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27 June 2021 > Cardiovascular > Flashcards

Cardiovascular Flashcards

(69 cards)

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1
Q

does digoxin have a long or short half life?

A

long

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2
Q

why is mr A taking digoxin BD

A

reduce nausea

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3
Q

what is dose based on

A

renal

ventricular rate at rest

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4
Q

can you switch between digoxin tablets to elixir or iv?

A

Need calculation. different bioavailabilities

tablet NOT oral solution NOT iv

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5
Q

what monitoring are needed for digoxin?

A

digoxin levels
renal
UE

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6
Q

what type of drugs interact with digoxin?

A

CYP inducers: rifampicin, SJW
CYP inhibitors: Mycins, amiodarone (HALF digoxin dose), DIVA
reduce renal excretion: ACE, ARB, NSAIDS
reduce K: thiazides, loops, theophylline, steroids

(always give spironolactone with digoxin, k sparing)

CRASED:
CCB: DIVA
Rifampicin
Amiodarone
SJW
Erythromycin
Diuretics
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7
Q

In what situations are unfractionated heparin preferred over LMWH?

A

renal

act quick

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8
Q

Why is LMWH prefered over heparin in pregnancy?

A

Lower risk of osteoporosis

lower risk of heparin induced thrombocytopenia

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9
Q

Do you use vitamin k to reverse LMWH?

A

NO. use PROTAMINE, LMWH are pros

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10
Q 
What medicines do you give a patient after stroke?
Aspirin
apixaban
dabigatran
clopidogrel
warfarin
enoxaparin
A

Aspirin 300mg initially (24h if TIA, 14 days if ischaemic)
then aspirin 75mg od

anticoagulants are not given for stroke unless have AF

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11
Q

Which medication has a MHRA warning for calciphylaxis?

A

Warfarin

In war there’s no calcium, and they’re under the sun and get a painful rash.

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12
Q

Which OTC product to be careful with in warfarin use?

A

Daktarin, miconazole oral gel causes bleeding:
nose bleeds, bruising, blood in urine

Refer. Do not sell.

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13
Q

What food to be cautious with warfarin?

A

GFW, Pomegranate, increase INR. longer to clot
alcohol (decrease warfarin affect)
green leafy

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14
Q

why not warfarin in preg?

A

teratogenic
k deficiency increase risk of haemorrhage
(crosses placenta)

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15
Q 
What is the likely treatmet duration of anticoagulant after a DVT in the calf?
14 days
3 months
1 year
5 years
life-long
A

anticoagulant treatment:

at least 3 months:
proximal DVT/PE, provoked by preg or OC, unprovoked
at least 6 months:
above with active cancer

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16
Q

which combination has a higher risk of bleeding? warfarin with:
aspirin
clopidogrel

A

warfarin and clopidogrel higher risk than
warfarin and aspirin.

make dual or triple therapy short.
or without antiplatlet until warfarin course finish

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17
Q

is heparin faster or LMWH faster in action?

A

HEPA HEPA SPEEDY HEPA. heparin fast. bd-tid

Loooow is sloooow. LMWH od.

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18
Q

does MR or immediate dipyridamole need to be dispensed in the original container?

A

MR: original pack with desiccant

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19
Q

MR dipyridamole, discard capsules after how long?

A

6 weeks

GTN tablets 8 weeks

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20
Q 
which oral coagulant does NOT have an ANTIDOTE?
Apixaban
Rivaroxaban
Edoxaban
Dabigatran
A

Edoxaban

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21
Q

which strength rivaroxaban need to be taken with food?

A

15mg and 20mg

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22
Q

What’s the antidote for rivaroxaban od(or bd) and apixaban BD?

A

andexanet alfa (Ondexxya)

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23
Q

What’s the antidote for dabigatran bd?

A

idarucizumab (praxbind)

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24
Q

What’s the difference between CVD and CHD?

