Cardiac Pharmacology

Question 1

What are the main side effects of ACEIs?

Answer 1

• Dry cough
• Hyperkalaemia
• 1st dose Hypotension
• Angioedema
• Renal failure

Question 2

What are the effects of NSAIDs and Alcohol on ACEIs?

Answer 2

NSAIDs antagonise the anti-hypertensive effects

Alcohol can cause a compound hypotensive effect

Question 3

What is the effect of ACEIs on the glomerular vessels?

Answer 3

Vasodilation of the efferent arteriole, lowering eGFR

Question 4

What are the 3 main classes of CCBs?

Answer 4

Dihydropyridines - target the peripheral vessel Ca channels more selectively
Non-dihydropyridines - target the cardiac Ca channels more selectively
Mixed selectivity

Question 5

Give examples of each of the 3 main classes of CCBs

Answer 5

Dihydro: Amlodipine and Nifedipine
Non-dihydro: Verapamil
Mixed: Diltiazem

Question 6

What are the side effects of CCBs?

Answer 6

Dizziness
Peripheral oedema - Amlodipine especially can cause ankle swelling
CI in HF - use non-dihydro

Question 7

How do Beta blockers reduce production of renin?

Answer 7

Blocking the beta 1 receptors in the JGA

Question 8

What 2 main conditions are Beta blockers typically contraindicated in? Why?

Answer 8

Asthma
COPD
Blockage of the B2 receptors, preventing bronchodilation

Question 9

What are the main side effects of Nitrates?

Answer 9

Headache
Dizziness
Palpitations
Tolerance (loss of efficacy)

Question 10

What is the target INR in most individuals? What does an INR that is too low or too high mean?

Answer 10

2-3
Too high = too runny, risk of bleed and haemorrhage
Too low = too sludgy and risk of thrombosis

Question 11

If anticoagulation is needed in pregnancy, what is the drug of choice?

Answer 11

LMWH

Question 12

In what 3 main circumstances is Warfarin given over DOACs?

Answer 12

Metallic heart valve
Severe renal impairment
Anti-phospholipid syndrome

Question 13

What coagulation factor does Apixaban, Rivaroxaban and Edixaban inhibit? What about Dabigatran?

Answer 13

Xa

IIa

Question 14

What are some of the reasons DOACs are now first line over warfarin?

Answer 14

No monitoring required 
Quicker onset and shorter half life 
No need for initiation by heparin 
Fewer interactions 
50% less chance of intracranial bleed 
Lower bleeding risk, especially of major bleeds

Question 15

How do you reverse DOACs? What about Warfarin?

Answer 15

Prothrombin concentrate +/- tranexamic acid

Vitamin K supplement

Question 16

What are the requirements for stopping DOACs for surgery?

Answer 16

24hrs before for minor bleed risk, 48 for major
Same time to wait after before you re-start it
LMWH can be used to bridge if at a particularly high risk of thrombosis

Question 17

What is the mechanism of heparin? What about LMWH?

Answer 17

Activation of antithrombin III, which inhibits Thrombin/IIa and Xa
LMWH only inhibits Xa
Allows dissocation and subsequent repeat inhibition

Question 18

Are anti-PLT drugs used for arterial or venous clots? What about anticoagulative drugs?

Answer 18

Anti-PLT: arterial

Anticoagulation: venous

Question 19

How do fibrinolytic drugs work? Can you name two examples?

Answer 19

Promotes conversion of plasmin into plasminogen on fibrin strands, increasing fibrin and clot breakdown
Alteplase and Streptokinase

Question 20

How do pro-haemostatic drugs work? Can you given an example?

Answer 20

Prevent conversion of plasmin into plasminogen (generally).

Tranexamic acid