Cardiac Medication Flashcards
What is postural hypotension?
A condition characterized by a drop in blood pressure upon standing up
It can lead to dizziness or fainting.
Name a class of medications that can cause postural hypotension.
Nitrates
These medications are often used to treat angina.
What are two examples of calcium channel blockers?
- Diltiazem
- Verapamil
They are used to manage hypertension and certain heart conditions.
What is the primary effect of beta blockers?
Reduced heart rate response and bradycardia
This can impact exercise tolerance and heart rate calculations.
What should be used to adjust THR calculations when using beta blockers?
RPE (Rate of Perceived Exertion)
This is a subjective method of measuring exercise intensity.
Which medication class is associated with aching legs or muscles?
Statins
Statins are commonly prescribed to lower cholesterol.
What considerations should be made for patients on diuretics?
- Access to toilets
- Avoiding dehydration, especially in hot weather
Diuretics increase urine production, which can lead to dehydration.
What symptoms might indicate tiredness or heavy legs in patients?
Use of beta blockers
This is a common side effect of these medications.
What is the effect of ACE inhibitors in heart failure patients?
Increased exercise capacity
ACE inhibitors help to relax blood vessels and lower blood pressure.
What should be considered regarding the effects of medications on blood pressure?
Drugs that lower blood pressure risk causing postural hypotension
This can complicate patient management during exercise.
What is the role of potassium channel activators in cardiac medication?
They help to relax blood vessels and improve blood flow
This class of drugs is less commonly used than others.
What is the function of Dapagliflozin?
It is used to manage blood glucose levels in diabetes and has cardiovascular benefits
Dapagliflozin belongs to the SGLT2 inhibitor class.
What are ACE inhibitors used for?
They are used to treat cardiac conditions.
ACE stands for angiotensin converting enzyme.
Name a type of drug that acts as an alpha blocker.
Alpha blockers are one of the drug classes used to treat cardiac conditions.
Alpha blockers help relax blood vessels.
What is the purpose of anti-arrhythmics?
They are used to treat irregular heartbeats.
Anti-arrhythmics help restore normal heart rhythm.
What do angiotensin receptor blockers (ARBs) do?
They are used to treat cardiac conditions by blocking angiotensin receptors.
ARBs help lower blood pressure.
What is the role of anticoagulants?
They prevent blood clots.
Anticoagulants are critical in managing patients at risk for stroke.
What are antiplatelets used for?
They prevent platelet aggregation to reduce the risk of clots.
Common antiplatelets include aspirin.
What is the function of beta blockers?
They reduce heart rate and lower blood pressure.
Beta blockers are often prescribed for hypertension and heart failure.
What do calcium channel blockers do?
They help relax blood vessels and decrease heart workload.
Calcium channel blockers are used for hypertension and angina.
What is dapagliflozin used for?
It is used to treat cardiac conditions as a sodium-glucose cotransporter 2 inhibitor.
Dapagliflozin is also used for diabetes management.
What is the purpose of diuretics?
They help reduce fluid buildup in the body.
Diuretics are commonly used for heart failure management.
What do lipid-lowering agents do?
They reduce cholesterol levels in the blood.
Statins are a common class of lipid-lowering agents.
What is the function of neprilysin inhibitors?
They enhance the levels of natriuretic peptides.
Neprilysin inhibitors are used in heart failure treatment.
What do nitrates do?
They dilate blood vessels to relieve angina.
Nitrates are often used in acute angina attacks.
What are PCSK9 inhibitors?
They lower LDL cholesterol levels.
PCSK9 inhibitors are a newer class of cholesterol-lowering drugs.
What is the role of potassium channel activators?
They help relax blood vessels and lower blood pressure.
Potassium channel activators are used in hypertension management.
What do sinus node inhibitors do?
They slow down the heart rate by affecting the sinoatrial node.
These are used in certain arrhythmias.
What are ACE inhibitors?
A class of drugs that prevent the formation of angiotensin II, a vasoconstrictor that raises blood pressure and causes fluid retention.
