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Year 3 Drugs > cvs > Flashcards

cvs Flashcards

1
Q

What is the management of stable angina?

A

First line= Mono therapy of a beta blocker or calcium channel blocker
Symptomatic relief- GTN spray

Second line= the above two together

Third line= add an additional anti angina- ivabradine or nicorandil and refer to cardiology for revascularisation

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2
Q

How does GTN work?

A

Converted to nitrous oxide which stimulates vascular smooth muscle relaxation through stimulation of cGMP dependent protein kinase with resultant reduction in intracellular calcium

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3
Q

State the effects of nitrates…

A

Venous dilatation- decreases preload
Arterial dilatation- decreases afterload
Coronary dilatation- improved myocardial oxygen supply

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4
Q

What are the uses of nitrates?

A

Oesophageal spasm
Angina
Heart failure
Topical use in anal fissure (GTN cream)

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5
Q

What are the side effects of nitrates?

A

Headache
Postural hypotension
Nausea and vomiting

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6
Q

What is the first line of heart failure?

A

ACE-I and beta blocker

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7
Q

What is the second line treatment for heart failure?

A

Aldosterone antagonist (spironolactone)

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8
Q

What is an important consideration of ACE-I and aldosterone anatagonist use?

A

Likely to be on both in heart failure, can cause hyperkalaemia therefore potassium should be monitored.

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9
Q

What is digoxin strongly indicated in?

A

It is strongly indicated in heart failure if there is co-existent heart failure

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10
Q

What vaccinations should be offered to heart failure patients?

A

Annual influenza and pneumococcal vaccination

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11
Q

What is the difference between cardio selective and non cardio selective drugs?

A

Cardio selective- selectively bind to and competitively inhibit the action of adrenaline and noradrenaline on beta 1 receptors, resulting in suppression of sympathetic nervous system

No cardio selective- inhibit the action of adrenaline and noradrenaline on both the beta 1 and beta 2 receptors

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12
Q

What effects do beta blockers have?

A

Reduce contractility, reduce heart rate, reduce electrical conduction, vasoconstrict

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13
Q

What are beta blockers used for?

A 
Hypertension 
Post MI 
Migraine prophylaxis 
Rate control for AF 
Stable AF
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14
Q

Side effects of beta blockers?

A

Fatigue, headache, brachycardia, postural hypotension, nausea and vomiting

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15
Q

What is the 3rd line management for heart failure?

A

Cardiac resynchronisation therapy

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16
Q

What are examples of ACE-I

A

RAMIPRIL, LISINOPRIL etc

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17
Q

How do ACE- I work?

A

Inhibit ACE which usually converts angiotensin 1 to 2 and therefore prevents aldosterone production
Ultimately results in a reduced preload and afterload

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18
Q

What are the clinical indications of ACE-I

A 
First line for under 55 year olds in hypertension 
First line in heart failure 
Used post MI 
Used in stable angina 
Diabetic nephropathy
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19
Q

What effect do ACE- I have on the kidneys?

A

Ang 2 is the major determinant of efferent vasoconstriction
This helps to maintain the GFR when-renal perfusion is low (old people with CCF, bilateral renal artery stenosis) blocking this protective mechanism in these patients can cause deterioration in kidney function and AKI.

20
Q

What are the side effects of ACE-I?

A 
Dry cough (build up of bradykinin) 
Hypotension 
Angio oedema 
Hyperkalaemia 
Renal impairemem t
21
Q

When shouldn’t ACE-I be used?

A

Pregnancy and renal artery stenosis

22
Q

Give an example of an angiotensin 2 receptor and what the MOA is

A

Competitively inhibit the action of angiotensin 2 at AT1 receptors

23
Q

What are the effects of angiotensin 2 receptors?

A

Vascular smooth muscle relaxation
Reduced tubular sodium and water reabsorption
Reduced aldosterone secretion

24
Q

How do aldosterone antagonists work?

A

They inhibit the action of aldosterone on the sodium- potassium exchange pumps in the distal convoluted tubule

25
Q

What are aldosterone antagonists used in?

A

Conns
Refractory hypertension
Refractory heart failure
Peripheral oedema

26
Q

What is the important adverse effect of spironolactone?

A

Hyperkalaemia

27
Q

What is the secondary prevention medical management for those with angina?

A 
Atorvastatin 
AMLODIPINE 
Aspirin 
Another anti platelet 
ACE-I 
Spironolactone in those with CCF
28
Q

What is first line management for stable angina?

A

Aspirin
Statin
Sublingual GTN
Beta blocker or rate limiting CCB

29
Q

When would you offer cardioversion for AF?

A

If it is reversible
If it has presented within the last 48 hours
If it causing heart failure
They remain asymptomatic despite being effectively rate controlled

30
Q

What are the treatment opetions for AF?

A

Rate control- beta blockers and non dihypyridone CCBs are first line

Rythm control is favourable over rate control in persistent AF in a young patient/ disabling features of AF
Flecainide
Amiodarone (for structurally abnormal hearts)

31
Q

What is paroxysmal AF and how should you treat this?

A

When AF comes and goes in episodes, not lasting more than 48 hours
Patients should be anti coagulated based on their CHADSVASC score and may be appropriate for a pill in the pocket, they have to have infrequent episodes without any underlying structural heart disease,

32
Q

How do you reverse warfarin?

A

Vit K

33
Q

How do you monitor warfarin and what are the side effects?

A

INR
SE: bleeding
Alopecia, nausea, vomiting

34
Q

A patient with tachycardia and adverse features should be offered synchronised shock, what are these adverse features?

A

Heart failure
Ischaemia
Shock
Syncope

35
Q

How do you treat a stable patient with tachycardia?

A

IV amiodarone

36
Q

What is the treatment of tachycardia if the patient is unstable?

A

Synchronised DC shocks- 3 atempts then give 300mg Amiodarone and repeat then give amiodarone 900mg over 24 hours

37
Q

How do you treat narrow complex tachycardia in a stable patient

A

AF- rate control with a beta blocker or CCB
A trial flutter- beta blockers
SVT- treat with vagal manoeuvres and adenosine

38
Q

How do you treat broad complex tachycardia in a stable patient?

A

Ventricular tachycardia/unclear= amiodarone infusion

39
Q

How would you treat a patient in atrial flutter?

A

Rate/ rythm control with beta blockers or cardioversion
Treat the underlying condition- hypertension, thyrotoxicosis
Radio frequency ablation of the re entrant rythm
Anticoagulation based on CHA2DS2VASc

40
Q

What is the definition of AF?

A

Uncoordinated atrial contraction

41
Q

What is the management of stable patients with SVT?

A 
Valsalva manouvre 
Carotid sinus massage 
Adenosine 
(Verapamil as an alternative) 
If above fails then 
Direct current cardioversion
42
Q

How does adenosine work?

A

Primarily works through the AV node and interrupts the AV node and accessory pathway during SVT and resets it back to sinus rhythm.
It actually briefly causes a period of asystole or bradycardia which is scary for both the patient and the doctor, however it is quickly metabolised and sinus rythm should return

43
Q

When should you avoid using adenosine?

A

If patient has asthma, heart failure, heart block or severe hypotension

44
Q

What is the dose for adenosine

A

Initially 6mg then 12mg

Can give a further 12mg if no improvement between doses

45
Q

What is the long term management in patients with paroxysmal SVT?

A

Meds- CCB, beta blockers, amiodarone

Radio frequency ablation

Year 3 Drugs (6 decks)

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