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Pharmacy Pre-reg > Cardio > Flashcards

Cardio Flashcards

1
Q

Initial management of Angina

A

Short acting Nitrate (GTN SL Spray) until stable then Beta blocker / CCB for prevention

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2
Q

If GTN + Beta blocker + CCB fail to control Angina what options are there

A

Long acting nitrate (Isosorbide mononitrate IR 1st then MR if required) / Ivabradine / Nicorandil / Ranolazine

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3
Q

Nitrate Contraindications

A

Aortic/Mitral stenosis, Anaemia, Hypotension, Hypovolaemia, Pericarditis, Brain bleeds with intracranial pressure, Pulmonary oedema

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4
Q

Nitrates Mechanism of Action

A

Converted into Nitric Oxide (Vasodilator) causes GTP->cGMP which causes vascular smooth muscle relaxation and dilation

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5
Q

How is Nitrate tolerance avoided

A

Maintain 10-14h Nitrate free period at night between doses, optimal ISMN dose is 8am 4pm

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6
Q

Nitrate SEs

A

Transient Hypotension (Dizzy, weak, palpitations, postural hypotension)

Headache (slow titration to avoid, subsides after 1-2w, caution if migraine)

Mouth burning, stinging, tingling = use lower strength/ GTN spray

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7
Q

Contraindicated interaction for Nitrates

A

Phosphodiesterase inhibitors (Sildenafil, Tadalafil) = excessive hypotension and myocardial infarction precipitation.

12h gap between dose of each

Angina attack during sex AVOID GTN

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8
Q

Ivabradine MoA

A

Inhibits SA node conductivity and prolongs diastolic depolarisation which slows heart rate, reducing cardiac muscle oxygen demand and so pain

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9
Q

Nicorandil MoA

A

cGMP mediated vascular smooth muscle dilation similar to nitrates

calcium channel inhibition causing muscle relaxation and dilation

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10
Q

Ranolazine MoA

A

Sodium and potassium channel inhibitor reducing contractility

Calcium channel inhibitor causing vascular smooth muscle dilation

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11
Q

Ivabradine SEs

A

Eyes - blurred vision, phosphenones (brief spots/flashes of light) v common

Bradycardia, AF, Transient headache, GI
QT prolongation, Angioedema, >Creatinine, Vertigo

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12
Q

Ivabradine interactions

A

CYP3A4ind/inh
QT prolongers
Grapefruit
rlCCBs excessive bradycardia aka heart block

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13
Q

Nicorandil issues

A

Headache in 22-48% people within 2 weeks treatment initiation
Dizzy, >HR, Flushing

uncommonly Angioedema,

GI ulcer rarely withdraw removes issue

Interacts with steroids and NSAIDs causing GI ulcer, PDE5i and AntiHTN causing hypotension

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14
Q

Ranolazine dose

A

375mg BD 2-4w -> 500mg BD, max 750mg BD

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15
Q

Ranolazine issues

A

AVOID CrCl <30mL/min, Ca 30-80mL/min
Ca if =<60kg
Interacts with = CI with CYP3A4ind/inh, statin dose adjust, QT prolonger, Immunosuppressant (Tac/Ciclo) toxicity

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16
Q

How do people score on a CHA2DS2VASc

A

CHF/ LV dysfunction 1pt
HTN (>140/90) or on AntiHTN 1pt
>=75y 2pts
DM (fasting >=7/ DM drugs/insulin)
Stroke/TIA/VTE 2pts
Vasc disease (MI/Peripheral Arterial Disease/Aortic plaque) 1pt
65-74 1pt
Female 1pt

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17
Q

What CHA2DS2VASc score warrants treatment

A

> =2 DOAC to all
1 consider DOAC unless only scoring for sex

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18
Q

When is Warfarin licensed for AF

A

2nd line to DOACs - target 2-3

1st if valvular AF (Mitral stenosis / Metallic valve, NOT graft valve) - target 3-4

