NPS Rotating term 1 Flashcards
Mr Jones presents for a check-up, complaining of angina-like pain brought on last night while at rest. He is a 72 year old man with a history of ischemic heart disease diagnosed on angiography 5 years ago and treated medically. He had a brief episode of pain a week ago, has a normal ECG, and you are awaiting his first troponin level. He does not have any contraindications to any of the medications which could potentially be prescribed.
aspirin and beta blocker
high risk NSTEACs patients should be prescribed what?
Aspirin and clopidogrel. Also some anticoagulants if not contraindicated
Clopidogrel loading dose is? then what is the dose used thereafter?
300mg, and then 75mg thereafter
what two things do we have to consider before prescribing enoxaparin?
patient body weight as the dosage depends on the body weight, and whether there is any renal impairment
what are some contraindications for aspirin?
Certain patients have true aspirin hypersensitivity and they should certainly not be prescribed it; this includes a history of anaphylaxis, urticaria, or asthma after ingestion of aspirin, other salicylates or NSAID’s. Other patients have significant other adverse reactions to aspirin which would also contraindicate its use e.g. history of vomiting, rash, thrombocytopenia with aspirin use. The other types of contraindications are patients at a high risk of bleeding e.g. those with active bleeding, active peptic ulcers.
what are some absolute contraindications for beta blockers
Absolute contraindications include bradycardia, hypotension, heart block, uncontrolled heart failure, and severe reversible airways disease.
what are some relative contraindications for beta blockers?
Relative contraindications include diabetes (worsening glycemic control and potential loss of hypoglycemic awareness), peripheral vascular disease (worsening claudication distance or rest pain if present) and milder forms of airways disease.
what can be cautiously used in a patient with prolonged ischaemic chest pain and who is currently on a beta blocker?
diltiazam
what drugs can cause decompensation of heart failure?
Drugs such as corticosteroids, NSAIDs and verapamil (negative inotropic) can all cause decompensation of heart failure.
why is heart failure exacerbated by NSAIDs?
Heart failure may be exacerbated by the use of NSAIDs, which reduce glomerular filtration rate and renal blood flow, leading to sodium and fluid retention.
Mr Pullis is 65 years old. He presents to his GP for his annual check up and is found to have a heart murmur. He is sent for an echocardiogram that reports aortic sclerosis and Left Ventricular Systolic Dysfunction (LVSD) ejection fraction 35%. This patient has asymptomatic LVSD. Which pharmacological combination should be started?
Ace inhibitor + beta blocker
what are some non drug ways of managing chronic heart failure?
General measures include:
•Fluid restriction (usually 1.5 L/day especially if hyponatraemic)
•Daily weighing, seek help if weight gain or drop >1.5 kg/day.
•Sodium restriction
what is standard treatment of chronic heart failure?
Standard treatment for chronic heart failure now would include ACE inhibitor, loop diuretic and a beta blocker when improved.
Management of the underlying disease with non-pharmacological and other drug measures e.g. aspirin, and a statin may also be needed.
One important issue for these patients is annual vaccination against influenza.
symptomatic heart failure due to LV dysfunction + fluid overload- what drugs do we give?
ace inhibitor + loop diuretic. If still symptomatic, then add spironolactone
Mr Donald is brought in by his friends with repeated generalised seizures. He has been attending a Rolling Stones concert where he has been enthusiastically dancing in front of the stage for some hours.
Which investigations are the highest priority?
blood sugar and electrolytes as Hypoglycemia and hyponatremia are both reasonably common in drug-induced seizures, more importantly their presence greatly alters the acute management.
+ urine drugs of abuse detection
