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BNF > CVS > Flashcards

CVS Flashcards

1
Q

3 types of atrial fibrillation

A

paroxysmal AF- episodes stop within 48h without trt
persistent AF- last > 7 days
permanent AF- present all the time

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2
Q

4 class of anti-arrhythmic drugs

A

CLASS I: Na+ blocker, membrane stabilising drugs: disopyramide, flecainide/propafenone (C/I in asthma, severe COPD, avoid in structural/ ischaemic heart disease) lidocaine
CLASS II: B blocker: propranolol, esmolol
CLASS III: K+ blockers: amiodarone (use b/f and a/f cardioversion), SOTALOL, dronedarone
CLASS IV: CCB (rate-limiting): verapamil, diltiazem
OTHER: adenosine, digoixin

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3
Q

two pathways for cardioversion to restore sinus rhythm

A

1 electrial current

2 pharmacological

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4
Q

which cardioversion method is preferred for arrhythmias > 48h

A

electrical

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5
Q

trt for acute new-onset presentation of arrhythmias 1-life threatening haemodynamic instability

A

electrical cardioversion

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6
Q

trt for acute new-onset presentation of arrhythmias 2- <48 hrs

A

rate or rhythm control (electrical or amiodarone/flecainide)

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7
Q

trt for acute new-onset presentation of arrhythmias 2- >48 hrs

A

rate control (verapamil, BB)

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8
Q

maintenance trt for arrhythmias: 1st line

A

rate control (BB not sotalol, CCB, digoxin) monotherpy -> dual therapy -> rhythm control

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9
Q

maintenance trt for arrthymias: 2st line

A

rhthym control: SOTALOL, amiodarone, dronedarone, flecainide, propafenone

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10
Q

What is “pill in the pocket” and which drug

A

self treatment for arrhythmias, FLECAINIDE or propafernone

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11
Q

preferred surgical treatment for atrial flutter

A

catheter ablation

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12
Q

What is the screening tool for risk of stroke

A

CHADS-VASc tool

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13
Q

what does CHA2DS2-VASc stand for? what score indicates treatment

A 
Chronic heart failure 
Hypertension
Age >75 (score2)
Diabetes
Stroke / TIA/ VTE Hx (score2)
Vascular disease
Age 65-74 
Sex (M-1,F-2)
Treat if score >2 or more
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14
Q

Treatment for pulseless/V fibrillation

A

immediate defibrillation and CPR then IV amiodarone in refractory

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15
Q

Trt for UNSTABLE sustained V tachycardia

A

direct current cardioversion, if fail add IV amidodarone

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16
Q

Trt for STABLE sustained V tachycardia

A

IV amiodarone preferred

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17
Q

Trt for NON-SUSTAINED V tachycardia

A

BB

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18
Q

maintanance trt for pt at high risk of cardiac arrest (2 types of therapy)

A
  1. implantable cardioverter defibrillator

2. some pt needs drugs e.g. sotalol, BB alone or BB + amiodarone

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19
Q

what’s prolonged QT interval also called

A

torsade de pointes

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20
Q

trt for QT prolongation i.e. TdP

A

magnesium sulphate

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21
Q

what are the causes for QT-prolongation (4)

A
  1. sotalol
  2. other drugs that prolong QT e.g. cirpofloxacin, amitriptyline, risperidone, ACE abx
  3. hypOKalaemia
  4. bradycardia
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22
Q

PSVT can go away spontaneously or with relflex vagal nerve stimulation (reduce BP) such as

A

valsalva manoeuvre, carotid sinus massage, immerse face in ice cold water

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23
Q

IV trt for PSVT

A

adenosine *c/i in asthma/copd, verapamil

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24
Q

trt for recurrent PSVT

A

catheter ablation or anti-arrhythmic drugs

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25
Q

what are the indications of amiodarone

A
  • PS arrhythemia

- V arrhythemia

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26
Q

titration of amiodarone

A

200mg TDS for 7, 200mg BD for 7, 200mg OD as maintenance

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27
Q

S/e of amidarone (6)

