Pass Med Q's Flashcards
where do Thiazide Diuretics act
block NaCl symporter on proximal part of distal convoluted tubule
where do Loop Diuretics act
ascending loop of Henley
side effects of thiazide diuretics
postural hypotension hyponatraemia , hypokalaemia hypercalcaemia hyperglycaemia gout
side effects of loop diuretics
postural hypotension
hyponatramia, hypokalaemia, hypocalcaemia
ototoxicity
if a patient develops an AKI after being started on an ACEi, what condition do they most likely have?
bilateral renal artery stenosis
what is Buergers disease
also known as thromboangitis obliterates – small + median vessel vasculitis strongly associated with smoking
symptoms of Buergers disease
intermittent claudication
ischaemic ulcers
superficial thrombophlebitis
reynauds
What is Boerhaaves syndrome
rupture of the oesophagus following repeated episodes of vomiting (typically in alcoholics)
triad: vomiting, thoracic pain, subcutaneous emphysema
presentation of mitral valve prolapse
chest pain / palpitations
mid systolic click / late systolic murmur
- associated with Polycystic kidney disease, marinas, turners, WPW
What is De Mussets sign
head bobs in time with pulse
- seen in aortic regurgitation
mechanism of dipyridimole
phosphodiesterase inhibitor
how long should warfarin be stopped prior to planned surgery
5 days
- when INR < 1.5 surgery can go ahead
how should a patient on warfarin requiring emergency surgery be managed
if surgery can wait 6-8 hours give 5mg Vit K IV
if surgery cannot wait give 25-50 units/Kg prothrombin complex
what drugs are inducers of p450 system ?
how does this affect INR ?
inducers will decrease INR (increased risk of clot)
- phenytoin / carbamazepine
- rifampicin
- st johns wart
- phenobarbitone
what drugs are inhibitors of p450 system ?
how does this affect INR ?
inhibitors will increase INR (increased risk of bleeding)
- ciprofloxacin
- clarithromycin
- amiodarone
- fluoxetine / sertraline
- fluconazole
management of a major bleed on warfarin
stop warfarin
give IV Vit K 5mg + prothrombin complex
- if prothrombin complex not available give FFP
management of high INR (>8) + minor bleed on warfarin
stop warfarin
give IV vit K 1-3 mg
repeat dose of Vit K if INR still high after 24 hours
restart warfarin when INR < 5
what heart murmur is associated with pulmonary HTN
tricuspid regurgitation
- pan systolic murmur
+ loud S2
BP target for Type 1 diabetic
- no albuminuria
- albuminuria present
no albuminuria = 135 / 85
albuminuria = 130 / 80
BP target for Type 2 diabetic
140 / 90
what drugs can be given in orthostatic hypotension
fludrocortisone or midodrine
electrical alternans on ECG
cardiac tamponade
symptoms of subclavian steal syndrome
dizziness
vertigo during use of an arm
when is atorvastatin given to Type 1 diabetics
20mg atorvastatin given if
- > 40
- diabetes > 10 years
- nephropathy
side effects of ivabradine
visual effects - luminous phenomena
headache
bradycardia
why should statins be withheld while patient completes course of macrolide antibiotics (e.g. clarithromycin)
increased risk rhabdomyolysis - increased CK
mechanism of action aspirin
inhibits thromboxane A2 production
mechanism of action clopidogrel
inhibits ADP
mechanism of action enoxaparin
activates antithrombin III
what cardiac drugs are contraindicated in pregnancy
ACEi
statins
what is Holter monitoring used for
to capture episodic arrhythmias
how do thrombolytic agents work e.g. alteplase
activating plasminogen to form plasmin
what is an absolute contraindication to thrombolysis
intracranial neoplasm
presentation of skin necrosis due to warfarin
occurs when drug is first started
INR will still be in therapeutic range
large red patch that progresses to petechiae – purpura – ecchymoses
what can cause widespread T wave inversion on an ECG
head injury / brain herniation
- hypertensive, bradycardic, tachypnoeic patient
inferior MI + new aortic regurgitation murmur suggests what
proximal aortic dissection
side effects of beta blockers
cold peripheries impaired hypoglycaemic awareness erectile dysfunction bradycardia / heart block hypotension
