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Pharmacy Pre-reg exam 2020-2021 > Cardiovascular system > Flashcards

Cardiovascular system Flashcards

1
Q

Why do we tell patients to change sites of tinzaparin injections?

A

Risk of lipodystrophy - drug can accumulate and not absorb properly.

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2
Q

Why are platelets checked with heparins?

A

Heparin-induced thrombocytopenia - low platelet count.

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3
Q

Monitoring parameters for tinzaparin and Co

A

U&Es, especially K, platelets

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4
Q

Which class of beta-blockers can cause sleep disturbances and nightmares and why?

A

Lipid-soluble - able to cross BBB

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5
Q

Which enzyme do Statins inhibit?

A

HMG-CoA reductase

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6
Q

What to do if you forgot take a Warfarin dose?

A

Remember before midnight - take it. If not - take the next one as usual, and let the GP/INR clinic know.

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7
Q

Foods to avoid on Warfarin

A

Grapefruit and cranberry juice, mango

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8
Q

What is Torsades des Pointes?

A

Type of ventricular tachycardia that can lead to sudden cardiac death. Associated with long QT

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9
Q

What are the two main ways (two types of control) to manage arrhythmia?

A

Rate control (ventricular rate) and Rhythm control (restore and maintain sinus rhythm)

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10
Q

Is rate or rhythm control a generally preferred first line for AF?

A

Rate control

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11
Q

Which type of control is preferred in onset of AF >48hrs or unknown?

A

Rate control

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12
Q

When is Digoxin preferred in AF management?

A

If AF is accompanied by congestive heart failure.

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13
Q

Rate-control medication examples

A

B-blockers, verapamil, diltiazem, digoxin

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14
Q

Rhythm-control medication examples

A

Sotalol, Amiodarone, flecainide acetate, dronedarone

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15
Q

Which is the first line rhythm-control medication?

A

Amiodarone

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16
Q

What else is needed as part of general AF management, apart from rhythm & rate control?

A

Stroke prevention - anticoagulation

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17
Q

Which medications are used in atrial flutter?

A

IV B-blockers, verapamil &diltiazem, digoxin

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18
Q

Which medications are used to manage torsades de pointes?

A

IV magnesium sulphate, b-blockers.

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19
Q

Name classes of anti-arrhythmic drugs (1-4) and examples

A

Class 1: membrane stabilising drugs - Lidocaine, flecainide
Class 2: Beta-blockers
Class 3: Amiodarone, Sotalol
Class 4: Verapamil, Diltiazem

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20
Q

Drug of choice in acute supraventricular arrhythmia?

A

IV Adenosine

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21
Q

In which case is digoxin and verapamil contraindicated?

A

In supraventricular arrhythmia associated with conductive pathways issues (WPW syndrome)

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22
Q

Which class of AF medication does verapamil interact and what is the nature of interaction?

A

B-blockers - increased risk of severe hypotention and bradycardia - AVOID

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23
Q

What kind of half-life does amiodarone have?

A

Very long half-life (weeks)

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24
Q

Which parameters do we monitor with Amiodarone?

A

LFTs, Thyroid Function, Pulmonary toxicity, Eyesight (corneal microdeposition), ECG on IV

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25
Q

Why does amiodarone affect thyroid gland?

A

It contains iodine

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26
Q

Advice for patients on amiodarone regarding photosensitivity

A

Protect skin from light during and several months after discontinuation

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27
Q

Does the QT prolongation in someone on Amiodarone indicate toxicity?

A

No

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28
Q

What checks do we need to do before Amiodarone initiation?

A

Potassium, ECG, Chest X-ray, LFTs, thyroid function

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29
Q

Which LFT in particular do we monitor for Amiodarone liver toxicity?

A

Transaminases

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30
Q

Which drugs are contraindicated with Amiodarone due to the risk of torsades de pointes?

A

Sotalol, Co-trimoxazole, Erythromycin, Chlorpromazine, Haloperidol, Amisulpride, Amitriptyline, Anti-malarials

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31
Q

Which drugs should be avoided or initiated under close supervision together with Amiodarone?

A

QT prolongators

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32
Q

Which AF management drugs should be avoided with Amiodarone?

A

B-blockers, diltiazem, verapamil

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33
Q

Which drug class should be avoided with Amiodarone due to the risk of hypokalaemia?

A

Stimulant laxatives

34
Q

Amiodarone action on CYP enzymes and consequences?

A

Enzyme inhibitor - plasma concentration of a large variety of drugs will be increased - consider and monitor everything

35
Q

What is the rescue drug for severe bradycardia following too rapid IV amiodarone admin?

A

Atropine

36
Q

Usual dose of Amiodarone?

A

200mg TDS for 1 week, then 200mg BD for 1 week, then 200mg OD

37
Q

MAO of Digoxin

A

Increases force of myocardial contraction + reduces conductivity in AV node

38
Q

When do you reduce the dose of Digoxin by 50%

A

With Amiodarone and Quinine

39
Q

How do you switch from IV Digoxin to oral

A

Increase the dose by 20-33% to achieve the same concentration

40
Q

When do you take sample for Digoxin lvls

A

6 hrs post dose

41
Q

When are compression stocking contraindicated

A

Acute stroke, peripheral arterial disease, peripheral neuropathy, leg oedema

42
Q

What is the VTE prophylaxis of choice in renal impairment?

