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YEAR 3 DRUGS > Cardiology > Flashcards

Cardiology Flashcards

1
Q

What drug class is Furosemide?

A

Loop diuretics

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2
Q

How do loop diuretics work?

A

Inhibits Na/K/Cl co transporter in ascending limb of loop of henle
Can improve contractile function of overstretched heart muscle

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3
Q

What are loop diuretics indicated for?

A 
Pulmonary oedema (alongside O2 and nitrates)
Fluid overload - oedmatous conditions
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4
Q

What are the side effects of loop diuretics?

A

Dehydration/ hypotension

Hearing loss, tinnitus - inner ear co transporter affected

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5
Q

What are the contraindications of loop diuretics?

A 
Hepatic encephalopathy
Hypokalaemia
Hyponatraemia
Hypovolaemia
Gout - reduced uric acid excretion
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6
Q

Important drug interactions of loop diuretics?

A

Lithium toxicity

Digoxin toxicity - due to diuretic associated hypokalaemia

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7
Q

What is the best time do give diuretics and why?

A

Morning due to nocturia problems

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8
Q

What drug class is Bendroflumethiazide?

A

Thiazide diuretics

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9
Q

What are Thiazides indicated for?

A

Alternative 1st line hypertension treatment where a calcium channel would have been used

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10
Q

How do Thiazide diuretics work?

A

Inhibits Na/K/Cl co transporter in distal convolated tubule

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11
Q

What are the side effects of Thiazide diuretics?

A 
Cardiac arrhythmias (due to low sodium and potassium)
Male impotence
Can increase plasma glucose - diabetes type 2
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12
Q

What are the contraindications of Thiazide diuretics?

A

Hyponatraemia
Hypokalaemia
Gout

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13
Q

Important drug interactions of Thiazide diuretics?

A

Effectiveness reduced by NSAIDs (not aspirin)

Loop diuretics

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14
Q

What drug class is Spironolactone?

A

Aldosterone antagonist - potassium sparing

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15
Q

What are Aldosterone antagonists indicated for?

A 
Liver cirrhosis (ascites/oedema) because of loop/thiazide diuretics
Chronic heart failure
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16
Q

How do Aldosterone antagonists work?

A

Competitively bind to aldosterone receptor, increasing sodium and water excretion; potassium retention

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17
Q

What are the side effects of Aldosterone antagonists?

A

Hyperkalaemia
Gynaecomastia
Steven Johnson syndrome
Liver impairment

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18
Q

What are the contraindications of Aldosterone antagonists?

A

Severe renal impairment
Hyperkalaemia
Addison’s disease (aldosterone deficient)
Pregnant or lactating women

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19
Q

Important drug interactions of Aldosterone antagonists?

A

Other potassium elevating drugs - ACEi and ARBs

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20
Q

Give an example of a potassium sparing diuretic that isn’t spironalactone?

A

Amiloride

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21
Q

What drug class is Atenolol?

A

Beta Blocker

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22
Q

What are Beta Blockers indicated for?

A

Ischaemic Heart Disease
Chronic Heart failure
AF, SVT
Hypertension

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23
Q

How do Beta Blockers work?

A

Beta blockers via B1 receptor reduce heart contraction and conduction speed
Prolong refractory period of AV node - slow ventricular rate in AF
Reduce renin from kidneys

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24
Q

What are the side effects of Beta Blockers?

