Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 Drug > cardiac > Flashcards

cardiac Flashcards

1
Q

what are some examples for loop diuretics

A

furosemide, bumetanide - ide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

indication for loop diuretics

A

for relief of breathlessness in acute pulmonary oedema in conjunction with oxygen and nitrates

for symptomatic treatment of fluid overload in chronic heart failure

for symptomatic treatment of fluid overload in other oedematous statues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

MOA for loop diuretics

A

work on the ascending limb of the loop of Henle where they inhibits the Na+/K+/2Cl- co-tranpsorters

this transporter transfer water into epithelial cells and so water can follow and inhibiting this can lead to the diuretic effects

also have a dilatation of capacitance veins of vessels and reduces preload and improves contractile function of the heart muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

contra-indication for loop diuretics

A

severe hypovalemia or dehydration

should be used with caution in pts at risk of hepatic encephalopathy - hypokalaemia can cause or worsen coma

avoid use in those with hypokalaemia and/or hyponatraemia

if taken chronically, loop diuretics inhibits uric acid excreation and this can worsen gout

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

side-effect of loop diuretics

A

dehydration and hypotension

should associate diuretics with almost any low electrolye state - as eliminating eletrolytes is how the loop diuretic work

the co-transporter also regulate endolymph in the inner ear and so in high dose it can lead to hearing loss and tinnitus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

interaction of loop diuretics

A

affects drugs that are excreted in the kidneys

lithium level might inc
digoxin toxicity might inc
inc ototoxicity and nephrotoxicity of aminoglycoside

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are some examples of thiazide

A

thiazide, thiazide-like (bendroflumenthiazide, indapamide, chlortalidone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

MOA for thiazide

A

inhibits the Na+/Cl- co-tranpsorter in the distal convoluted tubule of the nephron

prevent reabsorption of Na+ and hence water

also cause vasodilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

indiction for thiazide diuretics

A

alternative 1st line treatment for hypertension where calcium channel blocker would otherwise be used

also add-on treatment for hypertension in pts whose blood pressure is not adequately controlled by calcium channel blocker plus an ACEi or ARB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

contra-indication for thiazide diuretics

A

hypokalaemia and hyponatreamia

as they reduce urine excretion they can worse gout

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

side-effect of thiazide

A 
hyponatreamia 
hypokalaemia 
cardiac arhythmias 
might inc plasma conc of glucose, LDL-cholesterol and triglycerides 
can also cause impotence in men
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some examples for aldosteron antagonist

A

Spironolactone,epleronone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

MOA for amiloride

A

potassium sparing diuretics are relatively weak diuretics alone but in combination with another diuretics, they can counteract potassium loss

amiloride - act in the distal convulated tubules in the kidney, inhibits reabsorption of sodium and hence water by epithelial sodium channels leading to sodium and water excreation and retention of potassium

tends to be used in a combination with furosemide (as co-amilofruse) or with hydrochlorothiazide (as co-amilozide)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Indication for aldosteron antagonist

A

Ascites and oedema due to liver cirrhosis - spironolactone 1st line

Chronic heart failure - usually as an addition to beta blocker and ACEi/ARB

Primary hyperalderstonism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Contraindiction for aldersteron antagonist

A

Severe renal impairment
Hyperkalaemia
Addison’s disease (who are aldersteron deficiency)
Avoid using in pregnant women as it can cross placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

side effect of amiloride

A

GI upsets
if used with other diuretics -dizzines, hypotension, urinary symptoms
electolyte distrubance should cancel each other out but still risk of hypokalaemia, hyperkalaemia and hyponateraemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

interaction of amiloride

A

do not use in combination with other potassium elevating drugs incl potassium supplement and aldosteron antagonists due to risk of hyperkalaemia

renal clearnace of digoxin and lithium maybe altered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what are some examples of potassium sparing diuretics

A

amiloride (as co-amilfruse, am-amilzide)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are some examples for beta-blockers

A

bisoprolol, atenolol, propranolol, metoprolol -olol

20
Q

MOA for beta-blockers

A

beta1-adrenoreceptros are located mainly in the heart where beta2-adrenoreceptors are found mostly in smooth muscle of blood vessels and airways

through beta1-adenoreceptors, beta blocker reduce force of contraction and speed of conduction in the heart – relieves MI by reducing cardiac work and oxygen demand and inc myocardial perfusion

can also slow the ventricular rate of atrial fibrillation mainly by prolonging the refractory period of the AV node

SVT often involves a self-perpetuating circuit that takes in the AV node, beta-blocker stops this circuit and restore sinus rhythm

beta-blockers lower BP through reducing renin secretion from the kidney since this is mediated by beta1-adeoreceptors

21
Q

indiction for beta-blockers

A

ischaemic heart disease - 1st line option to improve symtpoms and prognosis associated with angina and acute coronary syndrome

chronic heart failure - first line option to improve prognosis

atrial fibriliation - 1st line option to reduce the ventricular rate and in paroxysmal AF to main sinus rhythm

SVT - 1st line option in pt without circulatory comprosie to restore sinus rhythm

hypertension - maybe be used when other agents eg calcium channel blockers, ACEi, thiazide diuretics are insufficient or inappropriate

22
Q

contraindiction for betablocker

A

asthma - bronchospam and should be avoid

when used in heart failure, dose should start low and inc slowly as it might initially damage cardiac function

contraindicated for heart block
should be avoid in pts with haemodynamic instability

significant reduction should be done when in hepatic failure

23
Q

interaction of amiloride

A

do nor sure in combination with other potassium elevating drugs incl potassium supplement and aldosteron antagonists due to risk of hyperkalaemia

renal clearnace of digoxin and lithium maybe altered

24
Q

where are beta-blockers eliminated

A

kidney and liver

25
Q

side effect of beta blockers

A

fatique, cold extremities, headache and GI disturbance
can cause sleep disturbance and nightmare
can also cause impotence in men

