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TDM > CVS > Flashcards

CVS Flashcards

1
Q

Non-pharmacological management for any patient with Cardiovascular Disease

A
  1. Stop smoking
  2. Physical activity
    - Aerobic 30min 3d per week
    - Resistance 2d per week
  3. Healthy diet
    - Low sodium and saturated fat
    - Increase vegetables and whole grains
  4. Limit alcohol intake
  5. Cardiac rehabilitation
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2
Q

NITRATES

Medication, dose, max, frequency and route

A

Isosorbide dinitrate
10mg - 40mg PO
TID
(max 480mg)

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3
Q

NITRATES

Side effects

A

HYPOTENSION -

  1. Orthostatic Hypotension
  2. Headache
  3. Reflex tachycardia
  4. Flushing
  5. Tolerance
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4
Q

NITRATES

Advices to patient regarding taking treatment

A
  1. Warn regarding orthostatic hypotension and to stay well hydrated
  2. Tolerence - only take treatment every 8 - 12 hours
  3. Hypotension - avoid taking it with Sildenafil
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5
Q

NITRATES

Contraindications

A
  1. Recent head trauma
  2. Cerebral haemorrhage
  3. Mitral valve stenosis
  4. Aortic stenosis
  5. Hypertrophic Obstructive Cardiomyopathy
  6. Restrictive Pericarditis
  7. With Phosphodiesterase 5 Inhibitors - Sildenafil (within 24h)
  8. Severe Hypotension
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6
Q

NITRATES

Drug interactions

A
  • Phosphodiesterase 5 Inhibitors (sildenafil)
  • Alpha Blockers (Prazosin)
  • DHP CCB (Amlodipine)

= HYPOTENSION

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7
Q

B-Blockers

Side effects

A

BBBBBBBBBBBBBBBB

Bradycardia

BP - Hypotension

Breathe - Bronchospasm | Acute pulmonary oedema

Block - Heart Block

BG - Decreased hypoglycemic awareness in DM

Brain - Fatigue | Depression | Impotence

Beweeg - Exercise intolerance | Worsening PVD

Beat - Sotalol = QT prolongation

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8
Q

B-Blockers

Contraindications

A

BBBBBBBBB

Bradycardia

BP - Cardiogenic shock

Block - Heart block

Beat - Sick Sinus Syndrome | Vasospastic angina

Brain - Cocaine use

Beweeg - Severe PVD

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9
Q

B-Blocker

Overdose - drugs used to treat

A
  1. Glucagon
  2. Calcium gluconate
  3. Epinephrine
  4. Insulin euglycemic therapy
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10
Q

DHP CCB

Side effects

A
  1. Hypotension
  2. Headache
  3. Flushing
  4. Oedema
  5. Reflex tachycardia
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11
Q

DHP CCB

Medication, dose, frequency, route

A

Amlodipine 5 - 10mg PO daily

max 10mg

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12
Q

DHP CCB

CI

A
  1. Severe aortic stenosis

2. Obstructive cardiomyopathy

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13
Q

DHP CCB

DI

A

Increased CCB effect - Macrolides, Grapefruit

CCB increases effects of:

  • Amiodarone
  • Digoxin
  • Statin
  • Carbamazepine
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14
Q

Non-DHP CCB

Medication, dose, route, frequency

A

Verapamil 80mg PO q8h

max 480

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15
Q

Non-DHP CCB

Side effects

A
  1. Hypotension
  2. Bradicardia
  3. AV Block
  4. Constipation (Verapamil)
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16
Q

Non-DHP CCB

CI

A

Bradicardia
AV Block
Heart failure
Cardiogenic shock

17
Q

Important question to ask a patient before initiating an ACE-I

A

History of Angioedema

18
Q

ACE-I

Side effects

A
  1. Hyperkalaemia
  2. Angioedema
  3. Renal failure
  4. Dry cough
  5. Hypotension (fatigue | dizziness | headache)
  6. Hepatotoxic
  7. Loss of taste
19
Q

ACE-I

CI

A
  1. Pregnancy
  2. Renal artery stenosis
  3. Angioedema
20
Q

ACE-I

DI

A

HYPERKALAEMIA - Spironolactone

Increase Lithium LEVELS

NSAIDS - inc BP + Renal failure

NEUTROPENIA - Allopurinol and corticosteroids

HYPOTENSION - Diuretics

21
Q

ACE-I

Monitoring

A
  • Side effects
  • Serum Creatinine
  • Potassium
    @ baseline + 2 weeks

Stop ACEI if

  1. K > 5.6
  2. Increase >30% in serum CREATININE
22
Q

ACE-I

Risk factors for hyperkalaemia

A
  • K-sparing diuretics | K-supplements | BB | Heparin
  • Renal failure
  • DM
  • Volume depletion
  • Advanced age
23
Q

ACE-I

Management of a patient on Enalapril with dry cough

A
  • Exclude heart failure
  • Stop Enalapril
  • Change to ARB - Losartan 50mg PO dly
  • Advise: cough may take up to 3 weeks to resolve
24
Q

60 yo smoker in emergency department with
chest pain for 3 hours
cold and sweaty
ECG shows ST segment changes

  1. No Cath lab available. What class and medication can be considered in this patient immediately
  2. Contraindications, list 4
  3. What other classes of medication can be considered for this patient?
  4. Non pharma advises on follow up
A
  1. Thrombolytics - Alteplase
    • Active bleeding
    • Pericarditis
    • Closed head or facial trauma within the prev 3 months
    • Ischemic stroke within previous 3 months
    • Antiplatelets
    • Thienopyradines
    • Beta Blockers
    • ACEI
    • Stop smoking
    • Cardiac rehab
    • Physical exercise
    • Healthy diet
25
Q

Fast AF in ER

Drugs and route for rate control

A

Metoprolol IV
Digoxin IV
Verapamil IV

26
Q

Amiodarone

Side effects

A

PPPPPPPPPPPPP

  • Liver toxic
  • QT prolongation
  • Hypothyroidism

Prolongation of QT ; AV block ; Bradycardia ; Hypotension

Peripheral conversion of T4 to T3 = Hypo/Hyperthyroidism

hePatitis

Photosensitivity of skin ; SJS

Pulmonary fibrosis

Peripheral neuropathy ; ataxia ; tremor

Pigmentation of skin + cornea (corneal deposits)

27
Q

Amiodarone

Monitoring

A

Liver function tests
Thyroid function tests

Baseline + q6months

TDM (7 decks)

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