1
Q
what are the 4 types of CVD?
A
- coronary heart disease
- strokes & transient ischaemic attacks
- peripheral arterial disease
- aortic disease
2
Q
what is primary prevention?
A
strategies that identify & alter modifiable risks to reduce incidence in disease-free pop.
3
Q
what is secondary prevention?
A
strategies that target individuals w/ established disease, usually have already had an event
4
Q
what is risk stratification?
A
• strategies used in primary care to identify potential patients
• estimate regularly >40s
• full formal assessment when risk 10% or higher
• use Q-risk
5
Q
what is coronary heart disease?
A
when arteries become narrowed by an atheroma
6
Q
what is acute coronary heart syndrome?
A
- when rupture/erosion of atherosclerotic plaque & subsequent thrombus formation
- thrombus because of platelet aggregation under high stress
7
Q
what is an ischaemic stroke/transient ischaemic attack?
A
when blockage because blood clot lodge in vessel narrowed by atheroma
8
Q
what is peripheral arterial disease?
A
- when build up of fatty deposits in arteries & restrict blood flow to leg muscles
- cause intermittent tiredness = claudication
9
Q
what treatments are required for arrhythmias?
A
- to control heart rhythm & rate to prevent cardiac arrest
- prophylactic to prevent stroke
10
Q
what is different in treatment of AF compared to treating arrhythmias?
A
- stagnation of blood in atria & incomplete ventricular emptying = clot formation
- strokes affect larger part of the brain & more likely fatal/leave bed ridden
- antiplatelets less effective = use anticoagulants
11
Q
what are 3 examples of ACS?
A
- unstable angina
- NSTEMI
- STEMI
12
Q
what is unstable angina?
A
- partial/transiently obstructive thrombus
- ischaemia, no necrosis
13
Q
what is an NSTEMI?
A
- partial/transiently obstructive thrombus
- ischaemia w/ necrosis
- partial thickness damage
14
Q
what is a STEMI?
A
- complete obstruction by intracoronary thrombus
- ischaemia w/ necrosis
- full thickness damage
15
Q
what are some symptoms of ACS?
A
- chest pain & pain in other parts
- sweating
- SOB
- lightheaded & dizzy
- nausea & vomiting
- anxiety & panic
- coughing & wheezing
16
Q
angina can be exacerbated and alleviated by?
A
- worse after food, cold winds, exercise, stress
- better after GTN, rest
17
Q
what are some ACS symptoms only found in women?
A
- heartburn
- cold sweats
18
Q
what are some ACS red flags?
A
- chest pain >15-20 mins
- recent onset unstable angina
- unresponsive GTN, w/ nausea, vomiting & sweating
19
Q
what are the differences between electrocardiograms taken for ACS conditions?
A
[ unstable angina & NSTEMI ]
- ECG can be normal
- may see ST depression/T-wave inversion
- no ST elevation
[ STEMI ]
- elevation ST
20
Q
what is cardiac troponin & what levels are considered?
A
- biological marker of cardiac muscle death
- normal = <14 ng/L
- if >14 ng/L = myocardial damage/necrosis
- if elevate 1st sample, repeat >3hrs later & rise >7 ng/L is likely MI
21
Q
what are some differential diagnosis for ACS?
A
- acid reflux
- pulmonary embolism
- anaemia
22
Q
what is treatment for angina for symptom relief?
A
[ 1st line ] - GTN spray
[ 2nd line ] - GTN sublingual spray
23
Q
what is treatment for angina for symptom prevention?
A
[ 1st line ] - BB or CCB
- if persist - BB + CCB
- if CI BB & CCB = add 2nd agent
[2nd line ] - long-acting nitrate/ Ivabradine/ Nicorandil
24
Q
what is treatment for angina for 2ndary prevention?
A
- aspirin
- statin
- ACEi
- hypertension treatment & lifestyle advice
25
what is used as initial management to treat unstable angina & NSTEMI?