26
Q

indiction for beta-blockers

A

ischaemic heart disease - 1st line option to improve symtpoms and prognosis associated with angina and acute coronary syndrome

chronic heart failure - first line option to improve prognosis

atrial fibriliation - 1st line option to reduce the ventricular rate and in paroxysmal AF to main sinus rhythm

SVT - 1st line option in pt without circulatory comprosie to restore sinus rhythm

hypertension - maybe be used when other agents eg calcium channel blockers, ACEi, thiazide diuretics are insufficient or inappropriate

27
Q

contraindiction for betablocker

A

asthma - bronchospam and should be avoid

when used in heart failure, dose should start low and inc slowly as it might initially damage cardiac function

contraindicated for heart block
should be avoid in pts with haemodynamic instability

significant reduction should be done when in hepatic failure

28
Q

interaction of beta-blockers

A

non-dihydropyridine calcium channel blockers eg verapamil, diltiazem - can cause heart failure , bradycardia and even asystole

29
Q

side effect of beta blockers

A

fatique, cold extremities, headache and GI disturbance
can cause sleep disturbance and nightmare
can also cause impotence in men

30
Q

side effect of aldosterone antagonist

A

hyperkalaemia - leads to muscle weakness, arrhythmia and even cardiac arrest

spionolactone can cause gynaecomastia

can cause liver impairment and jaundice and can cause Stevens-Johnson syndrome and bullous skin eruption

31
Q

interaction of aldersterone antagonist

A

combination with other potassium elevating drug incl ACEi and ARB inc risk of hyperkalaemia

should not be used with potassium supplements

32
Q

where is aldersterone aner tagonist eliminated

A

liver

33
Q

contraindication for aldosterone

A

pt with severe renal impairment, hyperkalaemia and Addison’s disease (aldosterone deficient)

pregnant women as it can cross placenta

34
Q

MOA for calcium channel blockers

A

reduce Ca2+ entry into vascular and cardiac cells - relaxation and vasodilation in arterial smooth muscle, lowering arterial pressure

in the heart, calcium channel blocker reduce myocardial contractility

it also suppress cardiac conduction (esp across the AV node) slowing ventricular rate

reduced cardiac rate, contractility and afterload reduce myocardial oxygen demand preventing angina

CCB can be divided into 2 classes - dihydropyridines, incl amlodipine and nifedipine (relatively selective for vasculature), non-dihydropyridines (more selective for the heart)

35
Q

indication for calcium channel blockers

A

amlodipine and nifedipine are used for the first or second line treatment for HTN to reduce risk of stroke, MI and death from cardiovascular disease

all CCB can be used to control symptoms in people with stable angina, beta-blockers are the main alternative

dilitiazem and verapamil are used to control cardiac rate in ppl with supraventricular arrhythmias incl SVT, artial flutter and AF

36
Q

contra-indiction for CCB

A

verapamil and diltiazem should be used with caution with pts with poor left ventricular function - can precipitate or worsen HF.

should avoid in ppl with AV nodal conduction delay - may provoke heart blocker

unstable angina with amlodipine and nifedipine as vasodilation causes a reflex inc in contractility and tachycardia - inc myocardial oxygen demand

severe aortic stenosis - amlodine and nifedipine should be avoided as they can provoke collapse

37
Q

interaction of CCB

A

non-dihydropyridine calcium channel blockers should not be perscribed with beta-blockers - can cause heart failure , bradycardia and even asystole

38
Q

where are CCB eliminated

A

kidney

39
Q

side effect of CCB

A

amlodipine and nifedipine - incl ankle swelling, flushing headache and palpitations (caused by the vasodilation and compensatory tachycardia)

verapamil - constipation and less common bradycardia, heart block and cardiac failure

40
Q

what are some examples of ACEi

A

Ramipril, lisinopril, perindopril - pril

41
Q

MOA for ACEi

A

blocks the action of ACE to prevent the conversion of angiotensin I to angiotensin II (vasoconstrictor and stimulates aldosterone secretion)

blocking angiotensin converting then reduces peripheral vascular resistance which lower BP (afterload)

it also dilute the efferent glomerular arteriole which reduces intraglomerular pressure and slow the progression of CKD

reducing aldosterone level promotes sodium and water excretion and this helps to reduce venous return (preload) which has a beneficial effect in heart failure

42
Q

indication for ACEi

A

hypertension - 1st or 2nd treatment for hypertension to reduce the risk of stroke, MI and death from cardiovascular disease

chronic heart failure - 1st line treatment for all grade of HF

ischaemic heart disease - reduce the risk of subsequent cardivascular events

diabetic nephropathy and CKD with proteinuria - to reduce proteinurai and progression of nephropathy

43
Q

side effect of ACEi

A

hypotension

persistent dry cough (inc level of bradykinin which is usually inactivated by ACE)

hyperkalaemia

cause or worsen renal failure - esp in pt with renal artery stenosis as they rely on efferent glomerular arteriole to maintain glomerular filtration

can cause angioedema and other anaphylactoid reactions

44
Q

interaction fo ACEi

A

avoid using with other postasium elvating drugs eg potassium sparing diuretics and potassium supplements

inc risk of renal failure - NSAIDs

45
Q

interactions of bendroflumenthiazide

A

NSAIDs - reduce effectiveness

combination treatment with loop diuretics - hypokalaemia

46
Q

examples of calcium antagonist

A

amlodipline, nifedipine, diltiazem, verapamil

47
Q

contrac-indication for ACEi and AT1 Blocker

A

AKI
renal artery stenosis
pregnancy/breastfeeding

Year 3 Drug (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions