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*B31 Cardioresp* > PPT > Flashcards

PPT Flashcards

1
Q

What is a risk of giving heparin

A

Heparin induced thrombocytopaenia

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2
Q

What blood tests would you do before giving LMWH and why?

A

COAG screen and FBC

To ascertain baseline coagulation status and to ensure platelet count is normal before starting a heparin (risk of heparin induced thrombocytopenia)

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3
Q

What blood tests would you do before CTPA

A

UnEs

Assess baseline renal function

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4
Q

What drugs are used to anticoagulate someone with PE

A

LMWH along with vitamin K antagonist (warfarin) for 5 days (monitor INR)

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5
Q

Why is LMWH used first line for PE

A

Not many side effects (some risk of bleeding) and predictable half life

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6
Q

Difference between using anticoagulants or thrombolytics in PE

A

Thrombolyse if patient has massive PE and haemodynamically unstable

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7
Q

If a patient is on warfarin and experiences a major bleed what should you give them?

A

Stop warfarin
Give IV vitamin K 5mg (phytomenadione)
Prothrombin complex concentrate - if not available then FFP*

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8
Q

Co-trimoxazole tends to be used in elderly because..

A

Less association with pseudomembranous colitis (C.diff)

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9
Q

Verapamil should not be taken with B-blocker due to risk of..

A

Bradycardia, heart block or even congestive cardiac failure

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10
Q

Clarithromycin should not be given with..

A

Statin

Risk of rhabdo

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11
Q

When is amiodarone given over fleicanide for rhythm control in AF?

A

In patients with structural heart disease (such as ill-functioning valves)

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12
Q

How to check for end-organ damage in hypertension

A

Kidney function - Albumin-creatinine ration (ACR) from urine

Bloods - glucose, UnEs, creatinine, EGFR, serum cholesterol

Fundoscopy - retinopathhy

12 lead ECG

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13
Q

If ACE inhibitor is not tolerated (ie cough) give..

A

ARB (losartan/Candesartan)

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14
Q

Main SE of ACE inhibitors

A

Hypotension
Persistent dry cough
Hyperkalaemia
Angioedema

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15
Q

Avoid ACE inhibitors in patients with..

A

Renal artery stenosis
AKI
Pregnant or breastfeeding women

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16
Q

ACE inhibitors might be helpful in

A

CKD

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17
Q

ACEi drug interactions

A

K sparing diuretics, potassium supplements - risk of hyperkalemia

NSAIDs - risk of AKI due to hypotension

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18
Q

What should be done before starting an ACE inhibitor

A

Check electrolytes and renal function and repeat 1-2 weeks into treatment

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19
Q

Primary prevention in those who have a 10% risk of developing CVD

A

Statin 20mg

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20
Q

Statin MOA

A

HMG-CoA reductase inhibitor

Inhibits the rate-limiting enzyme in hepatic cholesterol synthesis

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21
Q

Statins SE

A

Headache
GI disturbances
Myopathy - rhabdo
Rise in liver enzymes (ALT)

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22
Q

Statins should be used in caution in patients with

A

Hepatic impairment

Pregnancy and breastfeeding (can affect fetal development)

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23
Q

Statins drug interactions

A

Drugs that reduce metabolism of drug (higher conc for longer) - amiodarone, macrolides (clarithromycin), conazole, protease inhibitors

Avoid grapefruit juice - affects CYP3A4 and reduces statin metabolism -> increased risk of myopathy

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24
Q

Which bloods need checking with statins

A

Checking LFTs at baseline, 3 months and 12 months

Risk of hepatic impairment

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25
Q

Stable angina - what medications would you start patient on?

A 
Aspirin
Statin
Betablocker/Ca channel blocker
Nitrate (GTN) 
Nicorandil
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26
Q

Beta blockers SE

A 
Dizziness, fatigue 
Hypotension
Erectile dysfunction
Broncoconstriction (asthma) 
Raynaud's (Cold hands) 
Bradycardia/heart block 
Masking hypoglycaemia
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27
Q

Beta blocker contraindications

A

Uncontrolled HF
Asthma
Sick sinus syndrome
Verapamil (may precipitate severe bradycardia)

28
Q

Ca channel blockers (Verapamil and Diltiazem) SEs

A

Headache and flushing
Tachycardia
Peripheral oedema
Constipation

29
Q

GTN SEs

A

Hypotension
Tachycardia
Headaches
Flushing

30
Q

Aspirin MOA

A

COX1 and COX2 inhibitor

31
Q

Aspirin SE

A

GI irritation
Ulceration
Haemorrhage
Bronchospasm

32
Q

NSTEMI management

A 
Morphine - relieve chest pain 
Oxygen - if hypoxic
Nitrates 
Aspirin 300mg 
Antithrombin therapy (Heparin immediately, Ticagrelor for 12mo, IV glycoprotein inhibitor for high risk patients
33
Q

STEMI management

A

Aspirin
Clopidogrel
LMWH heparin

Oxygen
PCI
Thrombolysis

34
Q

When is rhythm control favoured in AF

A 
Younger than 65 years
Symptomatic
Reversible cause
First presentation
Lone AF or AF secondary to a corrected precipitant (e.g. Alcohol)
HF secondary to AF
35
Q

