Drugs & Doses: Cardiac

Question 1

Post MI Management (5 points)

Answer 1

1. Aspirin 100mg daily
2. Clopidogrel 75mg daily
3. B-blocker - Metoprolol tartate (or Atenolol) 25-100mg BD – as long as no heart failure / block
4. ACEi – eg Perindopril arginine 2.5-10mg daily (in most patients)
5. Statin – high dose ie atorvastatin 80mg daily (regardless of cholesterol levels)

Question 2

Pericarditis

Answer 2

Colchicine 500microg BD for 3/12

PLUS Aspirin 1g TDS for 2/52 then decrease by 250mg every 1-2 weeks, then cease

Question 3

Hypercholesterolaemia (Drug + Starting Dose)

Answer 3

Statin – Rosuvastatin 10mg daily to start

Question 4

Atrial Fibrillation - Rate Control

Answer 4

Rate control – Metoprolol tartate (or atenolol) 25 - 100mg BD

Question 5

Atrial Fibrillation - Rhythm Control

Answer 5

Rhythm control – Cardioversion electric OR try Amiodarone IV or oral as per ETG

Question 6

Atrial Fibrillation - ?Anticoagulation, considerations and then drug and dosing.

Answer 6

Assess CHA2Ds2VA score and HASBLED for risk of stroke (if >2 then anti coagulate)

Anti coagulate – Warfarin (if valvular) OR NOAC
Apixaban 5mg BD (do not use if CrCl <25)
Dabigatran 150mg BD (decrease to 110mg BD if >75yo or CrCl <50, CI’d in CrCl <30)
Rivaroxaban 20mg daily (CI’d if CrCl <29)

Question 7

Steps of Drugs and Dosing for Hypertension Management. (4 options)

Answer 7

ACEi – perindopril arginine 2.5-5mg starting
- OR ARB – candesartan 4mg

ADD if needed:
Thiazide diuretic – HCT (hydrochlorothiazide) 12.5mg (do not use <55yo, risk of DM)
CCB – amlodipine 2.5-5mg

Question 8

Heart Failure Management (congested vs euvolaemic, additions if congested, high-end options)

Answer 8

ACEi – perindopril arginine 2.5mg nocte + titrate up over 3-4 weeks to 10mg OR ARB eg Candesartan 4-32mg daily PLUS

Sprinolactone 12.5-50mg daily PLUS

WHEN EUVOLAEMIC -> Beta Blocker – once stable – start low + titrate up (Bisoprolol, Carevedilol, Metoprolol SR)
Metoprolol SR 23.75mg PO daily up to 190mg

PLUS Frusemide 20-40mg mane if congested

SWAP AceI/ARB to ARNI (sacubitril) for persistent HFrEF if LVEF <40%
Consider ADD ivabradine if SR >70bpm and LVEF <35%