A
  1. EYES: Corneal microdeposits (night time glares “dazzled” by headlight at night, no vision impairm)
    Optic neuropahty/neuritis (blidness) –> stop
  2. SKIN: Phototoxicity (burning)
    Grey skin on light exposure (shield skin from sunlight)
  3. NERVES: Peripheral neuropathy (numb, tingling hands and feets, tremors)
  4. LUNGS: Pneumonitis, pulmonary fibrosis (SOB, dry cough)
  5. LIVER: Hepatotoxicity (report if jaundice, NV, fatigue, pruritus, ab pain, 3x LTA
  6. THYROID
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28
Q

how does amiodarone affect thyroid level and why

A

amiodarone contains iodine -> hyPERthyroid and hyPOthyroid
hyper- weight loss, tachycardia, heat intolerance/ give carbimazole PRN, w/d amiodarone
hypo- weight gain, bradycardia, cold intolerance
start levothyroxine, no w/d of amio

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29
Q

Monitoring required with amiodarone

A
  • yearly Eye test
  • chest x ray
  • LFT every 6/12
  • thyroid TSH,T3,T4 before and every 6/12
  • BP (hypo) ECG (bradycardia)
  • K+ level (hypOKal)
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30
Q

Key interactions of amiodarone

A
  1. Grapefruit juice (enzyme inhibitor) increases amiodarone conc
  2. Amiodarone (enzyme inhibitor) —> reduce dose for warfarin phenytoin HALF DOSE digoxin
  3. Statins —> myopathy
  4. Bb, CCB —> Brady/AV block
  5. Floxacin, ACE thromycin, TCA, Li, quinine, anti malarial, antipsych (esp sulpiride amisulpiride pimozide
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31
Q

how does digoxin work?

A

increase force of contraction (+ve inotrope)

reduce conductivity in AV node (-ve chronotrope)

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32
Q

what type of drug is digoxin

A

cardiac glycoside HIGH RISK DRUG

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33
Q

therapeutic level of digoxin

A

1-2 mcg/L

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34
Q

how long after dosing can digoxin conc reach the therapeutic level

A

6 hours after does

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35
Q

is regular monitoring of digoxin level required as a high risk drug

A

no, not during maintenance therapy

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36
Q

under what condition monitoring of digoxin level is required

A

only if toxicity is suspected OR in RENAL impairment (renally cleared)

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37
Q

how often do you take digoxin as a maintenance therapy

A

OD

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38
Q

indications for digoxin and the associated dosage

A

worsening/severe HF 62.5-125mcg

atrial flutter/ non-paroxysmal AF in sedentary pt 125-250mcg

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39
Q

different dosage form of digoxin have different BA: -elixir, -tab, -IV

A
  • exlixir 75%
  • tab 90%
  • IV 100%
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40
Q

what are the signs of digoxin toxicity (5)

A 
SLOW and SICK Dr:
bradycardia/ heart block
NV, D+ ab pain
yellow blurred vision
confusion, delirium
rash
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41
Q

what factors increase the risk of digoxin toxicity (5)

A
  • hypOK (diurectics, theophylline, B2 agonist: salbutamol,tiotropium,aclidinium, steroid- prednisolone)
  • hypO Mg
  • hypER Ca
  • hypoxia
  • renal impairment (ACEi/NSAID)
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42
Q

what are the 2 options for digoxin toxicity

A

withdraw

digoxin-specific antibody if life-threatening V arrhythmia unrepsonsive to atropine

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43
Q

what are the key interactions with digoxin CRASED

A

C- ccb (RATE)
R- rifampicin (R = inducer) reduce dgx conc
A - amiodarone (A=inhibitor) increase dgx conc - toxicity HALF DGX DOSE
S - st.johns wort (S=inducer)
E - Erythromycin (ACE=marcorlids=inhibitor) increase dgx conc
D - diuretics (loop/thiazide) hypOKal

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44
Q

digoxin + NASID/ ACEi

A

reduced renal function –> toxicity (dgx renal excreted)

