Chapter 2- Cardiovascular System Flashcards
(206 cards)
1
Q
Two types of treatment in AF
A
Rate control Rhythm control
2
Q
First line option in AF?
A
Rate control
3
Q
What can hypokalaemia cause?
A
Torsade de pointes due to long QT interval
4
Q
Treatment of torsade de points?
A
IV infusion of magnesium sulfate
5
Q
Name two class 1 membrane stabilising drugs used in arrhythmias under the Vaughan Williams classification
A
Lidocaine Flecainide
6
Q
What class of drug is under the class two of the Vaughan Williams classification
A
Beta blockers
7
Q
Class 3 of the Vaughan Williams classification
A
Amiodarone Sotolol
8
Q
Class 4 of Vaughan Williams classification
A
CCB (includes verapamil but not dihydropyridines)
9
Q
Treatment of choice for terminating paroxysmal supraventricular tachycardia
A
Adenosine
10
Q
True or false - adenosine is preferred over verampamil in asthma?
A
False
11
Q
Name a cardiac glycoside
A
Digoxin
12
Q
The likelihood of toxicity increases progressively through what range of digoxin level?
A
1.3 - 3 mcg/litre
13
Q
True or false: hyperkalaemia exposes people to digitalis toxicity
A
False - hypokalaemia does
14
Q
Reducing raised BP decreases the risk of what 4 things
A
Stroke Coronary events Heart failure Renal impairment
15
Q
What two drugs form the basis of treatment for heart failure due to left ventricular dysfunction
A
Ace inhibitor Beta blocker
16
Q
What’s in co-flumactone and what’s it used for
A
Hydroflumethiazide and spironolactone used for congestive heart failure
17
Q
Drug action of sacubitril
A
A prodrug that inhibits the breakdown of natriuretic peptides resulting in varied effects including increased diuresis, natriuresis and vasodilation
18
Q
What is enoximone
A
Is a phosphodiesterase type 3 inhibitor that exerts most effect on the myocardium; it has positive inotropic properties and vasodilator activity
19
Q
Name two phosphodiesterase type 3 inhibitors used in heart failure
A
Enoximone Milrinone
20
Q
List 3 things that make someone at higher risk of developing cardiovascular disease
A
Diabetes CKD Familial hypercholesterolaemia
21
Q
You can use gemfibrozil and a station together to lower cholesterol
A
NO- this combination greatly increases the risk of rhabdomyolysis
22
Q
Name 5 classes of drug used in hyperlipidaemia
A
Statins Bike acid sequestrants Fibrates Lomitapide Nicotinic acid group
23
Q
How do bile acid sequestrants work?
A
Bind bile acids Prevent reabsorption Promotes hepatic conversion of cholesterol to bile acids Increased LDL receptor activity Increased clearance of LDL cholesterol
24
Q
How does ezetimibe work
A
It inhibits the intestinal absorption of cholesterol
25
MOA of fibrates
They act by decreasing serum triglycerides; they have variable effect on LDL-cholesterol
26
Name 4 fibrates that modify lipid levels
Bezafibrate Ciprofibrate Fenofibrate Gemfibrozil
27
Name a cholesterol absorption inhibitor
Ezetimibe
28
Mode of action if statins
Competitively inhibit HMG CoA reductase
29
When should patients not be started on a statin?
If the baseline creatinine kinase concentration is more than 5 times the upper limit of normal
30
Which drugs increase the plasma statin concentration
Macrolide antibiotics Imidazole antifungals Triazole antifungals Ciclosporin
31
MOA of lomitapide
An inhibitor of microsomal triglyceride transfer protein (MTP), reduces lipoprotein secretion and circulating concentrations of lipoprotein-borne lipids such as cholesterol and triglycerides
32
Patients with stable angina should be given what?
GTN for acute attacks Beta-blocker or CCB
33
Name three long acting nitrates used in stable angina
Ivabradine Nicorandil Ranolazine
34
How does cangrelor work
Antiplatelet- is a direct P2Y12 platelet receptor antagonist that blocks adenosine diphosphate induced platelet activation and aggregation
35
MOA of fibrinolytics
Act as thrombolytics by activating plasminogen to form plasminogen, which degrades fibrin and so breaks up thrombi
36
Alteplase is contraindicated if a patient has a history of hypersensitivity to what?