A

Fatigue
Cold extremities
Headache
GI disturbance

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25
What are the contraindications of Beta Blockers?
``` Asthma - life threatening brochospasm Slowly increase dose in heart failure Haemodynamic instability Heart block Hepatic failure ```
26
Important drug interactions of Beta Blockers?
Calcium channel blockers- can cause heart failure, bradycardia
27
What drug class is Diltiazem?
Calcium channel blocker
28
What are Calcium channel blockers indicated for?
Hypertension Stable angina symptom control Supraventricular arryhthmias
29
How do Calcium channel Blockers work?
Decrease calcium entry into vascular and cardiac cells Relaxation and vasodilation in arterial smooth muscle Suppress cardiac conduction
30
What Calcium channel blockers are used cardiac purposes?
Diltiazem, Verapamil
31
What Calcium channel blockers are used vascular purposes?
Amlodipine, nifedipine, Diltiazem (has both functions)
32
What are the side effects of cardiac Calcium channel Blockers?
Bradycardia Cardiac failure Heart block
33
What are the side effects of vascular Calcium channel Blockers?
Ankle swelling Flushing Headache Palpitations
34
What are the contraindications of Calcium channel Blockers?
``` Cardiac -Poor left ventricular function -AV nodal conduction delay Vascular -Unstable angina - drug can make it worse -Severe aortic stenosis ```
35
Important drug interactions of Calcium channel Blockers?
Not with B blockers
36
What drug class is Ramipril?
ACEi
37
What are ACEi indicated for?
``` Hypertension Chronic Heart failure Ischaemic Heart disease Diabetic nephropathy CKD ```
38
How do ACEi work?
``` Prevent conversion of angiotensin 1 to 2 Vasoconstrictor Stimulates aldosterone secretion Reduces proteinuria Reduces progression of nephropathy ```
39
What are the side effects of ACEi?
``` Hypotension (problem after 1st dose) Persistent dry cough Hyperkalaemia Renal failure Angioedema Anaphylaxis ```
40
What are the contraindications of ACEi?
``` Renal Artery stenosis AKI Pregnant Breastfeeding CKD ```
41
Important drug interactions of ACEi?
Potassium elevating drugs | NSAID + ACEi = increased risk of renal failure
42
If dry cough is a problem what is an alternative drug?
Losartan - ARBs
43
What drug class is Isosorbide Mononitrate?
Nitrates
44
Name a short acting nitrate.
Glyceryl Nitrate (GTN)
45
Name a long acting nitrate.
Isosorbide Mononitrate
46
What are Nitrates indicated for?
``` Short acting -Acute angina -ACS Long acting -Prophylaxis of angina IV -Pulmonary oedema (in combination with furosemide and oxygen) ```
47
How do Nitrates work?
Converted to NO (nitric oxide) Increases cGMP synthesis Reduces calcium in vascular smooth cells - causes relaxation Reduced preload, reduced cardiac work and myocardial oxygen demand
48
What are the side effects of Nitrates?
Flushing Headaches Light-headedness Hypotension
49
What are the contraindications of Nitrates?
Severe Aortic Stenosis Haemodynamic instability (unstable blood pressure) Hypotension
50
Important drug interactions of Nitrates?
Phosphodiesterase inhibitors - prolong hypotensive effect
51
What drug class is Digoxin?
Cardiac Glycosides
52
What are Cardiac Glycosides indicated for?
Atrial fibrillation and flutter (3rd line) | Severe heart failure (3rd line)
53
How do Cardiac Glycosides work?
``` Negative chronotropy (rate) Positive inotropy (force) Heart failure - increases calcium in myocytes for contraction ```
54
What are the side effects of Cardiac Glycosides?
``` Bradycardia GI disturbance Rash Dizziness Visual disturbance ```
55
What are the contraindications of Cardiac Glycosides?
Heart block Patients at risk of ventricular arrhythmias Dose reduced in renal failure Low potassium and magnesium and high calcium all cause digoxin toxicity
56
Important drug interactions of Cardiac Glycosides?
Loop and thiazide diuretics increase risk | Amiodarone, calcium channel and spirnolactone increase plasma conc of digoxin
57
What drug class is Amiodarone?
Anti-dysrhythmics
58
What are Anti-dysrhythmics indicated for?
Tachyarrhythmias (all) | when drugs and electrical cardioversion aren't effective
59
How do Anti-dysrhythmics work?
Blockade of sodium, calcium and potassium channels | Antagonism of alpha and beta adrenergic receptors
60
What are the side effects of Anti-dysrhythmics?
``` Hypotension Pneumonitis Bradycardia AV block Hepatitis Skin photosensitivity Skin grey discolouration ```
61
What are the contraindications of Anti-dysrhythmics?
Severe hypotension Heart block Active thyroid disease
62
Important drug interactions of Anti-dysrhythmics?
Too Many to know
63
What drug class is Aspirin?
NSAID (Antiplatelet)
64
What is Aspirin indicated for?
