Examples of Intrinsic Sympathomimetic Activity (ISA) beta blockers?
PACO
Pindolol
Acebutolol
Celiprilol
Oxprenolol
What do ISA beta-blockers do and what are their properties?
- STIMULATE & BLOCK beta receptors
- LESS BRADYCARDIA
- LESS coldness of extremities
Water-soluble beta blockers?
CANS
Celiprolol
Atenolol
Nadolol
Sotalol
Which beta blockers are cardio selective?
MAN-B
Metoprolol
Atenolol
Nebivolol
Bisoprolol
Common side effects of beta blockers?
- Fatigue
- Coldness of extremities
- Sleep disturbances / nightmares
- Mask symptoms of HYPOglycaemia
Contraindications and cautions of beta blockers?
- 2nd or 3rd degree heart block
- worsening UNSTABLE heart failure (caution with STABLE)
- avoid in patients with history of asthma or bronchospasm
- avoid in patients with frequent episodes of hypoglycaemia
VTE Treatment?
LMWH (1st line)
UFH (2nd line)
Continue for >/5 days + INR >2 for 24 hours
Start oral anticoagulant (e.g. warfarin) at SAME TIME
Can heparins be used in pregnancy?
- YES as do not cross placenta
- LMWH preferred
(reduced risk of osteoporosis and heparin - induced thrombocytopenia)
TIA Treatment?
1) ASPIRIN 300mg STAT until diagnosis established
2) CLOPIDOGREL (2nd line)
Start secondary prevention once diagnosis confirmed
Ischaemic Stroke - Treatment?
1) ALTEPLASE within 4.5 HOURS
2) ASPIRIN 24hrs after thrombolysis / ASAP within 48hrs if no thrombolysis
Are anticoagulants recommended for stroke?
No - except in patient with AF
TIA/ Ischaemic Stroke - long term management?
1) CLOPIDOGREL 75mg OD
OR
MR DIPYRIDAMOLE + ASPIRIN
OR
MR DIPYRIDAMOLE / ASPIRIN ALONE
2) WARFARIN / ANTICOAGULANTS for patients with AF
3) Initiate STATIN after 48 hours
4) MONITOR BP - target <130/80mmHg
* Dont use B-Blockers for hypertension following stroke unless indicated for co-existing condition*
5) Lifestyle Advice
Haemorrhagic stroke - treatment?
- usually requires SURGERY to remove haematoma
- DONT GIVE ANTICOAGULANTS (even in AF)
- AVOID STATINS (unless benefit > risk)
- STOP/REVERSE anticoagulants ( Vit K / Protamine ) - EXCEPT pts with DVT/PE
When would you have a target INR of 3.5?
1) RECURRENT DVT/PE with patients already receiving anticoagulation + their INR >2)
2) mechanical prosthetic heart valve
Which combination has highest risk of bleeding?
1) Aspirin + Warfarin
2) Clopidogrel + Warfarin
2) Clopidogrel + Warfarin
High risk of hyperlipidaemia?
- Diabetes
- CKD
- Family history
- > / 85yrs (esp smokers / hypertension)
- 10 year risk of CVD >10%
Is aspirin recommended for primary or secondary prevention of CVD?
Secondary (already established CVD)
Signs of DIGOXIN TOXICITY
G - GI disturbance (diarrheoa/n&v)
A - Arrhythmias / heart block
S - Skin reactions
V - Vision (yellow/blurred)
If life-threatening: DIGOXIN-SPECIFIC ANTIBODY
RATE CONTROL
B-Blocker
Verapamil
Diltiazem
If monotherapy fails: can combine
❌ B-Blocker + Verapamil ❌
Can use digoxin
RHYTHM CONTROL
FAB RHYTHM (after cardioversion)
1) B-Blocker
2) Amiodarone / Flecainide
HIGH RISK VTE
- reduced mobility
- obesity
- malignant disease
- history of VTE
- > 60yrs
- pregnancy / post-partum
- thrombophilic disorder
HEART FAILURE
- ACE/ARB + B-Blocker
- Add spironolactone / eplerenone
Loop diuretics - for fluid overload
Thiazides in mild HF
What to look out for in blood tests when diagnosing HF?
- B-type Natriuretic Peptide (BNP)
- pro-B-type Natriuretic Peptide (NT-proBNP)
⬆️ in HF!
How long before elective (planned) surgery do you need to stop warfarin?
5 days
