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Drugs > 1MB Cardio > Flashcards

1MB Cardio Flashcards

1
Q

Examples of ACE inhibitors

A

Ramipril
Lisinopril
Quinapril

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2
Q

How does Ramipril work?

A

Inhibit ACE conversion of angiotensin I to angiotensin II.

Angiotensin II is a vasoconstrictor, therefore ACE Inhibitors reduce blood pressure secondary to vasodilatation.

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3
Q

When to use an AC inhibitor such as Lisinopril

A 
Combined with thiazide-like diuretics and CCBs as anti-hypertensive agents
In patients under 55.
Heart failure
Left ventricular dysfunction
Post MI or CHD
Stroke prevention
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4
Q

Side effects of ACE inhibitors

A 
Dry, irritant cough 
(due to accumulation of bradykinin)
- Angioedema
- Hyperkalaemia (due to potassium retention, mediated by reduction of aldosterone)
-Renal dysfunction
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5
Q

Contraindications for durgs like Ramipril

A
  • Renal dysfunction in patients with renal artery stenosis

- Avoid in women with child bearing potential due to danger of foetal renal maldevelopment

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6
Q

Why would you prescribe an ARB instead of an ACE inhibitor?

A

If a patient suffers from the side effect of a dry cough as a consequence of taking an ACE inhibitor

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7
Q

Give examples of ARBs

A

Losartan
Valsartan
Eprosartan

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8
Q

What is the mechanism of action of losartan and valsartan?

A

Antagonise angiotensin II. Prevents vasoconstriction, aldosterone release and sympathetic activation.
Results in BP reduction secondary to vasodilation.

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9
Q

When to use an ARB

A

Combined with thiazide-like diuretics and CCBs as anti-hypertensive agents under 55.
ACEI intolerance
Type 2 Diabetic nephropathy

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10
Q

Side effects of drugs like eprosartan

A

Hyperkalaemia due to potassium retention mediated by reduction of aldosterone

  • Impairment of renal function
  • Dizziness and syncope
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11
Q

Contraindications of ARBs

A
  • Renal dysfunction in patients with renal artery stenosis

- Avoid in women with child bearing potential due to danger of foetal renal maldevelopment

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12
Q

Verapamil and dilitizem and examples of?

A

Rate limiting calcium channel blockers

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13
Q

How do rate limiting calcium channel blockers such as verapamil work?

A

Vasodilators with balance of actions as such that these drugs have noticeable cardiac effects including reduced heart rate

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14
Q

When to use verapamil/dilitizem

A

Anti-hypertensives in combination with ACEIs/ARBs
Anti-arrhythmic:
Tachyarrhythmias such as AF
Post myocardial infarction

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15
Q

Side effects of rate limiting calcium channel blockers

A
  • Bradycardia and AV conduction delay

- Constipation with verapamil

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16
Q

Contraindications of rate limiting calcium channel blockers like verapamil

A
  • Negatively chronotropic and inotropic, so should be used with caution in combination with beta-blockers
  • Heart block and heart failure
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17
Q

Examples of calcium channel blockers that are dihydropyridines

A

Amlodipine
Nifedipine
Felodipine

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18
Q

How do dihydropyridine calcium channel blockers work?

A

Anti-hypertensive with pronounced peripheral vasodilator properties and reflex cardiac stimulation overcomes any direct cardiac effects

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19
Q

When to use drugs such as amlodipine

A

Anti-hypertensives in combination with ACEIs/ARBs
Hypertension in the elderly
Angina

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20
Q

Side effects of amlodipine

A
  • Headache and flushing
  • Tachycardia and palpation (due to reflex activation of sympathetics)
  • Ankle oedema (and occasionally hands)
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21
Q

GTN is an example of?

A

Nitrates

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22
Q

How does GTN work?

A

Relax all types of smooth muscle (via metabolism to nitric oxide)

Cause veno-relaxation (decreasing preload), arteriolar dilation (decreased afterload), and increased coronary blood flow

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23
Q

Use of GTN

A

Angina – reduces myocardial oxygen requirement
Sublingual spray or tablet (short-acting/first-pass metabolism)
Can be used in acute angina attack or prophylactically
In combination with aspirin in acute coronary syndrome

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24
Q

Side effects of nitrates like GTN

A

Postural hypotension headaches

GTN Syncope can cause dizziness

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25
Q

Isosorbide mononitrate is an example of?

A

Nitrates

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26
Q

How does isosorbide mononitrate work?

A

Relax all types of smooth muscle (via metabolism to nitric oxide)
Cause veno-relaxation (decreasing preload), arteriolar dilation (decreased afterload), and increased coronary blood flow

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27
Q

Use of isosorbide mononitrate

A

Oral administration for angina for sustained effect (long-acting/resistance to first-pass metabolism)

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28
Q

Side effects of isosorbide mononitrate

A

Postrural hypotension, headaches

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29
Q

Examples of potassium channel openers

A

Minoxidil, nicorandil

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30
Q

How does minoxidil

A

Cause hyperpolarization, switching off L-type Ca channels. Acts on arterial smooth muscle, resulting in relaxation.

