Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
130 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
What is ectopic beats and how is it treated? |
Ectopic heartbeats are changes in a heartbeat that is otherwise normal. These changes lead to extra or skipped heartbeats treated with BB |
|
|
|
Patients with AF Should be assessed for what? |
Stroke and Thromboembolism risk |
|
|
|
How often should bleeding risk stroke and anticoagulation be reviewed in patients with AF |
Annually |
|
|
|
How long should oral anticoagulation be given after cardio version |
4 weeks |
|
|
|
What is used for ventricular rate control in atrial fibrillation? |
Standard BB not sotalol Or a rate limiting calcium channel blocker such as diltiazem or verapamil as mono therapy Digoxin only effective at controlling ventricular rate at rest |
|
|
|
In patients with infrequent episode of symptomatic paroxysmal AF how is sinus rhythm treated |
Pill in the pocket approach involves patients taking oral flecanide acetate or propafenone to self treat when af occurs |
|
|
|
What is the chadvas score used for ? |
Assess stroke risk Low risk score 0 for men low risk score 1 for women |
|
|
|
What is used to assess bleeding risk prior to anticoagulation |
Orbit Has bled score |
|
|
|
What is torsade de pointes and give an example of a drug that can cause QT Prolongation and torsade de pointes |
A form of ventricular tachycardia accociated with long qt syndrome iv infusion of magnesium sulfate can be used or a bb blocker can be used but not sotalol as this causes further qt prolongation Hydroxyzine hydrochloride avoid using in patients with a history of cardiovascular disease family history of sudden cardiac death electrolyte imbalance |
|
|
|
Class I are membrane stabilising drugs give one example |
Lidocaine flecanide |
|
|
|
What is class II ANTI ARHYTMIC DRUGS |
BB |
|
|
|
What are class III drugs |
Amiadarone sotalol |
|
|
|
What are class iv drugs |
Verapamil |
|
|
|
What is a side effect of lidocaine and how can it be treated |
Methaemglobinaemia can be treated with methylthionium |
|
|
|
What are the side effects of amidarone? |
With iv use - fall in BP Arrhytmias/ hyperthyroidism/ nausea/ skin reactions / nausea bronchospasm/ hypertension/ constipation / corneal deposits hypothyroidism photosensitivity sleep disorders taste altered pulmonary toxicity stop if new or progressive shortness of breath or cough develops |
|
|
|
What is the monitoring for amidarone? |
Thyroid function test - before treatment then every 6 months t4 t3 and tsh measured Liver function tests before treatment and every 6 months Serum potassium concentration before treatment Chest x ray before treatment |
|
|
|
What patient and carer advice is given with amidarone ? |
Sheild skin from light during treatment and for several months after stopping treatment use wide spectrum sunscreen |
|
|
|
What is the important safety information relating to sotalol? |
Can prolong QT interval can occasionally cause life threatening ventricular arrhythmias take care to avoid hypokylaemia in patients taking sotalol electrolyte disturbance correct hypokylaemia and hypo magnesium before treatment |
|
|
|
What are the signs and symptoms of digoxin toxicity and what is the treatment and list monitoring |
Treatment - digoxin specific antibody fragments Symptoms -nausea vomiting irregular heart beat fast heart beat vision changes For plasma-digoxin concentration assay, blood should be taken at least 6 hours after a dose. Monitor serum electrolytes and renal function. Toxicity increased by electrolyte disturbances. |
|
|
|
What is the range that digoxin toxicity increases? |
1.5-3.00 mcg/L hypoklyaemia increase risk of digoxin toxicity which can be managed by giving a potassium sparing diuretic such as spironlactone or potassium supplements |
|
|
|
When switching digoxin form Iv route to oral route how is the dose affected |