List some ACE inhibitors.
- Captopril
- Enalapril
- Fosinopril
- Lisinopril
- Perindopril
- Ramipril
- Trandolapril
What is the primary use of ACE inhibitors?
Standard drug therapy for post-MI patients, especially those at increased risk of deteriorating LV function and heart failure.
How do ACE inhibitors help the heart?
They reduce afterload and circulating volume, allowing the heart to pump more easily.
What are alpha blockers?
Drugs that block alpha-receptors in vascular smooth muscle, preventing vasoconstriction and reducing blood pressure.
List some alpha blockers.
- Doxazosin
- Indoramin
- Prazosin
- Terazosin
What condition are alpha blockers primarily used to treat?
Hypertension.
What are Angiotensin Receptor Blockers (ARBs)?
A class of drugs that directly block angiotensin II receptors, preventing the vasoconstrictor action of angiotensin I.
List some Angiotensin Receptor Blockers.
- Candesartan
- Irbesartan
- Losartan
- Telmisartan
- Valsartan
- Eprosartan
- Olmasartan
What is the main advantage of ARBs over ACE inhibitors?
They can be used when the dry cough associated with ACE inhibitors cannot be tolerated.
What is a common side effect of ACE inhibitors?
Dry annoying cough.
List some side effects of alpha blockers.
- Hypotension
- Headache
- Palpitations
- Swollen legs or ankles
- Nausea
- Tremor
- Fatigue
What should be monitored in patients taking ACE inhibitors?
Reduced kidney function and potential allergic reactions such as angioedema.
True or False: ACE inhibitors increase exercise capacity in heart failure patients.
True.
Fill in the blank: ACE inhibitors play a crucial role in the regulation of BP by the _______.
[kidneys]
What are the exercise considerations for patients on alpha blockers?
Rapid changes in posture or abrupt cessation of exercise can increase the risk of hypotension.
What is the mechanism of action for ACE inhibitors?
They prevent the formation of angiotensin II, leading to reduced blood pressure and fluid retention.
List some side effects of ARBs.
- Hypotension
- Taste disturbance
- Skin rash
- Dizziness
What is the role of angiotensin converting enzyme (ACE) in the body?
It regulates blood pressure by facilitating the formation of angiotensin II.
What is the name of the group of drugs that includes Valsartan and Sacubitril?
ANGIOTENSIN RECEPTOR-NEPRILYSIN INHIBITORS (ARNi)
Also known by the brand name Entresto.
When are Angiotensin Receptor-Neprilysin Inhibitors (ARNi) used?
As an alternative to ACE inhibitors or ARBs in heart failure with reduced ejection fraction (HFrEF)
They are specifically indicated for heart failure management.
What class of drugs is Amiodarone part of?
ANTI-ARRHYTHMICS
Other examples include Digoxin.
What heart conditions are treated with anti-arrhythmics?
Arrhythmias including:
* Atrial fibrillation
* Atrial flutter
* Ventricular arrhythmias
These conditions involve irregular heartbeats.
How do Angiotensin Receptor-Neprilysin Inhibitors (ARNi) work?
They act as vasodilators, widening blood vessels and reducing sodium and water in the blood
This leads to lower blood pressure and decreased myocardial workload.
What is a side effect of anti-arrhythmic medications?
Prolonged refractory period of the heart
This helps to suppress arrhythmias.
List some side effects of Angiotensin Receptor-Neprilysin Inhibitors (ARNi).
Side effects include:
* Angioedema
* Hypotension
* Mild renal impairment
* Low potassium
* Fatigue
* Nightmares
These effects can vary in severity among individuals.
True or False: Amiodarone increases myocardial contraction.
True
It also reduces conductivity within the AV node.
What are some exercise considerations for patients on anti-arrhythmics?
Possible slower heart rate response to exercise and reduced exercise capacity due to depressant effect on myocardium
Monitoring is important for safety during physical activity.
