Cardiology Flashcards

Question

Common examples of calcium channel blockers

Answer 1

``` Verapamil Amlodipine Diltiazem Felodopine Nifedipine ```

Answer 2

Inhibit influx of calcium ions in smooth muscle cells preventing Ca dependant myocyte contraction and vaso constriction

Answer 3

Negative inotropic effect so reduces HR and CO Relax vascular smooth muscle Dilate coronary and peripheral vessels which reduces BP Impairs AV conduction

Answer 4

Remember CHASMA ``` CHF HTN ANGINA SVT MIGRAINE AF / AF ```

Answer 5

Remember: Angina Never: amlodopine and nifodopine for angina and aortic stenosis Ventricular Dire: Verapamil and diltiazem for ventricular failure Generally avoid in patients with AV node block

Answer 6

Amlodopine and Nifodopine: Ankle swelling Flushing Headache Palpitations Verapamil: Constipation Brady Heart block Cardiac failure Diltiazem: All of the above

Answer 7

Any other negative inotropic or chronotrpic drug i.e. B-Blockers especially verapamil

Answer 8

Bendroflumethazide, Indapamide

Answer 9

Inhibit Na/Cl co-transporter in the distal convoluted tubule of nephron which prevents reabsorption of Na and associated water. REMEMBER T in thiazide and Ts in point of action

Answer 10

Alternative first line treatment for HTN when a CCB isn't working or pt has features of HF Add on treatment for HTN treatment where other drugs have failed i.e. CCB + ACEi or ARB

Answer 11

1. Hypokalemia 2. Hyponatremia 3. Gout - due to reduced uric acid excretion

Answer 12

``` GI disturbance Postural HTN Electrolyte disturbances: hyponat. at first but that can lead to hypokal. which may lead to cardiac arrhythmia Increased Glucose Increased trigs and LDL ```

Answer 13

Act principally on the ascending loop of henle Inhibit the Na/K/Cl co-transporter = diuretic effect Also have a direct effect on blood vessels by dilating capacitance veins = reduction in preload + +ve inotropic

Answer 14

Dilates capacitance veins = decreased preload = increased contractile force Increases urine output by inhibiting the co-transporters in ascending loop of henle

Answer 15

Relief of breathlessness in acute pulmonary oedema Symptomatic treatment of chronic heart failure Oedematous states

Answer 16

Any condition where the fluid volume is already low Those at risk of hepatic encephalopathy Hypokalemia/natremia Gout - it can inhibit uric acid excretion and make gout worse

Answer 17

Dehydration and hypotension Low electrolyte state due to increased urinary loss of ions Hearing loss and tinnitus due to similar ion compositions in endolymph in the ear ``` G-L-U-E Glucose increase Lipids increase Uric acid increase Electrolyte decrease ```

Answer 18

Anti-Dysrhythmic

Answer 19

Acts on myocardial cells Inhibits Na/K/Ca channels which decreases automaticity, increases resistance to depolarisation at AV node and prolongs the action potential Also acts as antagonist of A and B adrenergic receptors

Answer 20

AF, AF, SVT, VT, VF | Used when other avenues have been exhausted

Answer 21

Hypotentension Heart block Thyroid problems

Answer 22

``` Many IV acute use: hypotension Chronic use: BITCH Bradycardia Interstitial lung disease Thyroid disease Colour problems in skin and cornea Hypotension ```

Answer 23

Increases plasma levels of digoxin, diltiazem and verapamil

Answer 24

Spironolactone Co-amilofruse (amiloride + furosemide) Co-amilozide (amilordie + thiazide)

Answer 25

Block sodium channel at ENaC at DCT and so prevent osmotic movement of water into epi cells Retain potassium to counter effects of thiazide and loops

Answer 26

Aldosterone antagonist at aldosterone channels in DCT

Answer 27

Hypokalaemia as a combination therapy

Answer 28

Hyperkalaemia | Low fluid states

Answer 29

Electrolyte disturbances (unlikely) GI upset Hypotension

Answer 30

B1 adrenoceptors in heart, B2 in vessels and airway B1 blockers reduce force of contraction and speed of conduction = less work for the heart + prolongs the refractory period at the AV node so helps with re entry SVT

Answer 31

Remember I Admire Cash ``` IHD ACS CHF AF SVT HTN (not first line) ```

Answer 32

ABCDE ``` Asthma Block COPD DM Electrolytes ```

Answer 33

Remember BBC Lost Viewers in Rochdale ``` Brady Bronchoconstriction Claudication / Cold extremities Lipids Vivid dreams Impotence / inotrope neg Reduced sensitivity to hyperglycaemia ```

Answer 34

Block Ang2 at AT1 receptor = same affects as ACEi

Answer 35