- aspirin
- ticagrelor/ clopidogrel/ prasugrel
- LMWH = enoxaparin/ fondaparinux
[ to consider ] - O2 therapy, pain management, anti-sickness, hyperglycaemia
26
what is used as 2ndary prevention to treat unstable angina & NSTEMI?
- aspirin
- ticagrelor/ clopidogrel/ prasugrel
- ACEi
- statin
[ to consider ] - GTN spray for prophylaxis, hypertension treatment & lifestyle advice
27
what is the process of neural regulation?
via baroflex mechanisms
- baroreceptors in aorta send signal CV centre in brain = control vagus nerve
- brain send signal = change cardiac activity
- change heart contraction, HR & CO
28
what is the process of hormonal regulation w/ low BP?
- release renin = angiotensinogen to angiotensin I
- release ACE = angiotensin I to angiotensin II
- angiotensin II = potent vasoconstrictor & stimulate release aldosterone from adrenal cortex
29
what factors are affected by hormonal regulation?
- Na+ reabsorption
- osmotic pressure
- H2O reabsorption
- intravascular volume
- venous return
- CO
30
what is the process of hormonal regulation w/ high BP?
- stop release renin = block conversion angiotensinogen & no aldosterone release
31
what effect has erythropoietin w/ low BP?
- low O2 = trigger EPO release
- stimulate red bone marrow to produce RBC = increase O2 transport
- EPO is a vasoconstrictor = blood viscosity, resistance and pressure
32
what effect do catecholamines have w/ low BP?
- release by adrenal medulla
- vasoconstriction = increase HR & force of contraction
33
what effect do ADH and AUP w/ low BP?
- ADH secreted by hypothalamus & transporter to posterior pituitary = store until nervous stimuli
- ADH signal kidney reabsorb H2O & increase fluid level = constrict peripheral vessels & restore blood volume and pressure
34
what effect does ANP/ANH have w/ high BP?
- extreme stretching cardiac cells trigger ANP release; secreted atria cells
- natriuretic hormones = angiotensin II antagonists & promote Na+/H2O loss from kidneys; suppress renin, aldosterone & ADH release
- promote fluid loss = decrease blood volume & BP
35
what kind of information does the pulse give?
- heartbeat rhythm & heartbeat contraction; pulsatile volume and strength
- regular; regular irregular; irregular irregular
- weak, faint, strong and bounding
36
how is blood pressure measured?
- relaxed, temperate setting w/ person seated, arm outstretched and supported
- use both arms if significant difference > 15mmHg & use higher side for readings
- in-clinic > 140/90 = take other reading; if different again, take 3rd reading & record lower 2nd & 3rd
- 140/90 to 180/20; offer ABPM/HBPM
- BP > 180/20 = urgent treatment
37
what are some extra tests used for hypertension diagnosis?
assess for target organ damage
- haematuria & HbA1C for diabetes
- urine albumin:creatinine & examine fundi
- electrolytes, creatinine & eGFR for chronic kidney disease
- 12-lead ECG for left ventricular hypertrophic & assess CVD-risk w/ Q-risk
38
what should the patient be informed of when diagnosed for hypertension?
- absolute CVD risk & benefits/harms intervention in 10-year period
- present absolute event risk numerically
- use diagrams & text
39
what are the steps of full history taking?
- introduction
- presenting complaint
- history of presenting complaint
- past medical/surgical history
- family history
- social history
- drug history
- systems review
40
what should be involved in social history?
- alcohol intake
- tobacco use
- recreational drug use
- employment history
- home situation
- travel history
41
what is involved in drug history?
- confirm name & dose = prescribed, OTC, vitamins, supplements & herbal medicines
- borrowed, recently started, stopped & changed
- compliance
- allergies
42
what are the different types of metabolisers?
- poor metabolisers
- normal metabolisers
- rapid metabolisers
- ultra-rapid metabolisers
43
what are some BBs side effects?
