Cardiac Drugs Flashcards
Post coronary artery stent, what medication would we want to prescribe?
Dual anti platelet therapy like aspirin and prasugrel or aspirin and clopidogrel
What is a side effect of amlodipine?
Peripheral oedema
what drugs might we use for medical treatment of AF?
Rate control= 1. beta blockers + digoxin OR 2. centrally acting Ca2+ blockers
Rhythm control= sotalol and amiodarone
Anticoagulation= warfarin or other oral anticoagulant
what is first line treatment for heart failure?
ACE inhibitor
what are some side effects of spironolactone
Side effects of spironolactone= causes gynaemastia/post menopausal bleeding bc it cross-reacts (inhibits) with sex steroid receptors. It also causes hyperkalemia and renal impairment. It can also drop blood pressure
what is indapamide? what is it used for?
thiazide diuretic, but works for blood pressure control not really used as a diuretic.
why won’t we use dihydropyridines in cardiac failure?
Blood pressure control, not contraindicated but NO role in heart failure. Also side effect= peripheral oedema
why won’t we use non-dihydropyridines in cardiac failure?
contraindicated in systolic heart failure
How does digoxin work? what is it primarily used for?
• Slows heart rate and reduces AV nodal conduction by an increase in vagal tone and a reduction in sympathetic activity.
• Increases the force of myocardial contraction by increasing the release and availability of stored intracellular calcium.
-Used for AF/flutter
what are the adjunct therapies we use in an AMI?
- O2
- IV morphine
- Aspirin
- IV heparin/clexane
- IV GTN
- Clopidogrel if stent is inserted
Beta blockers and ACEi if LV dysfunction
what are some serious side effects of digoxin?
atrial or ventricular extrasystoles, paroxysmal atrial tachycardia with AV block, ventricular tachycardia or fibrillation, heart block. also can cause vision to appear ‘yellow’. Gynaecomastia with long-term use
What are some side effects of amiodarone?
- hyper and hypothyroidism
- may exacerbate arrhythmia and cause new arrhythmia
- grey skin pigmentation
- neuro effects- tremor, parasthesia, weakness, ataxia, neuropathy
- sleep disturbances
- hypotension
- ocular effects=corneal micro deposits and blurry vision. Optic neuritis in worst case
- pulmonary toxicity
what medical therapy would we use for a patient with chronic angina?
- Beta blocker atenolol OR Calcium non dihydropyridine- NOT BOTH!!
- Dual anti platelet therapy (aspirin + clopidogrel) if high risk, or aspirin alone in low risk in ACS risk stratification.
- Long acting nitrates like isosorbide mononitrate if GTN short acting PRN is not working. Remember that nitrates are contraindicated in postural hypotension
if beta blocker OR calcium verapamil/diltiazem does not work for treating anginal symptoms, then what should you suggest?
add a dihydropyridine like amlodipine and nefidipine
contraindications of beta blockers
contraindicated in asthma and diabetes as there is a blunting of sympathetic drive to hypoglycaemia
what drugs do we prescribe for acute medical treatment of pericarditis?
colchicine and NSAIDs
What are the SE of atropine?
tachycardia, SLUD effects- dry mouth, constipation etc.
what fruit juice can’t you give with simvastatin
grapefruit juice
Treatment protocol for hypertension?
ACT
Ace inhibitor ARB
Calcium channel blocker- like amlodipine
Thiazide diuretic
side effects of GTN
headaches
hypotension
why is morphine used in APO?
reduce preload to the heart due to slight vasodilating effects in the abdominal vessels
metabolic disturbances of thiazide diuretics?
BSL disturbances and hyperuricaemia predisposing gout
what should we prescribe with frusemide?
slow k bc frusemide causes hypokalemia
what are the four classes of antidysarrhythmic drugs?
- Na channel blockers
- Beta blockers
- sotalol/amiodarone
- calcium channel blockers
main use of flecainide?
paroxysmal AF
what do you have to worry about when prescribing digoxin and verapamil together?
digoxin toxicity bc verapamil displaces digoxin and reduces its renal elimination
main use of adenosine?
treat SVT
what type of drug is digoxin?
cardiac glycoside
are cardiac glycosides iontropes or chronotropes?
ionotropes bc increases contractility
what type of drug is dobutamine
B receptor agonist
ionotrope
Side effects of nitrates
hypotension and HEADACHE
side effect of hydralazine?
SLE like condition
should we use AT1 receptor antagonists in pregnancy?
no because is teratogenic
what medication do we use for hypertension during pregnancy?
methyldopa
should verapamil and beta blocker be prescribed together?
NO, bc risk of reduced CO
mechanism of action for statins
HMG COA reductase inhibitors
SE of statins
Myalgia
Raised liver enzymes
GIT disturbance
Insomnia
Rhabdomyolysis
Angio-oedema
What are fibrates?
PPAR alpha receptor agonists
peroxisome proliferator-activated nuclear receptors
how does ezetimibe work?
Reduces cholesterol absorption by blocking transport receptor in the enterocyte
