What drugs for what condition?

Question 1

Pt has chest pain which is relieved by rest or s/l GTN, what is the diagnosis?

Answer 1

Stable Angina

Question 2

Pt has a raised troponin and history of ACS
There angina symptoms have worsened and now occur at rest and is not relieved by s/l GTN or rest. What is the diagnosis?

Answer 2

ACS Unstable Angina

Question 3

A patient has severe chest pain, with a sudden onset often at rest and is sweaty, breathless, has N&V, restless, pale and grey, what is the diagnosis?

Answer 3

ACS: NSTEMI or STEMI

Question 4

What is given to a patient for primarily for stable angina?

Answer 4

-S/L GTN
-1st line - Beta blockers or CCB
Add on: Long acting nitrate, Ivabradine, Ranolazine, Nicorandil

Question 5

What is given for secondary prevention of stable angina?

Answer 5

-Lifestyle changes
-Antiplatelet 75mg Aspirin OD
-Atorvastatin 20mg OD

Question 6

What is give for primarily for NSTEMI?

Answer 6

Acute: Oxygen, Diamorphine, Aspirin, Clopidogrel (or Ticagrelor or Prasugrel)
+ Fondaparinux - given until stable
*NO thrombolysis or PPCI

Question 7

What is given primarily for STEMI?

Answer 7

Acute: Oxygen, Diamorphine, Aspirin 300mg STAT.
Clopidogrel or Ticagrelor or Prasurgel 300mg STAT (or 180mg or 60mg)

1st line acute - PPCI (surgical)
Or
Thrombolysis: Steptokinase, alteplase, tenecteplase, reteplase

Question 8

What would you expect a patient who has had a STEMI to be started on 48 hours after thrombolysis?

Answer 8

Heparin

Question 9

What is first line treatment for AF?

Answer 9

First line - Electrical Cardioversion

Question 10

What is the treatment for all heart failures?

Answer 10

Diuretics (furosemide)

Question 11

If a patient has heart failure with preserved ejection fraction what would the treatment be?

Answer 11

Manage co-morbid conditions, HTN, AF, IHD, DM

Question 12

What would you give to a patient who has heart failure with reduced ejection fraction?

Answer 12

1st line: ACEi or Beta blocker
-Offer an MRA if symptoms continue (Spironolactone or Eplerenone)
2nd line: Specialist advice: which can either-
1)Replace ACEI/ARB with an ARNI Sacubitril-Valsartan
2)Add Ivabradine, if HR is above 75 and LVEF is above 35%
3)Add hydralazine and nitrate (*Especially if African/Caribbean descent)
4)Digoxin for worsening HF
5)SGLT2 inhibitors - ‘flozins’ ADD on therapy in worsening heart failure.

Question 13

What are the 5 GOLDEN DRUGS if someone has had a NSTEMI or STEMI?

Answer 13

Dual antiplatelet therapy:
-Aspirin (for life), + Clopidogrel/ticagrelor/prasugrel (12 months)
-Beta blocker (Review at 12 months, continue if in Heart failure)
-ACE inhibitor for life
-Atorvastatin 80mg

Question 14

What dietary change should someone who has had a STEMI or NSTEMI follow?

Answer 14

Low saturated fat diet

Question 15

If ANY patient has had a cardiovascular event what should they be on?

Answer 15

ATORVASTATIN 80mg

Question 16

If ANY patient has not had a CVD event, what should they be on?

Answer 16

ATORVASTATIN 20mg

Question 17

What is (2nd line) drug therapy for AF?

Answer 17

2nd line - Drug therapy
Rhythm control:
1)Beta-blockers (Bisoprolol)
Others include: Dronedarone or Amiodarone* ESP in heart failure!

Question 18

If AF is Paroxysmal what is the treatment plan?

Answer 18

If disease is Paroxysmal (PAF) use -Flecainide
This treats attacks only, if they are frequent it aims to decrease frequency and prevent this occurring

Question 19

What is given for RATE control in AF?

Answer 19

Rate control:
1st line - Cardioversion
2nd line -
B-Blocker (bisoprolol) or
Rate-limiting CCB (Verapamil or diltiazem)
*Digoxin only used if sedentary lifestyle
2nd line - combine B-blocker + Diltiazem or digoxin! DUAL therapy