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31
Q

When to use minoxidil

A

in severe hypertension

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32
Q

Side effects of minoxidil

A

Reflex tachycardia, (prevented by beta-blocker) and salt and water retention (alleviated by diuretic)

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33
Q

How does nicorandil work?

A

Cause hyperpolarization, switching off L-type Ca channels. Acts on arterial smooth muscle, resulting in relaxation.

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34
Q

When to use nicorandil

A

used in angina refractory to other treatments

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35
Q

Side effects of alpha 1 adrenoreceptor antagonists

A

Postural hypotension

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36
Q

Prazosin and doaxazosin are to be used when?

A

Indicated for hypertensive patients with prostatic hyperplasia

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37
Q

How do alpha 1 adrenoreceptors work?

A

Cause vasodilation by blocking vascular adrenoceptors.

Reduced sympathetic transmission results in decreased MABP.

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38
Q

Examples of selective B1 beta blockers

A

Atenolol
Bisoprolol
Metroprolol

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39
Q

How do drugs like atenolol work?

A

Blocks B1 adrenoceptors on SAN

Slows heart rate, decreases workload on heart muscle.

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40
Q

Use of selective beta blockers

A

Angina
Hypertension
Heart failure

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41
Q

Side effects of bisoprolol and other drugs of its kind

A

Tiredness
Can worsen heart failure in short term
Cold peripheries

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42
Q

When should you be cautious when using selective B1 adrenoreceptor blockers?

A

Insulin-dependent diabetes – beta-blockers can mask hypos and their symptoms (as sympathetic nervous system is repressed)

43
Q

An example of a non-selective beta blocker

A

Propanolol

44
Q

How does propranolol work?

A

Decreases rate of depolarization in SAN and AVN

45
Q

When to use propanolol

A

Anti-arrhythmic

Thyrotoxicosis

46
Q

Side effects on non-selective beta blockers

A

Worsening of claudication (stops vasodilation in skeletal muscle vessels)

Bronchospasm in asthmatics
Cold peripheries
Tiredness

47
Q

Why might you be cautious about using propranolol?

A

Insulin-dependent diabetes – beta-blockers can mask hypos and their symptoms (as sympathetic nervous system is repressed)
COPD patients may not be able to use treatment

48
Q

Digoxin works by?

A

Stimulates vagal activity on the heart

Slows conduction and prolongs refractory period in AV node

49
Q

When might you give digoxin?

A

IV or oral for atrial fibrillation

50
Q

What can occur if too high a dose of digoxin is prescribed?

A

Heart block

51
Q

Adenosines mechanism of action?

A

Activates A1-adenosine receptors.
Opens ACh-sensitive K+ channels
Hyperpolarizes the AVN, suppressing impulse conduction

52
Q

Use for adenosine

A

Used to terminate paroxysmal supraventricular tachycardia (PSVT)

53
Q

An example of a thiazide diuretic

A

Bendroflumethiazide

54
Q

Bendroflumethazides mechanism

A

Increase secretion of Na, Cl and water, decreasing blood volume and the MABP.
Inhibits reabsorption in the distal tubule of NaCL

55
Q

When to use bendroflumethiazide

A

Anti-hypertensive -Moderate diuresis
Mild or congestive heart failure
Hypertension
Severe resistant oedema (with a loop agent)

56
Q

Side effects of thiazide diuretic like bendroflumethiazide

A 
Hypokalaemia (tired)
Arrhythmias
Hyperglycaemia
Increased uric acid (gout) – due to greater attraction o uric than OACS
Impotence
57
Q

Why might you be cautious about bendroflumethiazide?

A

Loss of potassium can cause hypokalaemia
Avoid in patients with gout history
Avoid in diabetic patients

58
Q

Examples of a loop diuretic

A

Furosemide and spironolactone

59
Q

Mechanism of furosemide

A

Increase secretion of Na, Cl and water, decreasing blood volume and the MABP.
Inhibits reabsorption of NaCl in the loop of Henle.

60
Q

When to use furosemide

A

Anti-hypertensive - Strong diuresis
Acute pulmonary oedema (IV)
Chronic or congestive heart failure

61
Q

Spironolactone mechanism

A

Aldosterone blocker. Therefore blocks sodium and re-abosorption.

62
Q

When to use spironolactone

A

Anti-hypertensive

63
Q

Side effects of furosemide

A 
Hypokalaemia (tired)
Arrhythmias
Hyperglycaemia
Increased uric acid (gout) – same reason as thiazides 
Impotence
64
Q

Why would you swap a thiazide diuretic for a loop?

