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14.03.06 Revision notes

Dihydropyridine calcium-channel blockers
  • Nifedipine
    • More affinity for vascular smooth muscle
    • Value in Raynaud's disease
    • Rarely precipitates heart failure: negative inotropic effects offset by reduction in afterload
  • Nicardipine
    • Similarly effective on smooth muscle
    • Used for angina prophylaxis and hypertension
  • Amlodipine and felodipine
    • Do not adversely affect myocardial contractility (with the risk of heart failure)
    • Longer duration of action than nifedipine
    • Useful in hypertension and angina
    • Valuable in angina associated with coronary vasospasm
    • Side-effects relate to vasodilatation and may improve after a few days (headache, flushing)
  • Isradipine, lacidipine and lercanidipine
    • Similar in effect to nifedipine but only indicated for hypertension
  • Nimodipine
    • Similar to nifedipine but has an enhanced, selective effect on the cerebral arteries
    • Useful for cerebral artery spasm and it is used solely for this purpose after subarachnoid haemorrhage (to prevent ischaemic deficit)


Antihypertensives in pre-eclampsia

  • Should be started in women with a systolic blood pressure over 160 mm Hg or a diastolic blood pressure over 110 mm Hg
  • Labetalol (PO/IV), nifedipine (PO), hydralazine (IV)
  • Avoid: Atenolol, ACEi, ARBs, Diuretics


Anterior mediastinal mass

  1. Thymus
  2. Teratoma (germ cell)
  3. Thyroid
  4. Terrible Lymphoma


Notes
  • Nicorandil
    • Dual action: Nitrate, plus causes K+ efflux => Hyperpolarisation
  • Don't use LABAs in children under 5 - Straight to LRA
  • Chlamydia treatment is given on the basis of exposure to infection rather than proven infection
  • Boerhaave's syndrome = The 10% of oesophageal perforations which occur due to vomiting
  • Titubation = Disturbance of body equilibrium in standing or walking, resulting in an uncertain gait and trembling, especially from diseases of the cerebellum
  • Quinolones (cipro) => Tendinopathy

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