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Cardiology Flashcards

1
Q

what medications should be avoided in HOCM

A

ACE inhibitors
nicorandil
nitrates

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2
Q

mechanism of action of hydralazine

A

causes arteriole vasodilatation by inhibiting oxidation of nitric oxide

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3
Q

what antihypertensive may cause drug induced lupus? how would this present?

A

hydralazine + methyldopa
joint pains, butterfly facial rash, pyrexia etc

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4
Q

medications responsible for drug induced lupus

A

hydralazine
methyldopa
phenytoin
isoniazid
procanamide
etanercept

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5
Q

how does ACE inhibitors cause hyperkalaemia

A

due to decreased levels of aldosterone which causes potassium retension in distal tubule and cortical collecting duct

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6
Q

cholesterol reducing drug which causes gallstones and mechanism of action

A

fibrates
activate PPAR alpha which reduces expression of 7-alpha-hydroxylase which is the enzyme for the rate limiting step of bile acid synthesis

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7
Q

cholesterol reducing drug which can cause reduction in fat soluble vitamins and mechanism of action

A

bile acid resins e.g. cholestyramine
disrupt enterohepatic bile acid circulation

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8
Q

cholesterol reducing drug which can cause hyperglycaemia or hyperuricaemia and its mechanism of action

A

niacin
inhibits lipolysis in adipose tissue reduces hepatic VLDL synthesis

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9
Q

mechanism of action of GTN

A

causes venodilation via c-GMP which decreases preload and decreases oxygen demand

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10
Q

contraindications to GTN

A

right ventricular infarction
concurrent PDE-5 inhibitors
HOCM

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11
Q

what patients may be more prone to angioedema caused by ACE inhibitors and why

A

ACE causes oedema due to decreased degredation of bradykinin
more prone in patients with history of hypersenstivity reactions
can occur at any stage even if they have been on it for years so alway suspect

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12
Q

side effects of niacin

A

cutaneous flushing
hyperglycaemia
hyperuricaemia

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13
Q

side effects of cholestyramine

A

reduced absorption of fat soluble vitamins

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14
Q

side effects of statins

A

myopathy
derranged LFT’s

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15
Q

side effects of fibrates

A

cholesterol gallstones

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16
Q

what type of anti-arrythmic is flecainide

A

Ic anti-arrhythmmic

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17
Q

what type of anti-arrythmic is lidocaine

A

Ib anti-arrythmic

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18
Q

what tyype of anti-arrhythmic is verapamil

A

IV anti-arrythmic

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19
Q

what type of anti-arythmic is ibutilide

A

type III anti-arythmic

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20
Q

what type of anti-arrythmic could cause torsades de pointes in WPW syndrome

A

type III antiarrythmics i.e. ibutilide or sotalol as they prolong the QT

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21
Q

what type of anti-arrythmic is procanamide

A

Ia anti-arrythmic

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22
Q

what is used to treat AF in a patient with WPW syndrome

A

type III antiarrythmics (i.e. ibutilide) or type Ia (i.e. procanamide)

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23
Q

what condition has similar disease mechanism to the action of GIIa/IIIb inhibitors

