Cardio factfiles Flashcards
(170 cards)
1
Q
Atorvastatin Counselling
A
- Avoid grapefruit juice
- Report any unexplained muscle pain
- Repeat LFTs in 3 months and 12 months
2
Q
Atorvastatin dose in primary prevention
A
20mg
3
Q
Atorvastatin dose in secondary prevention
A
80mg
4
Q
What dose is a high intensity statin for atorvastatin
A
20mg +
5
Q
Monitoring before starting statin
A
LFT
Hb1Ac
Renal
TSH
6
Q
What is the maximum dose allowed for atorvastatin while taking ciclosporin ?
A
10mg
7
Q
Key interactions of atorvastatin
A
Amiodarone
Clarithromycin
Azoles
8
Q
Adverse effects of atorvastatin
A
Nose bleeds
Hyperglycaemia
9
Q
what is high intensity simvastatin dose
A
80mg
10
Q
What is medium intensity simvastatin dose
A
20mg-40mg
11
Q
What is low intensity simvastatin dose
A
10mg
12
Q
CI of simvastatin
A
ALT > 3 TIMES UPPER
Pregnancy and BF
13
Q
Contraception and statins
A
Need during and one month after.
Stop 3 months before attempting to conceive
14
Q
Key interactions of simvastatin
A
Clarithromycin
Grapefruit jucie
Itraconazole
Increases plasma conc of statin
15
Q
Dose reduction to simvastatin 10mg when given with….
A
Bezafibrate
Clopidogrel
16
Q
Max 20mg simvastatin when given with …..
A
Verapamil
Amiodarone
Amlodipine
Ranolazine
Diltazem
17
Q
Which statins can be administered at any time of the day
A
ATORVA
ROSUVA
18
Q
What colour are 0.5mg warfarin tablets
A
White
19
Q
What colour are 1mg warfarin tablets
A
Brown
20
Q
What colour are 3mg warfarin tablets
A
Blue
21
Q
What colour are 5mg warfarin tablets
A
Pink
22
Q
INR monitoring with warfarin
A
- Initially daily/alternative until INR within therapeutic range on 2 consecutive days
- Then twice weekly for 1-2 weeks
- Then weekly until INR is in range on 2 consecutive occasions
- Then up to 12 weeks
23
Q
Major bleed and warfarin
A
Stop warfarin. Phytomenadione slow IV and/or dried prothrombin complex
24
Q
INR >8.0 and minor bleed
A
Stop warfarin. Phytomenadione slow IV injection
Restart warfarin once INR<5
25
INR >8.0 and no bleeding
Stop warfarin
Phytomenadione oral
Restart once INR <5
26
INR 5-8 and minor bleed
Stop warfarin
Phytomenadione slow IV injection
Restart once INR <5
27
INR 5-8 and no bleed
Withold 1-2 doses of warfarin. Reduce the maintenance dose
28
Warfarin cautions
Hyperthyroidism
Hypothyroidism
Increased bleeding risk
29
Warfarin in pregnancy
Avoid - especially 1st and third trimester
30
Which drugs decrease warfarin effect
St John wort
Carbamazepine
Rifampicin
Alcohol (chronic)
Phenytoin
SCRAP
31
Which drugs increase warfarin effect
Metrondiazole
Cranberry Juice
Macrolides
Azoles
Ciprofloxacin
MCMAC
32
When is the target INR 2.5
VTE
AF
Post MI
Antiphospholipid syndrome
33
When is the target INR 3.5
Recurrent VTE whilst on anticoagulation and anticoagulant control in range
34
Edoxaban normal dose and when dose reduction is required
60mg OD
30mg OD (below 61kg)
35
Apixiban normal dose and when dose reduction is required
5mg BD
2.5mg BD (age >80, creatinine >133, kg <61)
36
Rivaroxaban normal dose and when a dose reduction is required
20mg OD
15mg OD (creatinine clearance 15-49)
37
Dabigatran MOA
Reversible inhibitor of free thrombin, fibrin bound thrombin and thrombin induced platelet aggregation
38
Dabigatran normal dose and when a dose reduction is required
18-74 years - 150mg BD
75-79 years - 110-150mg BD
>80/ concomitant verapamil - 110mg BD
39
Amiodarone cautions
Elderly
HF
Hypokalemia
Severe bradycardia
40
Amiodarone monitoring
Thyroid
LFT
41
Amiodarone monitoring prior to treatment
LFT
Thyroid
Potassium
Chest x ray
42
Adverse effects of amiodarone
Pulmonary toxicity
Corneal micro-deposits
Thyroid disorders
Hepatotoxicity
Skin
43
Amiodarone interactions
-Digoxin - half dig dose
- Prolonging QT drugs
- Hypokalaemia
- Grapefruit jucie
- Bradycardia drugs
- Rate limiting CCB
44
Skin and amiodarone
Protect your skin from sunlight even on a bright but cloudy day. Do not use sunbeds.
