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Year 1 VIA Revision > Cardiac Pharmacology > Flashcards

Cardiac Pharmacology Flashcards

1
Q

Commonly used hypertensives are the ABCD’s which are?

A

A - Angiotensin converting enzyme inhibitors and Angiotensin receptor blockers
B - Beta Blockers
C - Calcium Channel Blockers
D - Diuretics

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2
Q

Commonly used classes of anti-anginal drugs

A

Beta blcokers, calcium channel blockers and nitrovasodilators (and diuretics have small role)

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3
Q

Glycerol Trinitrate

A

is a nitro-vasodilator which is usually applied sublingualy in acute angina attacks. It is vascular selective and may cause reflex tachycardia and hypotension. Can develop tolerance

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4
Q

Viagra

A

Phosphodesterase inhibitors which breaks down cGMP and causes vasodilation. Can cause cardiovascular collapse

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5
Q

calcium channel blockers

A

Block L type coltage gated calcium channels - reduces ca entry into vascular cells. Vasodilation greater in arteries than veins

Verapamil, dilitiazem, nifedipine, amliodipine in that order of cardioselectivity

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6
Q

Verapamil

A

Cardio selective

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7
Q

Nifedipine

A

Vascular selective (can cause reflex tachycradia)

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8
Q

Calcium channel blockers indications

A

Angina (reduce cardiac oxygen demand), hypertension, tachyarrhythmias (SVT)

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9
Q

Adverse effects calcium blockers and contraindications

A

bradycardia, cardiac depression

Contraindications: heart failure, beta blockers

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10
Q

beta-blockers

A

propanolol (beta 1 and 2), atenolol (beta 1), metropolol (beta 1 selective)

Decrease sympathetic drive to heart and inhibit renin release

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11
Q

beta - blocker indications

A

angina (decreased cardiac oxygen demand), hypertension, post MI, arrhythmias, clinically stable heart failure

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12
Q

beta blocker adverse effects

A

bronchoconstriction, decreased heart contractility, bradycardia, depression and sedation, masking hypoglycaemia

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13
Q

unstable angina medications

A

Dipyridamol: increases adenosine and is a vasodilator and anti-platelet drug

Aspirin: Antiplatelet

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14
Q

Heart failure treatment

A
  • lifestyle changes
  • Diuretics (reduce workload by lowering TBL)
  • Angiotensin RAS inhibition (ARB/ACEi) (reduce workload by lowering TBL)
  • Beta blockers (reduce workload by lowering HR)
  • Digoxin (increase cardiac contractility)
  • Dobutamine (beta agonist to increase cardiac contractility)
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15
Q

Dogoxin MOA

A

Inhibits Na/K ATPase and therefore increase myocardial intracellular calcium. Increased contractility and decreased O2 use

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16
Q

Digoxin indications

A

heart failure, cardiomyopathy, atrial arrhythmias but not ventricular

17
Q

Digoxin AE

A

narrow safety margin
long half life
arrhythmia, anorexia, nausea/vomitting, diarrhoea, visual distrurbances, agitation
Vagal Stimulation: bradycardia, possible AV block, high dose arrythmias

18
Q

Digoxin Interactions

A 
Diuretics (thiazides/loop reduce K)
Sympathomimetic drugs (arrhythmias)
19
Q

Digoxin Toxicity

A

Fall in Potassium levels or rise in calcium levels

20
Q

Dobutamine

A

beta 1 adrenoreceptor agonist

Increases cardiac contractility and cardiac output

Used limed IV and susceptible to desensitisation (already have downregulation in CHF)

21
Q

Treatment of CHF

A

Decrease cardiac workload via

  • beta blockers
  • diuretics (loop diuretics > thiazides)
  • Angiotensin RAS inhibition

Increase Cardiac Contractility via
- +ve ionotrope (digoxin or dobutamine (beta 1 agonist)

22
Q

Thiazide diuretics

A

Names: hydrochlorothiazide, indapamide

MOA: Act in distal tubule on sodium/chloride transporters and increases calcium reabsorption

Indications: Mild to moderate HT, oedema in mild to moderate CHF or renal/hepatic disease and diabetes insipidus

AE: hypokalaemia, hyperglycaemia, hypercholesterolaemia, digoxin toxicity,

23
Q

Loop diuretics

A

Names: Frusemide

MOA: Acts in thick ascending limb of loop of Henle, has greatest diuretic effect

Indications: acute pulmonary oedema, CHF, liver cirrhosis, renal failure (hypertension), treating drug overdose

AE: Hypokalaemia, hypercholesterol and glycaemia, ototoxicity and nephrotoxicity, hypovolaemia

24
Q

Potassium Sparing Diuretics

A

Names: Spirinolactone, eplernone, amlioride

MOA: either antagonist to aldosterone or block sodium channels. Sodium leaving drives in potassium

Indications: with loop/thiazide to prevent hypokalaemia, additional benefit in heart failure

25
Q

ACE inhibitors

A

end in -pril

Blocks conversion of angiotensin 1 to 2 and hence blocks RAAS and decreases water retention

Indications: hypertension, heart failure, preserve renal function in diabetes (nephropathy)

AE: dry cough due to bradykinin (also broken down by ACE), hypotension (start low dose), hyperkalaemia

Contra: pregnancy, bilateral renal artery stenosis, less effective in African

26
Q

ARB’s

A

end in- sartan

Block angiotensin 2 receptors and cause vasodilation

Same indications as ACEi but for those intolerance to ACEi due to no dry cough

More expensive`

27
Q

Beta blockers

A

end in -olol

Non selective: propanolol (beta and alpha), carvedilol (also blocks alpha)

Selective: atenolol, nebivolol

AE: cold extremities (b2), brochoconstriction (b2), mask hyperglycaemia

Indication: hypertension, heart failure (late), antiarrrhythmic, anti-ischemic, angina

28
Q

Steps in heart failure

A
  1. lifestyle changes
  2. diuretic or ACEi
  3. Combine different classes or increase dose of 1
  4. Add 3rd class e.g digoxin
  5. Add 4th class e.g. beta blocker, potassium sparing
29
Q

Anti-arrhythmics

A

Class 1: lignocaine IV (blocks fast NA current), used ventricular arrhythmias

Class 2: beta blockers, used in A fib and flutter and post MI

Class 3 K channel blocker, hyperpolarizes and prolongs refractory period

Class 4: Calcium channel blockers (used a fib)

Digoxin: inhibts NA/K pump, blocks AV conduction

Adenosine: hyperpolarises cells, used in supraventricular tachycardia

30
Q

Lipid lowering agents

A
  • statins
  • fibrates
  • cholesterol absorption blockers
31
Q

Statins

A

inhibit HMG CoA reductase and stop conversion of acetyl CoA to cholesterol in liver

Improve endothelial function and plaque stabilisation unrelated to LDL but still occur

Used in hypercholesterolaemia

AE: GI disturbances, insomnia, rash

32
Q

Fibrates

A

Name: gemfibrozil, fenofibrate

Stimulate lipoprotein lipase

Mainly used in hypertriglyeridaemia, slows diabetic retinopathy

AE: GI, liver disease

33
Q

Cholesterol absorption inhibitors

A

Bile acids binding resins e.g. colestipol and cholesyramin (rarely used anymore)

Ezetimibe: inhibits cholesterol absorption in intestine. Add on to statin

AE: greasy stool

34
Q

New lipid lowering

A

Propeptin convertase subtilism, type 9: degrades LDL receptors

Year 1 VIA Revision (6 decks)

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