Cardiac Flashcards
1
Q
what type of drug is aspirin
A
anti-platelet
2
Q
how does aspirin work
A
- decreases platelet accumulation and inhibits thromboxane, decreasing platelet aggregation
- inhibits cyclooxygenase 2, decreasing prostaglandins, decreasing pain and inflammation
3
Q
when is aspirin used
A
ACS, secondary prevention for CV syndromes, AF, angina
4
Q
contraindications for aspirin
A
- children under 16 - Reyes Syndrome
- Haemophilia
- Peptic ulcers
- NSAID hypersensitivity
5
Q
side effects of aspirin
A
GI disturbance, GI ulcers, bleeds, bronchospasm
6
Q
possible interactions with aspirin
A
alcohol - GI bleeds
ibuprofen - reverses anti-platelet effects
corticosteroids - decreases aspirin concentration
7
Q
what type of drug is clopidogrel
A
anti-platelet
8
Q
when is clopidogrel used
A
prevention of atherosclerosis for people with PAD, ACS, secondary prevention, prevents stunts from occluding, AF, when aspirin is contraindicated
9
Q
contraindications for clopidogrel
A
active bleeding
10
Q
side effects of clopidogrel
A
GI disturbance, GI / intracranial bleeds
11
Q
possible interactions for clopidogrel
A
antifungals/virals/bacterials/depressants/epileptics - decrease clop effect
analgesics increase risk of bleeding
anticoags - increases effect
12
Q
how is clopidogrel eliminated
A
liver
13
Q
how does clopidogrel work
A
decreases platelet aggregation and thrombus formation in arterial circulation
14
Q
example of thrombolytic
A
alteplase / streptokinase
15
Q
how does streptokinase works
A
dissolves clots
- activates plasminogen to form plasmin, decreases fibrin and breaks down thrombi
16
Q
when is streptokinase used?
A
acute MI, DVT, PE
17
Q
contraindications for streptokinase
A
haemorrhage, trauma or recent surgery
18
Q
side effects of streptokinase
A
N&V, bleeding
19
Q
possible interactions for streptokinase
A
antiplatelet/anti-coags - bleeding complications
20
Q
how is streptokinase eliminated
A
hepatic
21
Q
what type of drug is heparin
A
Anti-coag
22
Q
examples of heparin
A
enoxaparin / fondaparinux
23
Q
how does heparin / enoxaparin work
A
binds to and accelerates the activity of antithrombin III, decreasing co-factor 5a, decreasing prothrombin, decreasing thrombin, decreasing fibrin clot formation
24
Q
when is enoxaparin used
A
DVT, PE, ACS - unstable angina to decrease clot progression
25
when is enoxaparin contraindicated
bleeding / clotting disorders, severe hypertension, renal failure, surgery or trauma
26
side effects of enoxaparin
haemorrhage, hyperkalaemia, heparin induced thrombocytopenia (HIT
27
possible interactions of enoxaparin
antiplatelets increase effect, ACEi increase risk of hyperkalaemia
28
how is heparin eliminated
renal
29
what type of drug is warfarin
oral anti-coag
30
how does warfarin work
inhibits vitamin K dependent clotting factors
31
when is warfarin used
VTE, AF to prevent PE, prosthetic valves
32
contraindications for warfarin
pregnancy (teratogenic), patients at risk of bleeding
33
side effects of warfarin
bleeding / haemorrhage
34
possible interactions of warfarin
NSAIS / aspirin increases bleeding risk, abx increase effect, hypothyroid decreases effect and hyperthyroid increases effect
35
target INR for patients taking warfarin
2-3
36
what is INR
international normalised ratio
37
examples of statins
simvastatin, atorvastatin
38
how do statins work
HMG-CoA reductive inhibits - these are enzymes which help to produce cholesterol (decreases LDL and increases HDL)
39
when are statins used
- primary prevention of CVS events in patients >40 with >10% Q-risk off stroke
- secondary prevention on CVS events
- hyperlipidaemia
- hypercholesterolaemia
40
contraindications for statins
- liver disease
- renal impairment
- pregnancy
- hypersensitivity
- breastfeeding
41
side effects of statins
- dizziness and headaches
- GI disturbance
- muscle problems (myopathy, rhabdomyolysis, myalgia)
42
possible interactions of statins
- cytochrome P450 inhibitors such as amiodarone as these decrease the metabolism of statins
43
example of loop diuretics
furosemide
44
how does furosemide work
inhibits the Na+/K+/2Cl channel in the ascending loop of Henle, leading to decreased water reabsorption
45
when is furosemide used