Dose needs to be increase by 20-33% to maintain the same digoxin concentration |
|
|
|
What is the dose for tranexamic acid when used for menorrhagia? |
1g three times a day for up to 4 days |
|
|
|
What is nimodipine used for ? |
Subarachnoid haemorrhage |
|
|
|
What is epoprostenol used for |
For blocked catheter and lines is it is a prostaglandin and a poten vasodilator and inhibitor of platelet aggregation it has a short half life of 3 minutes so given by continus iv infusion
Inhibition of platelet aggregation during renal dialysis when heparins are unsuitable or contra-indicated Treatment of primary pulmonary hypertension resistant to other treatments, |
|
|
|
Prophylaxis with anti embolism stocking should be continued for how long in patients who have spinal injury/ elective spinal injury or cranial surgery |
30 days |
|
|
|
Which anticoagulation is preferred in patients with renal impairment |
Heparin infractionated |
|
|
|
How long should pharmacological prophylaxis be continued in general surgery |
For at least 7 days post surgery |
|
|
|
How long prophylaxis needed for major cancer surgery in abdomen |
28 days For spinal injury 30 days |
|
|
|
What thromoprophylaxis is given to patients under going elective hip replacement |
Give a lmwh for 10 days followed by low dose aspirin for further 28 days or lmwh given for 28 days with anti embolism stockings or Rivaroxaban |
|
|
|
what prophylaxis against VTE given for elective knee replacement |
Low dose aspirin 14 days Or lmwh for 14 days in combo with anti embolism stockings until discharge or rivaroxaban |
|
|
|
What prophylaxis is suitable for pregnant women and how long should it be continued in women who have given birth had miscarriage or termination of pregnancy in past 6 weeks |
Lmwh given 4-8 hours after event and carried on for 7 days |
|
|
|
If haemorrhage occurs with lmwh or unfraftionated heparin what is the treatment |
Protamine sulfate but only partially reversed the effects lmwh |
|
|
|
A patient comes in with ischaemic stroke how will this be managed? |
Give aspirin 300mg for 14 days and then clopidogrel 75mg indefinitely If clopidogrel is contraindicated then you can give can give Mr dipyridamole in combination with aspirin After 48 hours a high intensity statin should be started to |
|
|
|
How long does vitamin K antagonists such as warfarin phenonidone acenocoumarol take to work |
48-72 hours for anticoagulant effect to fully work if immediate effect is required then lmwh or unfractionated heparin should be used |
|
|
|
Target INR 2.5 recommended for what |
Treatment of DVT/PE AF Dilated cardiomyopathy Myocardial infarction Cardio version (target INR should be achieved 3 weeks before cardio version) and anticoagulation be continued for 4 weeks after procedure |
|
|
|
What is the target INR for recurrent DVT and PE in patients currently receiving anticoagulation and with INR above 2 |
3.5 |
|
|
|
What is healthy INR in normal individuals |
Below 1.1 INR range beetween 2-3 is good for people taking warfarin |
|
|
|
How long should warfarin be given for isolated calf vein DVT |
6 weeks |
|
|
|
How long is warfarin given for vte provoked by surgery or other transient risk factors such as combined oral contraceptive pregnancy using a plaster cast |
Give warfarin for 3 months |
|
|
|
The higher the INR the higher the bleeding risk if a patient is suffering from major bleeding due to anticoagulants what needs to be done ? |
Stop warfarin sodium give phytomeninadone by slow iv injection / give dried prothrombin complex |
|
|
|
If INR is 8 which is high but there is miner bleeding how is this treated ? |
Stop warfarin given phytomenadione by slow iv injection repeat dose of phytomenidone if INR is still high after 24 hours and restart warfarin when INR is below 5 |
|
|
|
If inr is 8 but there is no bleeding what should be done |
So warfarin should be stopped phytomenidone is given but not iv it is given orally as there is no bleeding risk and then restart warfarin once inr is below 5 |
