Introduction

 Cardiology MedicationsIntroductionThis is by no means an exhaustive list, but it attempts to highlight the medications that you will be prescribing on a regular basis in the future and likely to be in your exams. I have separated it into conditions with a few more breakdown details. The medications/interventions that are to be aware of only are in italics.Acute Coronary SyndromeAcute chest pain:Dual anti-platelet therapyGenerally ticagrelor & aspirin (loading doses 180 mg and 300 mg respectively)Sometimes you will see clopidogrel (300 mg loading dose, then 75 mg OD). This is generally used when the patient is already on an anti-coagulantPrasugrel – if patient not tolerant to other agentsNitratesGTN sprayFor unstable angina, patients may be commenced on a nitrate infusion before angiographyDiamorphine (or morphine) IVOxygen (if SpO2 <94%)FondaparinoxPrognostic benefit:Beta-blocker (be cautious in right coronary disease)Metoprolol (shorter half-life, usually BD/TDS, can be given IV BUT EXTREMELY POTENT)BisoprololCarvediololACE inhibitor/ARBStatinAtorvastatin 80 mg (or 40 mg in renal impairment)If atorvastatin is not tolerated, try rosuvastatinSimvastatin/pravastatin should be changed (high rates adverse events, which are idiosyncratic and can happen at any time)Dual anti-platelet therapy for 12 months, then life-long aspirinConsider PPI cover (specifically lansoprazole 15-30 mg OD) if prescribing aspirin life longer. Cardiac FailureAcute:Furosemide IV (in acute/flash pulmonary oedema doses of 80-300 mg are likely to be required)Diamorphine IVNitrate IVOxygenChronic (note most of the big trials were on heart failure with a reduced ejection fraction):Prognostic benefitBeta-blocker (metoprolol/bisoprolol/carvediolol)ACE inhibitor/ARBAldosterone antagonist (spironolactone/epleronone)Entresto (valsartan/sacubitiril) – newest CCF medicationsCardiac resynchronisation devices (dual ventricular pacemaker) – in selected patients onlySymptomatic reliefLoop diuretics (furosemide/bumetanide)Thiazide diuretics (bendroflumethiazide/metalazone)DigoxinIvabradineEpleronone has fewer oestrogen effects than spironolactone so might be consider in men with gynaecomastia.Bumetanide is better absorbed than furosemide when there is an element of gut oedema. Furosemide 40 mg = Bumetanide 1 mg.ArrhythmiasRhythm control:DC cardioversion if unstable/VT with poor prognostic signs (see resus council guidelines: )Flecainide (no structural heart disease, for recurrent supraventricular tachycardias)AmiodaroneSotalol (now rarely used, complex mechanism of action)Rate control:Beta-blockers (metoprolol/bisoprolol/carvediolol)Calcium channels blockers (diltiazem/verapamil) – tend to have more profound effects on blood pressure and do not have the cardiac remodelling effects of beta-blockers. DO NOT PRESCRIBE WITH BETA-BLOCKERSDigoxin (avoid in the young/active)Ivabradine – only in sinus rhythms (useful as an adjunct in angina to get the HR 60-70 or as a single agent when blood pressure is an issue)Anti-coagulationDOACs (apixaban/rivaroxaban/dabigatan) – not licensed for use with mechanical heart valvesWarfarinLow molecular weight heparin – useful in bridging peri-operative period or in oncology, where DOACs are not licenced and warfarin control in problematic ................
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