ischaemic heart disease Flashcards Preview

SBAs > ischaemic heart disease > Flashcards

Flashcards in ischaemic heart disease Deck (15)
Loading flashcards...
1

50 yr old. Chest and left arm feel heavy after he walks up a steep slope. Discomfort is relieved by 5 mins rest.
What drugs improve prognosis?

aspirin 75mg OD
clopidogrel 75mg OD (secondary treatment for pmts intolerant of aspirin)
statins 10-40mg OD

previous MI or co-existing HF:
beta blockers
ACEI

2

50 yr old. Chest and left arm feel heavy after he walks up a steep slope. Discomfort is relieved by 5 mins rest.
What drugs relieve symptoms?

Glyceryl trinitrate - nitrovasodilator
Isosorbide mononitrate - prophylaxis of angina
Beta blockers - decrease pre& afterload, decrease rate, decrease contractility
Ca channel blockers

3

Aspirin - what is the MOA
what are the SEs

irreversible inhibition of cyclooxygenase enzyme
Gastropathy

4

Statin - SEs?

myositis- stop if CK>x10
hepatitis - stop is ALT >x3

5

GTN - which is a common SE
diarrhoea
nausea
headache
hepatitis
pruritis

headache
flushing
hypotension

6

Isosorbide mononitrate - what is the main problem
headache
n/v
bradycardia
tolerance
tiredness

tolerance
interaction with sildenafil

7

beta blockers - what are common SEs

bronchospasm
tiredness
impotence
bradycardia
worsening HF
cold extremities
hypotension

8

Beta blockers
what do Beta 1 blockers do
examples..

cardiac - negatively inotropic and chronotropic
bisoprolol
metoprolol
atenolol

9

Beta 2 blockers - what do they do

vascular and pulmonary effects - decrease BP through vasodilatation

10

which is NOT a non selective beta blocker
timolol
metoprolol
propranolol
labetalol
sotalol

metoprolol

11

Ca channel blockers block ca channels in myocardium & vasculature. they decrease HR, contractility and increase vasodilatation.
Which 2 are not dihydropyridines?
verapamil
nifedipine
minodipine
diltiazem
amlopdipine
nicardipine

verapamil
diltiazem
(these are more useful for cardiac effects whereas amlodipine is more useful as a vasodilator)

12

SEs of Ca Channel blockers

oedema
headache
flushing
postural hypotension
aggravation of MI

13

Severe retrosternal chest pain and nausea and sweating. ECG - ST elevation
What treatments should be given immediately

Aspirin 300mg
Morphine
Metoclopramide
Oxygen
PCI asap
ACE I
Statins
Beta blockers
Nitrate for pain
Clopidogrel 300mg - probably not

14

Contraindications for PCI. Which is not a contraindication

recent CVA
GI haemorrhage
operations
hypertension
proliferative retinopathy
bleeding diathesis
Hx >8 hrs

Hx >24 hrs is a contraindication (not 8 hrs)

15

NSTEMI management / UA

Aspirin 300mg
B blocker
Nitrate infusion for pain
LMWH
Statin
GpIIb/IIIb receptor blocker if high risk (abciximab, eptifibatide , tirofiban )
Clopidogrel - give if high risk (not for 2ndry prevention)
?Coronary angiogram