CVS drugs Flashcards

Question

UFH overdose Tx?

Answer 1

stop infusion | if bleeding: protamine sulphate (discuss with a haematologist)

Answer 2

challenging and evolving area (including monoclonal anti-drug antibodies eg idarucizumab for dabigatran discuss with haematologist

Answer 3

INR 5-8, no bleed: Withold 1–2 doses. Restart warfarin at a lower maintanence dose once INR <5. INR 5-8, minor bleed (including epistaxis): Stop warfarin and admit for urgent IV vitamin K (give slowly). Restart warfarin when INR <5. INR >8, no bleed: Stop warfarin and seek haematology advice. INR >8, minor bleed: Stop warfarin and admit for urgent IV vitamin K. Check INR daily—repeat vitamin K if INR too high after 24h. Restart warfarin at a lower dose when INR <5. Any major bleed (including intracranial haemorrhage): Stop warfarin. Give prothrombin complex concentrate 50 units/kg (if unavailable, give FFP 15mL/kg ≈ 1L for a 70kg man) and 5–10mg vitamin K IV. Discuss with haematologist.

Answer 4

Pulmonary embolism and DVT. Aim for INR of 2–3; 3.5 if recurrent PE or DVT whilst anticoagulated. Atrial fibrillation: for stroke prevention (p130). Target INR 2–3. Prosthetic metallic heart valves: for stroke prevention. Target INR 2–3 if aortic valve or 2.5–3.5 if mitral valve. 1st episode: at least 3 months - extended to 6 months if more extensive, life-threatening clot at presentation, for those with transient but persistent risk factors (eg prolonged immobility) or if evidence of persistent clot at 3 months. For those with recurrent unprovoked emboli or underlying thrombophilia consider bleeding risks against benefits of indefinite treatment.

Answer 5

MOA: Blocking beta1-receptors is negatively inotropic and chronotropic; blocking beta2-receptors induces peripheral vasoconstriction and bronchoconstriction propanolol is non-selective, bisoprolol is relatively beta 1 selective uses: Angina, hypertension, anti dysrhythmic, post MI (reduces mortality), heart failure (with caution). CI: Severe asthma/COPD, heart block. SEs: Lethargy, erectile dysfunction, reduced joie de vivre, nightmares, headache, bronchospasm, heart failure, cold peripheries

Answer 6

hypertension, heart failure, post-MI SEs: dry cough, urticaria, renal failure, angio-oedema CIs: bilateral renal artery or aortic valve stenosis

Answer 7

reduce diuretic dose initially and use long-acting ACE-i. Monitor U&E when starting or raising ACE-i dose, a creatinine rise of >20% is concerning. If the patient starts ACE-i prior to discharge, ask the GP to check U&E in 1–2 weeks.

Answer 8

loop: furosemide - heart failure - inhibit the Na/2Cl/K co-transporter. SES: dehydration, reduced Na+, reduced K+, reduced Ca2+, ototoxic thiazide and thiazide like diuretics: indapamide (hypertension), metolazone (heart failure), bendroflumethiazide - SE: low K+, raised Ca2+, low Mg2+, raised urate (±gout), impotence potassium sparing diuretics: aldosterone antagonists (spironolactone, eplerenone) - block aldosterone receptors amiloride - blocks the epithelial sodium channel in the distal convoluted tubules.

Answer 9

heart failure, IHD, and hypertension nitrates preferentially dilate veins and the large arteries, reduce filling pressure (pre-load), while hydralazine (often used with nitrates) primarily dilates the resistance vessels, thus reducing BP(after-load). Prazosin (an alpha-blocker) dilates arteries and veins.

Answer 10

reduce cell entry of Ca2+ via voltage-sensitive channels in smooth muscle, thereby promoting coronary and peripheral vasodilation and reducing myocardial oxygen consumption. All current drugs block L-type Ca2+ channels. dihydropyridines: nifedipine, amlodipine - peripheral vasodilators (also dilate coronary arteries) and cause a refl ex tachycardia, so are often used with a beta-blocker. They are used mainly in hypertension and angina. non-dihydropyridines—verapamil and diltiazem— slow conduction at the AV and SA nodes- used to treat hypertension, angina, and dysrhythmias. Don’t give non-dihydropyridines with beta-blockers (risk of severe bradycardia ± LVF). SEs: Flushes, headache, ankle oedema (diuretic unresponsive), reduced LV function, gingival hypertrophy. CI: heart block

Answer 11

beta blockers - risk of severe bradycardia ± LVF

Answer 12

blocks Na+/K+ pump. slow pulse in fast AF, heart failure in sinus rhythm if symptomatic despite optimal ACE-i therapy (reduces admissions for worsening CCF) measure plasma level >6h post dose. Typical dose: 500mcg stat PO, repeated after 12h, then 125mcg (if elderly) to 250mcg/d PO OD ``` IV dose: 0.75–1mg in 0.9% NaCl over 2h. T0.5 = 36hrs CIs: HCM, WPW syndrome SEs: Any arrhythmia (supravent ricular tachycardia with AV block is suggestive), nausea, reduced appetite, yellow vision, confusion, gynaecomastia. ``` Mx: ECG, check digoxin levels, check K+, Mg2+, and Ca2+. If toxicity confirmed: stop digoxin, correct electrolyte imbalances, treat arrhy thmias, and consider IV DigiFab

