankle oedema (reduce or +ACEi/ARB)
• Gingival hyperplasia
• CI Non-DHP +B-blocker (severe brady)
• CI +Grapefruit juice

Question 7

Nitrate COUNCILLING

Answer 7

• Flushing
• Hypotension (CI)
• Headache (cerebral vasodilation)
• CI Cerebral haemorrhage
• Tolerance (take every 8hr)
• Tachycardia (CI)
• CI Containing heart disease

Question 8

Potassium channel activator COUNCILLING

Answer 8

• Flushing
• Hypotension (CI HF)
• Headache (cerebral vasodilation)
• CI Pregnancy and breast feeding
• Anal ulceration

Question 9

Loop diuretic COUNSILLING

Answer 9

• HYPOkalaemia
• HYPOtension
• Gout (urea absorption, cant Leap)
• Renal impairment
• Liver impairment
• Elderly (low dose)
• CI Pregnancy
• Ototoxic (frusomide)

Question 10

Thiazide diuretic COUNCILLING

Answer 10

• HYPOkalaemia
• HYPOtension
• Gout (urea absorption, canT leap)
• Renal impairment
• Liver impairment
• Elderly (low dose)
• CI Pregnancy
• HYPERcalcaemia
• HYPERglycaemia + Insulin resistance (I pre-/DM)
• +B-Blocker = Insulin insensitivity (monitor DM)
• RARE;
• Thrombocytopaenia
• Agranulocytosis

Question 11

Potassium sparing diuretic COUNCILLING

Answer 11

• HYPERkalaemia (low K diet)
  
  • CI if K+ >4.5 (hyperK = >5.5)
  • Risk: ACEi/ ARBs/ supplements
• Addison’s disease CI
• Renal (anuria) (CI, Cr >220half, >310stop)
• Hepatic failure (CI, stop)
• Gynaecomastia (spironolactone progesterone effects)
• Menstrual irregularities