A

Hypokalaemia causing tiredness in a patient - loop is potassium sparing. Specifically swap for spironolactone not furosemide.

65
Q

Side effects of spironolactone

A

Hyperkalaemia

‘Moobs’ - Gynaecomastia

66
Q

Why might you be cautious when using furosemide - a loop diuretic?

A

Loss of potassium can cause hypokalaemia
Avoid in patients with gout history
Avoid in diabetic patients

67
Q

Warfarin is?

A

Anti-coagulant

68
Q

How does warfarin work?

A

Structually related to vitamin K, prevents its action of conversion. Factors remain inactive.

69
Q

When to use an anti-coagulant such as warfarin

A

Treatment of DVT or PE, transient ischaemic attacks and prophylaxis of embolization

70
Q

Side effects of warfarin

A

It drug interactions

71
Q

Why should you be cautious when prescribing warfarin to a patient?

A

Risk of haemorrhage at high dose (low therapeutic index)

Dietary vitamin K can decrease warfarin action

72
Q

As well as warfarin, give a further four examples of anti-coagulants.

A

Heparin, LMWHs, rivaroxiban, and dabigatran.

73
Q

How does heparin work?

A

Heparin inhibits factor Xa and thrombin IIa. LMWHs inactivate factor Xa.

74
Q

When to use heparin

A

Heparin is preferred in renal failure patients due as LMWHs are excreted via renal excretion.

75
Q

Side effects of heparin and LWMHs

A

Haemorrhage
Osteoporosis
Hypoaldosteronism
Hypersensitivity reactions

76
Q

How does rivaroxiban work?

A

Xa inhibitor

77
Q

When to use rivaroxiban and dabigatran

A

Oral administration for prophylaxis of venous thromboembolism, or treatment of PE or DVT.
Usually used after hip or knee replacement

78
Q

Side effects of rivaroxiban

A

Haemorrhage and renal impairment

79
Q

Contraindications of rivaroxiban

A

Avoid in liver disease with coagulopathy

NO WAY OF REVERSING if patients are actively bleeding

80
Q

Action of dabigatran

A

Thrombin inhibitor

81
Q

Side effects of dabigatran

A

Haemorrhage and anaemia

82
Q

Contraindications for dabigatran

A

Do not use in patients under 50kg

83
Q

Examples of anti-platelets

A

Aspirin
Clopidogrel
Tirofiban

84
Q

Mechanism for anti-platelets such as clopidogrel

A

Irreversibly blocks cycloygenase (COX) in platelets, preventing TXA2 synthesis.

85
Q

When to use anti-platelets

A

Aspirin - Used orally main for thrombo-prophylaxis in patients with high cardiovascular risk
Copidogrel – in aspirin-intolerant patients
Tirofiban – preventative of MI in unstable angina patients

86
Q

Side effects of anti-platelets

A

GI bleeding and ulceration

87
Q

Fibrinolytic examples

A

Alteplase
Duteplase
Streptokinase

88
Q

Action of streptokinase and other drugs of its kind

A

Opposes the coagulation cascade. Reopen occluded arteries in acute MI or stroke.
Dissolve clots via activation of plasminogen.

89
Q

When to administer fibrinolytics

A

Administered IV in as short a period as possible of the event
More beneficial with aspirin

90
Q

Side effects of alteplase and drugs derived from the same family

A

Do not cause allergic reactions

Haemorrhage

91
Q

Specifically, what is the common action between clopidogrel and aspirin

A

They both prevent platelet aggregation

92
Q

Aspirin specifically is used when

A

Immediate STEMI or ACS with NSTEMI Treatment: 300mg, chewable.
Preventative of athero-thrombotic events

93
Q

Aspirin can cause

A

Bronchospasm, GI irritation , haemorrhage

94
Q

Contraindications for aspirin

A

Asthma and uncontrolled hypertension

95
Q

When specifically should you prescribe clopidogrel

A

Immediate STEMI or ACS with NSTEMI Treatment:
300mg
Preventative of athero-thrombotic events
(it is the same as aspirin)

96
Q

Side effect of clopidogrel

A

haemorrhage

97
Q

What should be prescribed alongside morphine

A

anti-emetic

98
Q

Give a property of morphine

A

It has vasodilator properties

99
Q

When to administer morphine

A

Administered to relieve pain and anxiety, reducing the tachycardia caused by MI.

100
Q

Examples of statins

A

Atrovastatin
Fluvastatin
Pruvastatin

101
Q

Mechanism of statins

A

HMG CoA reductase inhibitors

Lower total and LDL cholesterol

102
Q

When to prescribe statins

A

Reduce cardiovascular disease events – used in primary and secondary prevention

103
Q

Side effect of statins

A

Myopathy - rare

104
Q

Contraindications for statins

A

Avoid in pregnancy – cholesterol is essential for normal foetal development

Drugs (3 decks)

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