A

CVD is the umbrella term for:

CHD (Angina, MI, HF), stroke, peripheral arterial disease, aortic disease

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25
What's the difference between QRISK and JBS3?
QRISK is risk of CVD in next 10 years JBS3 is lifetime (stroke, TIA, MI etc)
26
Who are the HIGH risk patients that you would not use QRISK3 CALCULATor for? (bcos it underestimates the risk)
``` familial hypercholesterolaemia Diabetes 1 CKD established CVD >85yo >10% QRISK ```
27
Who needs primary prevention of CVS (atorvastatin 20mg)?
``` >85yo diabetes 1 (consider) diabetes 1, defo offer if -ckd -diabetes for 10years -over 40yo CKD Familial hypercholesterolaemia ```
28
who to give secondary prevention of CVS (atorvastatin 80mg)
established cardiovascular disease (for example past or current history of myocardial infarction, angina, stroke, transient ischaemic attack, or peripheral arterial disease).
29
Apixaban, rivaroxaban, edoxaban are factor Xa inhibitors. | what is dabigatran?
DabagaTRan is a | THROmbin inhibitor
30
What are the QRISK3 factors?
age, ethnicity, postcode ``` smoke, diabetes, RA angina, MI fam hx, AF SLE systemic lupus eryth MIGRAINE, mental steroids BP, cholesterol, BMI erectile dysfunction ```
31
If atorvastatin is used to prevent primary and secondary CVD like MI or stroke, what is ASPIRIN, CLOPIDOG, DIPYRIDAMOLE used to prevent?
used together with statin for secondary prevention of CVD ``` secondary stroke (post stroke long-term treatment) second DVT/PE ```
32
Rachel has high lipds. What are some medical conditions that can lower her lipds if controlled?
hypothyroidism diabetes liver, kidney disease smoking, obesity ``` drugs that cause high lipid: antipsychotic immunosuppressant antiretrovirals corticosteroids ``` other: familial cholesterol
33
which statins are high intensity?
atorvastatin 20,40,80mg rosuvastatin 10,20,40mg simvastatin 10mg atorvastatin + ezetimibe
34
What are 2 side effects of statins that need referral?
1) myopathy | 2) lung: dyspnoea sob, cough, weight loss
35
If patient on statin develops myopathy and myopathy is resolved, CK is returned to normal, what should you do? a) never reintroduce statin again, give ezetimibe b) never reintroduce statin again, give benafibrate c) reintroduce statin at a lower dose
reintroduced at a lower dose and the patient monitored closely
36
What monitoring needs to be assessed before starting a statin?
full lipid profile: total, HDL, LDL, TG thyroid liver, kidneys ``` creatine kinase (if pain) HbA1C (if diabetes) ```
37
how bad would the LFT be to discontinue or not start STATIN?
transaminases x3 upper limit | exclude or stop
38
If patient has muscle pain, how high would a creatine kinase be to not initiate STATIN?
CK 5 times higher, retest in 7 days, still 5 times higher don't start STATIN
39
What ongoing monitoring tests are compulsory for STATIN?
LFT: before, after 3 months, then annual | HbA1C if diabetic
40
``` what's the upper limit for these cholesterols? total cholesterol TG NON-HDL LDL HDL ```
``` total cholesterol 5 or below (6 is hyperlipidaemia) high risk total cholesterol 4 or below LDL 3 or below (Normal ppl) LDL 2 or below (for high risk pt) TG < 2 HDL 1 or above ```
41
When do you use fibrates?
1) statin not working | 2) want to reduce TG more than LDL (better than statin at reducing TriG)
42
examples of 2 add-ons to statin
ezetimibe (if statin not work) | fenofibrate (if TG high)
43
what is nicotinic acid indicated for: a) familial hypercholesterolaemia b) primary CVS prevent c) secondary CVS prevent d) high cholesterol and high TriG