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19
Q

How does a high INR affect Warfarin dosing

A

INR>8 hold Warfarin + Give Phytomenadiome (Vit K)
IV if bleeding, PO if not

Restart Warfarin when INR<5

INR 5-8 with bleeding hold Warfarin + Give IV Vit K, if not just hold 1-2 Warfarin doses

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20
Q

Peri-operative bridging of Warfarin

A

Hold 5d before op
High risk Start LMWH d3- + daily INRs
d1- If INR >1.5 give Vit K
LMWH 6h post op
To restart Warfarin co-administer LMWH until 2xINR in range

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21
Q

How long must DOACs be held for perioperatively

A

Apixaban, Edoxaban, Rivaroxaban 24h

Dabigatran with CrCl >80mL/min 24h, 50-80mL/min 48h

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22
Q

Under what conditions is an edoxaban dose reduced

A

=<60kg

CrCl 15-50mL/min

P-gp inhibitor co-administration (Ciclosporin, Dronadarone, Ketoconazole)

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23
Q

Under what conditions is Apixaban dose reduced

A

When using for nvAF if Pt has 2 from:
SCr >=133
>=80y
=<60kg
CrCl 15-29mL/min

Max dose 2.5mg BD

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24
Q

Indications for Apixaban

A

VTE prophylaxis following knee / hip replacement
Treatment then secondary prevention of DVT/PE
Stroke prevention in non-valvular AF

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25
Q

How is a DVT/PE treated with Apixaban

A

10mg BD 7d -> 5mg BD 6m -> secondary prevention 2.5mg BD

Weight and age don’t affect dose only CrCl 15-29mL/min

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26
Q

Which dose and how long for is Apixaban used for VTE prophylaxis in joint replacement

A

Both 2.5mg BD
Hip 10-14d
Knee 32-38d

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27
Q

What can Rivaroxaban be used for

A

VTE prophylaxis following hip/knee replacement and ACS
Treatment, then secondary prevention of DVT/PE
Stroke prevention in non-valvular AF

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28
Q

How must Rivaroxaban be administered

A

With food

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29
Q

How is a DVT/PE treated with Rivaroxaban

A

15mg BD 21d -> 20mg OD 6m -> 10mg OD (high risk stay on 20mg)

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30
Q

What dose and how long for is Rivaroxaban used for VTE prophylaxis in joint replacement

A

Both 10mg OD
Hip 2w
Knee 5w

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31
Q

What is the only factor that would warrant a dose reduction of Rivaroxaban

A

Max 15mg OD if CrCl 15-49mL/min

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32
Q

What other drugs can affect the licenses dose of dabigatran

A

Amiodarone
Verapamil

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33
Q

How does renal function affect Dabigatran dosing

A

Contraindicated in paediatrics if CrCl <50mL/min

Max 110-150mg and weight based dosing for adults with a CrCl 30-50mL/min

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34
Q

Surgical VTE prophylaxis dose for Dabigatran

A

18-74y = 110mg STAT 1-4h post-op -> 220mg OD starting on d1
>=75y or +Amiodarone/Verapamil = 75mg STAT 1-4h post-op -> 150mg OD

Hip 28-35d
Knee 10d

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35
Q

Is a DVT/PE treated the same as non-valvular AF with Dabigatran

A

Yes
5d LMWH 1st then on d6 post-op

18-74y 150mg BD
75-79y 110-150mg BD
>=80y 110mg BD

Max dose 110mg if Verapamil co-administered
Max 110-150mg if CrCl 30-50mL/min

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36
Q

What drugs increase bleed risk when given with DOACs

A

SSRIs, SNRIs, Venlafaxine
Antiplatelets
NSAIDs

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37
Q

What drugs can increase or decrease DOAC exposure/ efficacy

A

Strong inducers / inhibitors of CYP3A4 and P-gp
Inducers = Carbamazepine, Phenytoin, Rifampicin, St. John’s Wort
Inhibitors = Itraconazole, Ketoconazole, Ritonavir

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38
Q

How do you swap between Warfarin and a DOAC

A

Warfarin -> DOAC = INR <2 start DOAC, 2-2.5 start DOAC next day, >2.5 wait until <2 then start DOAC.