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45
Q

theothylline can ___ K level

A

Klevel reduces as theothylline conc increases –> hypOKaleamia

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46
Q

VTE risk assessment in hospital

A
  • immobility
  • obesity BMI>30
  • cancer
  • age>60
  • Hx of VTE
  • thrombophilic disorder
  • 1st degree of relative with VTE
  • HRT/COC
  • varicose vein (lost elasticity) with phlebitis (inflam vein)
  • pregnancy
  • critical care
  • sig co-morbidities
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47
Q

risk of bleeding assessment

A 
HAS-BLED 
hypertension (uncontorlled BP)
abnormal renal/liver func
stroke
bleeding tendency (throbocytopenia-low platelet)
labile INR
age >65
drugs eg aspirin/NSAID/alcohol
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48
Q

duration of VTE prophylaxis for general surgery

A

5-7 days or until mobility

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49
Q

duration of VTE prophylaxis for major cancer surgery in ab or pelvis

A

28 days

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50
Q

duration of VTE prophylaxis for knee/hip surgery

A

extended duration

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51
Q

which IV VTE drug is preferred in pt with renal impairment

A

unfractionated heparin

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52
Q

what needs to be monitored in pt using unfractionated heparin

A

APTT: activated partial thromboplastin time

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53
Q

what is a APTT test and what is the normal value and the value when taking heparin

A

speed of clotting
normal aPTT value is 30- 40 sec
heparin value 60-80 seconds

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54
Q

preferred choice for VTE in pregnancy

A

LMWH

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55
Q

MOA for unfractionated heparin

A

UH (renal imapir) activates antithrombin

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56
Q

MOA for LMWH

A

LMWH inactivates factor Xa

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57
Q

longer duration of action, UH or LMWH

A

LMWH

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58
Q

suitable for pt with high risk of bleeding, UH or LMWH

A

UH

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59
Q

used in pregnancy, UH or LMWH

A

LMWH

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60
Q

lower risk of oeteoporosis, heparin-induced thrombocytopeonia, UH or LMWH

A

LMWH

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61
Q

essential to measure APTT, UH or LMWH

A

UH

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62
Q

antidote for haemorrhage (heparin induced)

A

protamine

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63
Q

s/e of heparin

A
  1. hypERKalaemia
  2. osteoporosis
  3. thrombocytopoenia (low platelet)
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64
Q

how does heparin cause hypERKalaemia

A

heparins inhibit aldosterone secretion. aldosterone is an endogenous mineralcorticoid that retains Na and Water, excretes K

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65
Q

which group of pt use heparin IN CAUTION

A

DM and CKD (poor excretion of K already)

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66
Q

MOA of warfarin

A

Vit K antagonist

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67
Q

how long does it take for warfarin to work

A

2-3 days

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68
Q

what strength of warfarin are available in pharmacy and what colour are they

A

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

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69
Q

standard initial dose of warfarin and how often is monitoring

A

5mg monitor daily

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70
Q

maintenance dose of wargarin

A

3-9mg same time each day

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71
Q

how often is the monitoring for warfarin pts whoes INR is stable

A

every 3 months

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72
Q

what is INR

A

international normalised ratio

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73
Q

target INR (=/-0.5unit) in pts with VTE, AF, MI, cardioversion, prosthetic mitral valve

A

2.5

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74
Q

target INR (=/-0.5unit) in pts with RECURRENT VTE who’s receving anticoags

A

3.5

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75
Q

s/e of warfarin

A

any form of bleeding

calciphylaxis

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76
Q

what is calciphylaxis

which gp of pt has higher risk of getting it

A

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 (increased risk in end stage renal disease)

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77
Q

patient conselling for warfarin

A
  • yellow booklet INR
  • check INr level 2.5-3.5
  • check dosage
  • report painful skin rash (calciphylaxis)
  • check OTC med (miconazole- report if nose bleed/ blood in urine)
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78
Q

major interactions involving wafarin…

A
  1. warfarin x miconazole = miconazole, a potent enzyme inhibitor, increase anticog effect of warfarin –> increase risk of bleeding,report if nose bleed/ blood in urine
  2. warfarin x antivirals (hepC) = change in liver func= labile INR
79
Q

what is the antidote of warfarin

A

Vit K/phytomenadione=vitK1

80
Q

what to do when bleeding while on warfarin?