ACS, stroke Prevention of arterial, cerebro and cardio vascular disease Reduce risk of thrombus in AF Mild to moderate pain and fever
65
How does Aspirin work?
Irreversibly inhibits COX Reduces production of thromboxane Reduces platelet aggregation Occurs at low doses - antiplatelet effect
66
What are the side effects of Aspirin?
GI irritation, ulceration, haemorrhage Hypersensitivity - bronchospasm High dose aspirin - tinnitus
67
What are the contraindications of Aspirin?
Children under 16 - Reye's syndrome risk Aspirin hypersensitivity Third trimester pregnancy
68
Important drug interactions of Aspirin?
Antiplatelet drugs and anticoagulants
69
What drug class is Clopidogrel?
Antiplatelet
70
What is Clopidogrel indicated for?
ACS Prevent occlusion of coronary artery stents Long term prevention of arterial, cerebro and cardio vascular disease Reduce risk of thrombus with AF
71
How does Clopidogrel work?
Clopidogrel prevents platelet aggregation | Binds irreversibly to ADP receptors on platelets - reduces risk of arterial occlusion
72
What are the side effects of Clopidogrel?
Bleeding GI upset Thrombocytopenia (rarely)
73
What are the contraindications of Clopidogrel?
Active bleeding Elective surgery Renal impairment Hepatic impairment
74
Important drug interactions of Clopidogrel?
Pro drug which required P450 metabolism to activate Inhibitors may reduce its effect while inducers of P450 may increase it Antiplatelets and anticoagulants - bleeding
75
What drug class is Tissue Plasminogen Activator (t-PA) and give an example?
Thrombolytic, | Alteplase
76
What is t-PA indicated for?
Stroke STEMI Massive PE Where a thrombus is formed
77
How does t-PA work?
Promotes thrombolysis Converts plasminogen to plasmin Initiates fibrinolysis Recanalises occluded vessels
78
What are the side effects of t-PA?
Bleeding Injection site reaction Thromocytopenia
79
What are the contraindications of t-PA?
``` Clotting disorders Haemodynamic instability Recent surgery Trauma Renal impairment ```
80
Important drug interactions of t-PA?
Antithrombotics due to bleeding
81
What drug class is Enoxaparin?
Heparin
82
What is Heparin indicated for?
Venous thromboembolism: -DVT -PE ACS - LMWH or fondaparinux
83
How do Heparins work?
``` Unfractionated: -activates antithrombin -inhibits factor Xa -inhibits thrombin Low Molecular Weight: -Preferentially inhibit factor Xa ```
84
What are the side effects of Heparins?
Bleeding
85
What are the contraindications of Heparins?
``` Clotting disorders Severe uncontrolled hypertension Recent surgery/trauma Invasive procedures - Lumbar Puncture Renal impairment ```
86
Important drug interactions of Heparins?
Antiplatelets, antithrombin drugs
87
Which Heparin is suitable for people who don't eat pork?
Fondapurinux
88
What drug class is Warfarin?
Oral Anticoagulant
89
What is Warfarin indicated for?
Prevent clot extension Prevent recurrence of DVT and PE Prevent embolic complications in atrial fibrillation
90
How does Warfarin work?
Inhibits hepatic production of Vitamin K dependent coagulation factors and cofactors Inhibits Vit K epoxide reductase Prevents reactivation of Vit K and coagulation factor synthesis
91
What are the side effects of Warfarin?
Bleeding
92
What are the contraindications of Warfarin?
Immediate risk of haemorrhage Liver disease Pregnancy - causes foetal malformations
93
Important drug interactions of Warfarin?
P450 inhibitors decrease warfarin metabolism and increase bleeding risk Clotting risk is increased with P450 inducers
94
What drug class is Rivaroxaban?
Novel Anticogulants
95
What is Rivaroxaban indicated for?
DVT, PE - VTE | Prevention of cerebro and cardiovascular events
96
How does Rivaroxaban work?
Direct inhibitor of Factor Xa
97
What are the side effects of Rivaroxaban?
Bleeding
98
What are the contraindications of Rivaroxaban?
Pregnant Breastfeeding Hepatic Impairment Renal impairment
99
Important drug interactions of Rivaroxaban?
Antiplatelets and anticoagulants - bleeding
100
What drug class is Simvastatin?
Statins
101
What are Statins indicated for?
Primary prevention of cardiovascular disease with Q risk above 20% Secondary prevention Primary hyperlipidaemia
102
How do Statins work?
Inhibit HMG CoA reductase Decreases cholesterol production Increases clearance of LDL
103
What are the side effects of Statins?
``` Headache GI disturbance Aches Myopathy Rhabdomyolysis Can raise liver enzymes ```
104
What are the contraindications of Statins?
Hepatic impairment Renal impairment Pregnant Breastfeeding
105
Important drug interactions of Statins?
P450 inhibitors lead to accumulation of statins - extra risk of myopathy Amiodarone increase risk of rhabdomyolysis Amlodipine has a similar effect
106
When is best to take Statins?
At night

YEAR 3 DRUGS (8 decks)

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