sun 8th Flashcards
What classification is used to define heart failure severity?
NYHA classification
what is the first line investigation for heart failure?
NT-proBNP
what should be the action following NT-proBNP result (depends on level)
> 2000= high NT-proBNP -> should be reviewed for transthoracic echo within 2 weeks
400-2000 = raised NT-proBNP -> should be reviewed for echo within 6 weeks
what may cause a falsely raised NT-proBNP?
Left ventricular hypertrophy
Ischaemia
Tachycardia
Right ventricular overload
Hypoxaemia (including pulmonary embolism)
GFR < 60 ml/min
Sepsis
COPD
Diabetes
Age > 70
Liver cirrhosis
What may cause a falsely low NT-proBNP
Obesity
Diuretics
ACE inhibitors
Beta-blockers
Angiotensin 2 receptor blockers
Aldosterone antagonists§
what is the first line management of heart failure
beta blocker and ACEi
what is the second line management of heart failure
aldosterone antagonist (e.g. spironolactone)
what is the third line management of heart failure?
specialist medications (one of the following):
- ivabradine
- digoxin
- hydralazine with nitrate
- sacubilnl valsartan
what vaccines should someone with heart failure have?
one of pneumococcal and yearly influenza
what are causes of atrial fibrillation
mrs SMITH
Sepsis
mitral valve pathology
ischaemic heart disease
thyrotoxicosis
hypertension
what are the 4 pathological features of AF
- irregularly irregular ventricular rate
- tachycardia
- heart failure due to poor filling of ventricles
- increased stroke risk due to blood pooling in the ventricles
what will and ECG show in AF
absent p waves
narrow QRS complex tachycardia
irregularly irregular ventricular rhythmn
When would rhythmn control be used in AF?
if it is new onset within the past 24 hours
if it has a reversible cause
if it is causing heart failure
what two drugs might be used for cardioversion
amiodarone
flecainide
what is the first and second line rate control for AF?
1- beta blocker or CCB
2- Beta blocker + CCB/digoxin
when would immediate and when would delayed cardioversion be used?
immediate if onset was within 48 hours or the person is haemodynamically unstable
delayed by 3 weeks if not (take anticoagulants during 3 weeks)
what anticoagulatin is used in AF?
DOAC- apixiban
second line anticoagulation in AF
warfarin
what intervention might be used in AF if antiarrhythmic drugs arent effective?
catheter ablation
first line management of COPD
SABA or SAMA
second line management of COPD
depends if steroid responsive or not
if steroid responsive:
- add ICS and LABA
(if taking a SAMA already this should be changed to a SABA)
If not steroid responsive
- add LABA and LAMA
(if taking a SAMA already this should be changed to a SABA)
how is it determined if someone is steroid responsive or not in COPD
- if they have had a previous diagnosis of asthma or atopy
- if they have raised blood eosinophils
- if they have diurinal variation in the PEF > 20%
- if they have had variation in their FVC over time >400ml
3rd line management of COPD
- SABA when needed plus LAMA+LABA+ICS
what prophylactic antibiotic might be given to certain COPD patients
azithromycin
what medication may be able to reduce the amount of infective exacerbations in COPD?
phosphodiesterase inhibitors (such as roflumilast)
how are infective exacerbations of COPD managed?
5 day prednisolone + antibiotics if purulent sputum (either amoxicillin, clarithromycin or doxycycline)
what is the first line management of type 2 diabetes?
IF no CV risk/HF: metformin
If CVD risk/HF: metformin + SGLT-2 inhibitor
give an example of an SGLT-2 inhibitor
dapagliflozin
second line management of diabetes?
metformin plus one of the following:
- DPP-4 inhibitor
- SGLT-2 inhibitor
- sulfonylurea
- pioglitazone
3rd line management of diabetes?
triple therapy or insulin therapy
what might be added to diabetes management if triple therapy isnt working or insulin is contraindicated?
GLP-1 mimetic
Give the action, an example and side effect of sulfonylurea
action: inhibits the reabsorption of glucose in the kidneys
Example: gliclazide
SE: UTIs and thrush
Give the action, an example and side effect of DDP-4 inhibitor
action: increase incretin secretion which inhibits glucagon
Example: sitagliptin and alogliptin
SE: headaches
Give the action, an example and side effect of pioglitazone
it is an thiazolidinedione
action: increases the sensitivty to insulin and decreases hepatic glucose production
SE: Weight gain
Heart failure
Increased risk of bone fractures
A small increase in the risk of bladder cancer
Give the action, an example and side effect of GLP-1 mimetic
action: mimics incretin which inhibits glucagon
example: exenatide and liraglutide
SE: reduced appetite, weight loss and GI symptoms
what might levodopa be combined with
a peripheral decarboxylase inhibitor such as carbidopa or beserazide
- forms co-carbeldopa or co-beneldopa
what is the main side effects of levodopa and give some specific examples
dyskinesia
included:
- dystonia
- chorea
- athetosis
how might dyskinesias be treated in levodopa use and what is its action
amantadine - glutamate antagonist
How do COMT inhibitors work?
inihbit catechol-o-methyltransferase which is an enzyme that metabolises levodopa in the body and brain
give an example of a COMT inhibitor
entacapone
give 3 examples of dopamine agonsits
cabergoline, bromocriptine, pergolide
how doe MAO-B inhibitors work and give some examples
they inhibit the break down of dopamine
selegilline
rasagilline
what two drugs might be used in alcohol dependence management
acamprosate and disulfram
how does acamprosate work?
it is a weak agonist of the NDMA receptor
it reduces cravings
how does disulfram work?
it inhibits acetylaldehyde dehydrogenase - produces a reaction when the patient drinks alcohol making them ill