to lower TG and LDL
44
can gemfibrozil be used with statin?
NO. rhabdomyolysis
45
can nicotinic acid be used with statin?
caution: increased risk of rhabdomyolysis
46
can fenofibrate be used with statin?
Yes, if TG is high. Fibrates good at TRIs. | but increase risk rhabdomyolysis
47
What's statin's mechanism of action?
inhibits HMG CoA enzyme involved in cholesterol synthesis, especially in the liver
48
Jobie is on STATIN and she is planning to have a second child. What advice would you give?
STOP statin 3 months before attempting to conceive. (However, use contraception for 1 months after stopping) STOP statin, continue contraception for 1 month, but do not attempt to conceive for 3 months.
49
Can jobie breastfeed on statin?
avoid
50
Which classes of drugs are used for HF?
``` ABCD acei/arb BB CCB- but ONLY amlodipine (others contra in HF) Diuretics- spironolactone/epleronone ``` fursomide- loop, and thiazides are STRONG. only if patient has pulmonary oedema/fluid overload if all fails, digoxin, hydralazine, ivabradine, nitrates flu and pneumococcal vaccine
51
What are the drugs for HF treatment?
BAND AIDS BB (bisoprolol, carvedi, nebivolol) ACEI Nitrate/ Diuretics- spiro Amiodarone Ivabradine Digoxin Sacubutril varsartil
52
What are the drug treatments for MI? (acroynum)
Americans have a heart attack when they C OSAMA BIN Clopidogrel ``` Oxygen Statin (stemi) ACEI (Stemi) Metoclopramide Aspirin ``` BB IV heparin,morphine, diamorphine Nitrate
53
What are the steps of initial treatment of NSTEMI?
OXYGEN sub,bc GTN/ IV diTN IV diamorphine/morphine IV metoclopramide dual aspirin 300, clopi (prasugrel, ticagrelor) unfr Heparin/LMWH/Fondaparinux BB/ DIVA
54
lady's heart rate is getting low and would like a BB that does not slow the heart as much. Which one is best for her?
less COLD extremities and less SLOW HR COld PINACE Celiprolol Oxyprenolol PINdolol ACEbutolol
55
LONG acting BB, only needs OD?
``` She's BUSY AT the Celi with NADs all day Bisoprolol Atenolol Celiprolol Nadolol ```
56
which BB are preferable for an asthmatic?
cardioselective BB: MAN BABE Metoprolol Atenolol Nebivolol Bisoprolol Acebutolol Bextolol Esmolol
57
which BB are preferable for diabetics?
BB cause BOTH hyper and hypoglycaemia (autonomic and metabolic) cardioselective BB: MAN BABE Metoprolol Atenolol Nebivolol Bisoprolol Acebutolol Bextolol Esmolol
58
which BB to give for migraine?
propranolol | Mandy has anxiety, migraine, thyrotoxicosis
59
which BB to give for thyrotoxicosis?
propranolol | Mandy has anxiety, migraine, thyrotoxicosis
60
what is the most common side effect of verapamil?
constipation
61
does diltiazem need to be prescribed by brand?
Only for MR diltiazem over 60mg
62
What is the mechanism of action of thiazide diuretics?
inhibit Na reabsorption in the distal convulated tubule
63
onset of action for thiazide? | Duration of action?
onset 1 -2 hours | duration 12-24 hours
64
Name a very long acting diuretic
chlortalidone can be taken on alternate days
65
Contraindications of thiazides?
Low Na, Low K, = Addisons's high Ca thiazides inhibit reabsorption of Na, K also leaves with it
66
SE of furosemide if renal not good?
Rhema hula hoop with tinnitus/deafness LOOPS in renal: tinnitus/deaf
67
name a tablet and a diuretic type eye drop used of glaucoma
diuretics for Glaucoma acetazolamide tablets DORZOLAMIDE BRINZOLAMIDE inhibit aq humour synthesis
68
What's the lower limit of GFR for ACEI?
<60ml/min
69
aliskiren (for HTN) CONTRA with?
diabetes | ACEI ARB if GFR <60ml/min

27 June 2021 (3 decks)

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