Apixaban -> Warfarin = co-administer for 2 days then check INR if in range stop DOAC and recheck INR 24h later

Edoxaban -> Warfarin = 1/2 Edoxaban dose for co-administration, check >=2XINR in range then stop Edoxaban then recheck 24h later

Rivaroxaban / Dabigatran -> Warfarin = Co-administer 2d until INR >=2 then stop Rivaroxaban / Dabigatran and recheck INR 24h later

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39
Q

AF treatment pathway

A

<48h dc/pharm Cardioversion
>48h 3w Anticoagulation then dc Cardioversion

Stroke prevention = DOAC / Warfarin depending on risk/ valves
+
Beta blocker (not sotalol and only choice if decompensated HF) / rlCCB (if LVf >=40% Verapamil)

2nd = + Digoxin (monotherapy 1st if others unsuitable and sedentary)

Rhythm = Amiodarone/ Flecainide / Sotalol

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40
Q

CCB SEs

A

Gingivinal hyperplasia, ankle oedema

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41
Q

What must be monitored when treating with Amiodarone

A

Thyroid, Liver, Potassium, Lungs, corneal deposits in visual field, dazzling halo surrounding lights, peripheral neuropathy, phototoxic

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42
Q

What causes bradycardia, AV block and depressed heart function when given with Amiodarone

A

Beta blockers
rlCCBs

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43
Q

What can cause ventricular arrhythmias when given with Amiodarone

A

Chloroquine, citalopram, escitalopram, haloperidol, lithium, mefloquine, phenothiazines, quinine, TCAs, quinolones

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44
Q

Signs of an AKI

A

Anuria, confusion, N&V, dehydration

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45
Q

ACEi issues

A

AKI, Hyperkalaemia, Dry cough, lithium toxicity, postural hypotension, hypotension

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46
Q

Which antiemetic can exacerbate heart failure

A

Cyclizine

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47
Q

What heart failure medicines are contraindicated in asthma and why

A

Beta blockers cause bronchoconstriction

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48
Q

What antihypertensive can cause renal failure

A

ACEi

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49
Q

How must ramipril be initiated

A

1st dose of 2.5mg at night to avoid fall due to 1st dose hypotension side effect

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50
Q

A patient with AF taking max dose bisoprolol had a heart rate of 120bpm so a new medicine was started. Their HR is now 30 and blood pressure 85/55. What medicines would be a likely culprit?

A

Rate limiting calcium channel blockers with beta blockers cause fatal heart block
Amiodarone will also do this

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51
Q

What medicine will cause bronchospasm when given with a beta blocker and so should be avoided

A

Theophylline/ aminophylline

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52
Q

What class of antihypertensive can cause lithium toxicity and why

A

ACEi, ARB, TLD, Loops, MRA, sodium bicarbonate nephrotoxic, lithium renally cleared

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53
Q

Most common side effect of Isosorbide mononitrate

A

Headache
Due to intracranial vasodilation
Disappears after 1-3w

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54
Q

What population shouldn’t long term diuretics be used in

A

Elderly if only treating gravitational oedema aka ankle oedema.
Can be used in HF though

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55
Q

What is the digoxin maintenance dose in elderly and why

A

125mcg
Reduce risk of blood disorders aka bone marrow suppression

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56
Q

What is the maintenance dose of digoxin in renal patients and why

A

62.5mg to reduce risk of blood disorders like bone marrow suppression

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57
Q

Drugs that cause what should be avoided in elderly or renal patients taking digoxin

A

Bone marrow suppression
Eg. Co-trimoxazole

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58
Q

What is the best CCB for HF

A

Amlodipine

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59
Q

rlCCB contraindications

A

Porphyria, HFrEF, Heart block, Bradycardia, Aortic stenosis, Sick sinus syndrome, postural drop >=20