- fatigue
- cold extremities
- low pulse
44
what are factors that affect ADME?
[ genetic polymorphisms ]
- SNPs
- tandem repeats
- micro-satellites
- insertions & deletions
45
what are some drugs to be avoided with ACEi?
[ Aliskiren ]
- risk of renal impairment
[ Allopurinol ]
- risk hypersensitivity & haematological reactions
[ Azathioprine ]
- risk anaemia & leukopenia
[ Everolimus ]
- increased risk angioedema
46
what are some adverse effects of thiazide-like diuretics?
- postural hypotension
- hyperglycaemia
- hypokalaemia
- cardiac arrhythmias
- metabolic alkalosis
- dehydration
- hyponatremia
47
what are some contraindications of thiazide-like diuretics?
- refractory hypokalaemia
- hyponatraemia
- hypercalcaemia
- Addison’s disease
- pregnant women
- severe liver & renal impairment
48
what are some contraindications of CCBs?
- uncontrolled HF
- AV block
- unstable angina/recent MI
- hepatic & renal impairment
- pregnant/breastfeeding
- grapefruit
49
what are ACE inhibitors?
- target production angiotensin II = act on AT1 receptor; adrenergic innervations; release ADH
- block vasoconstriction & aldosterone release
50
what are the effects of ACEi?
[ arterial & venous vasodilation ]
- decrease arterial & venous pressure
- decrease ventricular preload & after load
[ decrease blood volume ]
- natriuresis
- diuresis
- down regulation sympathetic activity & suppression hypertrophy
51
what are some rare adverse effects of ACEi?
- hyperkalaemia = aldosterone
- taste disturbance = zinc in ACEi
- hypotension
- renal impairment
- angioedema
52
what are some clinical considerations with ACEi?
- cough = class effect
- hypotension = combine low-dose diuretics
[ dehydration ] = suspend
- diarrhoea & vomiting
- postural hypotension
- acute kidney disease
53
what are some renal risk assessments for ACEi?
- beneficial chronic kidney failure & hypertension
- monitor serum creatinine, electrolytes & eGFR
- periodically assess renal function
- discontinue bilateral renal artery stenosis
54
when are ACEi avoided?
- 55 or less
- caribbean/black african origin = decrease response renin-dependent BP regulation
- pregnant & breastfeeding
55
what are some adverse effects of ARBs?
- hyperkalaemia = aldosterone
- renal impairment
56
how do BBs work?
- block sympathetic effect
- adrenaline bind B-1 receptor & increase heart activity = BB block receptor
- prolong PR interval = decrease SA & AV nodes automaticity
57
what are the effects of BBs?
[ cardiac ]
- contractility
- relaxation rate
- HR & conduction velocity
[ vascular ]
- mild smooth muscle contraction
58
what are some adverse effects of BBs?
- bradycardia
- bronchoconstriction
- cardiac depression
- hypoglycaemia
59
what are some cautions w/ BBs?
- pre-existent bradycardia
- conduction defect
- HF
- cardio-selective CCBs
60
how do CCBs work?
- block Ca2+ channels
- reduce contraction force & smooth muscle contraction
61
what is the effect of dihydropyridines and non-dihydropyridines?
[ dihydropyridines ] = amlodipine
- vascular effect
- vascular smooth muscle relaxation
[ non-dihydropyridines ] = verapamil & diltiazem
- cardiac effect
- reduce contraction force & HR
- reduce conduction velocity
62
what are some side effects of dihydropyridines?
[ oedema ]
- CCB dilate arteries but veins constricted
- capillary overload forces fluid into surrounding tissue
[ reflex tachycardia ]
- baroreceptor reflex
63
what are some side effects of non-dihydropyridines?
- bradycardia
- AV node block = impaired electrical conduction; Ca2+ channels located in electrical nodes
- contractility = cardiac depression
64
what are some clinical considerations for thiazide-like diuretics?