Gentamicin
37
Name four fibrinolytics
Alteplase Reteplase Streptokinase Tenecteplase
38
How do nitrates exert their benefits in angina
Potent coronary vasodilators, their principle benefit follows from a reduction in venous return which reduces left ventricular work
39
How do thiazides work
They inhibit sodium reabsorption at the beginning of the distal convoluted tubule
40
What is dispyramide
Class IA antiarrhythmia drug- used to prevent arrhythmia post MI - has antimuscarinic effects so caution in glaucoma
41
Name a class IB antiarrhythmia drug
Lidocaine
42
Name two class IC anti arrhythmia agents
Flecainide Propafenone
43
Propafenone has what extra mild activity and why is this used with caution in obstructive airway disease
can affect airway
44
Name two class III anti arrhythmia drugs
Amiodarone Dronedarone
45
MHRA warning with amiodarone + sofosbuvir + daclatasvir + ledipasvir + simeprevir
Can cause severe bradycardia and heart block if used together
46
MHRA warning with sotalol
May prolong QT or life threatening ventricular arrhythmias - correct hypomagnesium + hypokalaemia before initiating
47
Tue or false: patient with heart failure in sinus rhythm needs a loading dose of digoxin
FALSE no loading required
48
True or false: digoxin has a long half life
TRUE DAT- once daily maintenance dosing as a result
49
Likelihood of Digoxin toxicity increases through what range of level?
1.5-3mcg/L
50
What electrolyte imbalances can predispose to digitalis toxicity
Hypercalcaemia Hypokalaemia Hypomagnesmia
51
Switching from IV to oral digoxin requires what dose increase?
20-33%
52
Pt on digoxin requires half the dose with concurrent use of what 3 drugs
Amiodarone Dronedarone Quinine
53
What type of drug is tranexamic acid
Antifibrinolytic
54
Name a haemostatic drug
Ethamsylate
55
Name a dihydropyridine CCB used to increase cerebral perfusion in subarachnoid haemorrhage
Nimodipine
56
True or false: nimodipine tablets are light sensitive
TRUEEE
57
What is epoprostenol?
Prostacyclin (prostaglandin) and potent vasodilator that inhibits platelet aggregation used for blocked catheters and lines in e.g renal dialysis
58
how many days VTE prophylaxis following hip replacement?
28-35 days
59
How many days VTE prophylaxis following knee replacement surgery?
10-14 days
60
VTE in pregnancy?
Heparins preferred as do not cross placenta - LMWH best as they reduce risk of osteoporosis and HIT
61
The coumarins and phenindione take how long for full effect?
48-72 hrs
62
Warfarin should be stopped how many days before elective surgery
Five days - give phytomenadione by mouth using IV prep day before surgery if INR \> 1.5
63
Which has a longer duration of action: UFH LMWH
LMWH
64
What is argatroban
Anticoagulation in adult patients with heparin induced thrombocytopenia type 2
65
Name a hirudin and what is it used for
Bivalirudin- thrombin inhibitor for unstable angina or NSTEMI/STEMI undergoing PCI
66
What is epoprostenol
Prostacyclin that inhibits platelet aggregation **during renal dialysis when heparins are unsuitable or contraindicated** - also for primary pulmonary hypertension resistant to other treatment
67
Name the antidote/chelator of dabigatran
Idarucizumab
68
Age limit for aspirin and why?
16yrs Risk of Reye's syndrome
69
What is Reye's syndrome
Swelling in liver and brain - in children/teens recovering from viral infection e.g flu or chicken pox
70
Max quantities to sell of aspirin OTC
32 - but pharmacists can sell multiple packs reaching a max of 100 in certain circumstances
71
Allergy and cross sensitivity info for clopidogrel
Caution in history of hypersensitivity reactions to thienopyridines (e.g prasugrel)
72
How do you take Dipyridamole
Dipyridamole given with food.
73
Mode of action of apixaban, edoxaban, fondaparinux and rivaroxaban
Inhibitors of factor X (factor Xa)
74
Dose and duration of apixaban for prophylaxis VTE following knee replacement?
2.5mg BD for 10-14 days to be started 12-24 hrs following surgery
75
Apixaban dose and duration for VTE prophylaxis in hip replacement surgery
2.5mg BD for 32-38 days to be started 12-24 hrs after surgery
76
Avoid apixaban if renal function \< what?
