Cardio Pharmacology Flashcards
What is the pharmacological action of Atorvastatin?
40% reduction of non-HDL
=Reduces cholesterol production by inhibiting HMG CoA
What does Atorvastatin inhibit?
HMG CoA
What antibiotics must be stopped while taking Statins?
Clarithromycin and Eythromycin
What should be prescribed 12 months before taking a post-MI patient off Aspirin?
Clopidogrel or Trigrelor
What is the pharmacological mechanism of action of ACE inhibitors?
Manipulates : RAAS (Renin-Angiotensin Aldosterone System)
Inhibits ACE enzyme (Angiotensin Converting Enzyme) and therefore prevents Vasoconstriction of arterioles by preventing release of aldosterone and therefore prevents increase of Na+ and H20 reabsorption.
What is the pharmacological mechanism of action of ARB (Angiotensin Receptor Blocker)?
Decreases vasodilation effects by antagonistically binding AT1 receptor, meaning Angiotensin II has to bind AT2 receptors instead. As there are fewer AT2 receptors than AT1, the action is decreased (NOT blocked).
Name the common ending for ACE inhibitors as well as a few common examples.
-pril
e.g Lisinopril, Ramipril (slower onset longer duration)
e.g Catopril and Enalapril (shorter duration)
Out of these three ACE inhibitors which two have the shorter duration? :
Lisinopril , Captopril, Enalapril, Ramipril
Captopril and Enalapril
(All other ACE inhibitors are shorter onset and longer duration)
Name the common ending for ARB inhibitors as well as a few common examples.
-sartan
e.g Losartan, Valsartan, Candesartan
Sort the following B blocker drugs into water soluble and lipid soluble:
Metoprolol, Atenolol, Propranolol, Sotalol
Lipid Soluble: Metoprolol and Propranolol
Water Soluble: Atenolol and Sotalol
What type of clearance is applicable to water soluble beta blockers e.g Atenolol?
Kidney clearance
Name a Beta Blocker that can cause poor sleep and nightmares.
Any lipid soluble Beta blocker can cross the BBB and therefore cause this.
E.g Propranolol
What Beta Blockers are indicated in critical care?
Metoprolol, Esmolol and Carvedilol
What Beta Blocker is generally prescribed for arrhythmias?
Sotalol
What two Beta Blockers are non-selective and therefore bind both B1 and B2 receptors?
Propranolol and Sotalol
What type of clearance is applicable to lipid soluble beta blockers e.g Propranolol
Hepatic clearance
Between Atenolol and Propranolol, which one can cross the BBB barrier?
Propranolol (as it is lipid soluble)
What are the side effects of B2 antagonism?
(Name 4)
-Claudication (cramping in skeletal muscles of calves)
-Bronchoconstriction
-Cold hands and feet
-Hypoglycaemia (less insulin caused by B2 antagonism means less glucose is stored)
(due to Beta blockers such as Propranolol and Sotalol)
What is the main side effect of taking beta blockers?
Bradycardia
=Hypotension, Syncope, Weakness and Dizziness
Which of these side effects apply to Beta Blockers?
Weight gain, Weight loss, Constipation, Diarrhoea, Nausea.
Weight gain, Diarrhoea and Nausea
What is an unusual yet serious side effect of Beta Blockers?
AV Block (Heart Block)
=due to the alteration of AV node, could cause impairment of conduction between atria and ventricles
Name the 4 general contraindications for Beta Blockers.
-Frequent episodes of Hypoglycaemia
-Asthma / COPD
-Type 1 Diabetes
-Patients already with Bradycardia
What are the 2 main adverse effects of long term use of Beta Blockers, that means a patient must stop taking their Beta Blockers.
1.Hypertension
2.Angina
Long term use of B-Blockers can cause a rebound so that the sympathetic stimulation starts up again causing the above problems.
A patient with Type 1 Diabetes is diagnosed with Angina. What first line drug is contraindicated and what drug is prescribed?
Beta blockers are contraindicated for Type 1 Diabetics, and so this patient would be prescribed a Calcium Channel Blocker such as Amlodipine.
Is Amlodipine mainly prescribed for primary or secondary hypertension?
Primary
What Calcium channel blockers are usually prescribed for patients with secondary hypertension?
Verapamil and Diltazem
What monitoring is required for a patient on ACE inhibitors?
After 1-2 weeks:
-Renal panel
-Serum electrolytes (to check for Hyperkalaemia)
What is a common side effect of Ramipril when on a high dose?
Dizziness
What 2 conditions require a patient to only take a low dose of ACE inhibitors?
Diabetes and Aortic Stenosis
A patient is put on Ramipril. What are the possible reasons for stopping and swapping to Losartan?
(Name 3)
- Angio-oedema
- Cough
- Pregnancy / Breast Feeding
A patient has suffered an MI. For his future care, what Beta Blocker would they most likely be put on?
Atenolol
A patient is diagnosed with Angina. What Beta Blocker would they most likely be put on?
Propranolol
What pre-existing conditions would mean a patient can only take a low dosage of their Beta Blocker?
(Name 3)
1.Diabetes Mellitus
2. AV Block
3. Portal Hypotension
A patient with a history of bradycardia and previous MI, is being considered for secondary CVD treatment. What drug will he most likely be put on?
Doxazosin
=Alpha Blocker
Note: Beta Blockers are contraindicated in patients with pre-existing Bradycardia.
A woman of Caribbean origin is diagnosed with hypertension. What medication would she be put on and why?
Candesartan or Losartan
(ARBS)
-Patients of Black African and Caribbean origin are contraindicated for ACE inhibitors.
