Passmed Cardiology Medications

Question 1

For patients with poor renal function, what changes should be made to their loop diuretics?

Answer 1

Increase the dose
-> Loop diuretics must be filtered into the tubules by the glomerulus in order to have an effect

Question 2

What are the adverse effects of loop diuretics?

Answer 2

Hypotension
Hyponatraemia
Hypokalemia and hypomagnaesemmia
Ototoxicity
Hyperglycaemia

Question 3

What is the action of ticagrelor?

Answer 3

REVERSIBLE ADP antagonist
-> It leads to impaired clearance of adenosine which can result in dyspnoea

Question 4

Which medication should clopidogrel avoid being prescribed with?

Answer 4

Clopidogrel should avoid being prescribed with PPIs like Omeprazole because they have anti-platelet effect.

Question 5

What is a contraindication of ticagrelor?

Answer 5

Severe hepatic dysfunction and patients at high risk of bleeding. Due to effects of dyspnoea, it is cautioned in asthma.

Question 6

Which bet blocker is most lipid soluble?

Answer 6

Propanolol which is likely to cause side-effects like sleep disturbance.

Question 7

What are the common side effects of beta blockers?

Answer 7

Bronchospasm
Cold peripheries
Fatigue
Sleep disturbances
Erectile dysfunction

Question 8

Which conditions should beta blockers be contraindicated?

Answer 8

Uncontrolled heart failure
Asthma
Sick sinus syndrome
Verapamil use

Question 9

Which medication should beta blockers be avoided with?

Answer 9

Verapamil due to the risk of severe bradycardia

Question 10

How are ACE inhibtors activated?

Answer 10

Phase 1 metabolism in the liver

Question 11

What are common side effects of ACE inhibitors?

Answer 11

First dose hypotension which is more common in patients taking diuretics
Hyperkalemia
Angioedema
Cough due to increased bradykinin levels

Question 12

What should be monitored with ACE inhibtiors?

Answer 12

Urea and electrolytes
-> There may be increase in creatinine and potassium once started, but signficant renal impairment may occur

Question 13

Which patients taking ACE inhibitors are at risk for signficant renal impairment?

Answer 13

Those with bilateral renal artery stenosis

Question 14

Which ACE inhibtiors are active without undergoing phase 1 metabolism?

Answer 14

Captopril and lisinopril

Question 15

What do beta blockers exacerbate?

Answer 15

Peripheral vascular disease
-> Beta blockers restrict blood flow in skeletal muscle by preventing vasodilation

Question 16

Which medication reduce the anti-hypertensive effect of ACE inhibtiors?

Answer 16

NSAIDs

Question 17

How does alcohol affect ACE inhibtiors?

Answer 17

Increases the hypotensive effects

Question 18

What are common adverse effects of electrolyte in thiazide diuretics?

Answer 18

Hypokalemia
Hyponatraemia
Hypercalcaemia
Hypocalciuria which reduces renal stone formation

Question 19

What are common adverse effects of thiazide diuretics?

Answer 19

Dehydration due to hypercalcaemia
Postural hypotension
GOUT
Hyperglycaemia

Question 20

What is the pharmacological of amiodarone?

Answer 20

It has a long half life because it is highly lipophilic and widely absorbed by tissue.

It requires a prolonged loading regime to achieve stable therapeutic levels

Question 21

What should thiazide diuretics be avoided with?

Answer 21

PPIs as there is risk of Hyponatraemia

Question 22

What is the actin of hydralazine?

Answer 22

Increases levels of cyclic GMP by increasing intracellular calcium and causing arteriole smooth muscle relaxation

Question 23

What should hydrasalazine be avoided in?

Answer 23

Systemic lupus erythematous
Ischaemic heart disease

Question 24

What is tirofiban?/

Answer 24

GPiib/IIIa antagonist which inhibits platelet aggregation

Question 25

What are the primary GPiib/IIa antagonists

Answer 25

Abciximab Eptifibatide Tirofiban

Question 26

What is the action of ivabradine?

Answer 26

Used in heart failure to reduce heart rate, by acting on SAN funny current to reduce activity.

Question 27

What are the common side effects of ivabradine?

Answer 27

Visual effects Headache Bradycardia and heart block

Question 28

What drug does amiodarone interact wih

Answer 28

It decreases warfarin metabolism and increases the risk of bleeeding

Question 29

How should amiodarone be adminsitered?

Answer 29

Central veins due to risk of thrombophlebitis

Question 31

How does amiodarone adversely affect ECG?

Answer 31

Prolongs the QT interval

Question 32

What should be avoided in pulmonary oedema?

Answer 32

Nicorandil, a vasodilator which will exacerbate pulmonary congestion

Question 33

What is the action of adenosine?

Answer 33

Agonist of A1 receptor in AV node which inhibits adenylyl cyclase to reduce cAMP and causes hyperpolarisation blocking conduction through the node

Question 34

What is the action of beta blockers on the kidneys?

Answer 34

Suppresses renin release

Question 35

What is a common side effects of statins?

Answer 35

Myalgia Liver impairment Rhabdomyolysis

Question 36

What increases risk of myalgia with statins?

Answer 36

Female Low BMI Older age Diabetes

Question 37

What are the lipophilic statins?

Answer 37

Simvastatin Atorvastatin -> these are at higher risk of myopathy

Question 38

What are the hydrophilic statins?

Answer 38

Fluvastatin Rosuvastatin Pravastatin

Question 39

What increases the risk of statin induced rhabdomyolysis?

Answer 39

Amiodarone

Question 40

What food item should be avoided with Ramipril?

Answer 40

Antacids

Question 41

What is the volume of distribution of warfarin?

Answer 41

It is protein bund and has a large volume of distribution

Question 43

What is the

Question 44

What are the adverse effects of amiodarone?

Answer 44

Thyroid dysfunction Corneal EPO sits Pulmonary fibrosis Liver fibrosis Peripheral neuropathy Slate grey appearance