\< 15ml/min
77
When do you reduce the dose of apixaban in prevention of stroke in AF
When crcl \< 30ml/min
78
Dose and duration of rivaroxaban for prophylaxis of VTE following knee replacement surgery
10mg OD for 2weeks to be started 6-10hrs after surgery
79
Dose and duration of rivaroxaban for prophylaxis of VTE following hip replacement surgery
10mg OD for 5 weeks to be started 6-10 hrs after surgery
80
Dose of apixaban for treatment of DVT/PE
Initially 10mg BD for 7 days then maintenance 5mg BD
81
Dose of rivaroxaban for treating DVT/PE
Initially 15mg BD for 21 days then 20mg OD
82
Main features of aspirin poisoning (salicylate poisoning)
Hyperventilation Tinnitus Deafness Vasodilatation Sweating
83
Name a heparinoid
Danaparoid
84
Antidote of heparin and partial antidote of LMWH
Protamine sulfate
85
How long after having heparin can HIT develop
5-10days
86
Signs of Heparin induced thombocytopaenia?
30% reduction of platelet count, thrombosis, skin allergy
87
Management of HIT
Stop heparin- switched to alternative anticoagulant such as danaparoid and ensure platelet count returns to normal range in those who require warfarin
88
How can heparin cause hyperkalaemia
Inhibition of aldosterone secretion
89
Does LMWH cross the placenta
No
90
True or false: argatroban can be used for anticoagulation in patients who've had HIT
True!
91
NICE recommendation on bivalirudin
Give in combination with aspirin and clopidogrel in STEMI in patients undergoing PCI
92
MOA of dabigatran
Direct thrombin inhibitor with a rapid onset of action
93
BP target in diabetes without secondary problems
140/80
94
BP target in diabetes with kidney, eye or cerebrovascular disease
130/80
95
Target BP in renal disease
Below 140/90 (130/80 is advised in patients with chronic kidney disease and diabetes, or if proteinuria exceeds 1g in 24hrs)
96
Three drugs used for hypertension in pregnancy
Labetolol Methyldopa MR nifedipine
97
Target BP for pregnant women with uncomplicated hypertension
\<150/100
98
Target BP for pregnant women with hypertension with target organ damage and in women with chronic hypertension who have just given birth
\<140/90
99
Women managed with methyldopa for hypertension during pregnancy should discontinue treatment and restart their original antihypertensive medication when?
Within 2 days of the birth
100
Pregnant women are at high risk of developing pre-eclampsia if they have what?
CKD Diabetes Autoimmune disease Chronic hypertension Hypertension during previous pregnancy
101
Pregnant women at high risk of pre-eclampsia are advised to take what?
Aspirin OD from week 12 of pregnancy until baby is born (unlicensed)
102
Alpha blocker used in phaeochromocytoma
Phenoxybenzamine Phentolamine
103
Disadvantage of clonidine
Sudden withdrawal can cause severe rebound hypertension
104
Name three centrally acting antihypertensives
Clonidine Methyldopa Moxonidine
105
Why should alpha blockers be used with caution?
They can reduce BP rapidly after the first dose
106
Name 4 alpha blockers
Prazosin Doxazosin Indoramin Terazosin
107
Other than hypertension, alpha blockers can we used in what?
Benign prostatic hyperplasia
108
Which two ARBs are licensed as adjuncts to ACEi under specialist supervision in the management of heart failure when other treatments are unsuitable?
Candesartan Valsartan
109
Name a renin inhibitor licensed for hypertension?
Aliskiren
110
True or false- clonidine can be used for prevention of recurrent migraines
TRUE DAT
111
Name the more water soluble b-blockers and what are their benefits?
Atenolol Celiprolol Nadolol Sotalol -less likely to enter brain and may therefore cause less sleep disturbance and nightmares
112
Water soluble beta blockers are excreted by what?
Da kidneys
113
Name the more cardioselective beta- blockers
Atenolol Bisoprolol Metoprolol Nebivolol Acebutolol- lesser extent
114
Name three side effects of beta blockers
Fatigue Coldness of extremities Sleep disturbances
115
Why should you choose cardioselective beta blocker in diabetes
Beta blockers can affect carbohydrate metabolism resulting in either hypoglycaemia or hyperglycaemia
116
Administration of which beta blocker can reverse the clinical symptoms of thyrotoxicosis within 4 days
Propranolol
117
Name four beta blockers used topically in glaucoma
Betaxolol Carteolol Levobunolol Timolol
118
Can beta blockers be used in the prophylaxis of migraine?
Yup
119
What symptoms of anxiety can beta blockers help to alleviate
Palpitations Tremor Tachycardia
120
Why caution of beta blockers in diabetes?
They can mask symptoms of hypoglycaemia
121
Can beta blockers reduce the responsiveness to adrenaline?