Fill in the blank: Anti-arrhythmics are used to correct _______.
fast and often irregular heartbeats
This includes various types of arrhythmias.
What are some potential vision-related side effects of anti-arrhythmics?
Vision disturbances and night glare
These side effects may be bothersome for patients.
What is a common gastrointestinal side effect of Angiotensin Receptor-Neprilysin Inhibitors (ARNi)?
Nausea and vomiting
These can affect patient compliance with the medication.
What is a possible effect on potassium levels when taking anti-arrhythmics?
Low potassium
This can lead to complications such as muscle cramps or arrhythmias.
Which side effect might cause patients to avoid direct sun exposure while on Angiotensin Receptor-Neprilysin Inhibitors (ARNi)?
Photosensitivity
Patients should take precautions to protect their skin.
What effect do anti-arrhythmics have on the conduction system of the heart?
They affect the conduction system at various points
This helps in correcting arrhythmias.
What is the group name for new oral anticoagulants?
NOACs
Name one example of a NOAC.
Apixaban
Other examples include Dabigatran, Edoxaban, and Rivaroxaban.
What is the standard drug following a large anterior MI?
Clopidogrel
What is the primary use of anticoagulants in patients with atrial fibrillation?
Reduce the risk of embolism forming
For how long should anticoagulants be taken after mechanical valve surgery?
For life
What is the mechanism of action for anticoagulants?
Prevent blood from clotting by interfering with the synthesis of clotting proteins in the liver.
What is the main side effect of anticoagulants?
Haemorrhage
Is there an antidote for NOACs?
No
What should patients avoid while taking anticoagulants?
Products containing aspirin unless under medical advice
What is the common side effect of Ticagrelor?
Breathing difficulties
True or False: NOACs have a lower incidence of gastrointestinal upset compared to aspirin.
True
Fill in the blank: Antiplatelets are indicated in AF in the absence of _______.
valve disease
Name two antiplatelet agents.
Prasugrel
Ticagrelor
What should patients do at the first sign of side effects like dizziness or lightheadedness?
Sit or lie down
What is the effect of alcohol and hot weather on side effects of anticoagulants?
May increase side effects
What is the recommended exercise consideration for patients on anticoagulants?
Avoid contact sports or sports with a high risk of injury
What is the effect of anticoagulants on heart rate or blood pressure?
No effect
How do antiplatelets work?
Decrease platelet aggregation that may stop clots forming in the arterial side of the circulation.
What is the treatment duration for antiplatelets post-PCI?
Limited period
What is a common side effect associated with anticoagulants?
Internal bleeding
What medication can rapidly reverse severe bleeding on warfarin?
Vitamin K
What should be considered when using equipment while on anticoagulants?
Care to avoid accidents
What are the standard beta blockers?
Atenolol, Bisoprolol, Carvedilol, Metoprolol, Nebivolol, Propranolol, Sotalol, Timolol
Bisoprolol, Carvedilol, and Nebivolol are licensed for use in heart failure.
What is the primary use of calcium channel blockers?
Hypertension, angina, arrhythmias, tachycardia, heart failure
Specifically, they are used for post-MI patients at increased risk of further MI and sudden cardiac death.
How do beta blockers work?
Block beta receptors to decrease sympathetic activity
This results in reduced myocardial oxygen demand, improved myocardial blood flow, suppression of arrhythmias, and reduced myocardial workload.
What are the effects of reduced heart rate due to beta blockers?
- Reduced myocardial oxygen demand
- Improved myocardial blood flow
- Suppression of arrhythmias
- Reduced myocardial workload in heart failure
What is the mechanism of action of calcium channel blockers?
Reduce calcium influx into specific types of cells, which decreases the strength of contraction
They suppress arrhythmias by slowing conduction through the AV node.
What are common side effects of beta blockers?
Reduced pulse rate, reduced BP, dizziness, tiredness, airway constriction, cold fingers/toes, male impotence, sleep disturbances
Sudden cessation may lead to rebound angina and possibly MI.
What side effects are associated with calcium channel blockers?
