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50 drugs > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Mechanism of action of Bisoprolol

A

Cardioselective beta-1-adrenoceptor antagonist.
Blocks beta-1 receptors in cardiac and renal tissue.
Inhibits sympathetic stimulation of the heart and renal vasculature.
Blockade of the sino-atrial node reduces heart rate (negative chronotropic effect) and blockade of receptors in the myocardium depresses cardiac contractility (negative inotropic effect).
Additionally, blockade of beta-1 adrenoceptors in renal tissue inhibits the release of renin, depressing the vasoconstrictive effects of the renin-angiotensin-aldosterone system.

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2
Q

Name 3 complications of Bisoprolol

A 
Bradycardia
Hypotension
Bronchospasm
Fatigue (Can affect up to 10% of patients)
Cold extremities
Sleep disturbances
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3
Q

What is the mechanism of action of Propanolol

A

Non-cardioselective beta-1-adrenoceptor antagonist.

Inhibits sympathetic stimulation in the heart and vascular smooth muscle.

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4
Q

Name 3 indications of Propanolol

A 
Hypertension
Angina
Anxiety
Migraine prophylaxis
Post-MI prophylaxis
Carvedilol or Bisoprolol may be used as part of supportive therapy for mild / moderate heart failure.
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5
Q

Name 3 side effects of Propanolol

A 
Bradycardia
Hypotension
Bronchospasm
Fatigue (Can affect up to 10% of patients)
Cold extremities
Sleep disturbances
Loss of hypoglycaemic awareness
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6
Q

What are the important pharmacokinetics/pharmacodynamics with Propanolol

A

Caution in diabetic patients – risk of deranged carbohydrate metabolism
Avoid in patients with Asthma and COPD – risk of bronchospasm
Do not combine Beta-Blockers with rate-limiting Ca2+-Channel-Blockers (Verapamil / Diltiazem) in anti-hypertensive therapy.
Propanolol is lipid-soluble and is predominantly cleared by the liver. Avoid in liver impairment. Avoid abrupt withdrawal – risk of liver impairment.

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7
Q

What type of drug are propanolol, atenolol and bisoprolol

A

beta blockers

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8
Q

What type of drugs are ramipril, enalapril, perindopril and lisinopril

A

ACE inhibitors

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9
Q

How do ACE Inhibitors work?

A

Inhibits conversion of Angiotensin I to Angiotensin II (a more potent systemic vasoconstrictor).
This inhibits Aldosterone release from the adrenal cortex, depressing renal sodium and fluid retention, thereby decreasing blood volume.

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10
Q

What are the indications of ACE inhibitors?

A

Hypertension
Heart Failure
Nephropathy
Prevention of Cardiovascular events in high risk patients

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11
Q

Name 3 side effects of ACE Inhibitors

A 
Dry cough (10% of Patients, causing cessation of treatment in 5%)
Hypotension
Hyperkalaemia
Renal Impairment
Angioedema
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12
Q 
What type of drugs are Isosorbide Mononitrate and
Glyceryl Trinitrate (GTN)
A

Nitrates

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13
Q

What is the mechanism of action of GTN?

A
  • Converted to Nitric Oxide (NO), a potent vasodilator.
  • Cardioselective, acting on coronary blood vessels, enhancing flow of blood to ischaemic areas of the myocardium.
  • Reduces myocardial oxygen consumption by reducing cardiac preload and afterload.
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14
Q

What are nitrates used for?

A
  • Angina

- Severe hypertension (intravenous GTN is sometimes used in this setting)

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15
Q

What are the side effects of nitrates?

A
  • Headache (incidence varies greatly, between 20-82%, causing cessation of treatment in 10%)
  • Postural Hypotension / Dizziness
  • Tachycardia
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16
Q

Why is GTN given as a spray/IV and not orally?

A

GTN is rapidly inactivated by first pass (hepatic) metabolism and therefore cannot be digested – sublingual spray/tablet only.
It can also be given intra-venously.

17
Q

What types of drugs are Verapamil and Diltiazem

A

Rate-limiting Calcium Channel blockers

18
Q

When are calcium channel blockers used?

A

Supraventricular arrhythmias
Treatment of angina
Hypertension

19
Q

What are the side effects of verapamil?