During and several months after treatment (long half life)
45
Rank from highest to lowest RISK OF CVD with NSAIDS
Diclofenac 150mg daily
Ibuprofen 2.4g daily
Naproxen 1g daily
Ibuprofen 1.2g daily
46
Rank from highest to lowest: Increased bleeding risk with NSAIDS
Piroxicam
Ketoprofen
Ketorololac
Indometacin
Diclofenac
Naproxen
Ibuprofen
47
MHRA Piroxicam
Should not exceed 20mg daily
48
NSAIDS and drug toxicity
MTX and lithium- NSAIDS may reduce clearance of these drugs
49
NSAIDS and risk of bleeding
Increased risk when given with :
- SSRI
Anticoagulants
Aspirin
Coricosteroids
50
NSaids+ Quinolones
Increased risk of convulsions
51
NSAIDS in pregnancy
Avoid especially in third trimester
52
NSAIDS and renal impairment
avoid in severe renal impairment
Below 30ml/min egfr
53
NSAIDS adverse effects
Gi (ulcers, bleeds)
CV (small risk of thrombotic events)
Renal complications
Bronchospasm (avoid in asthma)
Severe Hepatic reactions
54
Potassium sparing diuretics examples
Amiloride
Triamterene
Spironolactone
Eplerenone
55
What electrolyte disturbance do potassium sparing diuretics cause
Hyperkalaemia
56
Aldosterone antagonists Side effects
Gynaecomastia
SJS
Agranulocytosis
Thrombocytopenia
57
Key side effects of triamterene
Blue urine
Megaloblastic anaemia
58
Potassium sparing diuretics interactions
- Increases lithium toxicity
- NSAIDS reduce diuretic effect
- Increased hyperkalemia with ACEi, Ciclosporin, Potassium supplements etc
- hypotension effect increased with antihypertensives
59
Dipyridamole counselling
MR - take with food
IR- Take 30-60 mins before food
Capsules should be discarded 6 weeks after opening
60
Aspirin secondary prevention dose
75mg
61
Clopidogrel dose and indication
Prevention of atherothrombotic events in ACS. Usually up to 12 months
75mg OD
62
Dipyridamole indication and dose
Secondary prevention of iscahemic stroke and TIA
200mg BD
63
Prasugrel indication and usual dose
ACS undergoing PCI with ASPIRIN for prevention of atherothrombotic events. Usually up to 12 months
10mg OD
64
Ticagrelor indication and usual dose
Prevention of atherothrombotic events in patients with ACS WITH aspirin usually up to 12 months
90mg BD
65
Which drugs increase GI bleeding risk
SSRI
Anticoagulants
Prednisolone
NSAID
Nicorandil
Antiplatelets
66
Stroke/ TIA lifelong anti platelet
Clopidogrel
67
Key interactions of clopidogrel
Omeprazole/Esomeprazole- decreased antiplatelet effect
Fluconazole- decreased antiplatelt effect
68
Digoxin indications
HF
AF
69
Cautions of digoxin
Hypercalcaemia
Hypokalaemia
Hypomagnesasemia
All increase the risk of digoxin toxicity
70
How many hours after the dose of digoxin should bloods be taken?
6 hours
71
Monitoring requirements of digoxin
Renal function
Serum electrolytes
72
Adverse effects of digoxin
Bradycardia
GI disorders
Yellow vision
73
What to give in digoxin life threatening toxicity
Digoxin specific antibody- digifab
74
Interactions of digoxin
Hypokalaemia - Loop and thiazide
St John wort- Decreases digoxin conc
75
when to half the dose of digoxin
Amiodarone
Dronedarone
Quinine
76
Why is digoxin a good choice for AF patients with sedentary lifestyles
Reduces heart rate and increases force of contraction
77
Which beta blocker is used in pregnancy with HTN
Labetalol
78
Which beta blocker can be used in migraine prophylaxis
Propanolol
79
Withdrawing beta blockers
Avoid abrupt withdrawal as may cause rebound worsening of MI
80
Cautions with beta blockers
Asthma - May cause bronchospasm
Diab- may mask hypo and may also cause hypo/hyper
81
Which beta blockers can be given once daily
Bisoprolol
Atenolol
Nadolol
Celiprolol
82
Which beta blockers are less likely to cause cold extremities, fatigue and bradycardia
Pidnolol
Oxprenolol
Acebutalol
Celiprolol
Penguins observer artic coldness
83
Adverse effects of beta blockers
Erectile dysfunction
Nightmares
Coldness of extremities
Fatigue
84
Key interaction of beta blockers
Verapamil and diltiazem
Risk of bradycardia, severe hypotension and HF
85
Which beta blockers are water soluble and therefore less likely to cause nightmares and sleeping issues
Celiprolol
Atenolol
Nadolol
Sotalol
CANS
86
Which beta blockers are cardioselective - can use in a asthma
A BIG MEAN NURSE ADMINISTERS
Acebutolol
Bisoprolol
