Guidelines

Question 1

what are the guidelines for strok

Answer 1

Acute 300mg Aspirin

At hospital give TPA
24 hours after start 300mg Aspirin daily for 2 weeks

Then stop aspirin and start Clopidogrel 75mg per day

Secondary prevention…

• antihypertensive
• statin

Question 2

what are the guidelines for heart failure

Answer 2

Beta blocker + ACE/ARB

Beta Blocker + ACE/ARB + MRA (eplerenone/spironolactone)

Beta Blocker (stop ACE) + spironolactone + valsartan/sacubitril

Beta Blocker (stop ACE) 
\+ spironolactone 
\+ valsartan/sacubitril
\+ ivabradine
\+digoxin
\+ pace maker

Question 3

what are the guidelines for hypertension

Answer 3

<55 y/o >55y/o or Black/ Asian
ACE/ARB CCB

                   ACE + CCB

      ACE + CCB + thiazide like diuretic

ACE + CCB + thiazide like diuretic+ beta blocker

Question 4

what are guidelines for atrial fibrillation

Answer 4

anticoagulant to prevent stroke
(warfarin or apixiban)

+ rate control (flecanide or amioderone)
+ rhythm control (CCB, diltiazem, verapamil, beta blocker)

Question 5

what are the guidelines for heart attack (MI)

Answer 5

ACE inhibitor---> indefinatley
Aspirin ---> indefinitely 
\+
Clopidogrel --> max 12 months
\+
BB --> max 12 months
\+
Statin --> max 12 months

Question 6

angina

Answer 6

GTN spray

isosorbide mononitrate (BD dosing, asymmetric dosing to avoid nitrate tolerance, need daily nitrate free period of 8-10 hours, instead of taking second dose 12 hrs after the first should instead take 8 hours later e.g 1st dose 9 am, 2nd dose 5 pm)