Cardiovascular Flashcards by JESSICA Girgawi

What is the treatment for paroxysmal supraventricular tachycardia?

First line: Reflex vagal nerve stimulation e.g. Valsalva manoeuvre
Second line: IV adenosine
Third line: IV verapamil

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What is adenosine CI in ?

Asthma and COPD

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What is the first line maintenance drug treatment for arrhythmia rate control?

Rate control

beta blockers except sotalol
Rate limiting CCB
Digoxin

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What is the second line maintenance drug treatment for arrhythmia rhythm control?

beta blockers

2. oral anti-arrhythmic drugs

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What are Class I anti-arrhythmic and what is their MOA?

Sodium channel blockers

Disopyramide
Lidocaine
Flecainide acetate
Propafenone hydrochloride

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What are Class II anti-arrhythmic and what is their MOA?

Beta blockers
Propranolol 
Metoprolol 
Atenolol 
Timolol

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What are Class III anti-arrhythmic and what is their MOA?

Potassium channel blockers

Sotalol
Dronedarone
Amiodarone

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What is amiodarone MOA?

Potassium channel blockers but also blocks beta receptors, sodium and calcium channels

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What is the recommended dose of amiodarone?

200mg TDS for 1/52, then 200mg BD for 1/52 then a maintenance dose of 200mg OD

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How many days is amiodarone half life?

50 days

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What are the monitoring requirements of amiodarone?

Thyroid function before and every 6 months
Annual eye test
Liver function before and every six month
Potassium - as can result in hypokalaemia

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What action is taken if a patient has hypothyroidism due to amiodarone?

Treat with levothyroxine without withdrawing amiodarone

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What action is taken if a patient has hyperthyroidism due to amiodarone?

Withdraw amiodarone and give carbimazole

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What are the warning signs of amiodarone?

sSigns and symptoms of hypo/hyper thyroidism
Impaired vision i.e. optic neuritis/optic neuropathy
Photophobia / dazzled by headlights
Progressive SOB/ Cough
Neurological effects such as tremor, peripheral neuropathy
Phototoxic skin reactions
Slate grey skin discoloration
Bradycardia
Taste disturbance
Nausea/ Vomiting

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When is it recommended for amiodarone to be withdrawn?

Hepatotoxicity i.e. jaundice
Peripheral neuropathy
Pulmonary toxicity

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What are the signs of hepatotoxicity?

Jaundice 
Nausea
Vomiting
Malaise 
Itching 
Burning 
Abdominal pain
Decreased liver function

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What are the signs of pulmonary toxicity?

New or progressive SOB or dry cough

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What are the signs of peripheral neuropathy?

Numbness
Tingling hands and feet
Tremors

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What juice does amiodarone interact with and what does it result in?

Grape fruit juice (enzyme inhibitor) and it results in increased plasma amiodarone concentration

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What is the treatment dose for AF with digoxin and what is the maintenance dose?

Treatment is 0.75mg to 1.5mg

Maintenance is 125-250mcg

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What is the maintenance dose of digoxin in HF?

62.5-125mcg

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What class is digoxin?

Cardiac glycoside

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What is digoxin therapeutic target?

1-2mcg/L measured after 6 hours of taking first dose

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What are the monitoring requirements of digoxin?

Potassium
Liver and kidney function
Heart rate
Plasma concentration

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What are the warning signs of digoxin?

- Blurred/yellow vision - Cardiac e.g. arrhythmia / heart block - neurological - GI- anorexia, nausea, vomiting, diarrhoea, abdominal pain - Hyperkalaemia

What is unfractionated heparin "standard heparin" MOA?

Activates anti-thrombin

What is LMWH MOA and what does it include?

Tinzeparin, enoxaprin, dalteparin | inactivates factor Xa

What are the benefits of standard heparin?

good in renal impairment and high risk of bleeding as its easily reversible

What is used to reverse heparin?

Protamine

What are the benefits of LWMH?

Pregnancy and osteoporosis

What are the colours of warfarin tablets?

0.5 mg- white 1mg- brown 3mg - blue 5mg- pink

What is the MOA of warfarin?

Antagonises vitamin K

What is the duration of treatment and conditions with warfarin?

Isolated calf DVT- 6 weeks Provoked DVT- 3months Unprovoked DVT- 3months to long term

What are the target INR?

2. 5 for VTE, AF, MI, cardioversion, bio-prosthetic mitral valve 3. 5- recurrent VTE 3. 0- mechanical valve Can vary -/+0.5

What is the target BP for over 80 and under 80 with no further complications?

over 80- <150/90 | under 80- <140/90

What is the target BP for under 80 with further complications?

<130/80

What is the target BP during pregnancy?

150/100 chronic hypertension | <140/90 for chronic hypertension with organ damage or giving birth

What are the treatment for gestational hypertension? and what is first line

Labetalol- first time Methyldopa stopped after 2 days of birth MR nifedipine - unlicensed use

What are the side effects of ACE inhibitors?