- CCF
| - to help breathlessness in pulmonary oedema and oedema due to other things like renal/hepatic impairment
46
contraindications for furosemide
- hypovolaemia / dehydration
- AKI (not CKD)
- hypokalaemia / hyponatraemia
- hepatic encephalopathy (worsens hypokalaemia which increases risk of coma)
47
side effects of furosemide
- increase urge to pass urine
- low electrolytes
- tinnitus / hearing loss
- GI disturbance
- dehydration
- metabolic alkalosis
48
possible interactions of furosemide
- aminoglycosides, digoxin other drugs excreted by the kidney
49
how is furosemide eliminated
kidneys
50
example of thiazide diuretics
bendroflumethiazide, indapamide
51
how do thiazide diuretics work
inhibit the Na/Cl pump on the convoluted tubule of the nephron, decreasing water reabsorption
52
when are thiazide diuretics used
HF, hypertension (either with calcium channel blockers or instead of when they are contraindicated)
53
contraindications for thiazide diuretics
hypokalaemia, hypovolaemia, dehydration, hyponatraemia, gout
54
side effects of thiazide diuretics
hypokalaemia, hyponatraemia, gout, arrhythmias, impotence, GI disturbance, postural hypotension
55
possible interactions of thiazide diuretics
NSAIDS decrease their effectiveness
56
how do potassium sparing diuretics work
Inhibits effect aldosterone by competitively binding with the aldosterone receptor, thus increasing sodium and water excretion and increasing potassium retention
57
what type of drug is spironolactone
aldosterone antagonist
| potassium sparing diuretic
58
when is spironolactone used
- ascites and oedema due to liver cirrhosis
- chronic heart failure
- primary hyperaldosteronism
59
contraindications for spironolactone
hyperkalaemia, Addison's disease (low aldosterone), pregnancy, breastfeeding
60
side effects of spironolactone
- hyperkalaemia
- gynaecomastia
- liver impairment --> jaundice
61
possible interactions of spironolactone
potassium elevating drugs such as ACEi and potassium supplements
62
how is spironolactone eliminated
hepatic
63
examples of beta blockers
bisoprolol, atenolol, propanolol
64
how do beta blockers work
- blocks beta adrenoreceptors on the heart, leading to decreased conductivity and so decreased contractility, leading to decreased heart rate
- prolongs refractory period at the AV node
65
when are beta blockers used
- Ischaemic heart disease (angina, ACS)
- AF
- hypertension
- supraventricular tachycardia (SVT)
66
when are beta blockers contraindicated
- asthma
- COPD (specific B1 blockers like bisoprolol can still be used)
- heart failure
- haemodynamic instability
- hepatic failure
- heart block
67
side effects of beta blockers
- GI disturbance (nausea)
- sleep disturbance
- headache
- impotence
- cold extremities
- bronchospasm / exacerbation of asthma
- fatigue
68
possible interactions of beta blockers
veramapil: non-dihydropyridine calcium channel blocker - this can lead to heart failure, bradycardia and asystole
69
where are B1 receptors located
cardiac muscle
70
where are B2 receptors located
smooth muscle of blood vessels and airways
71
example of calcium channel blockers
amlodipine, verapamil
72
difference between amlodipine and verapamil
amlodipine is a dihydropyridine and focusses more on vasculature whilst verapamil is a non-dihydropyridine and focusses more on cardiac function
73
how do calcium channel blockers work
block calcium channels, inhibiting calcium influx into the cardiac muscle and vasculature, resulting in relaxation and vasodilation
- causes decreased myocardial contraction, especially at the AV node, decreasing oxygen demand
74
when are calcium channel blockers used
- hypertension
- supra ventricular arrhythmias
- angina
75
when are calcium channel blockers contraindicated
poor left ventricular function, unstable angina, aortic stenosis AV node delay
76
side effects of calcium channel blockers
flushing, ankle oedema, headache, palpitations, bradycardia, constipation, heart block, heart failure, chronic cough
77
possible interactions of calcium blockers
beta blockers with non-dihydropyridine calcium channel blockers - this could lead to bradycardia, heart failure or asystole
78
example of ACEinhibitor