A
  1. stop wafarin
  2. IV phytomenadione =VitK1 (IV if active bleeding, PO if INR>8)
  3. Dried prothrombin complex OR fresh frozen plasma
81
Q

what to do if pt has INR 5-8, no bleeding (on warfarin)

A

withhold 1-2 dose, reduce maintenance dose, measure INR after 2-3 days

82
Q

what to do if pt has INR 5-8 and minor bleeding (on warfarin)

A

omit warfarin, IV phytomenadione, restart warfarin INR <5

83
Q

what to do if pt has INR > 8, no bleeding (on warfarin)

A

omit warfarin, oral phytomenadione, restart warfarin INR<5

84
Q

what to do if pt has INR > 8, minor bleeding (on warfarin)

A

omit warfarin, IV phytomenadione, restart INR<5

85
Q

how many days before elective surgery to stop warfarin, what to give if INR>1.5 before surgery, when to restart

A

5 days, PO phytomenadione, restart on eve or next day

86
Q

surgery + pt at high risk of VTE (prev VTE, AF, TIA, mechanical valve)

A

gradually stop warfarin and bridge with LMWH (try dose) and stop 24h before surgery

87
Q

when to start which anticoag after a surgery if pt is at high risk of bleeding

A

restart LMWH 48h after surgery

88
Q

what to do if pt on warfarin needs emergency surgery

A
  1. delay 6-12h

2. no delay, give IV VitK and dried prothrombin complex

89
Q

MOA of noval oral anticoags (NOACs)

A

inhibit clotting factors ie thrombin or factor Xa

90
Q

4 examples of NOACs

A

dabigatran
apixaban
edoxaban
rivaroxaban

91
Q

how does dabigatran work? (MOA)

A

inhibit thrombin directly

92
Q

what is the storage advice for dabigatran?

A

special container to protect from moisture, use within 4 months once opened

93
Q

how does apixaban work? (MOA)

A

inhibit clotting factor Xa

94
Q

what is an ischaemic stroke

A

blood clots obstructs blood supply in brain

95
Q

what is a haemorrhagic stroke

A

weak blood vessels in brain burst causing intracerebal haemorrrhage

96
Q

is TIA (mini stroke) ischaemic or haemorrhagic

A

ischaemic (transient ischaemic attack)

97
Q

long term trt for TIA

A

M/R dipyridamole AND aspirin

98
Q

long term trt for ischaemic stroke

A

CLOPIDOGREL

99
Q

long term trt for both TIA and ischaemic stroke

A 
STATIN, irrespective of cholestrol level
treat HYPERTENSION (now with BB)
100
Q

what to avoid in intracerebral haemorrhage

A

avoid aspirin, statin, anticoags as increase risk of bleeding

101
Q

trt for intracerebral haemorrhage

A

treat hypertension

102
Q

name 5 anti-platelets

A

1- 75mg aspirin (2ndary prevention of CVD)
2- clopidogrel (following acute coronary syndrome or PCI-stent)
3 dipyridamole (take 1h before food, 2ndary prevention of stroke)
4- prasugrel
5- ticagrelor

103
Q

storage advice for M/R dipyridamole

A

special container, use within 6 weeks once opened

104
Q

BP of stage 1 hypertension

A

BP =/> 140/90

105
Q

trt for stage 1 hypertension

A

lifestyle advice only

106
Q

when to use drug trt for stage 1 hypertension

A

under 80s with 1. target organ damage (heart LV, kidney, eye)
2. CVD or CVD 10yr risk >20%, CKD, DM

107
Q

BP of stage 2 hypertension, lifestyle advice or trt

A

above 160/100, treat all

108
Q

BP of stage 3 HT

A

above 180/110

109
Q

what is hypertensive emergency

A

BP over 180/110 WITH acute target organ damage

110
Q

what is hypertensive urgency

A

BP over 180/110 WITHOUT target organ damage

111
Q

route of adm for HT emergency

A

IV

112
Q

aim of trt in HT emergency

A

reduce BP SLOWLY, otherwise reduced organ perfusion = blindness, MI, cerebral infarction, severe renal impair