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60
Q

Hyponatraemia symptoms

A

Headache
Dry coated tongue
Poor skin turgor/ no recoil
Sunken eyes
Convulsions
Irritable
N&V

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61
Q

Hypernatraemia symptoms

A

SALT
Skin flushed
Agitated
Low grade fever
Thirsty
Convulsions
Low blood pressure

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62
Q

Hypokalaemia symptoms

A

Skeletal muscle weakness
Slurred speech
Arrhythmias
Constipation
Hypertonic/tense
Irregular/ weak pulse
Orthostatic hypotension
Numbness

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63
Q

Hyperkalaemia symptoms

A

Irritable
Muscle weakness
Abdominal cramps
Hypotension
Numbness
Irregular pulse
Arrhythmias
Nausea
Diarrhoea

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64
Q

Hypocalcaemia symptoms

A

Fractures
Numbness
Confusion
Muscle twitches/fasciculations
Diarrhoea
Anxiety
Irritable

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65
Q

Hypercalcaemia symptoms

A

Fatigue
Confusion
Constipation
Bradycardia
Polyuria
Anorexia
Renal failure
Muscle weakness
Lethargy
Coma
N&V

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66
Q

Hypomagnesaemia symptoms

A

N&V
Tremor
Dysphasia
Hallucinations
Tachycardia
Confusion
Drowsiness
Hypertension
Personality changes
Anorexia
Decreased appetite

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67
Q

Hypermagnesaemia symptoms

A

N&V
Flushing
Headache
Cognitive impairment
Hypotension
Hyporeflexia aka poor reflexes

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68
Q

AKI symptoms

A

N&V
Dehydration
Confusion
Reduced urine output
Urine colour change
Hypertension
Abdominal pain often in rear
Oedema

69
Q

Ambulatory / home BP targets

A

<80y <135/85
>=80 <145/85

70
Q

HTN definition BP

A

120-129/80 elevated
130-139/80-89 stage 1
>140/90 stage 2

71
Q

Clinic BP Targets

A

<80y <140/90
>=80y <150/90

72
Q

Pre-eclampsia treatment

A

New Hypertension in pregnancy
1st Labetalol
2nd Nifedipine
3rd Methyldopa

Existing use normal HTN meds

73
Q

When can’t tranexamic acid be used

A

Vision colour change discontinue
Diarrhoea reduce dose
Embolism
Convulsions

74
Q

Loperamide MHRA warning

A

Cardiac side effects and fatal arrhythmias due to QT prolongation

75
Q

Pruritus is caused by an Imbalance of what

A

Hyperphosphataemia

76
Q

Ramipril in renal impairment

A

Hold in AKI
Max 5mg if CrCl 30-60

77
Q

Statin therapy target reductions

A

40% in 3 months

78
Q

Outline the CHA2DS2VASC scoring system

A

1 CHF / LV dysfunction
1 HTN / on AntiHTN
2 Age >=75
1 Diabetes / on AntiDM / Insulin / Fasting CBG >=7
2 Stroke / TIA
1 Vascular disease / MI / Peripheral Arterial Disease / Aortic plaque
1 Age 65-74
1 Sex Female

79
Q

What do different CHA2DS2VASC scores mean

A

> =2 warrants DOAC therapy

If male scoring 1 consider benefits of DOAC

all females score minimum 1 so their minimum score for therapy is 2

80
Q

Outline the ORBIT scoring system

A

2 Male Hb <130 / Haematocrit <40%
2 Female Hb <120 / Haematocrit <36%
2 Prev bleed
1 Age >=75
1 eGFR <60mL/min
1 Antiplatelet

Low 0-2 Medium 3 High 4-7

81
Q

What qualifies someone for DC Cardioversion

A

Life threatening haemodynamic instability caused by AF
Or
When rhythm control indicated after rate control failure >48h after AF symptom onset

Caution patient must be fully anti coagulated for 3 weeks before and 4 weeks after cardioversion