A women with a history of hypertension is currently on Ramipril. She is now pregnant and asking her doctor for advice as to whether it is safe to continue taking her Ramipril. What would you advise?
Stop Ramipril (ACE inhibitors). ARBs are also not appropriate.
Start on the following medications:
-Labetalol (Beta Blocker)
-Methyldopa 250mg twice daily
-Nifedipine (Calcium channel blocker) once daily
What the adverse effects of taking Labetalol during pregnancy?
(Name 3)
-Foetal growth restriction
-Decreased maternal energy levels
-Maternal depression.
What the adverse effects of taking Nifedipine during pregnancy?
(Name 2)
-Headaches
-Pretibial Oedema
A patient with stable angina is required to be put on a medication plan for secondary prevention. What medications are applicable here?
(Remember mnemonic)
4As:
Aspirin
Atorvastatin 80mg/daily
ACE inhibitor (If Diabetes, Hypertension, Chronic Kidney Disease, Heart Failure is also present)
Already on Beta Blocker
A patient with type 2 Diabetes is diagnosed with stable angina. What medications would they be prescribed?
Immediate relief:
-Sublingual Glyceryl Trinitrate
Long term:
-Labetalol (Beta Blocker)
-Diltiazem or Verapamil (Calcium Channel Blocker)
Secondary Prevention:
-Aspirin
-Atorvastatin
-Ramipril (ACE inhibitor)
A patient has been diagnosed with stable angina. What pre-existing conditions would require the patient to take an ACE inhibitor as well?
(Name 4)
1.Diabetes
2.Hypertension
3.Chronic Kidney Disease
4.Heart Failure
What is the name of the Antithrombin therapy used for patients with NSTEMI?
Fondaparinux
What drugs are used as part of secondary prevention after a person has had a STEMI or NSTEMI?
(Remember mneumonic)
6As
Aspirin
Another Antiplatelet (Trigrelor, Clopidogrel)
Atorvastatin (80mg/day)
ACE inhibitors (Ramipril)
Atenolol (or Bisoprolol Beta blocker)
Aldosterone Antagonist (Eplerenone)
Name a few examples of Aldosterone Antagonist.
Spironalctone (potassium sparing), Eplerenone, Finerenone
What 2 possible medication may be used during a Thrombolysis intervention?
Fibrinolytic agents:
1.Streptokinase
2.Alteplase
When prescribing Loop diuretics, what possible drug interactions could cause Hyperkalaemia and therefore Renal impairment?
(Name 3 drugs)
ACE Inhibitors
Thiazides
NSDAIDS
Name a few examples of Diuretics
Furosemide
What is the main condition that requires Loop Diuretics?
Left Ventricular Heart Failure
What is the main condition that required Thiazides?
Oedema due to Heart Failure
A patient develops Hyperkalaemia after being on Furosemide and Thiazides. What medication will you want to consider adding?
Spironolactone
=As it is a potassium sparing antagonist
Name 3 contraindications for Loop Diuretics.
Acute Kidney Injury, Cardiac Arrhythmias, Addison’s Disease
Name a few examples of Thiazides.
-Indapamide
-Chlorthalidone
-ending in -thiazide
A patient has renal impairment and therefore needs a diuretic as part of their plan. What type of diuretic can be used?
Osmotic Diuretics
e.g Mannitol and Glycerin
What is the main use of Mannitol and what kind of drug is it?
Osmotic Diuretic
=Used for increased intercranial pressure
What are the main reasons for a patient to take Heparin?
(Name 4)
-Pulmonary Embolism
-Unstable Angina
-Acute Peripheral arterial occlusion
-Deep Vein Thrombosis
What are the main reasons for a patient to take Warafin?
Emergencies such as
1.MI
2.Atrial Fibrillation
What drug can be used to reverse the side effects of Warafin?
Vitamin K
Name 2 examples of Thrombolytics.
Streptokinase and Alteplase
What the main reasons for prescribing Aspirin?
(Remember mneumonic)
I’M AAA :
Ischemia
MI (after heart attack)
Angina
Acute Coronary Syndrome
Atrial Fibrillation
What are the common contraindications for Aspirin?
(Remember mneumonic)
Loyds Banking Group
Leaving the body (Renal and Hepatic impairment)
Bleeding (Hemophilia)
Gastroinstinal bleeding (Peptic ulcer, GI haemorrhage)
Name an oral steroid.
Prednisolone
Name an IV steroid.
Hydrocortisone
Name 4 examples of immunosuppressants.
1.Cyclophosphamide
2.Methotrexate
3.Azathioprine
4.Rituximab and other monoclonal antibodies
A patient has suffered a heart attack in hospital. What are the immediate steps?
- EGG
2.Aspirin 300mg
3.Diamorphine
4.Oxygen saturation measurement
A patient is in hospital with confirmed Anteriolateral MI and has undergone immediate emergency treatment to stabilise them. Now what should be done?
Either Thrombolysis or Coronary Angioplasty
An Inpatient’s Blood Pressure has fallen to 75/50. What needs to be done immediately?
Continuous Positive Airways pressure
What should be prescribed with Opiates to counteract the vomiting effects?
Intravenous Metoclopramide
It is an Anti-Emetic
What ECG changes indicate Narrow Complex Tachycardia?
-QRS complex less than 0.12 s= equal or less than 3 small squares
-Looks like a QRS complex with a T wave immediately after
What ECG changes indicate Atrial Fibrillation?
-Absent P waves
-Narrow QRS =Less or Equal to 3 small squares