- potassium supplements
- potassium-sparing diuretics
- avoid ACEi = hyperkalaemia
65
how do thiazide-like diuretics work?
- moderately powerful = indapamide
- block Na+/Cl- symporter of early DCT = inhibit Na+ active reabsorption & Cl- transport = H2O reabsorption
- promote natriuresis & diuresis
66
how do aldosterone receptor antagonists work?
- antagonise mineral corticoid receptors
- prevent insertion Na+/K+ ATPase pumps & ENAC channels in late DCT & CD
- spironolactone & eplerenone
67
how do Na+ channel blockers work?
- block apical ENAC in late DCT & CD
- decrease influx Na+
- Na+ not retained at expense K+
- amiloride & triamterene
68
what are the 2 states of solid?
[ crystalline ]
- polymorphous; solvates & hydrates; co-crystals
- molecules packed in defined order
- cool slowly to below melting point & between melt and freeze
[ amorphous ]
- unstructured ice
- molecules packed in random order
- rapid solidification/precipitation & glassy and rubbery
- moisture sensitive
69
what is polymorphism?
- different molecular arrangements in crystal lattice
- difference = molecule orientation/conformation in lattice sites
70
how is x-ray diffraction used to differentiate between crystals?
- characteristic pattern of diffraction angles & intensity diffracted beam = planes of crystal
- crystalline = high intensity & narrow peaks
- amorphous = low intensity & broad peaks
- polymorphic = median intensity & narrow peaks
71
how does hydration occur in crystal lattices?
- small molecular size H2O
- multi-directional H-bonding capability
72
how is the salt form better than other crystal forms?
- increase solubility
- increase dissolution
73
what is a co-crystal?
- 2 or more molecules in same crystal lattice in definite stoichiometric ratio
- not based ionic bonds
= sildenafil & aspirin
74
what are some primary powder properties and their effects?
[ particle size ] & [ shape ]
- content uniformity
- flow & mixing
[ surface area ]
- dissolution rate
75
what are some secondary powder properties and their effects?
[ density ]
- tablet/capsule size
[ porosity ]
- compressibility
- permeability/H2O uptake
[ flowability ]
- content uniformity
[ compressibility ]
76
how are small & irregular particles measured?
- 3D size impractical
- only 1 dimension used
77
how is the surface area of irregular particles measured?
- Brunauer-Emmett-Teller theory (BET theory)
- powder filled into vacuum-sealed chamber
- small amounts N2 added & adsorb to powder surface until entire surface and pores covered
- pressure transducers sense gas amount adsorbed = used calculate SA
78
what are 4 equivalent diameters for sedentary particles?
- projected perimeter diameter & projected area diameter
- feret's diameter & martin's diameter
- sieve diameter
- diameter of equivalent volume/SA/mass sphere
79
what are 3 equivalent diameters for moving particles?
[ stoke's diameter ]
- sphere w/ same density & settling velocity as particle
[ aerodynamic diameter ]
- sphere w/ same density & terminal velocity in air/any relevant fluid as particle
[ hydrodynamic diameter ]
- sphere w/ same density & settling velocity that diffuses at same rate in liquid as particle
80
what are the different dimensions and types of particle shapes?
- 1D = acicular & rod-shaped
- 2D = flaky & dendritic
- 3D = porous, angular/irregular; spherical & rounded
81
how good is the flowability of each type of particle shape?
- spherical & rounded = good & easy mix
- acicular; rod-shaped & angular/irregular = tend interlock = increased mechanical strength
- flaky = cohesive effect because greater SA
82
what drugs often cause interactions?
[ problematic ]
- enzyme inducers & inhibitors
- PGP protein inducers/inhibitors & chelating agents
[ long half lives ]
[ overdose/underdose ]
- narrow therapeutic windows
- therapeutic drug monitoring
- critical medications
83
what are some resources used for drug interactions?
- BNF = paper, mobile & web app
- drug SPC
- Stockleys
84
what are some drugs that cause absorption issues?
