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3rd year > Cardio drugs > Flashcards

Cardio drugs Flashcards

1
Q

What class of drug is atenolol?

A

Beta antagonist

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2
Q

What are the indications for atenolol? 3

A

hypertension
angina
arrhythmia (fast)

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3
Q

What are the contraindication for atenolol? 4

A

Hypotension
bradycardia
asthma
peripheral vascular disease

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4
Q

What are the side effects of atenolol? 6

A 
Predicatble: 
Hypotension 
bradycardia 
wheezing 
cold peripheries

Unpredictable
nightmares

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5
Q

Give 2 examples of loop diuretics

A

furosemide

bumetanide

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6
Q

What are the indications for loop diuretics? 3

A

acute pulmomary oedema
chronic heart failure
oedematous states

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7
Q

What are the contraindications for loop diuretics? 5

A 
Hypovolaemia and dehydration
hepatic encephalopathy
hypokalaemia
hyponatraemia 
chronically can worsen gout
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8
Q

What are the side effects for loop diuretics? 4

A

dehydration
hypovolaemia
metabolic alkalosis- due to electrolyte loss

high doses–> tinitus and hearing loss} similar transporter regulates endolymph composition in inner ear

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9
Q

What are the interactions of loop diuretics? 4

A

Can affect drugs excreted by the kidneys

Can increases digoxin toxicity

can increases otoxicity and nephrotoxicity of aminoglycosides

Increases lithium levels

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10
Q

What is bendroflumethiazide?

A

a thiazide diuretics

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11
Q

Where in the kidney does bendroflumethiazide work?

A

Na+/Cl- transporter in the distal convoluted tubule

prevents reabsorption of Na and hence water

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12
Q

What are the indications for bendroflumethiazide? 1

A

Hypertension

-1st line option in >55 and black patients

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13
Q

What are the contraindications for bendroflumethiazide? 3

A

hypokalaemia
hyponatraemia
Gout- reduced uric acid excretion

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14
Q

What are the side effects of bendroflumethiazide?4

A

hypokalaemia
hyponatraemia
may cause impotence
May increase glucoes, LDL and triglycerides

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15
Q

What are the interactions of bendroflumethiazide?

A

effectiveness may be reduced with NSAIDs

Don’t use with loop diuretics

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16
Q

How can you counterbalance the hypokalaemia caused by bendroflumethiazide?

A

By giving ACEi or ARBs as well as they are synergistic in lowering BP and cause hyperkalaemia

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17
Q

What is spironolcatone?

A

A potassium sparing diuretic/ aldosterone antagonist

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18
Q

How does spironolcatone work?

A

Competitively binds to the aldosterone receptor –> increases Na and water excretion and K retention

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19
Q

What are the indications for spironolactone? 3

A

ascites and oedema due to liver cirrhosis

chronic heart failure- usually as an an addition to a B-blocker and ACEi/ARB

Primary hyperaldosteronism

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20
Q

What are the contraindications for spironolactone? 4

A

severe renal impairment
hyperkalaemia
Addison’s disease- who are aldosterone def
In pregnancy/ breastfeeding

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21
Q

What are the side effects of spironolactone?4

A

Hyperkalaemia
Gynaecomastia
Can –> liver impairment
Stevens-Johnson syndrome

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22
Q

What are the interactions of spironolcatone?

A

If combined with ACEis and ARBs may –> hyperkalaemia

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23
Q

What is atenolol? (bisoprolol, propanolol, metoprolol)

A

Beta-blockers

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24
Q

Where are Beta1-adrenoreceptors found?

A

In the heart

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25
Q

Where are Beta2-adrenoreceptors found?

A

In the smooth muscle of blood vessles and airways

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26
Q

What are the indications for atenolol? 5

A 
Ischaemic heart disease- 1st line
Chronic heart failure 
AF 
supraventricular tachycardia 
hypertension- 4th line
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27
Q

Give 4 examples of Ca channel blockers

A

Dilitiazem
amlodipine
nifedipine
verapamil

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28
Q

What are the 2 classes of Ca channel blockers?

