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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
Q

What are the contraindications of Beta Blockers?

A 
Asthma - life threatening brochospasm
Slowly increase dose in heart failure
Haemodynamic instability
Heart block
Hepatic failure
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26
Q

Important drug interactions of Beta Blockers?

A

Calcium channel blockers- can cause heart failure, bradycardia

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27
Q

What drug class is Diltiazem?

A

Calcium channel blocker

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28
Q

What are Calcium channel blockers indicated for?

A

Hypertension
Stable angina symptom control
Supraventricular arryhthmias

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29
Q

How do Calcium channel Blockers work?

A

Decrease calcium entry into vascular and cardiac cells
Relaxation and vasodilation in arterial smooth muscle
Suppress cardiac conduction

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30
Q

What Calcium channel blockers are used cardiac purposes?

A

Diltiazem, Verapamil

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31
Q

What Calcium channel blockers are used vascular purposes?

A

Amlodipine, nifedipine, Diltiazem (has both functions)

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32
Q

What are the side effects of cardiac Calcium channel Blockers?

A

Bradycardia
Cardiac failure
Heart block

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33
Q

What are the side effects of vascular Calcium channel Blockers?

A

Ankle swelling
Flushing
Headache
Palpitations

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34
Q

What are the contraindications of Calcium channel Blockers?

A 
Cardiac
-Poor left ventricular function
-AV nodal conduction 
delay
Vascular
-Unstable angina - drug can make it worse
-Severe aortic stenosis
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35
Q

Important drug interactions of Calcium channel Blockers?

A

Not with B blockers

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36
Q

What drug class is Ramipril?

A

ACEi

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37
Q

What are ACEi indicated for?

A 
Hypertension
Chronic Heart failure
Ischaemic Heart disease
Diabetic nephropathy
CKD
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38
Q

How do ACEi work?

A 
Prevent conversion of angiotensin 1 to 2
Vasoconstrictor
Stimulates aldosterone secretion
Reduces proteinuria 
Reduces progression of nephropathy
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39
Q

What are the side effects of ACEi?

A 
Hypotension (problem after 1st dose)
Persistent dry cough
Hyperkalaemia
Renal failure
Angioedema
Anaphylaxis
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40
Q

What are the contraindications of ACEi?

A 
Renal Artery stenosis
AKI
Pregnant
Breastfeeding
CKD
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41
Q

Important drug interactions of ACEi?

A

Potassium elevating drugs

NSAID + ACEi = increased risk of renal failure

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42
Q

If dry cough is a problem what is an alternative drug?

A

Losartan - ARBs

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43
Q

What drug class is Isosorbide Mononitrate?

44
Q

Name a short acting nitrate.

A

Glyceryl Nitrate (GTN)

45
Q

Name a long acting nitrate.

A

Isosorbide Mononitrate

46
Q

What are Nitrates indicated for?

A 
Short acting
-Acute angina
-ACS
Long acting
-Prophylaxis of angina
IV
-Pulmonary oedema (in combination with furosemide and oxygen)
47
Q

How do Nitrates work?

A

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
Q

What are the side effects of Nitrates?

A

Flushing
Headaches
Light-headedness
Hypotension

49
Q

What are the contraindications of Nitrates?

A

Severe Aortic Stenosis
Haemodynamic instability (unstable blood pressure)
Hypotension

50
Q

Important drug interactions of Nitrates?

A

Phosphodiesterase inhibitors - prolong hypotensive effect

51
Q

What drug class is Digoxin?

A

Cardiac Glycosides

52
Q

What are Cardiac Glycosides indicated for?

A

Atrial fibrillation and flutter (3rd line)

Severe heart failure (3rd line)

53
Q

How do Cardiac Glycosides work?

A 
Negative chronotropy (rate)
Positive inotropy (force)
Heart failure - increases calcium in myocytes for contraction
54
Q

What are the side effects of Cardiac Glycosides?

A 
Bradycardia
GI disturbance
Rash
Dizziness
Visual disturbance
55
Q

What are the contraindications of Cardiac Glycosides?

A

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
Q

Important drug interactions of Cardiac Glycosides?

A

Loop and thiazide diuretics increase risk

Amiodarone, calcium channel and spirnolactone increase plasma conc of digoxin

57
Q

What drug class is Amiodarone?

A

Anti-dysrhythmics

58
Q

What are Anti-dysrhythmics indicated for?

A

Tachyarrhythmias (all)

when drugs and electrical cardioversion aren’t effective

59
Q

How do Anti-dysrhythmics work?

A

Blockade of sodium, calcium and potassium channels

Antagonism of alpha and beta adrenergic receptors

60
Q

What are the side effects of Anti-dysrhythmics?

A 
Hypotension
Pneumonitis
Bradycardia
AV block
Hepatitis
Skin photosensitivity
Skin grey discolouration
61
Q

What are the contraindications of Anti-dysrhythmics?

A

Severe hypotension
Heart block
Active thyroid disease

62
Q

Important drug interactions of Anti-dysrhythmics?

A

Too Many to know

63
Q

What drug class is Aspirin?

A

NSAID (Antiplatelet)

64
Q

What is Aspirin indicated for?