``` Hypertension: if 55 or less and white AND and ACEi isnt working or is intolerable CHD IHD CKD Diabetic Neuropathy ```

Answer 36

Pregnancy | RAS

Answer 37

Hypotension Hyperkalemia Renal failure

Answer 38

Anything which increases potassium | NSAIDs

Answer 39

GTN (short acting) Isozorbide mononitrate isosorbide denigrate

Answer 40

Converted to nitric oxidase | Reduces intracellular Ca in vascular smooth muscle cells = relaxation = dilation

Answer 41

reduce preload therefore cardiac work

Answer 42

Angina acute treatment Angina prophylaxis where a BB or CCB is not working Pulmonary oedema (IV)

Answer 43

Severe aortic stenosis Hypotension Haemodynamic instability

Answer 44

do not use with phosphodiesterase inhibitors b/c prolong life of nitrates use in caution in people on antihypertensives

Answer 45

flushing headache dizziness hypotension

Answer 46

cardiac glycoside

Answer 47

Negatively chronotropic Positively inotropic Reduced conduction at AV node therefore less impulses to ventricles therefore lower heart rate Inhibits Na/K/ATP pump so more Na in cell therefore more Ca in cell because Ca requires low Na to move out of cell

Answer 48

1. AF/AF - but a bb or CCB should be tried first | 2. Severe HF - 3rd line with ACEi, BB + ARB or aldosterone antagonist

Answer 49

Any condition to do with conduction or rate and rhythm | Electrolyte disturbance particularly K

Answer 50

``` Digoxin toxicity Brady GI upset Vision disturbance Rash Dizziness ```

Answer 51

Loop diuretics and thiazide diuretics lower K Amiodarone, CCB, Spirinolactone, Quinine All increase risk of Dig Tox

Answer 52

Altaplase Streptokinase Reteplase Tenecteplase

Answer 53

catalyse and convert plasminogen to plasmin

Answer 54

Acute ischemic stroke Massive PE Acute STEMI

Answer 55

Any condition which has a risk of bleeding Brain bleed Prev. streptokinase treatment (if considering further use of streptokinase)

Answer 56

``` Brusing Nausea Vomiting Hypotension Arrhythmia if reperfusing heart tissue Cerebral oedema if reperufing brain tissue ```

Answer 57

Enoxaparin | Dalteparin

Answer 58

Fondaparinux

Answer 59

Enoxaparin and dalteparin preferentially inhibit factor Xa

Answer 60

Inhibits factor Xa only

Answer 61

Activates antithrombin which in turn inactivates Xa and thrombin

Answer 62

LMWH: PE, ACS, VTE prophylaxis Fondaparinux: ACS

Answer 63

Risk of bleeding Severe hypertension Recent surgery or trauma Use low dose or UFH in renal impairment

Answer 64

Bleeding Heparin induced thrombocytopenia Injection site reactions

Answer 65

fondaparinux

Answer 66

Inhibits vitamin k epoxide reductase which prevents reactivation of vitamins K coag factors

Answer 67

1. VTE 2. AF to prevent embolic event 3. Post heart valve surgery to prevent embolic event (temp. for animal valve, lifetime for mechanical)

Answer 68

DO NOT USE: pregnancy or active bleeding | Caution in hepatic impairment

Answer 69

Cytochrome p450 inhibitors

Answer 70

Direct inhibition of Xa

Answer 71

``` Nausea and vomitting diarrhoea constipation dyspepsia hypotension bleeding ```

Answer 72

Active internal bleeding Suspected aortic dissection Recent head trauma and/ or intracranial neoplasm Previous haemorrhagic stroke at any time Previous ischaemic stroke within the past year Previous allergic reaction to fibrinolytic agent, and Trauma and/ or surgery within the past two weeks at risk of bleeding.