CVS drugs 2

Question 1

Heart failure drugs?

Answer 1

Diuretics
ACE-i
beta blockers
mineralocorticoid receptor antagonists
digoxin
vasodilators

Question 2

SEs of loop diuretics?

Answer 2

hypokalaemia, renal impairment

Question 3

Indications of starting a K+ sparing diuretic in HF?

Answer 3

if K+ <3.2mmol/L, predisposition to arrhythmias, concurrent digoxin therapy, or preexisting
K+-losing conditions.

Question 4

When to consider ACE-i in HF? major SE in HF?

Answer 4

in all those with left ventricular systolic dysfunction (LVSD)

raised K+

Question 5

beta blocker usage in HF?

Answer 5

Use with caution: ‘start
low and go slow’; if in doubt seek specialist advice fi rst; wait ≥2weeks between
each dose increment.

Question 6

Example of mineralcorticoid?

Answer 6

spironolactone

eplerenone

Question 7

SE of hydralazine? Use in HF?

Answer 7

Drug induced lupus

should be used if intolerant of ACE-i and ARBS as it reduces mortality. It also reduces mortality when added to standard therapy (including ACE-i) in black patients with heart failure

Question 8

Mx of intractable HF?

Answer 8

Inpatient management may include:
• Minimal exertion; Na+ & fluid restriction (1.5L/24h PO).
• Metolazone (as above) and IV furosemide.
• Opiates and IV nitrates may relieve symptoms).
• Weigh daily. Do frequent U&E (beware low K+).
• Give DVT prophylaxis: heparin + TED stockings (p578).

Question 9

Mx of rheumatic fever>

Answer 9

benzylpenicillin IV STAT, then phenoxymethylpencillin for 10 days) - if allergic to penicillin, give erythromycin or azithromycin for 10 days

Question 10

Trigger of rheumatic fever? Dx?

Answer 10

Lancefi eld group A -haemolytic streptococci triggers rheumatic fever
2–4wks later - due to An antibody to the carbohydrate
cell wall of the streptococcus cross-reacts with valve tissue

Dx: use Jones’ criteria (2 major/ 1major+2minor)

Question 11

Jones criteria use? major criteria? minor criteria?

Answer 11

in Dx of rheumatic fever

major: Carditis,
arthritis (a migratory, ‘flitting’ polyarthritis)
subcutaneous nodules (small, mobile, painless nodules on extensor surfaces of joints and spine)
erythema marginatum, Sydenham’s chorea - Unilateral or bilateral
involuntary semi-purposeful movements. May be preceded by emotional lability
and uncharacteristic behaviour.

Minor: fever, raised ESR/CRP, arrthralgia, prolonger PR interval, previous rheumatic fever