A

ACS, stroke
Prevention of arterial, cerebro and cardio vascular disease
Reduce risk of thrombus in AF
Mild to moderate pain and fever

65
Q

How does Aspirin work?

A

Irreversibly inhibits COX
Reduces production of thromboxane
Reduces platelet aggregation
Occurs at low doses - antiplatelet effect

66
Q

What are the side effects of Aspirin?

A

GI irritation, ulceration, haemorrhage
Hypersensitivity - bronchospasm
High dose aspirin - tinnitus

67
Q

What are the contraindications of Aspirin?

A

Children under 16 - Reye’s syndrome risk
Aspirin hypersensitivity
Third trimester pregnancy

68
Q

Important drug interactions of Aspirin?

A

Antiplatelet drugs and anticoagulants

69
Q

What drug class is Clopidogrel?

A

Antiplatelet

70
Q

What is Clopidogrel indicated for?

A

ACS
Prevent occlusion of coronary artery stents
Long term prevention of arterial, cerebro and cardio vascular disease
Reduce risk of thrombus with AF

71
Q

How does Clopidogrel work?

A

Clopidogrel prevents platelet aggregation

Binds irreversibly to ADP receptors on platelets - reduces risk of arterial occlusion

72
Q

What are the side effects of Clopidogrel?

A

Bleeding
GI upset
Thrombocytopenia (rarely)

73
Q

What are the contraindications of Clopidogrel?

A

Active bleeding
Elective surgery
Renal impairment
Hepatic impairment

74
Q

Important drug interactions of Clopidogrel?

A

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
Q

What drug class is Tissue Plasminogen Activator (t-PA) and give an example?

A

Thrombolytic,

Alteplase

76
Q

What is t-PA indicated for?

A

Stroke
STEMI
Massive PE
Where a thrombus is formed

77
Q

How does t-PA work?

A

Promotes thrombolysis
Converts plasminogen to plasmin
Initiates fibrinolysis
Recanalises occluded vessels

78
Q

What are the side effects of t-PA?

A

Bleeding
Injection site reaction
Thromocytopenia

79
Q

What are the contraindications of t-PA?

A 
Clotting disorders
Haemodynamic instability
Recent surgery
Trauma
Renal impairment
80
Q

Important drug interactions of t-PA?

A

Antithrombotics due to bleeding

81
Q

What drug class is Enoxaparin?

82
Q

What is Heparin indicated for?

A

Venous thromboembolism:
-DVT
-PE
ACS - LMWH or fondaparinux

83
Q

How do Heparins work?

A 
Unfractionated:
-activates antithrombin
-inhibits factor Xa
-inhibits thrombin
Low Molecular Weight:
-Preferentially inhibit factor Xa
84
Q

What are the side effects of Heparins?

85
Q

What are the contraindications of Heparins?

A 
Clotting disorders
Severe uncontrolled hypertension
Recent surgery/trauma
Invasive procedures - Lumbar Puncture
Renal impairment
86
Q

Important drug interactions of Heparins?

A

Antiplatelets, antithrombin drugs

87
Q

Which Heparin is suitable for people who don’t eat pork?

A

Fondapurinux

88
Q

What drug class is Warfarin?

A

Oral Anticoagulant

89
Q

What is Warfarin indicated for?

A

Prevent clot extension
Prevent recurrence of DVT and PE
Prevent embolic complications in atrial fibrillation

90
Q

How does Warfarin work?

A

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
Q

What are the side effects of Warfarin?

92
Q

What are the contraindications of Warfarin?

A

Immediate risk of haemorrhage
Liver disease
Pregnancy - causes foetal malformations

93
Q

Important drug interactions of Warfarin?

A

P450 inhibitors decrease warfarin metabolism and
increase bleeding risk
Clotting risk is increased with P450 inducers

94
Q

What drug class is Rivaroxaban?

A

Novel Anticogulants

95
Q

What is Rivaroxaban indicated for?

A

DVT, PE - VTE

Prevention of cerebro and cardiovascular events

96
Q

How does Rivaroxaban work?

A

Direct inhibitor of Factor Xa

97
Q

What are the side effects of Rivaroxaban?

98
Q

What are the contraindications of Rivaroxaban?

A

Pregnant
Breastfeeding
Hepatic Impairment
Renal impairment

99
Q

Important drug interactions of Rivaroxaban?

A

Antiplatelets and anticoagulants - bleeding

100
Q

What drug class is Simvastatin?

101
Q

What are Statins indicated for?

A

Primary prevention of cardiovascular disease with Q risk above 20%
Secondary prevention
Primary hyperlipidaemia

102
Q

How do Statins work?

A

Inhibit HMG CoA reductase
Decreases cholesterol production
Increases clearance of LDL

103
Q

What are the side effects of Statins?

A 
Headache
GI disturbance
Aches
Myopathy
Rhabdomyolysis
Can raise liver enzymes
104
Q

What are the contraindications of Statins?

A

Hepatic impairment
Renal impairment
Pregnant
Breastfeeding

105
Q

Important drug interactions of Statins?

A

P450 inhibitors lead to accumulation of statins - extra risk of myopathy
Amiodarone increase risk of rhabdomyolysis
Amlodipine has a similar effect

106
Q

When is best to take Statins?

YEAR 3 DRUGS (8 decks)

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