Cardiac Medications Flashcards
ACE inhibitors and ARB’s:
Examples of ACE - 2 - R, L
Examples of ARB - 2 - L, C
Enalapil
Ramipril
Lisinopril
Losartan
Candesartan
ACE inhibitors and ARB’s:
What is the mechanism of both?
Draw out the renin angiotensin aldosterone system!!!
Angiotensin II increases BP:
- What does it cause systemically?
- What electrolyte does it cause more reabsorption of in the kidneys?
- What 2 hormones does AgII cause increased release of?
What organ releases ACE?
What organ releases renin and what triggers its release?
Reduces ACEi (which converts angiotensin I > angiotensin II) Stops angiotensin II activating the release of aldosterone from the adrenal glands
Systemic vasoconstriction
Aldosterone
ADH release
Sodium retention
Lungs
Kidneys - hypovolaemia or hypotension
https://www.britannica.com/science/renin-angiotensin-system
ACE inhibitors and ARB’s:
Side effects - ACEi-specific:
- Main SE
- What is another major side effect which is common in most allergies?
Side effects - Both:
- Why does it cause hyperkalaemia?
- How does it affect the kidneys? - 1
How are they both started?
Dry cough
Angio-oedema
As it lowers aldosterone:
- Aldosterone would usually cause increased reabsorption of sodium in exchange for potassium.
- if it is low, less potassium is lost.
Very low blood pressure when starting so start slowly and titrate
Renal effects - lowers GFR especially if bilateral disease
ACE inhibitors and ARB’s:
Contraindications:
What electrolyte inbalance would be a CI?
What disease affecting the flow to the kidneys is a CI?
Why is it not used in pregnancy?
Hyperkalaemia
Bilateral renal stenosis however used if unilateral
May cause cleft palate in pregnancy
ACE inhibitors and ARB’s:
Management:
When should the potassium and creatinine be checked? - 4
1 wk before starting and after starting
After each dose increase
If severe disease with dehydration
Annually or more if low GFR
Beta-blockers:
Mechanism:
- What type of beta receptors does the heart have?
- What 2 things happen when these beta receptors are activated? - 2
- Therefore, what 2 effects do beta-blockers do?
Examples of selective beta-blockers - mnemonic B1 MAN
Examples of non-selective beta-blockers - 4 - C, L, P, T
Cardiac beta -1 receptors
Increases HR at the sinus node
Increases contractility in the myocytes
Reduces HR at the sinus node
Reduces contractility in the myocytes
Bisoprolol
Metaprolol
Atenolol
Nebivolol
JUST REMEMBER B1 MAN AS IT WILL HELP IN CLINICAL SETTINGS WHEN TRYING TO WORK OUT IF THIS BETA-BLOCKER IS HAVING EXTRA-CARDIAC EFFECTS!
Carvedilol
Labetalol
Propranolol
Timolol
Beta-blockers:
Side-effects:
- Why does it cause tiredness?
- Why else may it make the person tired which is not directly related to BP?
- Why could it cause heart block?
- What are some side effects of hypotension?
- They can cause bronchoconstriction leading to wheezing. What type of beta-blockers can cause this?
- Why can it cause erectile dysfunction?
- What chronic disease may it worsen if combined with thiazides?
- What happens to their peripheries?
As it lowers BP as well as heart rate
Sleep disturbance
As it can affect the AV node
Fatigue
Dizziness
Nausea
Non-selective - so also blocks beta 2 receptors
Beta-blockers dampen the response to nerve impulses that lead to an erection. They also make it more difficult for the arteries in the penis to widen and let in blood
May worsen diabetes with thiazides
Cold due to vasoconstriction from non-selective agents (NOT selective as that is cardiac-specific)
Beta-blockers:
Contraindications
- Why does it cause bronchoconstriction meaning it is CI in lung diseases?
- What pre-existing heart disease would be a CI?
- Why is it avoided in those with a history syncope? - 2
- What drug is used in pregnancy?
Why should it be generally avoided in athletes because of risk-off fainting?
Bronchoconstriction occurs because sympathetic nerves innervating the bronchioles normally activate β2-adrenoceptors that promote bronchodilation.
Heart block
Bradycardia
Hypotension
Restricts fetal growth so should use non-selective agent labetalol
As there are likely to already be in bradycardia
Calcium Channel Blockers:
What is the mechanism of action?
Examples of rate-limiting CCB’s and MOA - 2 - V, D
Examples of non-rate-limiting CCB’s and MOA - 3 - A, N, L
Block L-type calcium channels reducing calcium inflow cells
Verapamil
Diltiazem
Reduces HR and contractility
Amlodipine
Nifedipine
Lercanidipine
Affect arterial smooth muscle causing vasodilation hence lower BP
Calcium Channel Blockers:
Side effects:
- What is a common side effect in the legs?
- Why do they get flushed?
- Why do they get headaches?
- What happens to the gums?
- How does it affect the bowels and why?
Oedema
Due to vasodilation, which is widespread
Due to vasodilation in the brain - I guess increased pressure
Calcium is needed for muscle contractions, so if it is blocked, the vessels will dilate!
Gum hyperplasia
CCBs, such as diltiazem (Cardizem). These drugs relax the smooth muscles in blood vessels to lower blood pressure. But they also relax the muscles in the gut and may cause constipation
Calcium Channel Blockers:
Contraindications - 2
What other cardiac drug interacts with CCB’s? - 1
Heart block
HF especially rate-limiting CCB’s
Beta-blockers interact with rate-limiting CCB’s
Diuretics:
What are the 3 types and given one example of each?
DO DIURETIC STUFF IN RENAL WHERE IT IS IN MORE DETAIL
Loop
Thiazide and thiazide-like
Potassium-sparing
Furosemide, bumetanide
Bendroflumethiazide
Chlorthialidone, indapamide, metolazone
Amiloride
Spironolactone
Diuretics:
Side effects of all:
- Urine
- Why can it lower GFR?
Urinary frequency
Renal impairment mainly due to hypovolaemia
Diuretics:
Side effects of furosemide (loop):
- potassium
- muscles
- why do they get kidney stones?
Side effects of thiazides:
- 3 electrolytes low and 1 high
- a type of rash
- glucose
- on neck
Side effects of spironolactone:
- potassium
- chest in men
Hypokalaemia
Muscle cramps
Kidney stones due to increase calcium excretion
Electrolytes - low sodium, potassium, magnesium and high calcium
Photosensitive rash
Hypoglycaemia
Gout
Hyperkalaemia
Tender gynaecomastia
Diuretics:
Contraindications:
- a type of arthritis
- kidneys
- what do thiazides cause in pregnancy?
Gout = can raise uric levels
Renal failure
Oligohydraminios
