CV system MHRA alerts Flashcards
Amiodarone can cause severe bradycardia with which group of medicines?
Risk of severe bradycardia when used with:
- Sofosbuvir with daclatasvir
- Sofosbuvir and ledipasvir
- Simeprevir with sofosbuvir
(they are antivirals used in the treatment of hepatitis C)
AVOID concomitant use unless other antiarrythmics cannot be given
Sotalol has a serious adverse cardiac effect.
Which electrolytes must you manage prior to starting treatment?
When would you reduce the dose?
May prolong QT and cause life threatening ventricular arrythmias
Take care to avoid hypokalaemia/ hypomagnesaemia in those taking sotalal (correct these if present before starting treatment)
Reduce dose if QT>550msec
Vitamin K antagonists e.g. warfarin, acenocoumarol, phenindione require close INR monitoring with a specific group of medications.
Interaction with antivirals used for hep C
Changes in liver function, secondary to hepatitis C treatment with direct-acting antivirals, may affect the efficacy of vitamin K antagonists
MHRA advises that INR should be monitored closely in patients receiving concomitant treatment
Warfarin is associated with a rare but serious cutaneous adverse effect. What is this effect?
Calciphylaxis
Patients should consult their doctor if they develop a painful skin rash
If calciphylaxis is diagnosed, treat it and consider stopping warfarin.
Calciphylaxis is most commonly observed in patients with known risk factors such as ESRD but however cases have also been reported in patients with normal renal function.
In which patients is calciphylaxis associated with warfarin usually seen?
Those with risk factors or calciphylaxis e.g. ESRF but can occur in those without too.
What is calciphylaxis?
Calcium accumulates in small blood vessels of the fat and skin tissues
Calciphylaxis causes blood clots, painful skin ulcers and may cause serious infections that can lead to death
DOACs have available reversal agents. Name these.
Reminder of bleeding risks and availability of reversal agents
Idarucizumab for dabigatran
Andexanet alfa for apixaban and rivaroxaban
Hydrochlorothiazide carries a risk of which type of cancer? Which patient counselling points are important for this?
Risk of non-melaenoma skin cancer, particularly with long term use
Inform patients of the cumulative, dose-dependent increased risk of skin cancer
Advise patients:
- regularly check for and report any new or changed skin lesions or moles.
- limit exposure to sunlight and UV rays and use adequate sun protection
Reconsider the use of hydrochlorothiazide in patients who have had previous skin cancer.
Riociguat should not be used for which group of patients?
Not for use in patients with pulmonary hypertension associated with idiopathic interstitial pneumonias
The use of riociguat is contraindicated in these patients and that existing treatment for this unauthorized indication should be discontinued.
Noradrenaline/norepinephrine
The noradrenaline/norepinephrine 0.08mg/ml (4mg/50ml) solution for infusion carries a potential risk of medication errors.
Be aware of the differences in strength and presentations.
Manufacturer advises noradrenaline 0.08mg/ml solution for infusion must not be diluted before use and should only be used for the on-going treatment of patients already established on noradrenaline therapy, whose dose requirement are clinically confirmed to be escalating.
How many adrenaline injectors should be carried at all times? In which cases is this particularly important?
What counselling points are important for patients/carers?
2 adrenaline auto-injectors are prescribed, which patients should carry at all time.
esp in those with allergic asthma, whoa re at increased risk of a severe anaphylactic reaction.
Patients and their carers should be trained to use the auto=injector they have been prescribed and encouraged to practice using a trainer device.
Patients are advised to check the expiry date of the adrenaline auto-injectors and obtain replacements before they expire.
