Cardio drugs Flashcards

Question

Where are Beta2-adrenoreceptors found?

Answer 1

In the smooth muscle of blood vessles and airways

Answer 2

``` Ischaemic heart disease- 1st line Chronic heart failure AF supraventricular tachycardia hypertension- 4th line ```

Answer 3

Dilitiazem amlodipine nifedipine verapamil

Answer 4

dihydropyridines | non-dihyrdopyridines

Answer 5

vasculature- decrease intracellular conc of Ca --> relaxation and vasodialtion--> lowers arterial pressure amlodipine nifedipine

Answer 6

heart- suppress cardiac conduction, especially across AV node --> slows ventricular rate--> redue myocardial O2 demand - prevents angina verapamil diltiazem

Answer 7

Hypertension- amlodipine (lesser extent nifedipine) stable angina - diliatzem and verapamil Supraventricular arrhythmias (e.g. AF, atrial flutter, supraventricular tachycardia)- diltiazem and verapamil

Answer 8

Poor left ventricular function can --> heart failure AV nodal conduction delay --> heart block Amlodipine and nifedipine should be avoided in unstable angina and severe aortic stenosis

Answer 9

ankle swelling flushing headache palpitations caused by vasodilation and compensatory tachycardia

Answer 10

constipation- common Less common: bradycardia heart block cardiac failure

Answer 11

verapamil and dilitiazem shouldn't be used with beta blockers --> heart failure, bardycardia, asystole

Answer 12

Block the angiotensin converting enzyme to prevent the conversion of angiotensin 1 to angiotensin2 (a vasodialtor that stimulates aldosterone secretion)

Answer 13

``` Hypertension <55 Chronic heart failure ischaemic heart disease Diabetic nephropathy CKD ```

Answer 14

Renal artery stenosis AKI Pregnant/ breast feeding women

Answer 15

Hypotension Persistent dry cough- due to increase bradykinin levels hyperkalaemia can worsen renal failure rare: angioedema

Answer 16

Avoid using with other K elevating drugs | With NSAIDs there is an increased risk of renal failure

Answer 17

Losartan cadesartan irbesartan

Answer 18

they block the action of angiotensin II on the AT1 receptor

Answer 19

``` Hypertension chronic heart failure Ischaemic heart disease CKD Diabetic nephropathy ```

Answer 20

AKI Pregnant/ breast feeding Renal artery stenosis

Answer 21

Hypotension Hyperkalaemia Can worsen renal failure

Answer 22

Other potassium elevating drugs | NSAIDs increase renal toxicity

Answer 23

``` isorbide mononitrate glyceryl trinitrate (GTN) ```

Answer 24

nitrate is converted into nitric acid NO --> increases cGMP synthesis and reduces intracellular Ca in vascular smooth muscle --> relax--> validation

Answer 25

Glyceryl trinitrate (GTN)- acute angina and pain from ACS

Answer 26

isosorbide mononitrate- prophylaxis of angina when a B-blocker or a Ca channel blocker are insufficient or not tolerated

Answer 27

Pulmonary oedema with furosemide and O2

Answer 28

severe aortic stenosis haemodynamic instability hypotension

Answer 29

flushing headaches light headedness hypotension

Answer 30

DO NOT use with phosphodiesterase inhibitors e.g. sildenafil- these enhance and prolong the hypotensive effect of nitrates caution with antihypertensives

Answer 31

a cardiac glycoside

Answer 32

AF and Atrial flutter - but B-blocker and Ca-channel blocker normally more effective Severe heart failure- 3rd line, unless they have coexisting AF

Answer 33

2nd degree heart block intermittent complete heart block ventricular arrhythmias reduce dose in renal failure