Yeh
122
Name the beta blockers used for hypertension in pregnancy
Labetolol
123
True or false - fat soluble beta blockers such as nadolol are more present in breast milk than other beta blockers
FALSE- water soluble such as nadolol are
124
What's in the combination product 'co-tenidone'
Chlortalidone and atenolol
125
Name two non-dihydropyridine CCBs
Verapamil Diltiazem
126
Most common side effect of verapamil
Constipation
127
Verapamil is indicated for the treatment of what?
Angina Hypertension Arrhythmias
128
True or false - you can use verapamil with beta blockers
False!! Heart block
129
Which type of CCBs should be avoided in heart failure due to risk of cardiac depression?
The non-dihydropyridines (verapamil + diltiazem)
130
Name 7 dihydropyridines
Amlodipine Felodipine Lacidipine Lercanidipine Nicardipine Nifedipine Nimodipine
131
Nifedipine, nicardipine, amlodipine and felodipine are used for the treatment of what?
Hypertension Angina
132
Side effects of CCBs
Flushing Ankle swelling
133
Name the CCB that can be used IV for acute life threatening hypertension
IV nicardipine
134
Name the three CCB indicated for the treatment of hypertension only
Isradipine Lacidipine Lercanidipine
135
Which CCB is confined to prevention and treatment of vascular spasm following aneurysmal subarachnoid haemorrhage
Nimodipine
136
What is clevidipine
CCB used for hypertension in the peri-operative setting (specialist use only)
137
What is contained in co-amilozide
Amiloride and hydrochlorithiazide
138
Main issue of diuretics
Hypokalaemia
139
Thiazides and related diuretics can exacerbate what
Diabetes Gout Systemic lupus erythematosus
140
Name the four thiazides and related diuretics under the BNF section
Bendrofluemthiazide Co-amiloride Hydrochlorothiazide Indapamide
141
True or false- indapamide is a thiazide like diuretic which at lower doses has a higher diuretic effect than antihypertensive
False- lower doses has more vasodilation/hypertensive effect, higher doses is where the diuretic effect increases
142
With regards to liver when should ACEi be discontinued
If marked elevations of hepatic enzymes or jaundice occur - as a result of reports of cholestatic jaundice, hepatitis, fulminant hepatic necrosis and hepatic failure
143
Name a guanylate Cyclase stimulator used in pulmonary hypertension
Riociguat
144
MHRA warning with riociguat
Efficacy and safety in patients with symptomatic PH-IIP1 Showed increased mortality and risk of serious adverse events with riociguat compared to placebo
145
Name three things that can cause shock
Haemorrhage Sepsis Myocardial insufficiency
146
Name three sympathomimetic inotropes used in shock
Adrenaline/ephedrine Dobutamine Dopamine
147
Mode of action of dopamine
Is a cardiac stimulant which acts on beta 1 receptors in the cardiac muscle, it increases contractility with little effect on rate
148
Name five drugs under the hypotension and shock BNF section
Dopamine Metaraminol Midodrine Noradrenaline Phenylephrine
149
Indication for midodrine
Severe orthostatic hypotension
150
What's in the combination of co-flumactone
Hydroflumethiazide and spironolactone
151
Dose adjustment and interactions of eplerenone
Max dose 25mg daily with concurrent use of amiodarone or moderate inhibitors of CYP3A4
152
Name 3 potassium sparing diuretics used in heart failure
Co-flumactone Eplerenone Spironolactone
153
Caution with aldosterone antagonists/potassium sparing diuretics
HYPERKALAEMIA
154
Dose adjustments due to interactions for the endothelin receptor antagonist 'Ambrisentan' used in pulmonary hypertension
Max dose 5mg daily and close monitoring with concurrent use of ciclosporin
155
Midodrine is a pro-drug of what?
Desglymidodrine which is a sympathomimetic agent that acts on peripheral alpha adreneegic receptors to increase arterial resistance, resulting in an increase in BP
156
Can you combine statin and gemfibrozil
NO - huge risk of rhabdomyolysis
157
Define high intensity statin
One than produces a greater LDL cholesterol reduction that simvastatin 40mg
158
What drug is better than statins at reducing high triglyceride concentration
Fibrates
159
Name two monoclonal antibodies used in primary hypercholesterolaemia
Alirocumab Evolocumab
160
Issue with bike acid sequestrants
They can aggravate hypertriglyceridaemia
161
When are fibrates used?
In those whose serum triglyceride conc is greater than 10mmol /litre or in those who cannot tolerate statin
162
Name three bile acid sequestrants
Colesevelam Colestipol Colestyramine
163
True or false: other drugs need to be taken 1 hour before or 4-6 hours after bile acid sequestrants
Trueeee
164
True or false: hypothyroidism should be corrected before initiating a statin
True!