Hypotension, facial flushing, palpitations, pounding headaches, mild ankle swelling
Swelling is mostly associated with nifedipine and amlodipine.
True or False: Beta blockers can be stopped suddenly without medical advice.
False
Stopping suddenly may lead to rebound angina and possible myocardial infarction.
Fill in the blank: Rapid changes in posture or abrupt cessation of exercise will increase risk of _______.
hypotension
What should be established from an ECG before exercise training in patients on beta blockers?
Training heart rate
Appropriate training intensity is best determined using a combination of RPE and HR responses.
What is the estimated maximum heart rate for those on beta blockers compared to those not on them?
20-30 bpm lower
This affects exercise responses and training protocols.
What is a common issue with verapamil and diltiazem regarding exercise?
Possible reduced heart rate response to exercise
What is a potential side effect of verapamil?
Constipation
What is the classification of Amlodipine?
Calcium channel blocker
Amlodipine is primarily used for angina and hypertension.
Which type of diuretics are Thiazide diuretics?
Weaker diuretics
Examples include Hydrochlorothiazide and Bendroflumethiazide.
What are examples of Loop diuretics?
- Bumetanide
- Furosemide
- Torasemide
Loop diuretics are considered ‘strong’ diuretics.
What is the primary action of diuretics?
Increases the volume of urine excreted by removing salt and water from circulation
This helps in managing conditions like hypertension and heart failure.
What is a common side effect of diuretics?
- Loss of potassium
- Ventricular arrhythmias
- Tiredness
- Muscle weakness
- Elevated cholesterol and triglycerides
These side effects may impact patient management and treatment adherence.
Fill in the blank: Amlodipine is used when the radial artery is used in CABGS as it helps to maintain _______ of the grafted vessel.
vasodilation
This is crucial for maintaining blood flow in grafted arteries.
True or False: Type 2 diuretics can cause a reflex increase in heart rate in response to reduced blood pressure.
True
This is particularly noted with medications like Nifedipine.
What conditions are diuretics commonly used to treat?
- Hypertension
- Heart failure
- Oedema
These conditions often involve fluid retention and elevated blood pressure.
What is a potential effect of dehydration during exercise?
Increases potential for hypotension
This is especially important for patients on diuretics who may already be at risk.
What is the effect of diuretics on blood pressure?
Reduces blood pressure by decreasing circulating fluid and causing vasodilation
This reduction decreases afterload and the work of the myocardium.
Name a potassium-sparing diuretic.
Spironolactone
Potassium-sparing diuretics are used to prevent potassium loss.
What are the side effects associated with Thiazide diuretics?
- Loss of appetite
- Gout
- Diabetes
- Impotence
These side effects can affect quality of life and treatment compliance.
What is the mechanism of action for calcium channel blockers like Amlodipine?
Relaxes smooth muscle in walls of systemic arteries, reducing BP and afterload
This action helps alleviate conditions such as angina.
Fill in the blank: Exercise considerations for patients on Type 2 diuretics include encouraging _______ during exercise.
fluids
This is particularly important in hot weather to prevent dehydration.
What are statins?
A class of lipid-lowering drugs used to lower LDL cholesterol levels
Includes Atorvastatin, Fluvastatin, Pravastatin, Rosuvastatin, Simvastatin
List the statins.
- Atorvastatin
- Fluvastatin
- Pravastatin
- Rosuvastatin
- Simvastatin
These drugs are used to manage cholesterol levels.
What is the role of Ezetimibe?
It prevents cholesterol absorption in the intestine.
Ezetimibe can be used alone or in combination with statins for better LDL-C reduction.
What are fibrates?
A class of lipid-lowering drugs that mainly target elevated triglyceride levels.
Includes Bezafibrate, Clofibrate, Fenofibrate, Gemfibrozil.
List the fibrates.
- Bezafibrate
- Clofibrate
- Fenofibrate
- Gemfibrozil
Fibrates are used to lower triglyceride levels and raise HDL cholesterol.
What are PCSK9 inhibitors?