A

Unfractioned heparin

43
Q

Immediate management of acute ischaemic stroke

A

Alteplase - 4-5hrs post event

High-dose aspirin if >24hrs

44
Q

Long-term management of TIA/Ischaemic Stroke

A

Statin (initiated within 48hrs) + Clopidogrel

45
Q

When do we need to consider target INR of 3.5?

A

If patient already on anticoagulant with INR >2 still having recurrent VTE

46
Q

Duration of warfarin treatment in provoked VTE

A

3 months

47
Q

When is aspirin contraindicated?

A

16

48
Q

Symptoms of aspirin overdose

A

Hyperventilation, tinnitus, deafness

49
Q

When do we avoid DOACs

A

CrCl <15ml/min

50
Q

What can unfractioned heparin cause during prolonged exposure in pregnancy

A

Maternal osteoporosis

51
Q

Maximum INR monitoring interval for warfarin

A

3 months

52
Q

Common interactions with Warfarin

A

Miconazole, NSAIDs, Amiodarone, Co-trimoxazole, Bezafibrate, Erythromycin, St John`s Wort

53
Q

What is the target BP for diabetic patient with CVD or end organ damage

A

130/80

54
Q

Which HTN medication has a special benefit in diabetes

A

ACE inhibitors due to their renoprotective action

55
Q

Which HTN medication is first line in gestational hypertension

A

Labetalol

56
Q

Hypertensive crisis teratment

A

IV sodium nitroprusside, nircadipine, labetalol

57
Q

Why do we titrate ACEinhibitors (and other BP meds slowly)

A

To avoid rapid fall in BP

58
Q

Examples of water-soluble b-blockers (3)

A

atenolol, nadolol, sotalol

59
Q

Examples of cardio-selective b-blockers (4)

A

atenolol, bisoprolol, metoprolol, nebivolol

60
Q

Side-effects of b-blockers

A

fatigue, cold extremities, glucose derangement (caution in diabetes), nightmares

61
Q

When are b-blockers contraindicated

A

2nd & 3rd degree heart block

62
Q

When do we avoid CCBs and what is the only exception

A

Heart failure

Except amlodipine

63
Q

What is the special side-effect for CCBs

A

Gingival hyperplasia

64
Q

When are thiazide diuretics cautioned

A

gout, diabetes, hyperaldosteronism, SLE

65
Q

When are thiazide diuretics ineffective

A

eGFR<30

66
Q

Primary cardiovascular prevention

A

Low-dose statin (atorvastatin 1st line)

Correct BP if HTN

Fibrates only if need to reduce triglycerides

67
Q

Secondary prevention

A

Aspirin or Clopidogrel

High-dose statin

Fibrates only if need to reduce triglycerides

Correct BP if HTN

68
Q

Why do we want to avoid high-dose simvastatin

A

Increased risk of myopathy

69
Q

HF managements

A

ACEinhibitor (or ARB) + b-blocker

Loop diuretics for oedema

70
Q

b-blockers licenced for HF

A

bisoprolol, carvedilol, nebivolol

71
Q

Doses of spironolactone in HF & oedema

A

100-400mg in oedema

25-50mg in HF

72
Q

What can spironolactone cause

A

benign breast neoplasms & breast pain

73
Q

Dose adjustments of simvastatin with fibrates;
verapamil, diltiazem, amlodipine & amiodarone;
ticagrelor

A

10mg

20mg

40mg

max dose respectively

74
Q

Stable angina management

A

b-blocker
GTN spray/long-acting nitrates
statin + aspirin

75
Q

Unstable angina/NSTEMI/STEMI acute management

A 
Oxygen
Nitrates for pain
Diamorphine for pain
Metoclopramide for nausea (from opioids)
High-dose aspirin
Heparins
b-blocker
76
Q

Long-term management post STEMI/NSTEMI

A 
Aspirin + Clopidogrel (12 months after NSTEMI/unstable angina)
b-blockers
ACEis/ARBs
Nitrates
Statin
77
Q

MAO of nitartes

A

Reduce venous return and relieve ventricular workload

Vasodilators

78
Q

Doses of adrenaline by age

A

1 month - 5 years - 150 microgram

6-11 years - 300 microgram

12 years and above - 500 micrograms

79
Q

Where in the kidneys do thiazide diuretics work

A

Distal convoluted tubules

80
Q

What can loop diuretics precipitate

A

hepatic encephalopathy

81
Q

What can loop diuretics exacerbate

A

gout and diabetes

82
Q

What HTN medicine should you avoid using together with K-sparing diuretics and why

A

ACEis/ARBs - risk of hyperkalaemia

Pharmacy Pre-reg exam 2020-2021 (20 decks)

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