Cardiac Drugs Flashcards
Name some examples of beta blockers
- Atenolol
- Propranolol
What are the side effects f beta blockers
- bronchospasm
- cold peripheries
- fatigue
- sleep disturbances
- erectile dysfunciton
What are the contraindications of beta blockers
- Uncontrolled heart failure
- asthma
- sick sinus syndrome
- concurrent verapamil use
What happens when beta blockers and verapamil are used together
- Can cause complete heart block
What happens if you have a beta blocker overdose
- bradycardia
- hypotension
- heart failure
- syncope
What is the management of beta blocker overdose
- atropine
- in resistant cases glucagon may be used
What does a negative inotrope do
these slow the hearts contraction and slows the heart rate down
name examples of negative inotropes
- beta blockers
- calcium channel blockers
What are the two types of calcium channel blockers
- non dihydropyridines
- Dihydropyridines
Name some examples of non dihydropyridine calcium channel blockers
- Dilitizem
- Verapamil
Name some examples of dihydropyridine calcium channel blockers
- Nifedipine
- Amlodipine
What are the side effects of verapamil
- heart failure
- constipation
- hypotension
- bradycardia
- flushing
What are the side effects of diltiazem
- hypotension
- bradycardia
- heart failure
- ankle swelling
What are the side effects of nifedipine, amlodipine, felodipine
- flushing
- headache
- ankle swelling
What are the side effects of ACE inhibitors
- cough
- angioedema
- hyperkalamia
- first dose hypotension
what are the contraindications for ACE inhibitors
- pregnancy and breastfeeding
- renovascular disease
- aortic stenosis
Name an example of an aldosterone inhibitor
Spironolactone
Eplerenone
What are the adverse effects of spironolactone
- hyperkalaemia
- gynaecomastia less common with eplerenone
What are the side effects of thiazide diuretics
- dehydration
- postural hypotension
- hyponatraemia
- hypokalaemia
- hypercalcaemia
- gout
- impaired glucose tolerance
- impotence
How do thiazide diuretics work
- Work by inhibiting sodium reabsorption at the beginning of the distal convoluted tubule by blocking the thiazide sensitive Na+Cl- symporter
Name some thiazide like diuretics
- Indapamide
- chloratalidone
Name a thiazide diuretic
bendroflumethiazide
What are the two types of potassium-sparing diuretics
- aldosterone antagonists e.g. spironolactone
- Amiloride - blocks the epithelial sodium channel in the distal convoluted tubule
what does amiloride do
- blocks epithelial sodium channel in the distal convoluted tubule
Name some loop diuretics
- furosemide and bumetanide
what are the adverse effects of loop diuretics
- hypotension
- hyponatraemia
- hypokalamiea
- hypomagensaemia -
- ototoxicity
- hypocalcaemia
- hypercholraemic alkossi
- renal impairment
What are the classes of anitarrhytmics
Class I
- sodium channel blockers e.g. flecainide, procainamide, quinidine
Class II
- Beta blockers e.g. propranolol and metoprolol
Class III
- Potassium channel inhibitors e.g. Amiodarone, Sotalol
Class IV
- Calcium channel blockers e.g. verapamil, dilimiazem
How does amiodarone work
- Works by blocking potassium channels which inhibits depolarisation and therefore prolongs the action potential
What are the adverse effects of amiodarone
- thyroid dysfunction = both hypothyroidism and hyperthyroidism
- corneal deposits
- pulmonary fibrosis
- liver fibrosis/hepatits
- peripheral neuropathy - photosensitivity
- slate-gray apperance
- bradycardia
- lengths QT interval
What drug interactions does amiodarone have
- decreases the metabolism of warfarin therefore results in an increase in INR
- increases digoxin levels
What is adenosine used for
- It is used to terminate supra ventricular tachycardias
How does adenosine work
- causes transient heart block in the AV node
- agonists of the A1 receptor in the atrioventricular node which inhibits adenylyl cyclase thus reducing cAMP and causing hyperpolarization by increasing outward potassium flux
what is the half life of adenosine
half life of about 8-10 seconds
What are the adverse effects of adenosine
- chest pain
- bronchospasm - avoided in asthmatics
- transient flushing
What is digoxin used in
- used in rate control in the management of atrial fibrillation
Name a positive inotrope
digoxin
How does digoxin work
- decreases conduction through the atrioventricular node which slows the ventricular rate in atrial fibrillation and flutter
- increases the force of cardiac muscle contraction due to inhibition of the sodium/potassium ATPase pump
What are the symptoms of digoxin toxicity
- generally unwell
- lethargy
- nausea and vomiting
- anorexia
- confusion
- yellow-green vision
- Arrhythmias
- gynaecomastia
What is the precipitating factors of digoxin toxicity
- hypokalaemia
- increasing age
- renal failure
- MI
- hypomagensaemia
- hypoalbuminaemia
- hypothermia
- hypothyroidism
How does atropine work
- anticholinergic medicine that increases firing of the SA node
What are the ECG features of digoxin toxicity
- down-sloping ST depression
- flattended/inverted T waves
- short QT interval
- Arrhythmias