A new class of drugs that lowers LDL cholesterol by blocking PCSK9.
Includes Alirocumab (Praluent) and Evolocumab (Repatha).
List the PCSK9 inhibitors.
- Alirocumab (Praluent)
- Evolocumab (Repatha)
These drugs are administered via injection.
When are lipid-lowering drugs used?
For all CVD patients and those at high risk of developing CAD or other vascular diseases.
They are crucial in managing hyperlipidaemia.
What is the primary effect of statins?
They lower LDL-C levels and moderately increase HDL-C.
Statins also moderately reduce elevated triglyceride levels.
How do fibrates work?
They stimulate enzymes that initiate the breakdown of triglycerides.
Their use has declined since statins became available.
What side effects are associated with lipid-lowering drugs?
- Gastrointestinal upsets
- Muscle pain
- Headache
- Gallstones
- Rash
- Acute pain in calf or thigh muscle if kidney function is impaired
- Mild back pain
- Cold/flu symptoms
Side effects vary by drug class.
True or False: Exercise is known to cause side effects in patients taking lipid-lowering drugs.
False
No known exercise-related side effects have been reported.
Fill in the blank: PCSK9 inhibitors block PCSK9, leading to increased receptors removing ______ from the blood.
LDL
This mechanism helps lower LDL cholesterol levels.
What is the primary use of nitrates?
To prevent and alleviate angina.
Name a long-acting nitrate used for angina prevention.
Isosorbide dinitrate.
Which drug is commonly known as GTN?
Glyceryl trinitrate.
What is the mechanism of action of nitrates?
Vasodilation of blood vessels.
How do nitrates improve coronary blood flow?
They dilate coronary arteries.
What effect do nitrates have on venous return?
They reduce venous return and preload.
What is the effect of nitrates on vascular resistance?
They decrease vascular resistance (afterload).
What is a potassium-channel activator mentioned in the content?
Nicorandil.
What is the effect of potassium on muscle action?
Essential for the stimulation and action of muscle.
What is a side effect of nitrates?
Hypotension.
True or False: Nitrates can cause facial flushing.
True.
What interaction is noted with nitrates?
Possible severe interaction with Viagra.
What should clients avoid when experiencing angina symptoms?
Exercise.
What is a possible side effect of ivabradine?
Bradycardia.
Fill in the blank: GTN can also be used to _______ angina.
prevent
What is the effect of rapid changes in posture while on nitrates?
Increases risk of hypotension.
What is the expected maximum heart rate decrease for patients on ivabradine?
20-30 bpm lower.
What gastrointestinal effect is associated with ivabradine?
Gastrointestinal effects.
How does ivabradine affect heart rate?
Slows sinus heart rate.
What phenomenon may occur in the eyes with certain medications?
Luminous phenomena.
What is a common side effect of both nitrates and ivabradine?
Dizziness.
What are SGLT2 inhibitors used for in T2DM?
Reduce blood sugar levels
Examples include Empagliflozin (Jardiance) and Dapagliflozin (Foxiga)
Which SGLT2 inhibitor is used in heart failure?
Dapagliflozin (Foxiga)
Used in symptomatic chronic heart failure with reduced ejection fraction (HFrEF)
How do SGLT2 inhibitors work in T2DM?
They work on the kidneys and increase the amount of sugar extracted
This helps to lower blood sugar levels
How do SGLT2 inhibitors affect heart failure?
Lowers preload and afterload, thus reducing workload and rate of kidney function worsening in people with HFrEF
This mechanism helps manage heart failure symptoms
What are common side effects of SGLT2 inhibitors?
- Dizziness
- Hypoglycaemia
- Risk of diabetic ketoacidosis in Type 1
- Increased urination leading to hypovolaemia
- Thrush
- Back pain
- Impaired renal function
- Hypotension
- Dehydration
What exercise considerations should be taken when using SGLT2 inhibitors?
Keep hydrated and be aware of postural hypotension
Maintaining hydration is crucial to prevent dehydration
