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Pre reg pharmacy > Cardiovascular > Flashcards

Cardiovascular Flashcards

(97 cards)

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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
Affects of antiarrhythmias on QT prolongation
Prolong QT interval - worsen condition
26
Classifications of antiarrhythmic drugs (2)
Action - supraventricular, ventricular, both Electrical behaviours
27
Class 1 antiarrhythmics
Membrane stabilising drugs (lidocaine/flecainide)
28
Class 2 antiarrhythmic drugs
Beta blockers
29
Class 3 antiarrhythmic drugs
Amiodarone/ sotolol
30
Class 4 antiarrhythmic drugs
CCB - verapamil / diltiazem (NOT pines)
31
Amiodarone loading dose
200mg TDS for 7 days 200mg BD for 7 days 200mg OD maintenance
32
When to avoid amiodarone
Bradycardia Heart block
33
Amiodarone side effects (6)
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
34
Amiodarone interactions - potential for 7weeks-months (long half life)
Drugs that cause hypokalaemia Drugs that cause QT prolongation CYP450 enzyme substrates - inhibitors and inducers Drugs that cause bradycardia
35
Amiodarone monitoring (6)
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
36
Digoxin loading dose
125-250mcg OD
37
Therapeutic range of digoxin
0.7ng/ml-2.0ng/ml
38
Digoxin toxicity risk levels
1.5ng/ml-3.0ng/ml
39
Treatment of digoxin toxicity
Digoxin specific antibody
40
Digoxin monitoring (2)
Bloods 6-12 hours after dose Monitor serum electrolyte and renal function
41
Signs of digoxin toxicity (4)
SA/AV block + bradycardia Diarrhoea + vomiting Dizziness, confusion, depression Blurred vision/yellow vision
42
Digoxin interactions
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
Indications of tranexemic acid
Surgeries Dental Extraction Menorrhagia
44
Tranexemic acid side effects
GI - nausea and vomiting
45
Desmopressin indications
Mild-moderate haemophilia Von willebrands disease
46
Drugs for secondary prevention of heart failure
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
Symptoms of heart failure (5)
SOB persistent cough/wheeze Ankle swelling Reduced exercise tolerance Fatigue
48
Treatment of chronic heart failure (6)
FIRST line - ACEI + beta blocker SECOND line - ARB if ACEI intolerated, Hydralazine +nitrate if both contraindicated 2. Symptoms persist - ADD aldosterone antagonist (spironolactone/eplerenone) 3. Symptoms persist - ADD amiodarone, Digoxin, Enteresto, Ivabradine, Dapagliflozin 4. Digoxin - sinus rhythm in worsening /severe AF 63.5-125mcg loading dose 5. Loop diuretics - relieve breathlessness + oedema in fluid retention
49
Healthy Cholesterol levels (5)
Total - 5 or less HDL (good) - 1 + LDL (bad) - 3 or less Non-HDL (bad) - 4 or less Triglycerides - 2.3 or less
50
Indications for lipid lowering agents
<85yrs with QRISK >10% Type 2 diabetes QRISK >10% Type 1 diabetes - 40+, >10yrs diabetic, established neuropathy Chronic CKD Familial hypercholesteralaemia
51
Statins to take at any time
Atorvastatin Rosuvastatin
52
Strongest statin
Atorvastatin 80 mg (secondary prevention)
53
Statin monitoring before initiation
Full lipid profile Thyroid function - hypothyroidism managed before starting Renal function Liver enzymes
54
Continued monitoring in statin treatment
Liver enzymes - 3 months , 12 months ( disco if transaminase raised >3 upper limit) Creatinine kinase - if previous persistent muscle cramps
55
Statin side effects
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
Statin interactions
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
Statin max doses in combination
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
Other lipid lowering agents
Ezetimibe Fibrates
59
Stage 1 hypertension classification