113
Q

aim for HT urgency

A

reduce BP SLOWLY over 24-48H

114
Q

clinical BP target for under 80s

A

lower than < 140/90 (gold standard for normality)

115
Q

bp target for under 80s with CVD/DM/CKD/retinopathy

A

bp < 130/80 (gold standard for any target organ complications, lower and more strict BP, more control)

116
Q

bp target for OVER 80s

A

bp <150/90

117
Q

bp target for pt with proteinuria > 1g in 24 hours, what trt need to be added

A

<130/80, consider ACEi/ARB for proteinuria

118
Q

bp target for renal disease pt (without CKD)

A

<140/90

119
Q

bp target for diabetic pt

A

<140/80 (odd one out)

120
Q

bp target for diabetic pt with complications in eye/kidney/cerebrovascular

A

<130/80

121
Q

bp target for pregnant women with chronic HT

A

bp< 150/100

122
Q

bp target for pregnant women with chronic HT and target organ damage or give birth

A

bp<140/90

123
Q

what are the 3 pharmalogical trt for HT in pregnancy

A
  1. labetalol (hepatotoxic)
  2. methylDOPA (stop 2 days after birth)
  3. MR nifedipine (unlicensed)
124
Q

MOA of ACEi

A

inhibits the conversion from angiotensin 1 to angiotensin II, AgII cause vasoconstriction

125
Q

which is the only ACEi that needs to be taken BD instead of OD

A

captopril

126
Q

which ACEi needs to be taken 30-60 min before food

A

Perindopril

127
Q

when is the best time to take the FIRST dose of ACEi

A

first dose at BED-TIME

128
Q

step ONE of the HT treatment

A

AB <55, CD>55, afro-carribean origin

AB (ACEI/ARB OR BB) CD (CCB OR Diuretics thiazide like)

129
Q

step TWO of the HT trt cascade

A

A/B + C/D (vice versa for 55+/ afro-carribean)

130
Q

Step THREE of the HT trt cascade

A

A + C + D

131
Q

step FOUR of the HT trt cascade (resistant HT)

A

A + C + D (thiazide) + D (low dose spironolactone or high dose TLD if K+ > 4.5); if other D CI, add A- or B-blocker

132
Q

which HT drugs to avoid in diabetic pt and why

A

TLD and BB can cause hypERglycaemia

133
Q

s/e for ACEi

A
  1. dry cough (give ARB)
  2. hypPERKalaemia (higher risk in DM/ CKD)
  3. anaphylactoid rxns (angioedema)
  4. renoprotective in renal disease (CKD); nephrotoxic in AKI
  5. hepatotoxic (jaundice, stop if liver transaminases 3x normal)
  6. oral ulcer, taste disturbance and
  7. hypOglycaemia
134
Q

what is the renal effects from ACEI

A

ACEI reduces eGFR via EFFerent arteriole dilation; avoid in renovascular disease (may give in unilateral renal artery stenosis NOT severe bilateral stenosis)

135
Q

can you use ACEI in pregnancy

A

NO should be avoided

136
Q

what are the drugs that are nephrotoxic

A

DAMN (diurectics, ACEi/ARB, metformin, NSAID)

137
Q

4 common drug interactions with ACEi

A
  1. hypERKalaemia: avoid aliskeren, ARB, spironolactone, eplerenone, amiloride (k sparring D)
  2. hypOtension: avoid Diuretics
  3. Nephrotoxic: avoid DAMN, esp NSAID- double wammy AFFerent ateriole constriction
  4. Renal impairm (avoid ACEi + ARB in diabetic nephropathy
138
Q

what causes the dry cough when using ACEi

A

build up of BK (bradykinin)

139
Q

what is aliskiren

A

renin inhibitor, renin converts Ag to Ag2

140
Q

name 3 centrally acting anti-hypertensives

A
  • methylDOPA (central alpha inhibitor?
  • clonidine
  • moxonidine
141
Q

name 2 vasodilator antihypertensives (not CCB)

A
  • Hydralazine

- Minoxidil

142
Q

name 3 common alpha blockers

A
  • doxazsin
  • prazosin
  • indoramin
143
Q

Which class of anti-arrhythmic drug does sotalol belong to?

