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Pre reg pharmacy > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

What is atrial fibrillation

A

Blood doesn’t fully eject may cause clot
Leads to complication (stroke)

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2
Q

Management of acute atrial fibrillation in LIFE THREATENING haemodynamic instability cased by AF

A

Emergency electrical cardio version without delaying to achieve anticoagulation

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3
Q

Management of Acute atrial fibrillation in NON life threatening haemodynamic instability (2)

A

Onset of AF <48hrs - Rate OR rhythm control
Onset of AF >48hrs - Rate control only

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4
Q

Electrical cardio version (rhythm control)

A

Start IV anticoagulation + rule out left atrial thrombus
Pt fully anticoagulation for 3 weeks - oral continue for 4 weeks after cardioversion

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5
Q

Pharmaceutical cardio version (rhythm control)

A

Flecainide
Amiodarone

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6
Q

Maintenance treatment of AF (3)

A
  1. Rate control - monotherapy
  2. Rate control dual therapy
  3. Rhythm control
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7
Q

AF maintenance Rate control monotherapy (3)

A

Standard beta blocker NOT sotalol OR

Rate limiting CCD (Diltiazem / verapamil) OR

Digoxin (predominantly sedentary pts with non-paroxysmal AF)

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8
Q

AF maintenance Rate control dual therapy

A

Beta blocker AND rate limiting CCB

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9
Q

AF maintenance therapy Rhythm control post cardioversion

A

Standard beta blocker

Sotalol, propaferone, amiodarone, flecanide (SPAF) - amiodarone can be started 4 weeks before and continue up to 12 months after electrical to increase success

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10
Q

Treatment of paroxysmal AF

A
  1. Ventricular rhythm control - standard beta blocker
  2. Symptoms persist/ standard beta blocker inappropriate - SPAF
  3. Symptomatic episodes - Sinus rhythm restored by Pill in Pocket - fleicanide/ propaferone PRN
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11
Q

CHA2 DS2- VASc risk assessment

A

Congestive heart failure
Hypertension
Age - 75+
Diabetes
Stroke/TIA
Vascular disease
Age - 65-74
Sex - female

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12
Q

Thrombolytics in stroke risk

A

Warfarin
NOACs in non valvular AF

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13
Q

Aims of treatment in Atrial flutter

A

To treat rhythm/rate control

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14
Q

Rate control in atrial fibrillation

A

Temporary until sinus rhythm restored
Beta blocker/ RL-CCB

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15
Q

Rhythm control in Atrial flutter (3)

A

Direct current cardioversion - when rapid control needed (haemodynamic compromise)

Pharmaceutical cardioversion

Catheter ablation - recurrent Atrial flutter

Flutter longer than 48hrs - anticoagulated for 3 weeks

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16
Q

Treatment paroxysmal supraventricular tachycardia

A
  1. Terminate spontaneously alone
  2. Reflex Vaal stimulation
  3. IV adenosine
  4. IV verapamil
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17
Q

Reflex canal stimulation in paroxysmal supraventricular tachycardia

A

Valsalva manouvre/ immerse face in ice water/ carotid sinus massage - performed under ECG monitoring

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18
Q

Treatment of recurrent episodes of paroxysmal supraventricular tachycardia

A

Catheter ablation
Prevent future episodes with beta blocker / RL CCB

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19
Q

Treatment of pulse ventricular tachycardia / ventricular fibrillation

A

Resuscitation

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20
Q

Treatment of unstable sustained ventricular tachycardia

A

Direct current cardioversion - IV amiodarone

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21
Q

Treatment of stable ventricular tachycardia

A

IV amiodarone - direct current cardioversion
Non sustained ventricular tachycardia - beta blocker

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22
Q

Treatment of patients at high risk of cardiac arrest in ventricular tachycardia

A

Implantable cardioverter defibrillator
Can add beta blockers/ amiodarone (in combo with standard beta blocker)

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23
Q

Cause of QT prolongation ( Torsade de pointes)

A

Drug induced - amiodarone, sotalol, macrolides, haloperidol, SSRI, TCA, Antifungal

