Management of common conditions

Question 1

Heart failure drug management?

Answer 1

1) ACE-inhibitor + B blocker
2) Aldosterone antagonist, angiotensin 2 inhibitor or hydralazine & GTN
3) Diuretics + Digoxin symptomatically
4) Ivabradine

Question 2

NSTEMI

Answer 2

1) MONA
2) Give ASPIRIN (from MONA) and FONDAPARINUX (LMWH antithrombin)
3) Use GRACE to assess risk of death - Coronary angiography if >3% risk of death in 6 months
3) Clopidogrel 300mg for 1+ year after

PREVENTION
1) Cardiac rehabilitation

Question 3

Standard therapy post-MI

Answer 3

aspirin
a second antiplatelet if appropriate (e.g. clopidogrel, ticagrelor)
a beta-blocker
an ACE inhibitor
a statin
ALDOSTERONE ANTAGONIST
Also cardiac rehabilitation

Question 4

Angina

Answer 4

1) GABS
GTN + Aspirin + Beta blocker + Statin
Ca2+ channel blocker can be used - w/o b blocker verpamil, w/b blocker nifedipine

Question 5

Broad complex VT

Answer 5

Unstable - DC cardioversion

Stable - Amiodarone (300mg) OR flecainide if no structural abnormality

Question 6

Narrow complex VT/SVT

Answer 6

1) Unstable - DV cardioversion

2) Stable - Vagal maneouevers + IV adenosine (6mg+12+12) OR verapamil in asthmatics

Question 7

Aspirin

Answer 7

Antiplatelet - inhibits the production of thromboxane A2

Question 8

Clopidogrel

Answer 8

Antiplatelet - inhibits ADP binding to its platelet receptor

Question 9

Enoxaparin

Answer 9

Activates antithrombin III, which in turn potentiates the inhibition of coagulation factors Xa

Question 10

Fondaparinux

Answer 10

Activates antithrombin III, which in turn potentiates the inhibition of coagulation factors Xa

Question 11

Bivalirudin

Answer 11

Reversible direct thrombin inhibitor

Question 12

Hypertension

Answer 12

Stage Criteria
Stage 1 hypertension Clinic BP >= 140/90 mmHg and subsequent ABPM daytime average or HBPM average BP >= 135/85 mmHg
Stage 2 hypertension Clinic BP >= 160/100 mmHg and subsequent ABPM daytime average or HBPM average BP >= 150/95 mmHg
Severe hypertension Clinic systolic BP >= 180 mmHg, or clinic diastolic BP >= 110 mmHg

Question 13

Step 3 treatment hypertension management

Answer 13

add a thiazide diuretic (D, i.e. A + C + D)
NICE now advocate using either chlorthalidone (12.5-25.0 mg once daily) or indapamide (1.5 mg modified-release once daily or 2.5 mg once daily) in preference to a conventional thiazide diuretic such as bendroflumethiazide

Question 14

Step 4

Answer 14

consider further diuretic treatment
if potassium < 4.5 mmol/l add spironolactone 25mg od
if potassium > 4.5 mmol/l add higher-dose thiazide-like diuretic treatment
if further diuretic therapy is not tolerated, or is contraindicated or ineffective, consider an alpha- or beta-blocker

Question 15

Absolute contraindications to thrombolysis

Answer 15

Haemorrhagic stroke or Ischaemic stroke < 6 months CNS neoplasia
Recent trauma or surgery
GI bleed < 1 month
Bleeding disorder
Aortic Dissection

Relative
Warfarin 
Pregnancy 
Advanced Liver Disease 
Infective Endocarditis