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Cardioresp > Cardio pharma > Flashcards

Cardio pharma Flashcards

1
Q

Vaughn Williams 1a

A

Quinidine - delays

Ventricular dysrhythmias, AF

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2
Q

Vaughn Williams 1b

A

Lidocaine - aborts premature beats

VT and VF

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3
Q

Vaughn Williams 1c

A

Flecainide
(Not specific to damage cells;
suppresses re-entrant rhythms)
Paroxysmal AF; recurrent tachy’s (WPW)

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4
Q

Vaughn Williams 2

A

Beta blocker

Mi, Tachycardia

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5
Q

Vaughn Williams 3

A

K+ Channel Blockers
e.g. Amiodarone
(Prolong repolarisation)
SVT (WPW)

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6
Q

Vaughn Williams 4

A

Calcium Channel Blockers
e.g. Verapamil; Diltiazem
SVT; reduce rate in
AF (SA & AV node)

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7
Q

Beta blockers example

A

Bisoprolol; Atenolol; Propanolol.

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8
Q

Beta blockers mechanism

A

Negatively inotrophic & chronotrophic.

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9
Q

Beta blockers indication

A

hypertension; angina pectoris; following

MI; cardiac dysrhythmias (e.g. AF).

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10
Q

Beta blockers side effect

A

GI disturbances; bradycardia; fatigue;
cold peripheries; heart failure; hypotension; dizziness;
sexual dysfunction; peripheral vasoconstriction;
bronchospasm.

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11
Q

Beta blockers CI

A

asthma; marked bradycardia;
heart block; uncontrolled heart failure; PVD;
Prinzmetal’s angina; hypotension; cardiogenic shock.
Note: β - Blockers should not be used in conjunction with verapamil
and diltiazem (non-dihydropyridines) in HF because of their additive
effects (↓HR, contractility, CO).

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12
Q

Non-dihydropyridines

A 
Verapamil & Diltiazem
􀀹 Negatively inotrophic / chronotrophic but DO NOT
USE IN HEART FAILURE
• Indications:
o Verapamil: fast AF, SVT, hypertension.
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13
Q

Dihydropyridines

A

Amlodipine, Felodipine, Nifedipine
􀀹 Dilates peripheral arteries, ↓ after-load, dilates
coronary vessels, act on vessels > myocardium

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14
Q

CCB Indications:

A

o Verapamil: fast AF, SVT, hypertension.
o Dihydropyridines: hypertension; to prevent
angina.

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15
Q

CCB ADRs

A

• Side effects:
o Verapamil & Diltiazem: constipation; N&V;
flushing, headache, dizziness; fatigue.
o Dihydropyridines: abdominal pain; nausea;
palpitations, flushing, oedema; headache;
dizziness; sleep disturbances; fatigue.

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16
Q

CCB CIs

A

• Contraindications:
o Verapamil & Diltiazem: HF, 2nd or 3rd degree
heart block, cardiogenic shock.
o Dihydropyridines: Unstable angina, significant
AS.

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17
Q

Nitrates

A

Examples: Isosorbide Mononitrate (PO); GTN infusion
(IV); GTN spray (S/L).
• Indications: stable angina (prevention + treatment);
unstable angina (IV); acute heart failure (IV); chronic
HF.

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18
Q

Nitrate CIs

A

Contraindications: hypersensitivity to nitrates;
hypotensive conditions; hypovolaemia; hypertrophic
obstructive cardiomyopathy; AS; MS; cardiac
tamponade; constrictive pericarditis; marked anaemia.

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19
Q

Nitrate ADRs

A

Side effects: postural hypotension; tachycardia;
throbbing headache; dizziness.
o TOLERANCE

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20
Q

Ace inhibitors examples

A

ACE inhibitors

• Examples: Ramipril; Lisinopril; Enalapril.

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21
Q

ACE inhibitors mechansism

A

Inhibits conversion of angiotensin 1 into
angiotensin 2, therefore inhibiting angiotensin 2 having
its effects:
o Increasing sympathetic activity.
o Fluid retention by kidney – via Increase in
aldosterone and direct action.
o Arteriolar vasoconstriction.
o Stimulating ADH secretion causing increased
fluid retention.
ACE inhibitors also cause:
o Reversal of left ventricular hypertrophy.
o Reversal of endothelial dysfunction.

22
Q

ACEi indications

A

Indications: hypertension; HF; following MI
(especially ventricular dysfunction); IHD risk; diabetic
nephropathy; progressive renal insufficiency.

23
Q

ACEi ADRs

A

Side effects: renal impairment; persistent dry cough;
angioedema; rash; hypotension; pancreatitis;
hyperkalaemia; GI effects.

24
Q

ACEi CIs

A

Contraindications: hypersensitivity to ACEi
(angioedema); renal artery stenosis; pregnancy; aortic
stenosis; toxicity.

25
Q

Loop diuretics

A

Loop diuretics
• Examples: Furosemide, Bumetanide.
• Action: Blocks Na+/K+/Cl- co-transporter in the apical
membrane of the thick ascending limb of loop of
Henle.

26
Q

Loop indications

A

• Indications: hypertension; water overload: pulmonary
oedema in LVF, chronic HF, nephrotic syndrome, renal
failure.

27
Q

Loop ADRs

A

Side effects: hypokalaemia; metabolic alkalosis;
sodium & magnesium depletion; hypovolaemia &
hypotension; deafness; nausea; allergies.