Answer 34

hypokalaemia hypomagnesaemia hypercalcaemia

Answer 35

``` bradycardia GI disturbances rash dizziness blurred or yellow vision Low therapeutic index toxicity--> arrhythmias ```

Answer 36

Loop and thiazide diuretics increase the risk of it's toxicity by causing hypokalaemia Amiodarone, Ca channel blockers, spirolonactone and quinine increase plasma conc of digoxin

Answer 37

an anti-dysrhythmic

Answer 38

blocks Na, Ca and K channels Antagonist of alpha and beta adrenergic receptors --> reduces spontaneous depolarisation, slows conduction velocity and increases resistance to depolarisation --> reduces ventricular rate

Answer 39

AF atrial flutter supraventricular tachycardia refractory ventricular fibrillation generally only used when other options aren't viable

Answer 40

severe hypotension heart block active thyroid disease- due iodine content (amIODarone)

Answer 41

hypotension during IV infusion ``` chronically- long 1/2 life --> months to be eliminated pneumonitis bradycardia AV block hepatitis phtosensitivity grey discolouration ``` thyroid abnormalities- due to iodine content and structurally similar to thyroid hormone

Answer 42

Increases plasma conc of digoxin, diltiazem and verapamil --> increased risk of bradycardia, AV block and heart failure The doses of these drugs should be halved if it's started

Answer 43

irreversibly inhibits cyclooxygenase (COX) to redcue production of thromboxane from arachidonic acid, reducing platelet aggregation

Answer 44

ACS acute ischaemic stroke AF- where warfarin and NOACs are contraindicated mild to moderate pain and fever control long term/ secondary prevention of thrombotic arteria events in patients with cardiovascular, cerebrovascular and PAD

Answer 45

children under 16- risk of Reye's syndrome 3rd trimester pregnancy- may lead to premature closure of ductus arteriosus Peptic ulceration Caution with gout

Answer 46

``` GI irritation ulceration GI haemorrhage hypersensitivity reactions--> bronchospasm regular high dose --> tinnitus ```

Answer 47

a thrombolytic

Answer 48

prevents platelet aggregation by binding irreversibly to ADP receptors on the surface of platelets

Answer 49

ACS prevent occlusion of coronary artery stents Prevention of thrombotic arterial events in patients with CV, cerebrovascular and PAD AF- where NOACS and warfarin are contraindicated

Answer 50

renal-heaptic impairment

Answer 51

bleeding GI upset Rarely thrombocytopenia- affects numbers as well as function

Answer 52

It is a pro-drug so is activated by P450 enzymes inhibitors of this will reduce its efficacy: omperazole ciprofloxacin erythromycin some antifungals some SSRIs

Answer 53

enoxaparin dalteparin unfractionated heparin fondaparinux- synthetic compound similar to heparins, inhibits factor Xa only

Answer 54

activates antithrombin that in turn inactivates clotting factor Xa

Answer 55

preferentially inhibit factor Xa

Answer 56

DVT PE ACS

Answer 57

clotting disorders severe, uncontrolled HTN recent surgery or trauma In renal impairment use of lower dose LMWH or fondaparinux or UFH instead

Answer 58

bleeding injection site reactions rarely heparin-induced thrombocytopenia- less likely with LMWH than UFH

Answer 59

protamine effective for UFH Less so for LMWH Not at all for fondaparinux

Answer 60

catalyses the conversion of plasminogen to plasmin

Answer 61

thrombolytic therapy following stroke Massive PE Acute STEMI

Answer 62

pregnancy | Head injurys- CT scan done before starting treatment to ensure there isn't a bleed

Answer 63

bleeding | bleeding ulcers

Answer 64

Protein C and S | 2,7,9,10

Answer 65

DVT PE AF Valve replacement

Answer 66

post trauma pre surgery patients with liver disease- less able to metabolise it pregnancy- 1st trimester and towards term

Answer 67

bleeding | spontaneous haemorrhage if in excess e.g. epistaxis or retroperitoneal

Answer 68

Metabolised by P450 Inhibitors: fluconazole, macrolides, protease inhibitors - decrease metabolism --> increase bleeding risk Inducers: phenytoin, carbamezepine, rifampicin- increase metabolism --. increase risk of clots ``` Antibiotics that kill gut flora that synthesise vit K: trimethorpim metronidazole fluconazole cirprofloxacin levofloxacin azithromycin clarirthromycin ```

Answer 69

inhibit HMG CoA reductase which is involved in making cholesterol --> decrease cholesterol production in the liver

Answer 70

Primary and secondary prevention of CV disease Hyperlipidaemia familial hypercholesterolaemia

Answer 71

Hepatic impairment excreted by kidneys- lower dose in renal impairment pregnancy/ breast feeding

Answer 72

``` headache GI disturbamces Muscle ache myopathy rarely rhabdomyolyis ALT-drug-induced hepatitis is a rare but serious SE ```

Answer 73

metabolised by CP450 inhibitors- amiodarone, diliatzem, itraconazole, macrolides --> accumulation Amloidipine has the same effect

Answer 74

competitive antagonist of factor X and thrombin

Answer 75

rivaroxaban apixaban dabigatran edoxaban

Answer 76

Prevention of VTE after knee or hip replacement DVT PE AF

Answer 77

renal impairment

Answer 78

``` bruising epistaxis haematuria haematemesis melena genitourinary bleeding dyspepsia GI bleeding ```

Answer 79

proton pump inhibitors reduce absorption | Rivaroxaban is metabolised by P450