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3A > sun 8th > Flashcards

sun 8th Flashcards

1
Q

What classification is used to define heart failure severity?

A

NYHA classification

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2
Q

what is the first line investigation for heart failure?

A

NT-proBNP

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3
Q

what should be the action following NT-proBNP result (depends on level)

A

> 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

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4
Q

what may cause a falsely raised NT-proBNP?

A

Left ventricular hypertrophy
Ischaemia
Tachycardia
Right ventricular overload
Hypoxaemia (including pulmonary embolism)
GFR < 60 ml/min
Sepsis
COPD
Diabetes
Age > 70
Liver cirrhosis

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5
Q

What may cause a falsely low NT-proBNP

A

Obesity
Diuretics
ACE inhibitors
Beta-blockers
Angiotensin 2 receptor blockers
Aldosterone antagonists§

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6
Q

what is the first line management of heart failure

A

beta blocker and ACEi

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7
Q

what is the second line management of heart failure

A

aldosterone antagonist (e.g. spironolactone)

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8
Q

what is the third line management of heart failure?

A

specialist medications (one of the following):
- ivabradine
- digoxin
- hydralazine with nitrate
- sacubilnl valsartan

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9
Q

what vaccines should someone with heart failure have?

A

one of pneumococcal and yearly influenza

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10
Q

what are causes of atrial fibrillation

A

mrs SMITH
Sepsis
mitral valve pathology
ischaemic heart disease
thyrotoxicosis
hypertension

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11
Q

what are the 4 pathological features of AF

A
  • irregularly irregular ventricular rate
  • tachycardia
  • heart failure due to poor filling of ventricles
  • increased stroke risk due to blood pooling in the ventricles
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12
Q

what will and ECG show in AF

A

absent p waves
narrow QRS complex tachycardia
irregularly irregular ventricular rhythmn

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13
Q

When would rhythmn control be used in AF?

A

if it is new onset within the past 24 hours
if it has a reversible cause
if it is causing heart failure

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14
Q

what two drugs might be used for cardioversion

A

amiodarone
flecainide

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15
Q

what is the first and second line rate control for AF?

A

1- beta blocker or CCB
2- Beta blocker + CCB/digoxin

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16
Q

when would immediate and when would delayed cardioversion be used?

A

immediate if onset was within 48 hours or the person is haemodynamically unstable
delayed by 3 weeks if not (take anticoagulants during 3 weeks)

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17
Q

what anticoagulatin is used in AF?

A

DOAC- apixiban

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18
Q

second line anticoagulation in AF

A

warfarin

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19
Q

what intervention might be used in AF if antiarrhythmic drugs arent effective?

A

catheter ablation

20
Q

first line management of COPD

A

SABA or SAMA

21
Q

second line management of COPD

A

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)

22
Q

how is it determined if someone is steroid responsive or not in COPD

A
  • 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
23
Q

3rd line management of COPD

A
  • SABA when needed plus LAMA+LABA+ICS
24
Q

what prophylactic antibiotic might be given to certain COPD patients

A

azithromycin

25
Q

what medication may be able to reduce the amount of infective exacerbations in COPD?

A

phosphodiesterase inhibitors (such as roflumilast)

26
Q

how are infective exacerbations of COPD managed?

A

5 day prednisolone + antibiotics if purulent sputum (either amoxicillin, clarithromycin or doxycycline)

27
Q

what is the first line management of type 2 diabetes?

A

IF no CV risk/HF: metformin
If CVD risk/HF: metformin + SGLT-2 inhibitor

28
Q

give an example of an SGLT-2 inhibitor

A

dapagliflozin

29
Q

second line management of diabetes?

A

metformin plus one of the following:
- DPP-4 inhibitor
- SGLT-2 inhibitor
- sulfonylurea
- pioglitazone

30
Q

3rd line management of diabetes?

A

triple therapy or insulin therapy

31
Q

what might be added to diabetes management if triple therapy isnt working or insulin is contraindicated?

A

GLP-1 mimetic

32
Q

Give the action, an example and side effect of sulfonylurea

A

action: inhibits the reabsorption of glucose in the kidneys
Example: gliclazide
SE: UTIs and thrush

33
Q

Give the action, an example and side effect of DDP-4 inhibitor

A

action: increase incretin secretion which inhibits glucagon
Example: sitagliptin and alogliptin
SE: headaches

34
Q

Give the action, an example and side effect of pioglitazone

A

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

35
Q

Give the action, an example and side effect of GLP-1 mimetic

A

action: mimics incretin which inhibits glucagon
example: exenatide and liraglutide
SE: reduced appetite, weight loss and GI symptoms

36
Q

what might levodopa be combined with

A

a peripheral decarboxylase inhibitor such as carbidopa or beserazide
- forms co-carbeldopa or co-beneldopa

37
Q

what is the main side effects of levodopa and give some specific examples

A

dyskinesia
included:
- dystonia
- chorea
- athetosis

38
Q

how might dyskinesias be treated in levodopa use and what is its action

A

amantadine - glutamate antagonist

39
Q

How do COMT inhibitors work?

A

inihbit catechol-o-methyltransferase which is an enzyme that metabolises levodopa in the body and brain

40
Q

give an example of a COMT inhibitor

A

entacapone

41
Q

give 3 examples of dopamine agonsits

A

cabergoline, bromocriptine, pergolide

42
Q

how doe MAO-B inhibitors work and give some examples

A

they inhibit the break down of dopamine
selegilline
rasagilline

43
Q

what two drugs might be used in alcohol dependence management

A

acamprosate and disulfram

44
Q

how does acamprosate work?

A

it is a weak agonist of the NDMA receptor
it reduces cravings

45
Q

how does disulfram work?

A

it inhibits acetylaldehyde dehydrogenase - produces a reaction when the patient drinks alcohol making them ill

46
Q
A

3A (42 decks)

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