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Applied Pharmacology > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What example of a medication has the strongest diuretic effect?

A

Loop diuretic - Furosemide, bumetanide

  • Work on the ascending limb of the loop of Henle
  • Inhibit the Na+/k+/2Cl- co-transporter
  • Cause dilation of capacitance veins
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2
Q

What is the MOA of thiazide diuretics?

A

Examples: bendroflumethiazide, indapamide, chlortalidone

MOA: Inhibit inhibit the Na/Cl co-transporter in the distal convoluted tubule of the nephron

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3
Q

What are important interactions of statins?

A

Metabolism of statins is reduced by cytochrome P450 inhibitors - amiodarone, diltiazem, itraconazole, macrolides and protease inhibitors

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4
Q

Main information about aldosterone antagonist?

A

Examples: spironolactone, eplerenone
Indications - chronic HF, ascites, oedema, primary hyperaldosteronism

MOA: competitively bind to the aldosterone inhibitor
This increases sodium and water excretion
Causes potassium retention

Side effects: hyperkalaemia, gynaecomastia, liver impairment (jaundice)

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5
Q

Warnings and interactions of spironolactone?

A

Warnings - severe renal impairment, hyperkalaemia, Addison’s disease

Interactions - potassium elevating drugs (ACE inhibitors, ARBs)

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6
Q

What type of drug is aspirin and what is its MOA?

A

Anti-platelet drug

MOA:

  • Irreversibly inhibits COX to reduce the conversion of arachidonic acid to thromboxane
  • Reduces platelet aggregation
  • Reduces the risk of arterial occlusion
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7
Q

What are the indications of Aspirin?

A
  • Treatment of ACS
  • Ischaemic stroke
  • Prophalaxis of DVT & PE in people with arterial disease
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8
Q

Side effects and warnings of aspirin?

A

Side effects:

  • GI irritation
  • peptic ulcers
  • peptic haemorrhage
  • tinnitus

Warnings:

  • not to be given to children under 16yrs - Reye’s syndrome
  • third trimester of pregnancy
  • peptic ulcers
  • gout
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9
Q

What is an example of an ADP-receptor antagonist and how does it work?

A

Clopidogrel

MOA:

  • Bind irreversibly to ADP receptors (P2Y12 subtype) on the surface of platelets
  • Prevents platelet aggregation
  • Reduce the risk of arterial occlusion
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10
Q

What are the important interactions of antiplatelets?

A
  • antiplatelet are pro dugs ( metabolised by hepatic cytochrome P450 enzymes)

They interact with any drug that inhibits cytochrome P450 enzymes:

  • omeprazole
  • ciprofloxacin
  • erythromycin
  • some antifungals
  • some SSRIs
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11
Q

What is the MOA of statins?

A
  • reduce serum cholesterol
  • inhibit HMG CoA reductase (involved in making cholesterol)
  • increase clearance of LDL from the blood
  • indirectly reduced triglycerides
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12
Q

Side effects of statins?

A
  • Headache
  • GI disturbance
  • Muscle weakness and aches
  • Rhabdomyolysis (rare)
  • increase in liver enzymes (ALT)
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13
Q

What time of the day should simvastatin be taken?

A

Usually taken in the evening

  • has a short half life
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14
Q

How are statins monitored?

A

1) lipid profile before initiating statin
2) lipid profile after 3 months (aiming for a 40% decrease in non-HDL cholesterol)

1) Liver function tests at baseline (ALT)
2) Check again at 3 and 12 months

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15
Q

What is the treatment for Atrial fibrillation?

A

1) DOAC (apixaban, rivaroxaban)

OR

2) Warfarin - prosthetic valves, anti-phospholipid
syndrome

3) Rate control treatment:
- Beta blocker
- Rate limiting CCB (diltiazem or verapamil)

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16
Q

When do you initiate treatment for AF

A
  • CHA2DS2VASc score of 2 or above

- Men with AF and a CHA2DS2VASc score of 1- consider a DOAC

17
Q

What can be used to reverse the action of heparin?

A

Protamine

18
Q

What can be used to reverse the action of warfarin

A

Phytomenadione (Vitamin K1)

19
Q

What patient education must be given to a patient initiated on warfarin?

A
  • Yellow Book - alert to their warfarin therapy
  • Small changes in food, alcohol and other drugs can affect the therapeutic index of warfarin
  • Regular blood tests are required (INR)
  • Dosage might be changed depending on INR results (to reach therapeutic index)
  • It takes a few days for full anticoagulation to start (might be started with heparin)
20
Q

What food and drink affect warfarin?

A

Food:
- Vitamin K rich food - fermented soybeans, broccoli, spinach, cabbage

Drink:
- Increased alcohol consumption (binge drinking)

21
Q

What drugs interact with warfarin and increase risk of bleeding?

A

1) Most antibiotics
2) Antifungals
3) Antidepressants
4) Antiplatelet
5) NSAIDS
6) Analgesia - tramadol, paracetamol

22
Q

What drugs interact with warfarin and increase risk of coagulation?

A

1) Rifampicin

2) St Johns wort

23
Q

What is the MOA of warfarin?

A
  • Inhibits vitamin K epoxied reductase

- Inhibits hepatic production of vitamin K dependent coagulation factors (factors II, VII, IX and X)

24
Q

What drug increases the risk of statin-induced rhabdomyolysis?

A

Amiodarone

25
Q

What is the MOA of nitrates?

A
  • Cause the release of nitric oxide in smooth muscle, activating guanylate cyclase which then converts GTP to cGMP
  • Decreased intracellular calcium levels
  • Relaxation of vascular smooth muscle
26
Q

Side effects of nitrates?

A
  • hypotension
  • tachycardia
  • headaches
  • flushing
27
Q

What is the MOA of DOACs?

A
  • Act on the final common pathway of the coagulation cascade
  • Factor Xa antagonist
  • This prevents conversion of prothrombin to thrombin
  • Inhibits fibrin formation
28
Q

Where specifically do DOACS prevent coagulation?

A
  • They prevent clot formation in the heart and veins

- They are less effective in the arterial circulation where clots are largely platelet driven

29
Q

What are common side effects of DOACs?

A
  • Bleeding
  • GI bleeding
  • Anaemia
  • GI upset
  • Elevated liver enzymes
30
Q

Warnings for initiating a DOAC?

A
  • Active clinical bleeding
  • Risk factor for bleeding (cancer, recent surgery, peptic ulcers, trauma)
  • Hepatic or renal disease
  • Pregnancy & breastfeeding
31
Q

What is a specific administration of riaroxaban?

A
  • Must be taken with due to absorption
32
Q

What communication is needed with a patient on a DOAC?

A
  • The medication increases their bleeding risk

- They will be given an alert card to be shon to health care professionals

33
Q

What condition does amlodipine worsen the symptoms of ?

A

GORD

34
Q

What is the only other medication available as an alternative to statins?

A

Ezetimibe

35
Q

How can thiazide diuretics cause confusion?

A
  • Secretion of sodium from the distal convoluted tubule

- Increased loss of sodium through the kidney can cause hyponatraemia which may present with confusion

Applied Pharmacology (13 decks)

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