Answer 13

low K+, low Mg+, raised Ca2+,

Answer 14

Class 1 - sodium channel blockers 1a: Procainamide, 1b: Lidocaine, 1c: Flecainide Class 2: Beta blockers Class 3: Potassium channel blockers (Amiodarone)

Answer 15

Procainamide (1a), lidocaine (1b) - can be used to terminate VT Flecainide (1c) - AF cardioversion, arrhythmia prophylaxis in patients with WPW or troublesome paroxysmal AF. CI: Heart failure, IHD, valve disease, and heart block.

Answer 16

Amiodarone prolongs the cardiac action potential, reducing the potential for tachyarrhythmias. Used in both supra-ventricular and ventricular tachycardias, including during cardiac arrest. SEs include: thyroid disease, liver disease, pulmonary fibrosis and peripheral neuropathy. Monitor TFTs and LFTs every 6 months.

Answer 17

Blocks the pacemaker ‘funny current’, slowing pulse rate without significantly dropping blood pressure angina, heart failure, and (off -licence) in autonomic tachycardia syndromes. CI: Acute MI, bradycardia, long QT syndrome, shock. Many drug interactions, including with calcium antagonists.

Answer 18

inhibit the enzyme HMG-COA reductase, which causes de novo synthesis of cholesterol in the liver. This increases LDL receptor expression by hepatocytes leading to reduced circulating LDL cholesterol. More effective if given at night SES: Muscle aches, abdominal discomfort, raised transaminases (eg ALT), raised CK, myositis, rarely rhabdomyolysis (more common if used with fi brates). CIs: porphyria, cholestasis, pregnancy

Answer 19

1st line: Atorvastatin 20mg PO at night, for primary prevention, and 80mg for secondary prevention and primary prevention in those with kidney disease. Simvastatin 40mg, is an alternative. Aim for >40% plasma cholesterol reduction in those with CVD. 2nd line: Ezetimibe—a cholesterol absorption inhibitor, may be used in statin intolerance or combination with statins to achive target reduction. 3rd line: Alirocumab—a monoclonal antibody against PCSK9 (acts to reduce hepatocyte LDL receptor expression). Very effective in reducing LDL, but expensive and needs to be given by injection every 2 weeks. others: fibrates, eg bezafibrate (useful in mixed hyperlipidaemias); anion exchange resins, eg colestyramine; nicotinic acid (raised HDL; reduced LDL; SE: severe flushes; aspirin 300mg ½h pre-dose helps this) Hypertriglyceridaemia: Responds best to fi brates, nicotinic acid, or fish oil.

Answer 20

Address exacerbating factors. Secondary prevention of cardiovascular disease - smoking, exercise, diet, hypertension, diabetes - 75mg aspirin daily PRN symptom relief - GTN spray or sublingual tabs ``` antianginal medication: beta blockers CCB long-acting nitrates eg. isosorbide mononitrate(alternative GTN skin patches) ivabradine Ranolazine nicorandil ``` revascularisation: Considered when optimal medical therapy proves inadequate. PCI - insert stent to reduce re-stenosis. use dual antiplatelet therapy for at least 12 month after stent insertion to reduce risk of instent thrombosis CABG

Answer 21

Low BP, headaches Advise the patient to repeat the dose if the pain has not gone after 5min and to call an ambulance if the pain is still present 5min after the second dose.

Answer 22

inhhibits late Na+ current antianginal Caution if heart failure, elderly, weight <60kg or prolonged QT interval.

Answer 23

K+ channel activator CI: acute pulmonary oedema, severe hypotension, hypovolaemia, LV failure

Answer 24

CABG less likely to need repeat revascularization and those with multivessel disease can expect better outcomes. However, CABG is open heart surgery and so recovery is slower and the patient is left with two large wounds (sternal and vein harvesting).

Answer 25

<55yrs, and black patients of any age - 1st lines is a Ca2+-channel antagonist or thiazide. <55yrs 1st line is ACE-i or ARB beta-blockers are not 1st line for hypertension, but consider in younger people, particularly if: intolerance or contraindication to ACE-i/ARB, she is a woman of child-bearing potential, or there is increased sympathetic drive. 2nd line: ACE-i + Ca2+-channel antagonist 3rd line: ACE-i, Ca2+-channel antagonist, and thiazide 4th line: consider spironolactone or higher-dose thiazide (monitor U+Es). Or beta blocker or selective alpha blocker

Answer 26

lisinopril

Answer 27

candesartan caution if valve disease or cardiomyopathy; monitor K+. SE: vertigo, urticaria, pruritus.

Answer 28

do this is AVNRT or AVRT - Vagal manoeuvres: carotid sinus massage, Valsalva manoeuvre (eg blowing into a syringe). 2 IV adenosine