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Cardiovascular Flashcards

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1
Q

What rate control drug is not to be used for Atrial Fibrillation in a patient with Heart failure

A

Calcium channel blocker

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2
Q

when is rate control given

A

If onset is more than 48 hours, as if you use rhythm control(cardioversion) there is risk of clot being thrown off

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3
Q

What two drugs are used for rhythm control

A

Amiodarone OR flecainide

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4
Q

What are the 7 side effects of amiodarone 2H 2L 2S BC

A
  1. skin Photosensitivity
  2. Skin Discolouration
  3. Hypo/hyperthyroidism (contains iodine)
  4. Liver toxicity
  5. Lung - pulmonary fibrosis
  6. bradycardia/heart block
  7. corneal microdeposits
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5
Q

How long is amiodarone used for AF

A

Started 4 weeks before cardioversion and 12 months after

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6
Q

what drugs are first line for AF

A

Beta blocker (Not sotalol) OR rate limiting CCB

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7
Q

How do we assess stroke and bleed risk in AF

A

CHADVASC and Orbit

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8
Q

What is 1st line hypertension treatment in diabetics

A

ACEi
If black afrocarribean then ARB

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9
Q

What is 1st line treatment for hypertension in those under 55

A

ACEi
If black afrocarribean then ARB

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10
Q

What is 1st line treatment for hypertension in those over 55 and black

A

Calcium Channel Blocker

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11
Q

what is stage 1 hypertension

A

above 140/90

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12
Q

what is stage 2 hypertension

A

above 160/100

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13
Q

What is used to treatment hypertension in pregnant women

A

Labetalol

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14
Q

What is a side effect of ACEi

A

Dry cough

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15
Q

How to treat and monitor an acute presentation of heart failure?

A

IV diuretic to treat the oedema and excess fluid.
- Monitor Kidney function
- Fluid output(urine)
- Weight to see if they are losing fluid

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16
Q

Treatment for chronic heart failure reduced ejection fraction

A

Step 1. Diuretic(thiazide or loop) for symptoms
Step 2. ACEi and BB
Step 3. add Mineralocorticoid receptor antagonist

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17
Q

How to start an ACEi

A

Start low and titrate up
First dose at night

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18
Q

What beta blockers are licensed for heart failure BCN

A

Carvedilol
Bisoprolol(B1 selective)
Nebivolol (over 70 years)

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19
Q

What beta blockers are less likely to cause sleep disturbances and nightmares

A

atenolol, sotalol

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20
Q

What beta blocker acts on both Beta 1 and Beta 2 receptors

A

Propranolol

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21
Q

What antihypertensive causes peripheral oedema, headaches and flushing.

A

Calcium channel blockers

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22
Q

Where is Beta-1 receptors and Beta- 2 receptors

A

B1(heart)↓ Inotropy and chronotropy ↓ BP
B2(lungs, vascular and smooth muscle) ↓ BP

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23
Q

Bradycardia?