|
|
|
If inr is beetween 5-8 and no bleeding what should be done |
So warfarin doesn’t need to be stopped permanently now only with hold 1-2 doses as inr is beetween 5-8 withholding 1/2 does will help go down and reduce the subsequent maintenance dose |
|
|
|
Before elective surgery how many days before is warfarin stopped? |
Stopped 5 days before if INR is still above 1.5 give phytomenidone orally the day before surgery Warfarin can be restarted at normal dose on evening of surgery or next day |
|
|
|
How long before surgery should lmwh be stopped and when it should be restarted |
Stopped 24 hours before hand if surgery Carries high risk of bleeding then wait 48 hours after surgery |
|
|
|
Heparin |
Lmwh - long duration of action examples dalterparin enoxaparin tinzaparin also have a low risk of thrombocytopenia doesn’t require anticoagulant monitoring once daily injection is Okah due to long duration of action Unfractionated heparin - rapid but short duration of action |
|
|
|
What is epoprostenol used for |
Inhibit platelet aggregation during renal dialysis can also be use for primary pulmonary hypertension resistant to other treatment has a short duration of action 3 mins so needs to be given repeatedly |
|
|
|
Which anti-platelets are given to patients following pci intervention |
Dual anti-platelet therapy with aspirin and either cangrelor clopidogrel prasugrel or ticagrelor aspirin should continue indefinitely |
|
|
|
Aspirin is contraindicated under 16’s and why and in which case can it be given to under 16? |
Contraindicated due to risk of Reye’s syndrome but can be given for Kawasaki disease |
|
|
|
What are the signs and symptoms of salicylate poisoning? |
Hyperventilation Tinnitus Deafness Vasodilation Sweating Coma indicates severe poisoning |
|
|
|
What is the prescribing and dispensing information relating to dipyridamole? |
Modified release capsules should be dispensed in original container and any capsules remaining should be discarded 6 weeks after opening |
|
|
|
What is the Usual apixaban dose ? |
For knee replacement surgery - 2.5mg bd for 10-14 days start 12-24 hours post surgery For hip replacement surger 2.5mg bd for 28-32 days start 12-24 hour post surgery |
|
|
|
What is the dose of apixaban in DVT and pe |
Initially 10mg Bd for 7 days then 5mg bd for maintenance |
|
|
|
What is the dose of edoxban for DVT and PE |
Body weight up to 61kg - 30mg once daily 61kg + - 60mg once daily When taken with erythromycin/ dronedarone/ circlosporin / ketoconazole dode should be reduce to 30mg |
|
|
|
What is the dose of rivaroxaban for dvt/pe |
Initially 15mg BD for 21 days then Maintenance 20mg once daily to be taken with food for duration of treatment |
|
|
|
What is the clinic blood pressure target of diabetics with hypertension |
135/85mmhg or less |
|
|
|
What is the 1st line treatment for patients who have HTN and Diabetes ? |
Ace/Arb regardless of age If black African Caribbean then give arb 1stline |
|
|
|
What is the 1st line treatment for patients who have HTN and Diabetes ? |
Ace/Arb regardless of age If black African Caribbean then give arb 1stline |
|
|
|
What is chronic hypertension in pregnancy? |
When hypertension begins in pregnancy in the 1st 20 weeks of gestation |
|
|
|
What is the 1st line treatment for patients who have HTN and Diabetes ? |
Ace/Arb regardless of age If black African Caribbean then give arb 1stline |
|
|
|
What is chronic hypertension in pregnancy? |
When hypertension begins in pregnancy in the 1st 20 weeks of gestation |
|
|
|
What is gestational hypertension? Pre eclampsia |
When hypertension occurs after 20 weeks gestation |
|
|
|
What are the symptoms of pre eclampsia |
Severe headache problems with vision severe pain below ribs vomiting and sudden swelling of hands feet’s or face and proteinuria and BP greater then 140/90mmhg |
|
|
|
Women with hypertension in pregnancy who are at high risk are given what |