165
Should statins be discontinued if there is an increase in the blood-glucose concentration or HbA1c
No- benefits still outweigh risks
166
Name 5 statins
Atorvastatin Fluvastatin Pravastatin Rosuvastatin Simvastatin
167
How does alirocumab and evolocumab work
They bind to a pro-protein involved in the regulation of LDL receptors on liver cells, receptor numbers are increased which results in increased uptake of LDL cholesterol from the blood
168
How does lomitapide work
Inhibitor of microsomal triglyceride transfer protein (MTP), reduces lipoprotein secretion and circulating concs of lipoprotein-borne lipids such as cholesterol and triglycerides
169
Management of stable angina
1) GTN acute attacks 2) beta blocker or CCB 3) beta blocker + CCB 4) beta blocker or CCB plus long acting nitrate 5) long acting nitrate if can't tolerate beta or CCB
170
What is nicorandil
Potassium channel activator with a nitrate component licensed for long term angina management
171
Name three glycoproteins IIB/IIA inhibitors and what type of drug are they
Abciximab Eptifibatide Tirofiban
172
Timings for the four fibrinolytics for STEMI
Alteplase- 6-12 hrs Streptokinase -12hrs Reteplase -12hrs Tenecteplase -6hrs
173
Sublingual GTN lasts how long?
20 to 30 mins
174
Caution for nitrates
Patients on long term long acting or transdermal nitrates rapidly develop tolerance
175
Common side effects of nitrates
Dizziness Postural hypotension Tachycardia Throbbing headache Flushing
176
Onset of action of thiazides and related diuretics
1-2 hrs after oral administration
177
Duration of action of thiazides and related diuretics
12-24hrs
178
MOA of thiazides and related diuretics
Inhibit sodium reabsorption at the beginning of the distal convoluted tubule
179
Furosemide and bumetanide oral take how long to work and last for how long?
1 hour 6hours Can be given BD without affecting sleep
180
IV furosemide reaches peak affects after how long
30mins
181
Why do we give amiloride or trianterene with thiazide or loop diuresis?
Because they are weak diuretics on their own but cause potassium retention and are more effective than giving potassium supplements
182
True or false: hyperglycaemia is more likely with thiazides than loop diuretics?
True: Thiazides are more likely to cause hyperglycemia
183
Plot twist - in what condition can loop diuretics cause urinary retention
Enlarged prostate
184
Name two drugs used with thiazides or loops for their potassium conservation effect
Triamterene Amiloride
185
Name an osmotic diuretic and what's it used for
Mannitol - to treat cerebral oedema and raised intra-ocular pressure
186
7 signs of digoxin toxicity
N&V Blurred yellow vision Weight loss Anorexia Palpitations Hallucinations Abdominal pain
187
When do you measure digoxin levels
Normally 6 hrs after dose
188
Side effect of furosemide if infused too quick
Deafness (if exceeds 4mg/min)
189
Side effect of bumetanide
Myalgia
190
Side effect of amiloride
Urine can look blue in some lighting
191
Four symptoms of hyperkalaemia
Fatigue Palpitations Nausea and vomiting Chest pain
192
Name 4 beta blockers less likely to cause coldness of extremities or bradycardia
Oxyprenolol Pindolol Acebutol Celiprolol
193
Name 4 water soluble beta blockers
Atenolol Celiprolol Nadolol Sotalol
194
Name three beta blockers than are long acting and taken once daily
Atenolol Bisoprolol Nadolol
195
Name 5 cardioselective beta blockers
Atenolol Bisoprolol Metoprolol Nebivolol Acebutol
196
Name a non cardioselective beta blocker
Sotalol
197
Name three beta blockers which reduce mortality in MI
Atenolol Metoprolol Propranolol
198
Name 3 beta blockers that reduced morality in heart failure
Bisoprolol Carvedilol Nebivolol
199
Which beta blocker is used in anxiety?
Propranolol
200
Big side effect of nicorandil
Ulceration
201
Can you use pravastatin in preganancy and breastfeeding
NO
202
Name the two longer acting statins that can be taken any time of day as a result of this
Atorvastatin Rosuvastatin
203
Alirocumab Evolocumab
two monoclonal antibodies used in primary hypercholesterolaemia
204
What is Idarucizumab and side effects?
(NOAC) reversal agent that will only reverse the anticoagulant effects of dabigatran.
headache,
low blood potassium levels (hypokalemia),
delirium,
constipation,
fever,
pneumonia,
blood clots,
hypersensitivity,
205
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