- calcium-containing products = Adcal & Calchichew
- aluminium-containing antacids = Gaviscon & Peptac
- chelating agents = doxycycline, alendronic acid & levothyroxine
85
what are some drugs that affect distribution?
- sodium valproate
- phenobarbital
- phenytoin
- carbamazepine
- warfarin
86
what are the steps of phase 2 in metabolism?
- conjugation
- acetylation
- sulfation
87
what are some metabolism inducers?
- carbamazepine
- rifampicin
- phenobarbitone
88
what are some metabolism inhibitors?
- sodium valproate
- ketoconazole
- erythromycin/clarithromycin
89
how is excretion affected by drug interactions?
- via glomerular filtration & active tubular secretion
- site competition = interactions when eliminated via same active transport mechanism in PT
- elim. w/ low affinity to transport protein = drug accumulation
- urine pH can also affect reabsorption
90
what are some PGP inducers/inhibitors?
- apixaban
- colchicine
- ciclosporin
- dabigatran
- digoxin
- tacrolimus
91
what affects warfarin effect?
[ increase ]
- grapefruit/pomegranate/cranberry
- large acute alcohol
[ decrease ]
- green leafy vegetables/egg yolks/chickpeas
- chronic heavy alcohol
92
what are MAOI?
- monoamine oxidase inhibitors
- antidepressant w/ frequent interactions
93
what should be avoided w/ MAOI?
- tyramine-rich & dopa-rich foods
= mature cheese; salami & alcohol
- only fresh food products
- continue 2-3 weeks after stopping = long half life
94
how does grapefruit juice affect ADME?
- inhibit CYP 3A4 isoenzyme
- statins; CCBs & antibiotics
95
what are patients at higher risk of interactions?
- elderly = less renal & liver function
- children = underdeveloped metabolising systems
- w/ co-morbidities
- polypharmacy
96
what is heart failure diagnosis based on?
- signs & symptoms
- patient history
- blood levels NT-proBNP
- ECG
- exercise tolerance test
- transthoracic echocardiography
97
what are some other tests used to confirm HF?
- full bloods
- thyroid function tests
- chest x-ray
- peak flow test
98
what is HF?
- increased pressure in heart & inadequate cardiac output
- due to left ventricular & myocyte dysfunction from MI
- progressive & no cure
99
what are the features of HF?
[ fatigue ]
- low CO = low O2
[ oedema ]
- pulmonary & peripheral
- fluid retention; increase heart pressure affect pulmonary vessels & failing kidneys
[ breathlessness ]
- dyspnoea & orthopnea
- lying down redistribute oedema on lungs
- patient sleep w/ multiple pillows (3+)
100
what is NT-proBNP and its function?
- released response pressure changes in heart
- less 400ng/L = less likely HF
- more 2000ng/L = poor prognosis
- used monitor progress HF
101
what may decrease levels of NT-proBNP?
- obesity
- african-caribbean
- current treatment ACEi/ARBs/mineral corticoid receptor antagonists
102
what may increase levels of NT-proBNP?
- age > 70
- LV hypertrophy
- renal dysfunction
- sepsis
- COPD
- diabetes
- ischaemia
103
how is severity of HF graded?
- NYHA functional classification system
- symptoms alone & show effect functional ability & QoL
104
what is preserved EF?
- preserved Ejection Fraction
= more 40%
- preserving EF = slow deterioration
105
how is HF with preserved EF treated?
- loop diuretic & titrate
- relieve congestive symptoms & fluid retention
- 1st line = ACEi & BB
- add in = mineralcorticoid receptor antagonists
106
what is the future treatment for HF?
- SGLT2 inhibitors = dapaglifozin/empaglifozin
- symptomatic HF w/ reduced EF
[ only add optimised care by HF specialist ]
- ACEi/ARB & BB & MRA
- Entresto & BB & MRA
107
what is used to control symptoms in palliative care?