Hypokalaemia

Servers Bradycardia

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24
Q

Treatment of QT prolongation

A

IV magnesium sulphate
Beta blocker (not sotalol) + atrial/ventricular pacing may be considered

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25
Q

Affects of antiarrhythmias on QT prolongation

A

Prolong QT interval - worsen condition

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26
Q

Classifications of antiarrhythmic drugs (2)

A

Action - supraventricular, ventricular, both
Electrical behaviours

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27
Q

Class 1 antiarrhythmics

A

Membrane stabilising drugs (lidocaine/flecainide)

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28
Q

Class 2 antiarrhythmic drugs

A

Beta blockers

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29
Q

Class 3 antiarrhythmic drugs

A

Amiodarone/ sotolol

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30
Q

Class 4 antiarrhythmic drugs

A

CCB - verapamil / diltiazem (NOT pines)

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31
Q

Amiodarone loading dose

A

200mg TDS for 7 days
200mg BD for 7 days
200mg OD maintenance

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32
Q

When to avoid amiodarone

A

Bradycardia
Heart block

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33
Q

Amiodarone side effects (6)

A

Corneal micro deposits - reversible when treatment ends (vision impaired - STOP)

Thyroid disorders - hypo/hyper due to iodine content

Photosensitivity - Avoid sunlight, use sun cream for months after treatment

Hepatotoxicity - Stop if signs of liver disease

Pulmonary toxicity - Report cases of new/progressive SOB/cough

Driving / skilled tasks impaired

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34
Q

Amiodarone interactions - potential for 7weeks-months (long half life)

A

Drugs that cause hypokalaemia
Drugs that cause QT prolongation
CYP450 enzyme substrates - inhibitors and inducers
Drugs that cause bradycardia

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35
Q

Amiodarone monitoring (6)

A

Thyroid function test - before, then every 6 months
Liver function test - before then every 6 months
Serum potassium - before treatment
Chest X-ray - before treatment
Annual eye exam
ECG + Liver transaminase - IV Use

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36
Q

Digoxin loading dose

A

125-250mcg OD

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37
Q

Therapeutic range of digoxin

A

0.7ng/ml-2.0ng/ml

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38
Q

Digoxin toxicity risk levels

A

1.5ng/ml-3.0ng/ml

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39
Q

Treatment of digoxin toxicity

A

Digoxin specific antibody

40
Q

Digoxin monitoring (2)

A

Bloods 6-12 hours after dose
Monitor serum electrolyte and renal function

41
Q

Signs of digoxin toxicity (4)

A

SA/AV block + bradycardia
Diarrhoea + vomiting
Dizziness, confusion, depression
Blurred vision/yellow vision

42
Q

Digoxin interactions

A

Beta blocker - increased risk of AV block + increase plasma conc
TCA - can induce arrhythmia
Drugs that cause hypokalaemia - increase risk of toxicity
CYP450 inducers - reduce plasma conc
CYP450 inhibitors - increase plasma conc

43
Q

Indications of tranexemic acid

A

Surgeries
Dental Extraction
Menorrhagia

44
Q

Tranexemic acid side effects

A

GI - nausea and vomiting

45
Q

Desmopressin indications

A

Mild-moderate haemophilia
Von willebrands disease

46
Q

Drugs for secondary prevention of heart failure

A

Dual platelet therapy - life long aspirin / 12 month clopidogrel/ prasugrel/ ticagrelor

ACEI/ ARB

Beta blocker - may be disco after 12 months in LVEF

Statin - high strength (Atorvastatin 80mg)

47
Q

Symptoms of heart failure (5)

A

SOB
persistent cough/wheeze
Ankle swelling
Reduced exercise tolerance
Fatigue

48
Q

Treatment of chronic heart failure (6)

A

FIRST line - ACEI + beta blocker
SECOND line - ARB if ACEI intolerated, Hydralazine +nitrate if both contraindicated

  1. Symptoms persist - ADD aldosterone antagonist (spironolactone/eplerenone)
  2. Symptoms persist - ADD amiodarone, Digoxin, Enteresto, Ivabradine, Dapagliflozin
  3. Digoxin - sinus rhythm in worsening /severe AF 63.5-125mcg loading dose
  4. Loop diuretics - relieve breathlessness + oedema in fluid retention
49
Q