82
Q

When can rhythm control be started in AF

A

Onset AF <48h
Or
If dual rate control not effective

83
Q

Rate control drugs in AF

A

Beta blockers not sotalol

Or rlCCBs never together

If sedentary and non-pAF and above not controlling Digoxin

84
Q

What drugs are required surrounding electrical Cardioversion

A

Beta blocker rate control
Antiarrhythmic 4 weeks before and 12 months after to improve success
Anticoagulant 3 weeks before and 4 weeks after

85
Q

How does atrial flutter treatment differ from AF

A

Rate control temporary until normal sinus rhythm restored
Additional Cardioversion option using catheter ablation aka manual pacing for recurrent atrial flutter

86
Q

Things that can induce torsades de pointes aka QT prolongation

A

Hypokalaemia
SEV bradycardia
Amiodarone
Macrolides
Antifungals
SSRIs
TCAs
Haloperidol

87
Q

Classes of antiarrhythmics

A

1 membrane stabilisers - Lidocaine, Flecanide
2 beta blockers
3 Amiodarone, Sotalol
4 rlCCBs

88
Q

Amiodarone side effects

A

AVOID in Bradycardia = Heart block

STOP if corneal microdeposits = blurred vision affecting driving

Hypo / Hyper Thyroidism

Photosensitivity = suncream + avoid exposure

STOP if Hepatotoxic signs = Jaundice, pale stools

DR if Pulmonary fibrosis signs = SoB, cough

89
Q

Amiodarone interactions

A

Will interact for minimum 1 month after treatment cessation

Hypokalaemia causers
QT prolongers
CYP substrates as it is an inhibitor, also a substrate itself
Bradycardia causers

90
Q

Amiodarone HCP monitoring

A

TFT pre- treatment then q6m
LFT pre-treatment then q6m
K+ pre-treatment
Chest XR pre-treatment
Eye test annually

91
Q

Digoxin therapeutic range

A

0.7-2

92
Q

Digoxin toxicity

A

Blurred vision
Yellow vision
Bradycardia
N&V
Confusion

Palpitations
Headache
Dizziness
Lethargic / Weak
Diarrhoea

93
Q

Digoxin side effects

A

Hypokalaemia
Hypomagnesaemia
Hypercalcaemia
Arrhythmias
Heart block
Nephrotoxic
Pericarditis

94
Q

Digoxin reversal agent

A

Digoxin specific antibody
Digifab

95
Q

Max digoxin dose in specific populations

A

125mcg elderly
62.5mcg CrCl <30mL/min
125mcg with bone marrow suppressors like Co-trimoxazole

96
Q

Digoxin interactions

A

TCA arrhythmias
Hypokalaemia causers induce toxicity
CYP inducers decrease efficacy
CYP inhibitors cause toxicity

97
Q

Desmopressin advice

A

Restrict fluid intake before bed

98
Q

How long after surgery should a patient receive VTE Prophylaxis

A

Minimum 7d or until mobility re-established
28d after major cancer abdominal surgery
30d after spinal surgery
28d after hip surgery
42d after ankle surgery
14d after knee surgery

99
Q

VTE treatment lengths

A

Distal aka Calf DVT 6 weeks
Proximal aka any higher 3 months (6 if active Ca)
Provoked VTE 3 months if causative factor gone (immobility, HRT)
Unprovoked VTE 3 months
Recurrent VTE lifelong warfarin

100
Q

Patient has a major bleed whilst taking warfarin what do you do

A

STOP Warfarin
GIVE IV Vit K and Dried Prothrombin

101
Q

What indications warrant a target INR of 3-4

A

Mechanical heart valves
Recurrent VTEs

102
Q

What indications warrant a target INR of 2-3

A

VTE
AF
Cardioversion
MI
Cardiomyopathy

103
Q

Warfarin MHRA warnings

A

Calciphylaxis - see Dr if painful skin rash

Antivirals that induce CYP reduce efficacy

104
Q

Warfarin in pregnancy

A

Teratogenic in 1st and 3rd trimester use LMWH instead

AVOID 48h post-partum

105
Q

Warfarin interactions

A

CYP inducers and inhibitors affect INR

Specifically avoid Azole antifungals and CYP inducers

Pomegranate, cranberry increase INR

Vitamin K foods decrease INR (green leafy veg and green tea)