A

Glanzman thrombasthenia

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24
Q

what lipid loweing drug causes flushing and how can this be prevented

A

niacin
concomittant use of aspirin

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25
main side effects of nitroprusside
Prolonged use of nitroprusside can lead to cyanide toxicity, especially in individuals with decreased renal function. Cyanide acts primarily via inhibition of mitochondrial cytochrome C oxidase in the electron transport chain.
26
treatment for hypertensive emergency and how they work
nitroprusside - dilatation due to release of NO fenoldopam - dopamine D1 agonist which causes coronary, perheral, splanchnic and renal vasodilatation
27
side effects of fenoldopam
D1 receptor agonist used to treat hypertensive crisis can cause hypotenion, flushing, nausea
28
side effects of nitroprusside
cyanide toxicity used to treat hypertensive emergency cyanosis, diarrhoea, headache, confusion
29
mechanism of action of CCB
slow AV node conduction
30
how does alpha blockers cause postural hypotension
baroreceptor reflex dysfunction
31
how do ACE inhibitors affect vascular smooth msucle
activation of phospholipase C and decreased activation of Gq
32
cardioselective betablockers
atenolol esmolol metoprolol nebivolol
33
action of cardioselective betablockers
affect phase 4 of cardiac cycle decrease activity of funny If channels which decreases cGMP activity of SA node = slows heart rate
34
action of milrinone and what its used for?
PDE-3 inhibitor used in acute decompensated heart failure causes increased peripheral vascular resistance and increased cardiac contractility by increasing cAMP
35
why would you avoid BB and ACE inhibitors in asthma
BB - bronchoconstriction ACE inhibitors - may be unable to differentiate between asthma or ACE induced cough
36
antihypertensives allowed in pregnancy
nifedipine methyldopa hydralazine labetalol (New Moms Love Hugs)
37
mode of action of sacubitril
neprilysin inhibitor
38
mode of action of CCBs
block voltage gated L type calcium channels of cardiac and smooth muscle which decreases muscle contractility
39
what CCB is used in subarachnoid haemorrhage
nimodipine
40
indication for use of nicardipine
hypertensive emergency
41
CCB that can cause hyperprolactinaemia
verapamil
42
indication for dihydropyridine vs non-dihydropyridine CCB
dihydropyridine - vascular smooth muscle non-dihihydropyridine - cardiac muscle
43
action of hydralazine
increased cGMP - smooth muscle relaxation. Dilates arterioles > veins. Reduced after load.
44
side effects of hydralazine
medication induced lupus reflex tachycardia fluid retention headache angina
45
ranolazine mode of action and indication
inhibits the late phase of the inward Na current thereby reducing diastolic wall tension and oxygen consumption. Doesnt affect HR or BP. Used for refractory angina.
46
side effects of ranolazine
constipation, dizziness, headache, nausea
47
mode of action of sacubitril and indication
neprilysin inhibitor - prevents degredation of bradykinin, nautriretic peptides, angiotensin II and substance P which increases vasodilatation and reduced ECF volume. Used in combination with ARB in HFrEF.
48
what is the best lipid lowering drug for hypertriglyceridaemia
fibrates i.e. fenofibrate, gemfibrozil
49
mode of action of ezetimibe
prevents cholesterol absorption at small intestine brush border
50
action of ivabradine
prolongs slow depolarisation (IV phase) by selectively inhibiting funny If funny Na channels
51
side effects of ivabradine
luminous phenomena / visual brightness hypertension bradycardia
52
action of nebivolol
combined selective B1 antagonist and B3 activation (activates NO synthase in the vasculature and decreases SVR)
53
Selective betablockers (B1>B2)
'olol' first half of alphabet i.e. bisoprolol, atenolol
54
non-selective betablockers (B1=B2)
'olol' second half of alphabet i.e. 'timolol, propranolol
55
non-selective beta and alpha blockers
not selective in prefix labetalol, carvedilol
56
side effects of methyldopa
direct coombs test positive haemolysis, hyperprolactinaemia, drug induced lupus
57
adverse effects of atropine
increased body temp increased HR disorientation constipation angle closure glaucoma in older adults urinary retention in men with BPH
58
mechanism of action of atropine
muscarinic antagonist
59
what betablocker can cause dyslipidaemia
metoprolol
60
which betablockers have been shown to help with mortality in heart failure
Betablockers Curve Mortality bisoprolol carvedilol metoprolol
61
centrally acting anti-hypertensive and mode of action
clonidine - only widely used centrally acting anti-hypertensive used in hypertensive emergencies alpha 2 agonist
62
major side effect of sudden discontinuation of clonidine
alpha 2 agonist - abrupt discontinuation can cause rebound hypertension

Pharmacology (15 decks)

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