Aspirin from 12 weeks of pregnancy till the baby is born |
|
|
|
What is the 1st line second line treatment for hypertension in pregnancy? |
Oral labetalol to Achieve a Bp below 135/85mmhg if this is unsuitable consider nifedipine Mr and if both are unsuitable consider methyldopa |
|
|
|
What is the recommended treatment for hypertension in breast feeding women? |
Enalapril If black or African Caribbean offer nifedipine or amlodipine if one drug alone doesn’t work offer a combination of 2 if this still not effective swap one of the medications for labetalol or atenolol |
|
|
|
Women who are taking methydopa for hypertension during pregnancy should discontinue this how long before giving birth? |
2 days before birth and switch to an alternative treatment |
|
|
|
When is hydralizine use and why isn’t it given alone? |
Use as an adjunct to treatment for severe resistant hypertension not given alone due to it can cause fluid retention and tachycardia |
|
|
|
When is hydralizine use and why isn’t it given alone? |
Use as an adjunct to treatment for severe resistant hypertension not given alone due to it can cause fluid retention and tachycardia |
|
|
|
Why is minoxidil not given to women ? |
Minoxidil is used for severe hypertension resistant to other drugs can’t be used in women due to hypertrichosis ( excessive hair growth) |
|
|
|
Before starting ace inhibitors what should be measured ? |
Renal function and electrolytes |
|
|
|
What is the main side effect of ace inhibitor patients have Problems with? |
Cough due to breakdown of bradykinin |
|
|
|
What is the monitoring required for methydopa and what cautions? |
Used for hypertension caution in use in patients who have depression Monitor blood counts and live functions tests before treatment and at intervals during 6-12 weeks or if unexplained fever occurs |
|
|
|
Which BB are less likely to cause bradycardia and coldness of extremities ? |
COPA celioprolol , oxorenolol, acebutolol, pindolol |
|
|
|
Which BB are water soluble and less likely to cause sleep disturbances and nightmares ? |
CANS Celioprolol Atenolol Nadalol Sotalol |
|
|
|
Which BB are water soluble and less likely to cause sleep disturbances and nightmares ? |
CANS Celioprolol Atenolol Nadalol Sotalol |
|
|
|
Which Bb have long duration of action and require once daily dosing? |
Banc Bisoprol , atenolol, nadalol , celioprolol |
|
|
|
BB cause bronchospasm so should be avoided in asthmatic patients if they are given a selective Bb should be given list some examples ? |
MANBA Metoprolol, atenolol, bisoprolol, nebivolol, acebutolol |
|
|
|
What are the side effects of BB? |
Fatigues coldness of the extremities sleep disturbances affect carbohydrate metabolism hyperglycaemia bradycardia confusion abdominal discomfort dry eyes dysopnea rash synocope (fainting or passing out) Over dose treatment - atropine if excess bradycardia occurs when given IV over dose can cause light Headness dizziness and bradycardia |
|
|
|
Which BB can be given for thyrotoxicosis? |
Propanolol |
|
|
|
What is the most common side effect of verapamil ? |
Constipation |
|
|
|
What are the side effects of calcium channel blockers |
Flushing headache dizziness ankle swelling palpations gingival hyperplasia myalgia synocope |
|
|
|
Which 2 ccb should be prescribed by brand name ? |
Diltiazem when above 60mg and nifedipine as modified release preparations vary |
|
|
|
Thiazide and related diuretics should be used in caution in who? |
Diabetes / gout / systemic lupis erythematosis |
|
|
|
What is the MHRA safety alert relating to hydrochlorothiazide? |
There is a risk of non melanoma skin cancer advice patients to report any new unchanged skin lesions or moles limit exposure to sunlight and uv rays |
|
|
|
What is sodium nitroprusside indicated for ? |
Hypertensive emergencies Monitor Bp and blood cyanide concentration of treatment exceeds 3 days and blood thiocyanite concentration |
|
|
|