106
Q

Warfarin management around surgery

A

Minor procedures when INR <2.5 and restart within 24h

Major procedures stop 3-5d before, check INR day before if >=1.5 GIVE Vit K and bridge with LMWH 24h before

Emergency if it can be delayed 6-12h GIVE IV Vit K, if not GIVE IV Vit K + Dried Prothrombin

107
Q

Heparins contraindications

A

Heparin induced thrombocytopenia
Can cause Hyperkalaemia
Haemorrhage, if occurs during therapy treat with Protamine
Renal impairment affects dose - UNF best here
LMWH preferred in pregnancy

108
Q

What is 1st like antihypertensive for a 56 year old with type 2 diabetes

A

ACEi

109
Q

What is 2nd line for a Jamaican man aged 45

A

Already on CCB
+ ARB preferred to ACEi

110
Q

What is 4th line for hypertension if potassium is 5

A

Alpha blocker
Or
Beta blocker

111
Q

ACEi + ARB side effects

A

Dry cough ACEi only
Hyperkalaemia
Hepatic failure
Angioedema
Renal impairment
Dizziness
Headaches

112
Q

ACEi/ARB interactions

A

Vomiting / Diarrhoea STOP

Lithium Toxicity

Hyperkalaemia with heparins, NSAIDs, Ksparing, Beta blockers

Hypovolaemia with diuretics

Renal failure with Ksparing, Diuretics, NSAIDs

113
Q

Cardioselective beta blockers and what that means

A

Bisoprolol
Atenolol
Metoprolol
Acebutolol
Nebevilol

Less likely to cause bronchospasm

114
Q

Water soluble beta blockers and what that means

A

Water CANS

Celiprolol
Atenolol
Nadolol
Sotalol

Won’t cross BBB so less Nightmares

115
Q

Lipid soluble beta blockers and what that means

A

Propranolol
Pindolol
Penbutalol
Timolol

Will cross BBB can cause nightmares

116
Q

Intrinsic sympathomimetic beta blockers and what that means

A

Pindolol
Acebutol
Celiprolol
Oxprenolol
Labetalol

Less likely to cause cold extremities

117
Q

Beta blocker side effects

A

Bradycardia leading to HF
Dampen symptoms of Hypoglycaemia
Can cause Hyperglycaemia
Bronchospasm so CI in Asthma
Peripheral vasoconstriction so CI in PVD

118
Q

What drugs are a complete no go with beta blockers

A

Rate limiting calcium channel blockers will cause complete heart block leading to death by bradycardia

119
Q

What is the name of non-rate-limiting calcium channel blockers

A

Dihydropyridine

120
Q

What are the dihydropyridine calcium channel blockers

A

Amlodipine
Felodipine
Larcidipine
Lercanidipine
Nifedipine

121
Q

Side effects associated with dihydropyridine calcium channel blockers

A

Dizziness
Gingivinal hyperplasia
Vasodilatory effects = Flushing, Headaches, Ankle oedema
bradycardia

122
Q

Side effects associated with rate limiting calcium channel blockers

A

Dizziness
Gingivinal hyperplasia
Bradycardia leading to complete heart block
Flushing, headaches, ankle oedema more with dihydropyridines