[ breathlessness ]
- repeated small dose opioids
- oramorph
[ pain ]
- opioids PO or SC
- morphine/oxycodone
[ anxiety ]
- midazolam = help agitation
[ N&V ]
- depends trust & other meds = cyclizine
[ secretions ]
- prevent death rattle = hyoscine hydrobromide
108
what is palliative care?
- optimise QoL & reduce suffering in patients w/ life-threatening conditions
- symptom control = make comfortable
- honour patient wishes & family informed trajectory
109
how is acute/decomposed HF treated in 2ndary care?
- IV diuretics = bolus/infusions furosemide
- risk ototoxicity & renal impairment
- stable 48 hours = stop IV & re-start meds
- monitor renal function, electrolytes, HR & BP
110
what is some lifestyle advice for HF patients?
- regular exercise & physically active
- sleep & careful hidden salts
- balanced diet & health weight
- lower alcohol & smoking
- eligible flu vaccine
111
what is a cardiac rehab programme for HF patients?
- personalised, exercise-based programme for stable HF
- exercise training = increase tolerance & QoL
- include psychological & education component
112
how is HF treatment monitored?
- assess functional capacity; fluid status; cardiac rhythms
- cognitive & nutritive status
- assess renal function & other Us and Es
- monitor NT-proBNP
- teach patient recognise symptoms change & alert HP
113
what if optimal drug management doesn't work for a HF patient?
- w/ severe refractory symptoms = cardiac transplant
- if older & co-morbidities = unlikely consider
- referral specialist centre & waiting list
- complications = life-long immunosuppression; risk rejection & graft failure
114
what is the CVS disease continuum?
- endothelial dysfunction
- atherosclerosis
- ischaemia
- coronary artery disease
- thrombosis & lesion rupture
- myocardial infarction
- reduced contraction
- ventricular dilation & remodelling
- heart failure
- death
115
what can affect endothelial dysfunction?
- hypertension
- dyslipidemia
- diabetes mellitus
- smoking
116
how does ischaemia occur?
- thicken internal surface arteries & atherosclerotic lesions
- block & affect O2 supply heart muscles
117
what are the troponin levels for angina, NSTEMI & STEMI?
stable & unstable = no change troponin
NSTEMI = changes troponin
STEMI = rise troponin
118
how does NO cause vasodilation?
- endothelial cells release NO
- NO stim. cytoplasmic guanylyl cyclase
- elevate intracellular cGMP
- activate protein kinase G
- smooth muscle relaxation = vasodilation
- PDE isoform breaks down cGMP
119
what are the features of systemic circulation?
- venous dilation > arterial dilation
- decreased venous pressure
- decreased arterial pressure = small effect
120
what are the features of cardiac circulation?
- reduced preload and afterload = decreased wall stress
- decreased O2 demand
121
what are the features of coronary circulation?
- prevent/reverse vasospasm
- vasodilation epicardial vessels
- improve subendocardial perfusion
- increased O2 delivery
122
what are nitrates used for and what types are there?
- acute attacks/ preventative measures
- direct = nitroglycerin & sodium nitroprusside
- organic = isosorbide dinitrate & mononitrate
123
what are the 2nd line antianginal drugs?
- IF current inhibitors = ivabradine
- Class ID sodium-channel blocker = ranolazine
- Potassium channel activator = nicorandil
124
what are the 3 types of antithrombotic drugs and their functions?
- anticoagulants = prevent thrombus formation
- antiplatelets = prevent platelet aggregation
- fibrinolytics = clot retraction
125
what are the 2 types of oral anticoagulants?
- vitamin K antagonist = warfarin
[ direct oral anticoagulant ]
- reversible factor Xa inhibitor = apixaban; edoxaban & rivaroxaban
- reversible thrombin inhibitor = dabigatran
126
what class is aspirin and its function?