Wha are the signs and symptoms of HF |
Shortness of Breath, persistent coughing, wheezing, ankle swelling, reduced exercise tolerance and fatigue Signs - pulmonary oedema, pulmonary crackles, elevated jugular venous pressure |
|
|
|
What is the New York heart association used for ? |
Define the progression of chronic HF according to severity of symptoms and limitations to physical activity |
|
|
|
What vaccinations are recommended for chronic HF |
Pneumococcal and annual influenza vaccination |
|
|
|
How long after discontinuing ace inhibitor should you wait before starting enteresto? |
Wait 36 hours after discontinuing ACE inhibitor |
|
|
|
Why should statins be avoided with fibrates? |
Increase risk of rhabdomylosis Especially with gemfibrozil and statin these should never be given together |
|
|
|
Which statins are High intensity |
Atorvastatin (20/40/80) Rosuvastatin (10/20/40/80) Simvastatin (80mg) |
|
|
|
Which statins are High intensity |
Atorvastatin (20/40/80) Rosuvastatin (10/20/40/80) Simvastatin (80mg) |
|
|
|
Which statins are medium intensity and list their strengths? |
Atorvastatin 10mg Fluvastatin 80mg Rosuvastatin 5mg Simvastatin 20/40mg |
|
|
|
Which statins are High intensity |
Atorvastatin (20/40/80) Rosuvastatin (10/20/40/80) Simvastatin (80mg) |
|
|
|
Which statins are medium intensity and list their strengths? |
Atorvastatin 10mg Fluvastatin 80mg Rosuvastatin 5mg Simvastatin 20/40mg |
|
|
|
Which statins are low intensity ? |
All pravastin strengths 10/20/40 Simvastatin 10mg Fluvastatin 20mg |
|
|
|
How do statins work? |
They inhibit 3- hydroxy-3 methlyglutaryl coenzyme (HMG Coa) reductase |
|
|
|
Who should statins be used in caution with? |
History of alcohol intake Hypothyroidism (should be managed before starting a statin) Risk of muscle toxicity Family history or history of muscular disorders High alcohol intake |
|
|
|
What are the side effects of statins? |
Asthenia/ constipation/ diarrhoea flatulence dizziness myalgia / sleep disorders thrombocytopenia |
|
|
|
What advice regarding contraception is given for statins? |
Adequate contraception is needed during treatment and for one month afterwards avoid statins in pregnancy |
|
|
|
What monitoring is required for statins ? |
One full lipid profile (non fasting) total cholesterol HDL cholesterol non hdl cholesterol triglyceride concentrations TSH and renal function liver function liver enzymes should be measured before treatment and repeated within 3 months and at 12 months of starting treatment if serum transaminases are 3x the upper limit should discontinue statin treatment If there is unexplained muscle pain before treatment creatinine kinase should me measured if concentration is 5x upper normal limit a repeat Measurement should be taken after 7 days if it remaines 5x then don’t start it Diabetes - patients at high risk of diabetes should have fasting blood glucose concentration of HBa1c checked before statin treatment and then every 3 months |
|
|
|
What dose of atorvastatin is recommended for primary and secondary prevention of cardiovascular events don’t get confused with aspirin! |
Primary prevention 20mg Secondary prevention 80mg |
|
|
|
If statins are taken with circlosporin what is the max dose that can be given of atorvastatin? |
Max 10mg daily |
|
|
|
What is the max dose of simvastatin when taken with bezafibrate or ciprofibrate |
10mg daily |
|
|
|
When can simvastatin be sold otc ? |
Simvastatin 10mg max pack size of 28 tablets to reduce the risk of first coronary event in individuals who are at moderate risk |
|
|
|
When should omega 3 acid ethyl esters be taken and list side effects |
Taken with food Side effects burping constipation Gi discomfort nausea vomiting |
|
|
|
Which statins can be taken during the day? |
Atorvastatin and rosuvastatin |
|
|
|
Which statins can be taken during the day? |
Atorvastatin and rosuvastatin |
+ arrrrAdd a hint |
|
|
Which statins must be taken at night |
