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PSA > Cardiovascular Drugs > Flashcards

Cardiovascular Drugs Flashcards

1
Q

how to treat acute CCF?

“UNLOAD FAST”

A 
Upright position
Nitrates
Loop diuretic
Oxygen
ACEi
Digoxin

Fluids (↓)
Afterload (↓)
Sodium restriction
Test (digoxin level, ABGs, K+ level)

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2
Q

Tx for acute attacks of stable angina?

long-term prevention?

A

1st line sublingual glyceryl trinitrate

1) B-block (atenolol, bisoprolol, metoprolol, propranolol)
2) CCB (verapamil or diltiazem) if beta-blockers CI (HF or Prinzmetal’s angina - amlodipine)
3) B-block + CCB
4) long-acting nitrate as monotherapy (ivabradine, nicorandil, or ranolazine)

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3
Q

Tx for STEMI?

“MONAT”

A

M - morphine - 2.5-10mg IV (metoclopramide 10mg IV)
O - oxygen - only if desaturating - 15 litre non-rebreathe
N - nitrates - GTN 2 puffs sublingual
A - aspirin - 300mg oral
T - ticagrelor 180mg/clopidogrel 300mg

+ if present w/n 12 hrs of Sx, primary PCI within 120 mins
+ (if no reperfusion therapy) give fondaparinux (LMWH analogue)
+ β-blocker (atenolol 5mg oral) (unless LVF/asthma)
+ transfer CCU

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4
Q

Tx for NSTEMI?

A

MONAT + GRACE score risk

if no PCI/reperfusion therapy, give LMWH/fondaparinux

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5
Q

long term Tx of MI?

“CRABS”

A 
Clopidogrel
Ramipril
Aspirin
B-blocker
Statin
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6
Q

Tx of chronic HF?

A

1) ACEi (unless asthma - ARB)
+ B-block if congested chronically
if neither ACEi or ARB tolerated hydralazine + nitrate
2) aldosterone antagonist (SPIRINOLACTONE, eplerenone, amilioride - fluid offload)

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7
Q

which Tx improves PROGNOSIS of Chronic HF?

A

spirinolactone

furosemide only improves Sx not prognosis

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8
Q

how to Tx AF>48 hours?

A

RATE CONTROL:
- otherwise 1st line = CCB (verapamil + diltiazem) “Vera & Dill - sweet slow old ladies with AF)
- if FAST AF then B-blocker (not in asthma!!)
(if CI then digoxin)

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9
Q

why is digoxin generally used in older patients?

A

affects exercise tolerance

narrow therapeutic window

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10
Q

how to Tx AF<48 hours?

A

RHYTHM CONTROL

  • amiodarone/flecanide (“Amy & Flec” the crazy rhythm drummers)
  • or DC cardioversion
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11
Q

what Ix is needed before Tx with Amy & Flec (amiodarone and flecanide)?

A

CXR - can cause ILD

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12
Q

when is the choice of either amiodarone/flecanide CI?

A

structural heart disease

just give amiodarone

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13
Q

when to DC cardiovert for AF?

A

life-threatening haemodynamic instability caused by new-onset atrial fibrillation (rhythm control)

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14
Q

which kind of cardioversion for AF>48 hours?

what risk to remember?

A

electrical DC cardioversion (rather than pharmacological)

consider amiodarone therapy starting 4 wks before and <12 months after electrical cardioversion to maintain sinus rhythm

HIGH RISK OF THROMBOEMBOLISM therefore anticoagulate someone who is being cardioverted with AF> 48 hours

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15
Q

Tx acute heart failure?

A 
ABC + 15L non-rebreathe
sit the patient up
morphine + metoclopramide
GTN
furosemide 40-80mg IV
\+/- isosorbide (nitrate infusion)
\+/- CPAP
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16
Q

how to assess non-sinus ↑HR? (>125bpm) + haemodynamically unstable?

A
  • DC cardiovert, then amiodarone 300mg IV over 10-20 mins & repeat
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17
Q

what could cause non-sinus stable but broad complex (>0.12 s) ↑HR? (>125bpm)?

A

get HELP

AF + BBB
polymorphic VT- torsade de pointes
VT
SVT + BBB

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18
Q

Tx polymorphic VT - torsades de pointes?

A

magnesium 2g over 10 min

19
Q

Tx ventricular tachycardia ?

A

Amiodarone 300mg IV over 20–60 min, then ↑

20
Q

how to assess non-sinus stable, regular, but narrow complex (<0.12 s) ↑HR? (>125bpm)?

A

vagal manoeuvres

adenosine 6mg rapid IV bolus (if this works, re-entry paroxysmal SVT)

21
Q

how to assess non-sinus stable, irregular, but narrow complex (<0.12 s) ↑HR? (>125bpm)?

A

Probable AF

control rate with: β-blocker or diltiazem (+/- digoxin or amiodarone if evidence of heart failure)

22
Q

when to Tx HT?

A 
ambulatory BP monitoring:
●BP >150/95 mmHg
●or >135/85 mmHg +
- vascular disease (IHD), stroke, PVD)
- HT organ damage (intracerebral bleed, CKD, LVH, retinopathy)
23
Q

target BP in HT?