A

sotalol blongs to Class 3 (K+ channel blocker)

144
Q

which b-blocker is ususally used peri-operatively as it has a short half life?

A

Esmolol

145
Q

which b-blockers cause LESS bradycarida, COLD extremities? What is this effect called?

A

ICE PACO - Pindolol, Acebutol, Celiprolol, Oxyprenolol

intrinsic sympathomimetic activity

146
Q

which b-blockers cause LESS nightmare? Why is this?

A

WATER CANS - Celiprolol, Atenolol, Nadolol, Sotalol

CANS are water solution, less likely to cross BBB in brain to cause nightmares

147
Q

Which b-blockers are more cardio-selective therefore less bronchospasm thus can be rx for WELL-controlled ASTHMA or under SPE care

A

Be A MAN - Bisoprolol, Atenolol, Metoprolol, Acebutol, NebIvolol (CardIao)

148
Q

which b-blockers are longer acting thus OD dosing?

A

BACoN - bisoprolol, Atenolol, Celiprolol, Nadolol

149
Q

what are the main side effects of b-blockers? (3)

A

hypotension
bradycardia
GBL - hyPO and hyPER: mask symp of hyPO (shaky, tachycardia)

150
Q

C/I (conditions) of B-blockers (4)

A

ASTHMA: brochospasm (inc eye drops TIMOLOL)
UNSTABLE HF (worsen)
2nd/3rd degree HEART BLOCK
severe HYPOTENSION and BRADYcardia

151
Q

common interactions with b-blockers (2)

A
  • VERAPAMIL INJECTION = asystole and hypotension

- THIAZIDE-like-DIURETIC = hyPERglycaemia (avoid in DIABETES)

152
Q

which dihydropyridine CCB (vasodialation) requires SAME M/R brand

A

NIFEDIPINE

153
Q

s/e of dihydropyridine CCB (3)

A

ankle swelling, flushing, headaches (common)

154
Q

C/I condition for rate limiting CCB

A

Heart failure

155
Q

which rating limiting CCB is the ONLY CCB licensed for arrhythmias

A

VERAPAMIL

156
Q

diltiazem requires to be maintained on SAME BRAND when doses above xx mg?

A

SAME BRAND when dose > 60mg

157
Q

what can increase conc of CCB? thus what to AVOID (diet)

A

enzyme inhibitor = AVOID grapefruit juice

158
Q

what is pheochromocytoma?

A

tumour in adrenal glands which releases adrenaline and noradrenaline, causes HIGH BP, HEAVY SWEATING

159
Q

trt for pheochromocytoma?

A

B-blocker and alpha-blocker (e.g. phenoxybenzamine) vasodilation

160
Q

what is the key SE of vasoconstrictor sympathomimetics (noradrenaline, phenylephrine)

A

reduced PERFUSION to vital ORGANS (e.g. KIDNEYS)

161
Q

3 key symptoms of HF

A

1- dyspnoea (rest/exercise)
2- exercise intolerance
3- oedema (PULMONARY/PERIPHERAL) SOB/ swollen ankles, legs

162
Q

NICE guidance trt of HF stage1-3

A

stage 1. ACEi + b-blocker
stage 2. add SPIRONOLACTONE
stage 3. add IVARABADINE or add DIGOXIN (severe)

163
Q

what is the alternative option instead of ACEI+ BB in HF

A

HYDRALAZINE + ISOSORBIDE dinitrate. specialist/afro-carib

164
Q

which ARBs are licensed in HF

A

candeSARTAN, valSARTAN

165
Q

which BB is used in mild-mod stable HF and 70+

A

NEBIvolol (carDIO-selective)

166
Q

which BBs are used in ALL grades of LVSD

A

BISOprolol, CARDEvilol

167
Q

Which ACEI/ARB combination is used in HF with LVEF <35%

A

Sacubutril + valsartan

168
Q

which 2 types of DIURETICS are used in fluid overload in HF, which has limited effect in certain condition