28
Q

Thiazides

A

Examples: Bendroflumethiazide.
• Action: Inhibits Na+ reabsorption at the beginning of
the distal convoluted tubule. Blocks Na+/Cl- symporter
that is associated with the luminal membrane.
• Side effects: postural hypotension; hypokalaemia;
hypomagnesaemia; hyponatraemia; hypercalcaemia;
metabolic alkalosis; hyperuricaemia; impotence;
hyperglycaemia.

29
Q

Thiazide indications

A

• Indications: hypertension; severe resistant oedema;

HF.

30
Q

Thiazide side effects

A

• Side effects: postural hypotension; hypokalaemia;
hypomagnesaemia; hyponatraemia; hypercalcaemia;
metabolic alkalosis; hyperuricaemia; impotence;
hyperglycaemia.

31
Q

Thiazide CIs

A

• Contraindications: refractory hypokalaemia;
hyponatraemia; hypercalcaemia; symptomatic
hyperuricaemia; Addison’s disease.

32
Q

Potassium sparing

A

K+ Sparing Diuretics
• Examples: Spironolactone; Amiloride.
• Action: Act on collecting tubules. Spironolactone is
an aldosterone antagonist. Other potassium sparing
diuretics act by directly inhibiting sodium channels e.g.
Amiloride.
• Indications: co-use with K+ losing diuretics; CCF;
cirrhosis; oedema.

33
Q

Potassium sparing ADRs

A

• Side effects: GI disturbances; impotence;
gynaecomastia; menstrual irregularities; lethargy;
headache; confusion; hyperkalaemia; hyponatraemia;
hepatotoxicity.

34
Q

Lipid lowering drugs

A 
Main indications:
o Secondary prevention of MI and stroke.
o Primary prevention arterial disease (raised
serum Cholesterol).
o Dyslipidaemias.
• Main drug classes:
o Statins
o Fibrates
o Ezetimibe
35
Q

Statins

A

• Examples: Atorvastatin; Simvastatin.
• Action: Lowers cholesterol levels in blood by:
o Blocking liver enzyme hydroxy-methylglutarylcoenzyme
A reductase (HMG-CoA reductase),
thereby inhibiting liver synthesis of cholesterol.
o This leads to upregulation of expression of LDL
receptors on liver cells causing ↑ absorption of
LDL from the circulation.

36
Q

Statin CIs and ADRS

A

Side effects: myositis; rhabdomyolysis; headache;
altered LFTs; paraesthesia; GI effects.
• Contraindications: active liver disease; pregnancy;
breast-feeding.

37
Q

Other lipid lowering drugs

A

Fibrates
• Lower triglycerides more than LDL.
Ezetimibe
• ↓ Cholesterol absorption in the intestine.
Note: Risks of rhabdomyolysis increases with combination lipid lowering treatment. NEVER co-prescribe GEMFIBROZIL (a fibrate) and a STATIN.

38
Q

Antiplatelet indications

A

Main indications relate to arterial thrombosis:
acute MI; CABG; unstable angina; coronary artery
angioplasty / stenting; cerebrovascular disease; AF.

39
Q

Aspirin

A

• Suppresses production of prostaglandins and
thromboxane by irreversibly inactivating the
cyclooxygenase (COX) enzyme.
• Irreversibly blocks the formation of thromboxane A2 in
platelets, inhibiting platelet aggregation.

40
Q

Clopidogrel

A

Inhibits ADP-induced aggregation through an active
metabolite.
• STEMI / NSTEMI given with aspirin.

41
Q

Dipyrimadole

A

• Phosphodiesterase inhibitor. May be given in addition
to aspirin in those with a history of recurrent
cerebrovascular disease.

42
Q

Glycoprotein IIA/ IIIB receptor antagonists

A

• Example: Abciximab.

43
Q

Heparin mechanisms

A

• UHF:
o Binds to Antithrombin III (ATIII).
o ATIII is an endogenous inhibitor of coagulation.
o Increases ATIII ability to inhibit factors IXa, Xa,
XIa, XIIa (serine proteases) and thrombin
(unfractionated).
o UHF fully reversible with Protamine.
• LMWH:
o Inhibits factor Xa but not thrombin.
o LMWH not fully reversible with Protamine.

44
Q

Heparin indications

A 
• Main indications: acutely for short-term
anticoagulation: DVT; PE; AF; prosthetic heart valves;
cardiac events (unstable).
45
Q

Heparin side effects and CIs

A

• Side effects: haemorrhage.
• Contraindications: uncontrolled bleeding / risk of
bleeding e.g. peptic ulcer, recent cerebral
haemorrhage; endocarditis.

46
Q

Warfarin

A

• A coumarin
• Action: Inhibits vitamin K dependent clotting factors
(II, VII, IX, X, protein C & S). Does this through
inhibiting the reductase enzyme responsible for the
regeneration of the active form of vitamin K.

47
Q

Warfarin indications

A

• Indications: long-term anticoagulation: DVT; PE; AF;

prosthetic heart valves; cardiac events (unstable).

48
Q

Warfarin ADRs and CIs

A

• Side effects: haemorrhage.
• Contraindications: peptic ulcer; severe
hypertension; bacterial endocarditis; pregnancy.

49
Q

Warfarin OD

A 
• Overdose: INR <6: Decrease / omit Warfarin
INR 6-8: Stop Warfarin. Restart
when INR<5
INR >8: If no bleeding stop
Warfarin &amp; give 0.5-
2.5mg vitamin K if risk of
bleeding.
50
Q

Managing a major bleed on warfarin

A

• Major bleed: Stop Warfarin. Give prothrombin
complex concentrate (Beriplex) contains factors II, VII,
IX, X or FFP. Give 5mg vitamin K. Get HELP!

Cardioresp (6 decks)

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