Metoprolol
Nebivolol
Atenolol
87
Sotalol indications
Ventricular/ superaventricular arrhythmias
88
Sotalol cautions
-Prolongs QT
-Avoid hypokalaemia and hypomagnesaemia
-Can cause prolonged/severe diarrhoea
89
Sotalol interactions
QT prolonging drugs- Amiodarone, citalopram, clarithromycin
Hypokalaemia- Aminophylline, clomipramine, prednisolone
90
Sotalol monitoring requirements
ECG
Electrolytes
91
Sotalol and renal impairment
Avoid if below 10
quater dose if between 10-25 and half dose if between 30-60 ml/min
92
What to do if ulceration occurs with nicorandil
Stop and see GP
93
Nicorandil common Side effects
Headaches (transient)
Nausea
Vomitting
Flushing and dizziness
94
Drug interactions of nicorandil
NSAIDS/Corticosteroids- Increase risk of GI ulceration
Phosphodiesterase inhibitors - Serious hypotension
95
Drug treatment for stable angina
1st- BB/CCB
2nd- BB + CCB (not rate limiting)
3rd- If CI/not tolerated use a long acting nitrate (nicorandil/ ivabradine/ ranolazine)
96
Short acting nitrate examples
GTN spray or sublingual tablets
97
Long acting nitrates
ISM
ISD
98
Nitrate free period with ISM
Twice daily ISMN should be taken morning and mid afternoon, patches should be applied in the morning and removed at night.
This is to avoid tolerance and ensure nitrate free interval
99
After opening GTN sublingual tablets when should they be discarded
8 weeks
100
Interactions of nitrates
Antihypertensives- can increase the hypotensive effect of nitrates
phosphodiesterase inhibitors - CI as can cause serious hypotension and may PRECIPITATE a Mi
101
Thiazide renal cut off
ineffective below 30ml/min
102
Thiazide electrolyte changes
Hypokalaemia
Hypomagnesaemia
hyponatraemia
Hypercalcaemia
Hyperglycaemia
103
Thiazide like diuretic indications
Oedema
HTN
104
What has a longer half life thiazide or loop
thiazide, therefore it is best to give it in the morning so its diuretic effect is maximal when the person is awake
105
Bendro side effects
Blood disorders
Hyperglycaemia
Erectile dysfunction
Gout
106
Thiazide and pregnancy
Avoid. May cause neonatal thrombocytopenia, bone marrow suppression, jaundice, electrolyte disturbances and hypoglycaemia
107
Perindopril caution label
take 30-60 mins before food
108
ACEi electorate disturbances
Hyperkalemia
Hyponatraemia
109
ACEi in CKD
Slow progression of CKD by dilating the efferent folmerular arteriole, thus reducing intraglomerular pressure
110
Monitoring of rivaroxaban
Renal
Liver
FBC
at least annually
111
Renal impairment and rivaroxaban
Avoid if cccl is below 15 and caution in 15-29
112
What drugs increase the bleeding risk when given alongside rivaroxbaan
NSAIDS
Anticoagualnts
SSRI
SNRI
Antiplatlets
113
What drugs cause decreased plasma levels of rivaroxaban
Enzyme inducers: Carbamazepin, st john wort, pheyntoin
114
What drugs cause increased plasma levels of rivaroxaban
Enzyme inhibitors such as ketconazole and dronedarone
115
Apixiban and renal impairment
avoid if less than 15
Dose requirements may be necessary between 15-29ml/min
116
Which medications increase the bleeding risk when given with apixaban
NSAIDS
SSRI
ANTIPLATLETS
SNRI
ANTICOAGULANTS
117
What medications increase apxiban levels
Clarithromycin
118
What medications decrease plasma levels of apixaban
Enzyme inducers like carbamazepine and phenytoin
119
MHRA Simvastatin 80mg
Increased risk of myopathy associated with 80mg simva. Only consider in patients with severe hypercholestrolaemia and high risk CVD complications
120
Which enzyme metabolises statins
CYP3A4
121
What drink increases simvastatin exposure
Grapefruit juice
122
What is the maximum dose of simvastatin when using verapamil and diltazem
20mg
123
What is the max dose of simvastatin when using bezafibrate/fenofibrate
10mg
124
What is the max dose of simvastatin when taking amiodarone/amlodpine/ranolzaine
20mg
125
General adverse effects of statin
Constipation
Dizziness
tHROMBOCYTOPENIA
Myopathy
Peripheral neuroapthy
Tendiopathy
Pancreatitis
126
Statins and pregnancy
Avoid- discontinue 3 months before trying to conceive
127
Statins and pregnancy
Adequate contraception is required during and 1 month after
128
Statins monitoring before and during
Before- Lipids, thyroid, renal function, LFT, diabetic marker
During- Lipids, LFT