ramipril
79
how do ACEi work
- inhibit angiotensin converting enzyme which prevents angiotensin I from converting into angiotensin II
- angiotensin II causes vasoconstriction and stimulates aldosterone production
- blocking angiotensin II stops vasoconstriction so causes a decreases in peripheral vascular resistance
- also decreased levels of aldosterone increases water and sodium excretion
80
when are ACEi used
HTN, CCF, IHD, diabetic nephropathy and CKD
| - used as either a treatment of preventor
81
contraindications of ACEi
- aki
- renal artery stenosis
- breastfeeding
82
side effects of ACEi
- hyperkalaemia
| - persistent dry cough
83
possible interactions of ACEi
- NSAIDS as this can increase risk of renal failure
- potassium sparing diuretics
- potassium increasing drugs or supplements
84
examples of angiotensin II receptor antagonist
losartan
85
how do AT1 blockers work
similar to ACEi
- inhibit angiotensin II from binding to its receptor
- inhibiting vasoconstriction - causing vasodilation
- inhibiting aldosterone production, thus increasing water and sodium excretion
86
when are AT1 blockers used
hypertension, CCF, IHD, diabetic nephropathy and CKD
87
contraindications of AT1 blockers
aki
renal artery stenosis
breastfeeding
88
side effects of AT1 blockers
hyperkalaemia, hypotension, renal failure
89
possible interactions of AT1 blockers
NSAIDs, potassium sparing diuretics, potassium enhancing supplements or drugs
90
examples of nitrates
isosorbide mononitrate
91
how do nitrates work
- nitrates are converted into nitric oxide
- nitric oxide increases cGMP synthesis and decreases calcium in smooth muscle
- causes vasodilation
- decreases oxygen and cardiac demands
92
when are nitrates used
- angina prophylaxis (long acting)
- angina relief (short acting like GTN spray)
- pulmonary oedema (IV)
93
contraindications of nitrates
aortic stenosis
hypotension
haemodynamic instability
94
side effects of nitrates
causes vasodilation so: flushing, hypotension, headaches
95
possible interactions for nitrates
phosphodiesterase inhibitors (sildenafil) as these increase hypotensive effects, viagra
96
what type of drug is digoxin
cardiac glycoside
97
how do cardiac glycosides work
- negatively chonotropic (decrease HR) and positively inotropic (increase the force of contractions)
- inhibits Na+/K+-ATPase pump, increasing intracellular Na
98
when is digoxin used?
AF and atrial flutter to decrease HR, 3rd line treatment in HF
99
contraindications of digoxin
heart block, renal failure
100
side effects of digoxin
bradycardia, GI disturbance, headaches and dizziness, rash, visual disturbances, arrhythmias
101
possible interactions of cardiac glycosides
loop and thiazide diuretics (due to increase K+), calcium channel blockers, spironolactone (this increase the plasma concentration)
102
example of anti-dysrhythmics
amiodarone
103
how does amiodarone work
blocks Na+, Ca2+, K+ channels and causes antagonism of alpha and beta adrenergic receptors - decreases spontaneous depolarisation, slows conduction, decreasing heart rate - overall, restores rhythm
104
when is amiodarone used
AF, atrial flutter, SVT, VT, VF
105
contraindications for amiodarone
severe hypotension, hyperthyroidism, heart block
106
side effects of amiodarone
if used chronically: bradycardia, pneumonitis, hepatitis, hypo/hyperthyroidism, hypotension
107
possible interactions of amiodarone
amiodarone increases plasma concentration of certain drugs such as digoxin and verapamil
108
examples of novel anticoags
rivaroxiban, dabigatran
109
how do NOACs work
inhibit factor Xa, inhibiting thrombin formation
110
when are NOACs used
- similar to wafarin but safer and easier to monitor
- to prevent recurrence of PE, DVT
- to prevent complications like stroke in AF
111
contraindications of NOACs
haemorrhage risk, surgery
112
side effects of NOACs
bleeding - no antidote (in warfarin, vit K can be given)
113
possible interactions of NOACs
cytochrome P450 inhibitors
114
how are NOACs eliminates
liver
115
what is an anti-coag
inhibits clotting factors, thus slowing down the body's process of making clots
116
what is an anti-platelet
inhibits platelets from clumping and forming clots