- COX-inhibitor
- low dose irreversibly inhibit thromboxane in platelets = decrease platelet aggregation
- in endothelial cells, aspirin inhibit prostaglandins = increase platelet aggregation
127
what are glycoprotein IIb/IIIa inhibitors and 2 example types?
- prevent platelet aggregation by block binding fibrinogen to receptor on platelet
- abciximab
- eptifibatide & tirofiban
- specialists only & administer i.v. hospital & high risk bleeding
128
what are the 2 example types of tissue plasminogen activators?
- streptokinase
- alteplase; reteplase & tenectplase
129
what are the features of alteplase, reteplase & tenectplase?
- synthetic recombinant
- highly-selective fibrin-bound plasminogen = clot selective
- reteplase & tenectplase = longer half-life alteplase
130
which drugs does warfarin interact with?
- macrolide antibiotics; azole antifungals; H2 receptor antagonists = breakdown warfarin
- NSAIDs; broad-spectrum antibiotics = kill gut flora and vitK synthesis = potentiate warfarin
131
what are some adverse effects of warfarin?
- bleeding
- skin necrosis
132
what are the adverse effects of HUF & LMWH?
- haemorrhage
- heparin-induced thrombocytopenia/ low platelet
- hyperkalaemia
133
how is haemorrhage stopped for HUF & LMWH?
- withdraw HUF/ LMWH
- if rapid reversal of heparin effects needed = protamine sulfate
- spec. antidote = neutralise/inactivate heparin but only partially reverse effect LMWH
134
what are the 3 classes of drugs used to treat hyperlipidaemia?
- HMG-CoA reductase inhibitors = statins
- cholesterol absorption inhibitors = ezetimibe
- fibrates = fenofibrate & gemfibrozil
- anion exchange resins = colestyramine
135
what are high number of small LDLs associated with?
- hypertriglyceridemia
- low HDL levels
- obesity - type 2 diabetes
- infectious & inflammatory states
136
what are adverse reactions due to statins?
- GI disturbances
- skeletal muscle myopathy
- myalgia
- myositis w/ rhabdomyolysis
137
how do K+ channel blockers work?
- block outflow K+
- prolong QT interval = prolong refractory period & AP duration
138
what are the 3 types of familial hyperlipidaemia?
- combined hyperlipidaemia
- hypercholesterolaemia & polygenic hypercholesterolaemia = high chol. content
- hyperapobetalipoproteinemia = high levels apolipoprotein B
139
what are the three arrhythmias that are treated with anti-arrhythmic drugs?
- supraventricular arrhythmias
- both supraventricular & ventricular arrhythmias
- ventricular arrhythmias
140
what does CHAD2DS2-VASC stand for?
- Congestive failure (1)
- Hypertension (1)
- Age (65-74 =1) (+75 = 2)
- Diabetes (1)
- Stroke/TIA (2)
- Vascular disease (1)
- Age (")
- Sex (females = 1)
141
which DOAC to use if no renal impairment/active cancer/ antiphospholipid syndrome/haemodynamic instability
- apixaban/rivaroxaban
- LMWH (5 days) then dabigatran/edoxaban
142
how to monitor for DOACs
Factor Xa
143
how to reverse heparin
protamine
144
how to reverse warfarin
vitamin K (phytomenadione)
145
how to reverse rivaroxaban
andexanet
146
how to reverse dabigatran
idarucisumab
147
drugs that cause hyperkalaemia
- co-trimoxazole
- trimethoprim
- ACEi
- ARB
- K+ sparing diuretics
- Heparin
148
side effects of warfarin
- calciphylaxis = painful skin rash
- abnormal hepatic function
149
drugs that cause hypokalaemia
- theophylline
- nebulised salbutamol
150
what is the CYP enzyme involved in warfarin metabolism
CYP2C9
151
what are the water-soluble BBs
- atenolol
- sotalol
152
which BBS are given once daily and are cardio-selective
- atenolol
- bisoprolol
Pharmacy 201
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