Simvastatin pravastatin and fluvastatin |
|
|
|
How are acute attacks of stable angina treated ? |
Sublingual glyceryl trinitrate can be used before performing an activity known to bring on an attack long term prevention Bb used 1st line 2nd line ccb diltiazem or verapamil if one alone fails to work can give BB and ccb 3rd line ling acting nitrate can be given |
|
|
|
Who is ranolazine used in caution with ? |
Body weight less than 60kg moderate to severe congestive HF Qt prolongation |
|
|
|
What is the main side effect of nicorandil? |
Can cause serious skin mucosal and eye ulceration including GI disorders which may progress to perforation haemorrhage fistula or abscess stop treatment if occurs |
|
|
|
What are the side effects of nitrates? |
Flushing, headache, postural hypotension asthenia hypotension with elderly first dose can cause postural hypotension avoid abrupt withdrawal |
|
|
|
What are the cautions with nitrates |
Tolerance can develop when patients are on long acting or transdermal nitrates leading to reduced therapeutic effects reduction of blood nitrate concentrations to low levels for 4-12 hours each day maintains effectiveness of tolerance is suspected when using transdermal patches they should be left of for 8-12 hours usually overnight in modified release preparations the second of the 2 daily doses should be given after 8 hours rather than 12 hours |
|
|
|
How is GTN given sublingually? |
400–800 micrograms, to be administered under the tongue and then close mouth, dose may be repeated at 5 minute intervals if required; if symptoms have not resolved after 3 doses, medical attention should be sought.
1 tablet, dose may be repeated at 5 minute intervals if required; if symptoms have not resolved after 3 doses, medical attention should be sought. |
|
|
|
How often are glyceryl trinitrate patches changed? |
One ‘5’ or one ‘10’ patch to be applied to lateral chest wall, upper arm, thigh, abdomen, or shoulder; increase to two ‘10’ patches every 24 hours if necessary, to be replaced every 24 hours, siting replacement patch on different area. |
|
|
|
How long after should GTN tablets be discarded once opened ? |
Rectal ointment should be discarded 8 weeks after first opening.
tablets should be supplied in glass containers of not more than 100 tablets, closed with a foil-lined cap, and containing no cotton wool wadding; they should be discarded after 8 weeks in use. |
|
|
|
How is cardiopulmonary resuscitation treated? |
Adrenaline / epinephrine - 1mg every 3-5 mins as required 1 in 10,000 solution recommended |
|
|
|
Which thiazide diuretic has the longest duration of action and can be given on alternate days? |
Chlortalidone |
|
|
|
Which thiazide diuretic has the longest duration of action and can be given on alternate days? |
Chlortalidone |
|
|
|
Furosemide and bumetanide are loop diuretics how long do they take to work ? |
Work within 1 hour and diuresis is complete within 6 hours so can be given twice daily |
|
|
|
What is acetazolamide used for? |
Mountain sickness is it also a weak diuretic |
|
|
|
When simvastatin is taken with amlodipine/ diltiazem/ verapamil / amidarone / ranolazine what is the maximum dose |
20mg |
|
|
|
What is the interaction between carbamazepine and amlodipine ? |
Can reduce exposure to amlodipine |
|
|
|
What are the side effects of thiazide like diuretics ? |
Hypoklyaemia Hyponotraemia Hyperglycaemia ( that’s why it’s sued in caution in patients with diabetes ) Postural hypotension |
|
|
|
When should indapamide be taken ? |
Should be taken in the morning as it may increase urination |
|
|
|
What are the side effects of spironlactone |
Hypertrichosis (excessive hair growth) Gynaecomastia Alooecia Hyperkylaemia |
|
|
|
What is the interaction between spironolactone and lithium? |
It can increase lithium levels |
|
|
|
What is the usual dose of spironolactone for hypertension and when should it be taken |
25mg OD should be taken with food |
|