123
Q

Who is high risk for pre-eclampsia and how do we manage said risk

A

Kidney disease
Diabetes
Autoimmune disorders
HTN

Aspirin from w12 until birth

124
Q

Treatment pathway for pre-eclampsia

A

BP >140/90
1st Labetalol
2nd Nifedipine MR
3rd Methyldopa
Aiming for BP <135/85

125
Q

BP Target age cutoff

A

80

126
Q

BP Target for over 80 year olds in clinic and home

A

Clinic <150/90
Ambulatory <145/85

127
Q

BP Target for under 80 year olds in clinic and at home

A

Clinic <140/90
Ambulatory <135/85

128
Q

BP Target in renal disease

A

140/90

129
Q

BP Target in Pregnancy

A

135/85

130
Q

BP Target for type 1 diabetics

A

<135/85

131
Q

Normal lipid profile

A

Total cholesterol >=5
HDL >=1
LDL >=3
non-HDL =<4
Triglycerides =<2.3

132
Q

What is high intensity statin therapy

A

Atorvastatin 20,40,80 NOT 10
Simvastatin 80 NOT 10,20,40
Rosuvastatin 10,20,40 NOT 5
NOT Pravastatin or Fluvastatin

133
Q

What should be checked before starting a statin

A

Lipid profile

TFT - hypothyroid should be managed before starting statin therapy
If DM do fasting HbA1c and repeat at 3m

Renal function
<30mL/min max simvastatin 10, avoid Rosuvastatin, max fluvastatin 40
30-60 max 40 Rosuvastatin
Titrate from lowest doses of a
Atorvastatin and Pravastatin

Liver function pre-treatment at 3 months then every 12 months, STOP if ALT 3xULN

Creatine Kinase if muscle aches or long lies, STOP if 5xULN

134
Q

Statin SEs

A

Muscle aches or weakness sign of Rhabdomyolysis

SoB, cough, weight loss sign of Interstitial lung disease

Teratogenic AVOID in pregnancy

135
Q

Statin interactions

A

CYP inducers make them ineffective
CYP inhibitors increase toxicity aka rhabdomyolysis,
suspend with Macrolides
AVOID grapefruit as CYP inh
Simvastatin max 20mg with Amlodipine, rlCCBs, Ticagrelor (40mg), Ciclosporin (10mg), HIV drugs (10mg)

136
Q

What drug that isn’t a statin also increases risk of rhandomyolysis

A

Ezetimibe and fibrates

137
Q

What must we do to manage nitrates

A

8-12h Nitrate free period to prevent tolerance aka move BD dosing to 8am and 4pm to allow for 8h between doses

138
Q

What antiplatelet is only indicated if a patient with a heart attack undergoes percutaneus coronary intervention

A

Prasugrel

139
Q

Cardiac secondary prevention

A

DAPT 1y then Aspirin lifelong
ACEi
Beta blocker
High intensity statin

140
Q

Pillars of heart failure

A

SGLT2i (Dapagliflozin, Empagliflozin)
Beta blocker
MRA (Spironolactone, Eplerenone)
ACEi/ARB

141
Q

What is indicated for heart failure if both ACEi and ARBs are contraindicated

A

1st Hydralazine / Nitrates
2nd Entresto (Sacubitril with Valsartan)

142
Q

How long do the effects of loop diuretics last and what does that allow us to do with dosing

A

6 hours
Can give BD morning and lunch
Without affecting sleep

143
Q

Arrange the loop diuretics in order of strength

A

Lowest
Torasemide
Furosemide
Bumetanide
Highest

144
Q

Why must thiazide like diuretics be given In the morning

A

They last 24h so can disrupt sleep causing nocturia

145
Q

What shouldn’t you take with mineralocorticoid receptor antagonists

A

Potassium supplements, risk of Hyperkalaemia

146
Q

How do potassium sparing diuretics affect the urine

A

Amiloride and Triamterene turn urine blue

147
Q

Diuretic side effects

A

All Hyponatraemia
All Hypomagnesaemia
Ksparing Hyperkalaemia
Loop and Thiazide Hypokalaemia, Hypotension, exacerbate DM
Loop exacerbates Gout

148
Q

Diuretic interactions

A

Hypokalaemia causers for Loop and TLDs
Hyperkalaemia causers for Ksparing
Aminoglycosides and Loop are both nephrotoxic and ototoxic
Lithium toxicity with Ksparing or Loop as more hypovolaemic

