The Practice of Treating Cardiovascular Patients Flashcards
what drugs do ABCD stand for?
A- ace inhibitor+ Angiotensin 2 receptor blockers
B- beta blocker
C- calcium antagonist
D- diuretic
what drug treatment is used for hypertension?
primary: A, C, D- especially thiazide like diuretics
secondary: alpha blocker- Doxazosin, aldosterone blocker- spironolactone
what is the drug treatment plan for patients with hypertension under 55?
A then C then D if still necessary
afterwards: beta, alpha or spironolactone
what is drug treatment method for patients with hypertension over the age of 55?
C then A then D last and if still you can add the beta, alpha and spironolactone
briefly describe chronic heart failure.
heart damaged by some disease and as a result the damaged parts of the heart doesn’t contract as well as the rest of the heart and therefore there is a reduced CO
what is the drug treatment for chronic heart failure?
D- loop diuretic- get rid of fluid accumulated due to poor CO
A
B
if still breathless spironolactone or eplerenone which is more specific can be given
why would you use eplerenone over spironolactone?
spironolactone blocks androgens also hence males have less testosterone- gynecomastia
what devices can be used to treat chronic heart failure?
- cardiac resynchronisation therapy
- implantable cardiac defibrillators- sense heart rhythms and life threatening ones
in severe heart failure what drug now replaces A?
sacubitril- Valsartan
- valsartan is an ARB
- sacubitril inhibits enzyme Neprilysin which breaks down vaso active peptides such as B-type nasoactive peptide hence this is increased
What drug treatment is given to prolong the survival of angina patients?
- statin
- aspirin
- A
- B
what drugs are used to relieve angina symptoms allowing patient to exercise more?
- B
- C
- anticoagulants- Ivabradine, Ranolazine
what other treatments are used to relieve angina symptoms?
- coronary angioplasty
- coronary artery surgery
How is acute chest pain classified?
Troponin negative- acute coronary syndrome, unstable angina, severe ischaemia
Troponin positive- MI- ST or Non ST elevation
How is STEMI treated? emergency? long term?
-treatment must be rapid
emergency- aspirin, angioplasty or if unable then thrombolysis
long term- aspirin and either tiagrelor or clopidogel (anti platelet drugs), low molecular weight heparin, fondaparinux
give: statin, A and B also
how is NSTEMI treated? what prophylaxis treatment is give?
- aspirin+ clopidogel or tiagrelor
- fondaparinux
prophylaxis: statin, A and B
How is troponin negative acute coronary syndrome treated?
- preventative so it doesn’t become something worse
- Aspirin, selective angioplasty, A, B, statin
What treatment can you give for ongoing chest pain? what is the new anti platelet drug?
- glycoprotein 2b and 2a inhibitor
- Tirofiban
- Prasagrel- new anti platelet
what is the drug treatment for atrial fibrillation? what is the aim for the drugs to do?
- B and digoxin
- pharmacological blockade between atria and ventricle
what anti thrombotic drugs are used in treatment of atrial fibrillation? Why are these used?
- warfarin, rivaroxaban
- because atria aren’t contracting there is a tendency for blood clots to form in atrial wall which may form emboli and go to brain
what are the 3 causes of strokes?
- cerebral thrombosis
- cerebral embolism
- cerebral haemorrhage
if stroke treatment is not due to haemorrhage what is the treatment method?
- emergency thrombolysis with streptokinase and aspirin
- clopidogrel afterwards
- statin, A, diuretic Indapamide
what are the side affects of ACE?
cough, renal dysfunction, angioneurmtic oedema, never during pregnancy
what is angioneurmtic oedema?
allergic response where tissues swell, if larynx swells it could close off the airway and be fatal
what are the side affects of B?
bradycardia, tiredness, asthma
what are the side affects of C?
ankle oedema for amlodipine, heart block for diltiazem and verapamil
what are the side affects of D?
hypokalaemia, diabetes, gout
what are the side affects of ARB?
renal dysfunction, never in pregnancy