Healthy Cholesterol levels (5)

A

Total - 5 or less
HDL (good) - 1 +
LDL (bad) - 3 or less
Non-HDL (bad) - 4 or less
Triglycerides - 2.3 or less

50
Q

Indications for lipid lowering agents

A

<85yrs with QRISK >10%

Type 2 diabetes QRISK >10%

Type 1 diabetes - 40+, >10yrs diabetic, established neuropathy

Chronic CKD

Familial hypercholesteralaemia

51
Q

Statins to take at any time

A

Atorvastatin
Rosuvastatin

52
Q

Strongest statin

A

Atorvastatin 80 mg (secondary prevention)

53
Q

Statin monitoring before initiation

A

Full lipid profile
Thyroid function - hypothyroidism managed before starting
Renal function
Liver enzymes

54
Q

Continued monitoring in statin treatment

A

Liver enzymes - 3 months , 12 months ( disco if transaminase raised >3 upper limit)
Creatinine kinase - if previous persistent muscle cramps

55
Q

Statin side effects

A

Myopathy + Rhabdomyolysis - Muscle toxicity - seek medical advice if tenderness/pain/weakness

Interstitial lung disease - med attention if dyspnoea, cough, weigh loss

Teratogenic - Avoid in pregnancy - disco 3 months before conceiving

56
Q

Statin interactions

A

CYP450 Inducers - reduce statin conc
CYP450 inhibitors - increase statin conc (increase risk of rhabdomyolysis ) - macrolides - stop statin , avoid grapefruit
Oral fucidic acid - stop treatment - restart 7 days after treatment

57
Q

Statin max doses in combination

A

Amiodarone - MAX 20mg Simvastatin
Amlodipine - MAX 20mg Simvastatin
Diltiazem/verapamil - MAX 20mg Simvastatin
Ticragreor - MAX 40mg Simvastatin
Cyclosporin - MAX 10mg Atorvastatin
Tipranavir - MAX 10mg Atorvastatin

58
Q

Other lipid lowering agents

A

Ezetimibe
Fibrates

59
Q

Stage 1 hypertension classification

A

140/90mmHg - 159/99mmHg (clinic)
135/85 mmHg - 149/94 mmHg (ambulatory)

60
Q

Stage 2 hypertension classification

A

160/100mmHg - 180/120mmHg (clinic)
>150/95mmHg (ambulatory

61
Q

Stage 3 Hypertension classification

A

180/1200mmHg

62
Q

Stage 1 hypertension treatment criteria

A

Drug Treatment - <80yrs with kidney disease, diabetes, CVD/10%risk. >80yrs BP>150/90 mmHg

Drug + Lifestyle treatment - <60yrs with 10% QRISK

63
Q

Hypertension Treatment Stage 1

A

<55yrs + T2 diabetic - ACEI/ ARB (T2 +Afro)
>55/afro - CCB

64
Q

Hypertension stage 2 treatment

A

<55yrs/ T2 diabetic - ACEI/ARB + CCB or TLD
>55yrs/Afro - CCB + ACEI/ARB/TLD

65
Q

Hypertension step 3 treatment

A

ACEI/ARB + CCB + TLD

66
Q

Hypertension Step 4 treatment (based on potasssium)

A

<4.5mmol/L - low dose spironolactone
>4.5mmol/L - alpha/beta blocker

67
Q

Side effects of ACEI (CHHARD)

A

Cough (arb instead)
Hyperkalaemia
Hepatic failure
Angioedema
Renal impairment
Dizziness + headaches

68
Q

ACEI interactions (4)

A

Increase risk of renal failure - arb, k-sparing diuretics, nsaids

Increase hyperkalaemia - heparins, arbs, nsaids, ksparing diuretics, beta blockers

Volume depletion - diuretics

Increase plasma levels of lithium

69
Q

ARB side effects - same as ACEI except cough and angioedema (HHRD)