A

●<80 years, <140/85 (clinic) /<135/85 (ambulatory)

●>80 +10 mmHg to systolic

24
Q

Tx chronic HF?

A

● ACEi
● B-blocker
● then ↑
● then if mild, + ARB
● then if mod-severe + African–Caribbean: + hydralazine
+ isosorbide
● then if moderate–severe (other patients): add spironolactone

25
Q

what does CHA2DS2-VASc stand for?

A

stroke risk (clotting) in AF

C - congestive HF (or LHF alone)
H - HT
A - age >75 (2 points)
D - DM
S- stroke/TIA before (2 points)
V - vascular disease (e.g. PAD or IHD)
A - age 65–74
S - sex (female)
26
Q

CHA2DS2-VASc score of 0, 1, 2, indication?

A

0 - aspirin 75 mg daily
1 - aspirin or warfarin (aiming INR 2.5)
2/>2 - warfarin aiming INR 2.5

27
Q

when is rhythm control preferable in AF? (amy & flec)

A

young
Sx
1st episode
secondary to treated precipitant

cardioversion: electrical or pharmacological (amiodarone 5 mg/kg IV over 20–120 mins). The patient will require anticoagulation if more than 48 hours since onset.

28
Q

when is rate control preferable in AF?

A

old/long-standing AF w/ HR >90

1) B-blocker
2) CCB
3) + digoxin (1st line if B-blockers + CCB CI)

29
Q

Tx for stable angina? (3)

A

1) GTN spray PRN
2) secondary prevention: aspirin, statin + cardiovascular risk factor modification
3) one anti-anginal drug, either B-blocker or CCB
● then ↑ dose B-blocker or CCB
● then + 2nd anti-anginal therapy
● then + lisosorbide or nicorandil (K+ channel activator)
● then PCI or CABG

(Even if controlled with medical management, patients should be referred routinely for consideration of revascularization)

30
Q

DDx central crushing chest pain + *sweating or V?

A

sweating or V makes STEMI or NSTEMI more likely than unstable angina (at rest) or stable angina (OE, better with GTN and rest)

31
Q

what are ACS?

A

unstable angina
NSTEMI
STEMI

32
Q

Ix suspected ACS? (3)

A

● ECG, troponin and 12 hr troponin
● if troponin ↑ = STEMI/NSTEMI ⇒ look at ECG to determine which
(Nb ST ↓ in anterior leads (V1–4) may be anterior ischaemia (i.e. stable/unstable angina) or posterior infarction: add leads V7–9 posteriorly to confirm ST ↑ for latter)
● if 1st trop NOT ↑ then use ECG:
- if normal/ST depression then angina, but need to exclude NSTEMI with 12 h troponin
- if ST ↑ then STEMI + trop will be ↑ even if having to await 12 h trop

33
Q

1st line Tx for chronic HF to ↓ morbidity and mortality?

A

ACEi or B-blocker - these affect mortality/morbidity

patients are often on diuretics to ↓ Sx but this DOESN’T affect mortality

34
Q

time of day to dive furosemide?

A

in the morning due to subsequent diuresis. (i.e. not at night.)

35
Q

which is the only ACEi to give in the morning?

A

perindopril erbumine/perindopril arginine

both are licensed in HT but the differing doses stress the need to write full names

36
Q

how to write out GTN prescription for acute angina?

A

“GTN spray (glyceryl trinitrate)” (can write 400 micrograms/metered dose if you want next to this)
“2 sprays sublingual”

37
Q

Tx acute pulmonary oedema?

A

loop diuretics
(furosemide can be given IV)
20-50 mg IV

38
Q

how to check efficacy of ACEi in HF?

A

exercise tolerance test

39
Q

role of beta-blockers in HF?

A

CHRONIC: improve morbidity/mortality
but
ACUTE/UNCONTROLLED: contraindicated as worsen Sx

40
Q

medications that may exacerbate heart failure?

A
  • pioglitazone is contraindicated as it causes fluid retention
  • verapamil (negative inotropic effect)
  • NSAIDs/glucocorticoids (caution: fluid retention)
  • (low-dose aspirin is an exception - many patients will have coexistent cardiovascular disease and the benefits of taking aspirin easily outweigh the risks)
  • class I antiarrhythmics: flecainide (negative inotropic and proarrhythmic effect)
41
Q

patient with angina is being Tx with atenolol and verapamil - why are you worried?

A

beta-blockers should not be prescribed concurrently with verapamil (risk of complete heart block)

if beta-blocker + CCB prescribed, use long-acting (e.g. modified-release nifedipine)

42
Q

Tx high cholesterol in someone with a Hx of CVD (PAD, etc) - (secondary prevention)?

A

atorvastatin 80mg

43
Q

who should be on a statin?

A
  • established CVD (stroke, TIA, IHD, PAD)
  • 10-year cardiovascular risk >10%
  • T2DM: QRISK2
  • T1DM diagnosed >10 years ago OR are aged >40 OR have established nephropathy

PSA (29 decks)

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