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