A

dihydropyridines

non-dihyrdopyridines

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29
Q

Where do dihydropyridines work? and give examples

A

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

amlodipine
nifedipine

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30
Q

Where do non-dihyrdropyridines work? give examples

A

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

verapamil
diltiazem

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31
Q

What are the indications for Ca channel blockers? 5

A

Hypertension- amlodipine (lesser extent nifedipine)

stable angina - diliatzem and verapamil

Supraventricular arrhythmias (e.g. AF, atrial flutter, supraventricular tachycardia)- diltiazem and verapamil

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32
Q

What are the contraindications for Ca channel blockers? 4

A

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

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33
Q

What are the side effects of amlodipine and nifedipine?4

A

ankle swelling
flushing
headache
palpitations

caused by vasodilation and compensatory tachycardia

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34
Q

What are the side effects of verapamil?

A

constipation- common

Less common:
bradycardia
heart block
cardiac failure

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35
Q

What are the interactions of Ca channel blockers?

A

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

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36
Q

What are ramipril, lisinopril and perindopril?

A

ACEis

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37
Q

How do ACEis work?

A

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

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38
Q

What are the indications of ACEIs? 5

A 
Hypertension <55
Chronic heart failure 
ischaemic heart disease
Diabetic nephropathy 
CKD
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39
Q

what are the contraindications of ACEIs? 3

A

Renal artery stenosis
AKI
Pregnant/ breast feeding women

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40
Q

What are the side effects of ACEIs?5

A

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

rare: angioedema

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41
Q

What are the interactions of ACEIs? 2

A

Avoid using with other K elevating drugs

With NSAIDs there is an increased risk of renal failure

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42
Q

Give 3 examples of ARBs

A

Losartan
cadesartan
irbesartan

43
Q

How do ARBs work?

A

they block the action of angiotensin II on the AT1 receptor

44
Q

What are the indications for ARBs? 5

A 
Hypertension 
chronic heart failure 
Ischaemic heart disease
CKD 
Diabetic nephropathy
45
Q

What are the contraindications for ARBs? 3

A

AKI
Pregnant/ breast feeding
Renal artery stenosis

46
Q

what are the side effects of ARBs? 3

A

Hypotension
Hyperkalaemia
Can worsen renal failure

47
Q

What are the interactions of ARBs?

A

Other potassium elevating drugs

NSAIDs increase renal toxicity

48
Q

Give 2 examples of nitrates

A 
isorbide mononitrate 
glyceryl trinitrate (GTN)
49
Q

How do nitrates work?

A

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

50
Q

What is the indication for short lasting nitrates?

A

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

51
Q

What is the indication for long lasting nitrates?

A

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

52
Q

What is the indication for IV nitrates?

A

Pulmonary oedema with furosemide and O2

53
Q

What are the contraindications of nitrates? 3

A

severe aortic stenosis
haemodynamic instability
hypotension

54
Q

What are the side effects of nitrates? 4

A

flushing
headaches
light headedness
hypotension

55
Q

What are the interactions of nitrates?

A

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

caution with antihypertensives

56
Q

What is digoxin?

A

a cardiac glycoside

57
Q

What are the indications for digoxin? 3

A

AF and Atrial flutter - but B-blocker and Ca-channel blocker normally more effective

Severe heart failure- 3rd line, unless they have coexisting AF

58
Q

What are the contraindications of digoxin? 4

A

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

59
Q

Which electrolyte disturbances increase the risk of digoxin toxicity? 3

A

hypokalaemia
hypomagnesaemia
hypercalcaemia

60
Q

What are the side effects of digoxin? 7

A 
bradycardia 
GI disturbances 
rash 
dizziness 
blurred or yellow vision 
Low therapeutic index 
toxicity--> arrhythmias
61
Q

What are the interactions of digoxin? 6

A

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

62
Q

What is amiodarone?

A

an anti-dysrhythmic

63
Q

How does amiodarone work?