149
Q

How do you treat reynaud’s phenomena

A

Avoid cold exposure
Smoking cessation
Nifedipine

150
Q

What are the ranges for each type of HF

A

HFrEF <40
HFmEF 40-50
HFpEF >50

151
Q

Which Cardio med must be prescribed by brand

A

Diltiazem

152
Q

Which calcium channel blockers are best in HF

A

Avoid all apart from Amlodipine

153
Q

What meds do rlCCBs interact with

A

Statin increased exposure
Beta blocker fatal heart block
Ivabradine fatal bradycardia
Reduce digoxin dose as increased exposure
Amiodarone and other antiarrhythmics cause heart block and bradycardia
Ritonavir, Dabigatran, carbamazepine, Ciclosporin, colchicine, Rifampicin, phenytoin, NSAIDs

154
Q

Which cardiac med affects Uric acid levels

A

Hyperuricaemia with loop and thiazide like diuretics

155
Q

Drugs that cause bradycardia

A

Beta blockers
rlCCBs
Fentanyls
AChEi
Antiarrhythmics
Ivabradine
Ticagrelor
Clonidine

156
Q

Drugs that prolong the QT interval

A

Antiarrhythmics
Antipsychotics
SSRI
Fluconazole, Voriconazole
Erythromycin
Quinolones
Ondansetron
Methadone
Quinine
Ranolazine
Sotalol

157
Q

Drugs that cause Hyperkalaemia

A

ACEi/ARB
NSAIDs
MRAs
Heparins
Tacrolimus
Trimethoprim

158
Q

Drugs that cause Hypokalaemia

A

Theophylline
Corticosteroids
Diuretics
Beta 2 agonists
Amphotericin B

159
Q

Drugs that cause first dose hypotension

A

ACEi
Alpha blockers

160
Q

Drugs that cause hypotension

A

ACEi/ARB
Alpha and Beta blockers
Alcohol
CCBs
SGLT2i
TCAs
Antipsychotics
Diuretics
MAOi
Ketamine
Methyldopa
Nitrates

161
Q

Drugs with antiplatelet effects

A

NSAIDs
Clopidogrel
Benzydamine
Phosphodiesterase inhibitors
SSRI/SNRI
Omega-3

162
Q

Pulmonary embolism symptoms

A

Pain on inspiration or expiration
Haemoptysis (sputum)
Cough
Sudden Dyspnoea (SoB)

163
Q

Deep vein thrombosis symptoms

A

Throbbing pain in area of clot that is exacerbated by movement or standing

Firm swelling that is sensitive to the touch

Warm red/darkened skin

Unilateral symptoms or whole abdomen if there

164
Q

Stroke symptoms in community

A

Facial dropping
Arm weakness
Slurred speech
Test/Time

165
Q

Stroke symptoms in HCP setting

A

V3FAST
Vision loss, blurred, double/ abnormal eye movements
Vertigo
Vestibular instability aka weakness, ataxia (slow movements), sideways veering when walking
Facial drooping
Arm weakness
Slurred speech
Test time

Rule out seizures and hypoglycaemia

166
Q

When is fondaparinux indicated

A

When thrombosis isn’t indicated

167
Q

When is thrombolysis indicated

A

Within 4.5h of stroke onset
Within 12h of STEMI onset and Primary PCI can’t be given within 2h (surgery)

No bleeds / risk of including drugs thinning blood
No surgery
Recent clots
Cancer
Good glucose control
NIHSS >=3

168
Q

LMWH doses in VTE based on risk and what makes them those risks

A

High risk 1mg/kg BD
PE - Obese, Symptomatic PE, Ca, recurrent VTE, Surgery
DVT - Obese, Ca, Recurrent VTE, active Proximal DVT, Surgery

Low risk 1.5mg/kg OD

169
Q

Subarachnoid haemorrhage treatment

A

Aneurysmal get Nimodipine 60mg every 4h for 21d course
Trauma get nothing

Pharmacy Pre-reg (5 decks)

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