A

Hepatic failure
Hyperkalaemia
Renal impairment
Dizziness and headaches

70
Q

Cardio selective beta blockers (BAMAN)

A

Bisoprolol
Atenolol
Metoprolol
Acebutolol
Nebivolol

71
Q

Action of water soluble beta blockers (2)

A

Less likely to cross BBB
Less likely to cause nightmares

72
Q

Water soluble beta blockers (water CANS)

A

Celiprolol
Atenolol
Nadalol
Sotalol

73
Q

Intrinic sympathomimetic beta blockers (ice PACO)

A

Pindolol
Acebutolol
Celiprolol
Oxprenolol

74
Q

Side effects of beta blockers (4)

A

Bradycardia/heart failure
Blunt effects of hypoglycaemia
Can cause hyperglycaemia
Bronchospasms - contraindicated in asthmatics

75
Q

Beta blocker interactions

A

Digoxin - heart block
Other hypotensives

76
Q

Dihydropyridine CCBs (5)

A

Amlodipine
Felodipine
Lacidipine
Lercanidipine
Nifedipine

77
Q

Rate limiting CCBs (2)

A

Diltiazem
Verapamil

78
Q

CCB side effects (4)

A

Dizziness
Gingival hyperplasia
Vasodilatory effects - flushing, headache, ankle swelling (more in pines)
Complete atrioventricular block (more in RLCCB)

79
Q

Hypertension in pregnancy (BP> 140/90mmg) treatment

A

FIRST line - labetolol
Second line - nifedipine/ Methyldopa

80
Q

<80yrs old hypertension targets

A

140/90mmHg clinical
135/85mmHg ambulatory

81
Q

> 80yrs hypertension targets

A

150/90mmHg clinical
145/85mmHg ambulatory

82
Q

Hypertension target in renal disease

A

140/90mmHg

83
Q

Hypertension target in pregnancy

A

135/85mmHg

84
Q

Hypertension target in Type 1 diabetes

A

135/85mmHg

85
Q

Definition of Stable Angina

A

Predictable chest pain/ pressure due to physical/ emotional exertion

86
Q

Initial treatment of stable angina

A

GTN - prophylactic/when symptoms arise
- take at 5 min intervals - call 999 5 mins after 2nd dose not working

87
Q

Long term prevention of stable angina (4)

A

FIRST - Beta blocker (RL CCB if BB contraindicated)
SECOND - Beta blocker + CCB (Amlodipine / Lacidipine)
THIRD - long acting nitrate (Nicorandil, Ivabradine, Ranolazine)
*implement healthy lifestyle measures + 75mg aspirin + low dose statin

88
Q

GTN sublingual tablet storage requirements

A

Discard 8 weeks after opening

89
Q

Nitrate tolerance (3)

A

Should have nitrate free period to prevent tolerance
Second dose should be given 8hrs after first dose instead of 12
Transdermal patch should be left off for 8-12hrs/day

90
Q

Nitrate side effects (3)

A

Dizziness
Flushing
Headaches

91
Q

Risk factors for acute coronary syndrome (5)

A

Family history
Hypertension
Hypercholesterolaemia
Diabetes
Smoking

92
Q

Initial management of confirmed ACS (3)

A

Loading dose aspirin 300mg
Pain relief - GTN +/- IV morphine
Oxygen if needed

93
Q

Partial blockage of artery only

A

Unstable angina

94
Q

Partial blockage of artery AND ST zone of ECG NOT elevated

A

NSTEMI

95
Q

Complete blockage or artery AND ST zone elevated`

A

STEMI

96
Q

When to deliver percutaneous coronary intervention

A

Within 2 hours in STEMI
- heparin if PCI through radial access
- prasugel long term management
Secondary prevention in NSTEMI to prevent future MI

97
Q

Secondary prevention of ACS

A

Dual anti platelet - Lifelong Aspirin, 12 months clopidgrel, prasugrel, ticragrelor

ACEI - ARB if contraindicated

Beta blocker - disco after 12 months in LVEF + without LVEF

Statin - high strength

Pre reg pharmacy (4 decks)

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