A

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

64
Q

what are the indications of amiodarone? 4

A

AF
atrial flutter
supraventricular tachycardia
refractory ventricular fibrillation

generally only used when other options aren’t viable

65
Q

What are the contraindications of amiodarone? 3

A

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

66
Q

What are the side effects of amiodarone? 8

A

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

67
Q

what are the interactions of amiodarone? 3

A

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

68
Q

How dose aspirin work?

A

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

69
Q

What are the indications of aspirin? 5

A

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

70
Q

What are the contraindications of aspirin? 4

A

children under 16- risk of Reye’s syndrome

3rd trimester pregnancy- may lead to premature closure of ductus arteriosus

Peptic ulceration

Caution with gout

71
Q

What are the side effects of aspirin?

A 
GI irritation
ulceration 
GI haemorrhage 
hypersensitivity reactions--> bronchospasm 
regular high dose --> tinnitus
72
Q

What is clopiodgrel?

A

a thrombolytic

73
Q

how does clopidogrel work?

A

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

74
Q

What are the indications of clopidogrel?4

A

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

75
Q

What are the contraindications of clopidogrel? 1

A

renal-heaptic impairment

76
Q

What are the side effects of clopidogrel? 3

A

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

77
Q

What are the interactions of clopidogrel?

A

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

78
Q

Give 4 examples of heparins

A

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

79
Q

How does unfractionated heparin work?

A

activates antithrombin that in turn inactivates clotting factor Xa

80
Q

How do LMWH (enoxaparin and dalteparin) work?

A

preferentially inhibit factor Xa

81
Q

What are the indications for heparins? 3

A

DVT
PE
ACS

82
Q

What are the contraindications of heparins? 4

A

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

83
Q

What are the side effects of heparins?

A

bleeding
injection site reactions

rarely
heparin-induced thrombocytopenia- less likely with LMWH than UFH

84
Q

How can you reverse heparins?

A

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

85
Q

How does tissue plasminogen activator work?

A

catalyses the conversion of plasminogen to plasmin

86
Q

What are the indications of tPA?3

A

thrombolytic therapy following stroke
Massive PE
Acute STEMI

87
Q

What are the contraindications of tPA? 2

A

pregnancy

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

88
Q

What are the side effects of tPA?

A

bleeding

bleeding ulcers

89
Q

Which factors does warfarin affects?

A

Protein C and S

2,7,9,10

90
Q

What are the indications for warfarin?

A

DVT
PE
AF
Valve replacement

91
Q

What are the contraindications of warfarin?

A

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

92
Q

What are the side effects of warfarin?

A

bleeding

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

93
Q

What are the interactions of warfarin? 13

A

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
94
Q

How do statins work?

A

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

95
Q

What are the indications for statins? 3

A

Primary and secondary prevention of CV disease
Hyperlipidaemia
familial hypercholesterolaemia

96
Q

What are the contraindications for statins? 3

A

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

97
Q

What are the side effects of statins? 6

A 
headache 
GI disturbamces 
Muscle ache 
myopathy 
rarely rhabdomyolyis 
ALT-drug-induced hepatitis is a rare but serious SE
98
Q

What are the interactions of statins? 2

A

metabolised by CP450
inhibitors- amiodarone, diliatzem, itraconazole, macrolides –> accumulation

Amloidipine has the same effect

99
Q

How do NOACs work?

A

competitive antagonist of factor X and thrombin

100
Q

Give 4 examples of NOACs

A

rivaroxaban
apixaban
dabigatran
edoxaban

101
Q

What are the indications for NOACs? 4

A

Prevention of VTE after knee or hip replacement
DVT
PE
AF

102
Q

What are the contraindications of NOACs? 1

A

renal impairment

103
Q

What are the side effects of NOACs? 8

A 
bruising 
epistaxis 
haematuria 
haematemesis 
melena 
genitourinary bleeding 
dyspepsia
GI bleeding
104
Q

What are the interactions of NOACs? 2

A

proton pump inhibitors reduce absorption

Rivaroxaban is metabolised by P450

3rd year (9 decks)

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