- persistent dry cough - hyperkalaemia so also hypoglycaemia - nephrotoxic so avoid the DAMN drugs - diuretics, ACE, ARB, metformin, NSAIDs - cholestatic jaundice, hepatic failure - avoid in pregnancy

Which beta blockers have intrinsic sympathomimetic activity and less cold extremities / less bradycardia SE?

ice PACO Pindolol Acebutolol Celiprolol Oxprenolol

Which beta blockers don't cross the BBB and has less sleep disturbance and nightmares SE?

water CANS Celiprolol Atenolol Nadolol Sotalol

Which beta blockers have cardio-selective properties therefore cause less bronchospasm?

Be A MAN ``` Bisoprolol Atenolol Metoprolol Acebutolol Nebivolol ```

Which beta blockers have a long duration of action therefore are taken once daily?

BACoN Bisoprolol Atenolol Celiprolol Nadolol

What are dihydropyridine calcium channel blockers? and what do they include?

- amlodipine - felodipine - lacidipine - lercanidipine - nifedipine - maintain on same MR Brand they have vasodilating effects

What are dihydropyridine calcium channel blockers side effects?

Ankle swelling flushing headaches

What are Amlodipine and nifedipine CI in?

unstable angina

What are rate limiting calcium channel blockers? and what do they include?

More selective for the heart; lowers HR and force contraction - Verapamil - Diltiazem maintain on same brand when dose over 60mg

What are rate-limiting CCB CI in?

heart failure

What is a BNP test and what does it indicate?

A BNP test is a blood test that measured the level of BNP protein. When BNP levels are high it means you have heart failure

What is first line treatment for heart failure?

ACEi/ARB + B blocker ARB- candesartan/valsartan mild-mod stable HF/70+= nebivolol All grades of LVSD= Bisoprolol/Carvedilol

What is second line treatment for heart failure?

Spironolactone/ eplerenone after acute MI with LVSD or mild HF

What are the alternative second line treatment for HF?

Hydralazine+ Isosorbide dinitrate (esp. in African/ Caribbean) ARB (on top of ACE) Entresto

What is third line treatment for heart failure?

Ivabradine (added if patient in sinus rhythm/ HR >75bpm) or Digoxin in worsening or severe HF

Pregnancy and statins

Statins are teratogenic | use effective contraception during and 1 month after stopping

How long before conceiving do you stop statins and when do you restart them?

3 month before conceiving and restart after finishing breast feeding

What is the max dose of statin with fibrates?

10mg

what is the max dose of statin with amiodarone, amlodipine, diltiazem, and verapamil?

20mg

What is the max dose of atorvastatin with ciclosporin?

10mg

What is the max dose of Rosuvastatin with clopidogrel?

20mg

What is GTN converted into and what does it do?

GTN is converted into nitric oxide and its a vasodilator

How long does the effects of GTN last?

20-30minutes

What is the dose instructions for GTN? and what is the dose equivalence for tablets and spray?

1 dose = 1 tablets or 1-2 sprays Maximum of 3 doses with 5 minutes interval between each After the third dose if the symptoms are not relieved call 999

What is the first line treatment for long term prophylaxis of stable angina?

Beta blocker or CCB

What is the second line treatment for long term prophylaxis of stable angina?

Beta blocker + CCB

What can be used for the prophylaxis of stable angina if beta blockers or CCB are CI?

Vasodilators such as isosorbide mononitrate Ivabradine Nicorandil

What actions are taken if tolerance is suspected

1. leave patches off for 8-12 hours overnight | 2. take second dose after 8 hours not 12 hours for the isosorbide mononitrate/dinitrate

What are the side effects of nitrates?

- flushing of the face - throbbing headache - dizziness - postural hypotension

What is the long-term management plan for STEMi/ NSTEMi?

1. statin 2. treat blood pressure i.e ACE/ARB.... 3. Aspirin + Clopidogrel for short term use 4. beta blockers

What is used to access stroke risk?

CHA₂DS₂-VASc

What is is used to access bleeding risk?

HASBLED

Which diuretic is to be avoided with gout?

furosemide

which diuretic causes musculoskeletal pain?

Torasemide

What the onset of action and duration of action of loops? and how many times can they be taken a day?

they can be taken BD with last one at 4pm onset of action is 1 hr duration of action is 6 hrs

What are the side effects of loop diuretics ?

- ototoxicity at high doses - Acute urinary retention= too rapid diuresis - Hyperglycaemia - hyperuricaemia - Hypo K+, Na+, Cl-, Mg2+, Ca2+

Which thiazide like diuretic is used in severe renal impairment?

Metolazone

Which thiazide like diuretic is less aggravating to diabetes and is used for hypertension and HF?

Indapamide

What the onset of action and duration of action of thiazide?

1-2hr onset of action | 12-24 hr duration of action

What is the dose of Bendroflumethiazide for HF and hypertension?

``` HF= 5mg OM Hypertension= 2.5mg OM ```

What are the SE of spironolactone?

- Gynaecomastia - hypertrichosis - Change in libido - Hyperkalaemia, Hyperuricemia, Hyponatraemia

What includes osmotic diuretics and what is it used for ?

Mannitol and cerebral oedema

Cardiovascular Flashcards

(80 cards)