A

less 60 beats per min

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24
Q

Tachycardia

A

More than 100bpm

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25
What is included in CHADVASC score(8)
congestive heart failure Hypertension 75+ 65-74 years Diabetes Previous TIA, stroke/ VTE Vascular disease Female
26
What should you do if a womens CHADVASC score is 1
Do not offer oral anticoagulation
27
What is the chadvasc score?
Risk of having a stroke
28
patient has chadvasc of 2, should you give anti-coagulation
Yes but also consider bleeding risk
29
What is the anticoagulation therapy for AF
Vitamin K antagonist(warfarin) DOAC(apixaban, edoxaban, rivaroxaban or dabigatran )
30
What is a DOAC
A DOAC is a direct thrombin inhibitor
31
what DOACs inhibit factor Xa
Apixaban, Edoxaban, Rivaroxaban
32
How does Apixaban, Edoxaban, Rivaroxaban work
Inhibition of factor Xa prevents thrombin generation.
33
What is the mechanism of action of dabigatran
inhibitor of free thrombin, and thrombin-induced platelet aggregation.
34
What factors affect the dosing of apixaban
Age - 80+ Weight - lower than 60 Serum creatinine - more than 133micromol/L CrCL below 30
35
What is the dosing of apixaban
2.5 - 5mg BD
36
What DOAC is preferred if patient is renally impaired
dabigatran
37
Is dabigatran a CYP34A substrate
NO It is a only a P-GP substrate
38
Can dabigatran(P-gp substrate) be given with amiodarone or Verapamil (both are mild P-gp inhibitor)
amiodarone - yes but monitor Verapamil - reduce dose
39
Do you give a person on a DOAC VTE prophylaxis
No - bleed risk
40
What is first line oral anticoagulation in AF
DOAC
41
What oral anticoagulant do you give in AF if a DOAC is contraindicated
Warfarin
42
What are symptoms of heart failure
Breathlessness/SOB Oedema, Fatigue, Coughing
43
What are the classes of heart failure
Class 1: no symptoms during normal activity Class 2:comfortable at rest but normal physical activity triggers Class 3: comfortable at rest but minmial physical activity triggers Class 4: occurs at rest
44
What is the treatment for chronic heart failure with preserved ejection fraction
- Lifestyle advice - Manage co-morbidities - low to medium dose loop diuretic for symptoms - if tx failure -> Specialist
45
Lifestyle advice for heart failure
Smoking cessation reducing alcohol consumption, increasing physical exercise weight control diet - increasing fruit and vegetable consumption and reducing saturated fat intake.
46
What is MONA
Acute treatment in ambulance: - Morphine + Metoclopramide - Oxygen - Nitrate (GTN) - Aspirin 300mg loading dose
47
NSTEMI vs STEMI vs Unstable Angina
STEMI is generally caused by a complete and persistent blockage of the artery resulting in myocardial necrosis with ST-segment elevation seen on the EC. NSTEMI and unstable angina, a partial or intermittent blockage of the artery occurs, which usually results in myocardial necrosis in NSTEMI but not in unstable angina.
48
What the five drugs prescribed after a heart attack
BB ACEi Statin Aspirin Antiplatelet
49
How is STEMI treated
Percutaneous coronary intervention
50
What antiplatelets are given during STEMI
Aspirin + either Prasugrel, Ticagrelor or Clopidogrel
51
Which second antiplatelet should be chosen for NSTEMI
Prasugrel and ticagrelor has better antiplatelet activity but has higher bleed risk compared to clopidogrel
52
What is an alternative to PCI
Fibrinolysis - which breaks down fibrin and clots
53
What drugs are used for fibrinolysis?
Alteplase, reteplase, tenecteplase, streptokinase
54
What is unstable angina?
does not respond to stable angina treatment and is emergency
55
What is stable angina?
Predictable chest pain or pressure, often caused by physical exertion which increases the myocardium demand for oxygen. Pain alleviated at rest
56
What causes angina?
Atherosclerotic plaques which block the coronary arteries, restricting blood flow to the heart
57
What is both the prophylaxis and treatment of angina attacks
short acting nitrate i.e glyceryl trinitrate
58
What is the dosing of glyceryl trinitrate
59
Is warfarin safe in pregnancy
not to be used in first or third trimester
60
What should be monitored with warfarin
Baseline prothrombin time INR: every other day initially until stable then up every to 12 weeks. Must provided patient with yellow book
61
What food interact with warfarin
High vitamin K foods(green leafy vegatables, chickpeas, liver, egg yolks) Cranberry juice Grapefruit juice
62
What is nitrate tolerance
Patients on long acting or transdermal nitrates develop tolerance which reduces their effectiveness.
63
What is the mechanism of action of glyceryl trinitrate
converts to nitric oxide which is a potent vasodilator
64
How is glyceryl trinitrate taken
Can be taken by sublingual tablets or as a spray - onset is very fast. Transdermal patches and IV preparations
65
What is isosorbide mononitrate
Isosorbide mononitrate is a Long acting nitrate administered orally (Half life 4 hours) there is also a slow release preparation
66
What drugs are used as long term prevention of angina
1st line - BB (if BB contraindicated then rate limiting CCB) 2nd BB+ CCB
67
what are the 11 risk factors for HTN
1. Age 2. Gender(below 65 men, above 65 women) 3. Ethnicity(black/afrocarribean) 4. genetic factors/family hx 5. social deprivation 6. diabetes/CKD 7. smoking 8. alcohol intake 9. Unhealthy diet 10. physical activity 11. Anxiety or stress
68
How do statins work?
statins work by inhibiting HMG-CoA reductase which is the rate limiting step of mevalonate pathway which eventually produces cholesterol

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