A

Constipation (up to 11.7% of patients)

Flushing / Headache / Dizziness / Hypotension (up to 2.5% of patients)

20
Q

What are the side effects of Diltiazem?

A
  • GI disturbances (up to 6% of patients)
  • Bradycardia (up to 3.6% of patients)
  • Peripheral oedema i.e. ankle swelling (up to 15% of patients)
  • Dizziness / Headache / Hypotension (up to 4.3% of patients)
21
Q

What are the important pharmacokinetics/dynamics with Calcium Channel Blockers?

A

Contra-indicated in heart failure and left ventricular dysfunction due to potent negative inotropy.
Avoid in bradycardia and hypotension.
Do not use with beta-blockers.

22
Q

Name 3 Non Rate-limiting Calcium Channel Blockers

A

Amlodipine
Nifedipine
Felodipine

23
Q

What is the mechanism of action of Amlodipine?

A

Prevent cellular entry of Ca2+ by blocking L-type calcium channels.
Myocardial and smooth muscle contractility depressed – these drugs mainly affect smooth muscle.
Dilate coronary blood vessels and reduce afterload

24
Q

What is amlodipine used for?

A

Hypertension

Treatment of Angina

25
Q

Give 2 side effects of amlodipine

A

Ankle oedema (up to 15% of patients)
Abdominal pain / Nausea
Palpitations (up to 4.5% of patients)
Flushing / Headache / Dizziness

26
Q

Give two examples of statins

A

Simvastatin
Atorvastatin
Pravastatin

27
Q

What is the mechanism of action of statins?

A
  • Competitively inhibits HMG CoA Reductase; the rate-determining enzyme in the mevalonate pathway synthesis of cholesterol.
  • This causes an increase in LDL-receptor expression, on the surface of hepatocytes.
  • Increases hepatic uptake of cholesterol, reducing plasma cholesterol levels.
  • Reduces development of athersclerotic plaques.
28
Q

What are the indications of statins?

A

Familial hypercholesterolaemia

Prevention of cardiovascular events in high-risk patients.

29
Q

Give two side effects of statins

A 
Myalgia (5-7% of patients)
Myopathy (with creatine kinase elevation) and rhabdomyolysis are rare.
GI disturbances (Varied symptoms; up to 6% of patients affected)
Liver abnormalities – deranged LFT’s
30
Q

Which drug is a cardiac glycoside?

A

digoxin

31
Q

What is the mechanism of action of digoxin?

A
  • Increases vagal parasympathetic activity and inhibits the Na+/K+ pump, causing a buildup of Na+ intracellularly.
  • In an effort to remove Na+, more Ca2+ is brought into the cell by the action of Na+/Ca2+ exchangers.
  • The buildup of Ca2+ is responsible for the increased force of contraction and reduced rate of conduction through the AV node.
32
Q

What are the side effects of digoxin use?

A

nausea
vomiting
diarrhoea
confusion

33
Q

What is digoxin used for?

A

Atrial fibrillation

heart failure

34
Q

What is important to remember in digoxin use?

A

Digoxin has a long half-life and maintenance doses may only be required once-daily.
Renal function, age and heart disease are major determinants for safe digoxin dosage.

35
Q

Which drug is used for Supraventricular / ventricular arrhythmias?

A

Amiodorone

36
Q

What is the mechanism of action of amiodorone?

A

Amidorone blocks cardiac K+ channels, prolonging repolarization of the cardiac action potential.
Restores regular sinus rhythm.
It also slows atrioventricular nodal conduction.

37
Q

Give two side effects of amiodorone

A

Photosensitivity skin reactions (up to 75% of patients)
Hypersensitivity reactions
Hyper / Hypothyroidism (linked to high iodine content)
Pulmonary fibrosis
Corneal deposits (69-100% of patients)
Neurological disturbances
GI disturbances / Hepatitis

38
Q

Which drugs are given in AF

A

Beta blocker e.g. bisoprolol
Rate limiting calcium channel blocker
Digoxin - second line
DOACs - apixaban, dagigatran

39
Q

Why can amlodipine not be used in AF?

A

Causes reflex tachycardia

50 drugs (7 decks)

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