A
  1. LOOP diuretics (furosemide, bumetanide)

2. THIAZIDE diuretics in mild HF (ineffective if eGFR<30)

169
Q

what is the manifestation of hyperlipidaemia

A
  • fat in BV (atherosclerosis)
  • CVD (MI,angina)
  • strokes TIA
  • peripheral sterial disease
170
Q

which groups of population require PRIMARY prevention of CVD (6)

A 
T1DM
T2DM only if CVD risk >10%
QRISK2 10years CVD risk >10%
CKD/albuminuria (eGFR<60)
familial hypercholesterolaemia
85+
171
Q

which group of population needs SECONDARY prevention of CVD

A

previous established CVD

172
Q

QRISK2 is suitable for age under what

A

age under 84

173
Q

cholesterol targets - diagnosis of hyperlidaemia

A

6mmol/L total cholesterol

174
Q

TOTAL CHOLesterol for HEALTHY adults should be

A

= 5mmol/L

175
Q

TOTAL CHOLesterol for HIGH RISK adults should be

A

=4mmol/L

176
Q

LDL (bad cholesterol) for HEALTHY adults should be

A

= 3mmol/L

177
Q

LDL (bad cholesterol) for HIGH RISK adults should be

A

=2mmol/L

178
Q

HDL (good cholesterol - higher the better) for general adults should be

A

> 1mmol/L

179
Q

Triglycerides level in adults should be

A

<1.7mmol/L

180
Q

Which 4 groups of drug can cause hyperlipidaemia

A

antipsychotics - weight gain
immunosuppressants
corticosteroids (increase BGL?)
antiretrovirals (HIV drugs)

181
Q

which 5 conditions can cause hyperlipidaemia?

A 
hyPOthyroidism
liver/kidney disease
DM
family Hx
lifestyle e.g. smoking, alcohol, obesity, fatty diet
182
Q

dosage for Atorvastatin in PRIMARY and 2NDARY prevention of CVD

A

20mg OD

80mg OD -2ndary

183
Q

high intensity of rosuvastatin and simvastatin

A 
rosuvastatin 10mg
simvastain 80mg (MHRA warning high risk of myopathy)
184
Q

what is the effect of thiazide like diuretic and ACEI on K+ level

A

thiazide like diuretics–> hyPOKALaemia
ACEI–> hyPERKalaemia
together - K+ neutral

185
Q

how does diuretics affect the exerction of uric acid and what is the implication

A

diuretics reduces uric acid excretion –> gout

186
Q

high dose of loop diurectics can also cause … (s/e) therefore cant be used with which ABx

A

tinnitus, hearing loss, AVOID aminoglycoside ( gentamicin, amikacin, tobramycin, neomycin, and streptomycin.) increase ototoxicity, nephrotoxicity

187
Q

equivalent of bumetanide 1mg = xx furosemide

A

1mg bumetanide= 40mg furosemide

188
Q

how does loop diuretic affect eletrolyte level

A

LOW eletrolyte state : LOW Na, K, Ca, Mg, Cl

189
Q

Treatment for HF with reduced LVEF

A

ACEI AND BB

190
Q

Treatment for HF with reduced LVEF after ACEI AND BB and LVEF<35

A 
- replace ACEI /ARB with
Sacubitril and valsartan 
- add ivabradine for sinus rhythm with HR> 75
- add hydrazine and nitrate (esp afro)
-add digoxin
191
Q

Treatment for stable angina

A

Either BB OR CCB

Or nitrate/ ivabradine/ nicorandil/ ranolazine

192
Q

Medical management for STEMI

A

300mg aspirin
Ticagrelor with aspirin or
Clopidogrel with aspirin or aspirin alone if high bleeding risk

193
Q

Medical treatment for NSTEMI

A

300mg aspirin and continue indefinitely

Fondaparinux

194
Q

Secondary prevention for MI

A

Acei
Two Antiplatelet including aspirin for 12M
Bb or ccb heart
Statin

BNF (13 decks)

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