129
Max dose of atorvastatin when using ciclosproin
10mg
130
Atorvstatin and grapefruit juice
Caution. May increase exposure. Avoid 1.2L>
131
Warfarin and calciphylaxis
Report any painful rash
132
Lithium and aldosterone antagonists
Concurrent use can reduce excretion of lithium, thus increasing conc of lithium
133
Indications of aldosterone antagonists
Oedema, ascities in cirrhosis of liver
Resistant hypertension (adjunct)
Moderate to severe HF (ADJUNCT)
134
what cautionary advisory label is required for spironolactone
Take with or just after food
135
What is first line in AF
Rate control- BB (not sotalol)
if combination therapy indicated can combine with digoxin or diltazem
136
When should diltazem be prescribed by brand
above 60mg MR
137
When should verapamil be prescribed by brand
All MR
138
Verapamil and pregnancy
Avoid in 1st trimester
139
Diltiazem in pregnancy
Avoid
140
Interactions of rate limiting CCB
Statins- Increased myopathy
Anthypertensives- increased antihypertensive effect
Amiodarone- Risk of AV block and bradycardia
Beta blockers- Risk of bradycardia, HF, reduced cardiac output
Enzyme inducer- reduced exposure of rate limiting CCB
141
Side effects of CCB rate limiting
AV block
Bradcardia
142
Overdose of rate limiting CCB
Hypotension
Complete heart block
143
Which NSAIDS are COX-2 specific
CELECOXIB
ETORICOXIB
144
which NSAID to avoid in CVD and use when you want fewer GI issues
COX-2 inhibitors
. COX-2 inhibitors have a higher risk of cardiovascular risk but is associated with fewer gastro-intestinal side effects as the prostaglandins that COX-2 enzymes are related to are not the same prostaglandins involved in the formation of gastrointestinal lining.
145
When is bempedoic acid recommended
For patients unable to tolerate statins + inadequate response to ezetimibe alone. Can be used in combination with ezetimibe or mono therapy alone
146
Does bempedoic acid cause muscle issues
Unlike statins it is a prodrug and is activated in the liver. This reduces the risks of muscle related side effects
147
Monitoring of bempedoic acid
Before: LFT, Uric acid
then every 3 months
148
Max dose of simvastatin when given with bempedoic acid
20mg
149
Adverse effects of bempedoic acid
Anaemia
Gout
Pain in extremities
Hepatic changes
150
What protein does Inclisiran inhibit
Inhibits the synthesis of PCSK9.
151
Usual dose regimen of inclisiran
6 monthly injection (SC)
initial injection-> rpt injection after 3 months then every 6 months
152
When to prescribe inclisiran
If LDL remains high despite max tolerated statins/ezetimbe/ bempedoic acid
OR
Statins are CI/not tolerated
153
What are the two factors that must be present to be able to prescribe inclisiran
- Established CVD
- Non-HDL >2.6
154
mAX FIBRATE dose when on statins
200mg
155
fibrates best used in
Hypertriglyceridaemia or mixed dyslipidaemia
156
Fibrates ADR
Abdo pain
Pancreatitis
Sexual Dysfunction
Myopathy
Gallstones
157
Renal impairment and fibrates
Use in caution due to increased rhab risk
158
When switching from ace inhibitors to entrestro how long to leave from the last ace inhibitor dose
36 hours
159
Lercanidipine renal cut off
30
160
What electrolyte do thiazide disturb
Hypokalaemia
Hyponatraemia
Hypercalcaemia
Hypomagneasemia
161
Which thiazide is preferred in management of HTN
Indapamide
162
What level of potassium are you unable to add on spironolactone due to hyperkalemia
CI if 4.5 and above
163
Alpha blocker side effects
Postural hypotension
Headaches
Dizziness
Nasal congestion
Sexual dysfunction
164
Alpha blocker interaction
Enhanced hypotensive effect when given with PDE5 inhibitors such as sildenafil
165
Can you stop beta blockers abruptly
No due to risk of rebound- withdraw over 7-14 days
166
When would you use rate limiting CCB
Rate control AF
Stable angina
Hypertension
Cluster headache prophylaxis
Chronic anal fissures
167
Rate limiting CCB x BB
Risk of heart block and hypotension
168
How long can you use a rate limiting CCB for chronic anal fissure
2% twice daily for a maximum of 8 weeks
169
Key side effects of rate limiting CCB
Bradycardia
Lightheadiness
Overgrowth of gums (gingival)
Constipation
BLOC
170
Amiodarone x BB
Bradycardia, AV block and myocardial depression is increased with concurrent use