140/90mmHg - 159/99mmHg (clinic) 135/85 mmHg - 149/94 mmHg (ambulatory)
60
Stage 2 hypertension classification
160/100mmHg - 180/120mmHg (clinic) >150/95mmHg (ambulatory
61
Stage 3 Hypertension classification
180/1200mmHg
62
Stage 1 hypertension treatment criteria
Drug Treatment - <80yrs with kidney disease, diabetes, CVD/10%risk. >80yrs BP>150/90 mmHg Drug + Lifestyle treatment - <60yrs with 10% QRISK
63
Hypertension Treatment Stage 1
<55yrs + T2 diabetic - ACEI/ ARB (T2 +Afro) >55/afro - CCB
64
Hypertension stage 2 treatment
<55yrs/ T2 diabetic - ACEI/ARB + CCB or TLD >55yrs/Afro - CCB + ACEI/ARB/TLD
65
Hypertension step 3 treatment
ACEI/ARB + CCB + TLD
66
Hypertension Step 4 treatment (based on potasssium)
<4.5mmol/L - low dose spironolactone >4.5mmol/L - alpha/beta blocker
67
Side effects of ACEI (CHHARD)
Cough (arb instead) Hyperkalaemia Hepatic failure Angioedema Renal impairment Dizziness + headaches
68
ACEI interactions (4)
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
ARB side effects - same as ACEI except cough and angioedema (HHRD)
Hepatic failure Hyperkalaemia Renal impairment Dizziness and headaches
70
Cardio selective beta blockers (BAMAN)
Bisoprolol Atenolol Metoprolol Acebutolol Nebivolol
71
Action of water soluble beta blockers (2)
Less likely to cross BBB Less likely to cause nightmares
72
Water soluble beta blockers (water CANS)
Celiprolol Atenolol Nadalol Sotalol
73
Intrinic sympathomimetic beta blockers (ice PACO)
Pindolol Acebutolol Celiprolol Oxprenolol
74
Side effects of beta blockers (4)
Bradycardia/heart failure Blunt effects of hypoglycaemia Can cause hyperglycaemia Bronchospasms - contraindicated in asthmatics
75
Beta blocker interactions
Digoxin - heart block Other hypotensives
76
Dihydropyridine CCBs (5)
Amlodipine Felodipine Lacidipine Lercanidipine Nifedipine
77
Rate limiting CCBs (2)
Diltiazem Verapamil
78
CCB side effects (4)
Dizziness Gingival hyperplasia Vasodilatory effects - flushing, headache, ankle swelling (more in pines) Complete atrioventricular block (more in RLCCB)
79
Hypertension in pregnancy (BP> 140/90mmg) treatment
FIRST line - labetolol Second line - nifedipine/ Methyldopa
80
<80yrs old hypertension targets
140/90mmHg clinical 135/85mmHg ambulatory
81
>80yrs hypertension targets
150/90mmHg clinical 145/85mmHg ambulatory
82
Hypertension target in renal disease
140/90mmHg
83
Hypertension target in pregnancy
135/85mmHg
84
Hypertension target in Type 1 diabetes
135/85mmHg
85
Definition of Stable Angina
Predictable chest pain/ pressure due to physical/ emotional exertion
86
Initial treatment of stable angina
GTN - prophylactic/when symptoms arise - take at 5 min intervals - call 999 5 mins after 2nd dose not working
87
Long term prevention of stable angina (4)
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
GTN sublingual tablet storage requirements
Discard 8 weeks after opening
89
Nitrate tolerance (3)
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
Nitrate side effects (3)
Dizziness Flushing Headaches
91
Risk factors for acute coronary syndrome (5)
Family history Hypertension Hypercholesterolaemia Diabetes Smoking
92
Initial management of confirmed ACS (3)
Loading dose aspirin 300mg Pain relief - GTN +/- IV morphine Oxygen if needed
93
Partial blockage of artery only
Unstable angina
94
Partial blockage of artery AND ST zone of ECG NOT elevated
NSTEMI
95
Complete blockage or artery AND ST zone elevated`
STEMI
96
When to deliver percutaneous coronary intervention
Within 2 hours in STEMI - heparin if PCI through radial access - prasugel long term management Secondary prevention in NSTEMI to prevent future MI
97
Secondary prevention of ACS
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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