When is rate control favoured in AF

A

Older than 65

Hx of IHD

36
Q

Rate control drugs for AF

A

Beta blocker
Ca channel blocker
Digoxin (only really used if pt has HF)

37
Q

Rhythm control drugs for AF

A

Sotalol
Amiodarone
Flecainide

38
Q

Amiodarone SE

A 
Thyroid dysfunction (hypo and hyper)
corneal deposits
Pulmonary fibrosis/pneumonitis
Liver fibrosis/hepatitis
Peripheral neuropathy
Myopathy
Photosensitivity
'slate-grey' appearance
Thrombophlebitis
Bradycardia
QT interval prolongation
39
Q

Investigation for PE

A

Well’s score

Signs and symptoms of DVT
PE is most likely
HR >100
Immobilisation of at least 3/7 or 6/52
Previous PE or DVT 
Haemoptysis
Malignancy
40
Q

What treatments to initiate for PE

A

LMWH or Direct factor Xa inhibitor (apixaban)

41
Q

For a massive PE should you use fractioned or unfractioned heparin

A

unfractioned heparin

However difficult to control INR

42
Q

Blood tests needed prior to starting LMWH for PE

A

COAG screen and FBC

To ascertain baseline coagulation status and to ensure platelet count is normal before starting a heparin (risk of heparin induced thrombocytopenia)

43
Q

Risk with heparin

A

Heparin induced thrombocytopenia (low platelets)

44
Q

When is thrombolysis used in PE

A

If it’s a severe PE and patient haemodynamically unstable

Needed to break down clot immediately

45
Q

What factors need to be considered when starting LMWH

A

Body weight to calculate dose
Pregnancy
Severe renal impairment

46
Q

When starting warfarin you need to continue LMWH for 5 days - why?

A

Warfarin takes around 5 days to reach an appropriate level of anticoagulation

47
Q

How to treat a high INR

A

Oral vitamin K

48
Q

Major bleed on warfarin give

A

IV phytomenadione (Vitamin K)

49
Q

Advantages of DOACs

A

No monitoring needed (predictable)

Disadvantages - no reversal agent yet

50
Q

How long on warfarin if first episode of PE

A

3 months

51
Q

Why does hyponatraemia occur in pneumonia?

A

SIADH

or other medications (thiazides, loop diuretics, spironolactone)

52
Q

To correct hyponatraemia give..

A

IV fluids (NaCl or Hartmanns) and stop drugs contributing to hyponatraemia

ALWAYS check UnE’s

53
Q

What type of healthcare acquired infections does broad spectrum antibiotics predispose you to?

A

C diff
MRSA
ESBL (Extended-spectrum beta-lactamases are enzymes that confer resistance to beta lactam ABX)

54
Q

Which ABX predispose you to C Difficile

A

Clindamycin
Broad spectrum penicillins
Cephalosporins

55
Q

Compliance

A

patient expected to stick to regimen prescribed by doctor, without question!

56
Q

Concordance

A

A mutually agreed contract between doctor and patient, to take medicines in a way which suits both parties

57
Q

Adherence

A

why a patient may not take medicines in the way agreed between doctor and patient (lack of understanding or doesn’t agree with what was decided)

58
Q

Complete control of asthma is defined as..

A

No daytime symptoms, no night-time awakening due to asthma, no asthma attacks, no need for rescue medication, no limitations on activity including exercise, normal lung function

59
Q

Asthma management

A

SABA
SABA + ICS
SABA + ICS + LTRA
SABA + ICS + long-acting beta agonist (LABA)

60
Q

A low dose ICS should be used if

A

Inhaled SABA used more than 3x a week
Symptomatic 3x a week or more
Waking at night due to asthma at least once a week

61
Q

Given an example of a LABA

A

Salmeterol or formeterol

Formoterol has a more rapid onset of action

62
Q

Severe asthma

A

PEFR 33 - 50% best or predicted
Can’t complete sentences
RR > 25/min
Pulse > 110 bpm

63
Q

Life threatening asthma

A 
PEFR < 33% best or predicted
Oxygen sats < 92%
Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma
64
Q

SE of beta agonist (salbutamol)

A

Fine tremor

Tachycardia

65
Q

Acute asthma treatment

A 
Oxygen driven salbutamol nebuliser
Ipratropium bromide
Hydrocortisone
IV Magnesium sulfate
IV Aminophylline
IV fluids
66
Q

HF treatments

A

First-line treatment = an ACE-inhibitor and a beta-blocker*. Generally, one drug should be started at a time
second-line treatment= either an aldosterone antagonist, ARB or a hydralazine in combination with a nitrate

if symptoms persist cardiac resynchronisation therapy or digoxin** should be considered. An alternative is ivabradine.

Diuretics should be given for fluid overload

67
Q

Normal INR

A

Patients on anticoagulants usually have a target INR between 2 and 3

VTE target INR = 2.5, if recurrent 3.5
AF target INR = 2.5
Mechanical heart valves, target INR depends on the valve type and location. Mitral valves generally require a higher INR than aortic valves.

*B31 Cardioresp* (9 decks)

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