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308: Clinical pharmacology and therapeutics > Cardiology > Flashcards

Cardiology Flashcards

1
Q

Alteplase

  • Drug class + Mechanism
  • Indications
  • Side effects
  • Contraindications
A

Thrombolytic drug

  • Protease that binds to fibrin and enables fibrinolysis.
  • Activates plasminogen into plasmin= degrades fibrin

Indications
- Thrombotic events: Acute MI, PE, Acute ischaemic Stroke

Side effects

  • Bleeding

Contraindications

  • Bleeding states: haemorrhagic stroke,
  • Hypersensitivity to gentamicin
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2
Q

Amiodarone

  • Drug class + Mechanism
  • Indications
  • Side effects
  • Contraindications
A

Antiarrhythmic agent
- Blocks voltage gated K and Ca channels= prolongs phase 3 of cardiac potential (repolarisation)

Indications

  • Atrial fibrillation/ flutter
  • VF, V tach

Side effects

  • Lungs: pulmonary fibrosis/ ILD
  • Eye: corneal deposits
  • Liver: abnormal LFTs
  • Sensitivity to sun/ Blueish skin?
  • Thyroid dysfunction (hyper or hypo)
  • Gynaecomastia

Contraindications

  • Pregnancy, breastfeeding
  • Thyroid disease
  • Av block/ bradycardia
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3
Q

Amlodipine

  • Drug type/ mechanism
  • Indications
  • Side effects
  • Contraindications/ Caution
A

Calcium channel blocker
- Blocks L-type Ca channels (dihydropyridine) on vessels and cardiomyocytes= vasodilation

Indications

  • Hypertension (first line for <55/ Black)
  • Heart failure

Side effects

  • Peripheral oedema
  • Abdominal pain
  • Dizziness/ flushing

Contraindicatons/ Caution

  • Caution in elderly
  • Cardiogenic shock/ Unstable angina/ severe AS
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4
Q

Clopidogrel

  • Drug type/ mechanism
  • Indications
  • Side effects
  • Contraindications/ Caution
  • Pregnancy + breastfeeding
A

Antiplatelet

  • Reversible P2Y-12 inhibitor
  • Prevents platelet aggregation

Indications

  • Cardiovascular prophylaxis = 75mg
  • Before PCI= loading dose = 300mg/ 600mg

Side effects

  • Bleeds
  • Gi discomfort

Caution/ contraindications

  • Active bleeding/ risk of bleeds
  • Caution in elderly

Pregnancy + breastfeeding
- Avoid

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5
Q

Cellulitis

  • Description
  • Most common causative agents
  • Presentation
  • Complications
A

Infection of the connective tissue: especially dermis and subcutaneous fat
- Most commonly caused by S pyogenes, S aureus

Symptoms

  • Red, hot and painful area with increasing margins overtime
  • Localised oedema
  • Fever, chills

Complications

  • Abscess
  • Fasciitis
  • Sepsis
  • Osteomyelitis
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6
Q

Aspirin

  • ACS treatment
  • Administration instructions
A

Loading dose= 300mg
- Maintenance= 75mg OD

Take with food

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7
Q

Clopidogrel

- MI treatment

A

Loading dose= 300mg or 600mg

Maintenance= 75mg

  • NSTEMI= for 1 year
  • STEMI= up to 1 year

Stents

  • BMS= 1 month
  • DES= 6-12 months
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8
Q

Ticagrelor

  • MI treatment
  • Side effects
A

Loading dose= 180mg

Maintenance= 90mg BD
- Up to 12 months

Side effects= SO

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9
Q

Prasugrel

  • MI treatment
  • Side effects
A

Loading dose= 60mg

Maintenance dose

  • > 60kg= 10mg OD
  • < 60kg/ >75 years= 5mg OD
  • Up to 12 months

Side effects
- GI bleeds

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10
Q

Bisoprolol

  • Drug type/ mechanism
  • Indications
  • Side effects
  • Contraindications/ Caution
  • Pregnancy + breastfeeding
A

Cardioselective beta-blocker

  • Blocks B1 on heart= slows SAN= slower HR
  • B2 on lungs, liver

Indications

  • Hypertension
  • Heart failure
  • Variceal bleed prophylaxis

Side effects

  • Hypotension, bradycardia: fatigue, dizziness
  • Bronchospasms
  • Hypoglycaemia
  • Cold hands/ feet

Contraindications

  • Asthma/ COPD
  • 2nd/ 3rd degree heart block
  • Unstable heart failure
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11
Q

Erysipelas

  • Description
  • Presentation
  • Most common causative agents
A

Bacterial infection of the upper dermis

  • Extends to subcutaneous lymphatic vessels
  • More superficial than cellulitis

Presentation

  • Red, hot lesion
  • Lethery, rough skin
  • Well-defined margins
  • More typically affects the face

Causative agent
- Beta-hameolytic Strep (S pyogenes)

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12
Q

Furuncles

  • Description
  • Causative organism
  • Presentation
A

Deep folliculitis

  • Deep infection of the hair follicle
  • Most common caused by Staph aureus

Presenation

  • Swollen area, due to accumulation of pus/ dead tissue
  • Boils= pus filled.
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13
Q

Glyceryl trinitrate (GTN)

  • Drug type/ mechanism
  • Indications
  • Side effects
  • Contraindications/ Caution
  • Pregnancy + breastfeeding
A

Pro-drug
- Release of NO2 = vasodilation

Indications
- Angina treatment/ prophylaxis

Side effects

  • Flushing, headache, dizziness
  • Postural hypotension

Caution/ Contraindications

  • Caution with driving
  • Alcohol increases dizziness
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14
Q

Nicorandil

  • Drug type/ mechanism
  • Indications
  • Side effects
  • Contraindications/ Caution
  • Pregnancy + breastfeeding
A

Nirate and ATP-K+ agonist

  • Coronary Vasodilation at low K+
  • Reduces coronary vascular resistance at high K+

Indications
- Second line for angina

Side effects

  • dizziness
  • Headaches
  • nausea
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15
Q

Digoxin

- Dosing

A

PO or IV
- They are not equal, IV peaks quicker

Loading

  • 750mg-1mg over 24 hours
  • Lower dose in elderly

Maintenance
- 125-250 mg OD

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16
Q

Digoxin excretion and monitoring

A

Renally excreted

Digoxin needs to be monitored regularly

  • Dose taken >6 hours post dose
  • Toxic levels >1.5-3mcg/L
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17
Q

Factors that increase digoxin toxicity

A

AKL

Hypokalaemia

Hypercalcaemia

Hypomagnesaemia

18
Q

Digoxin toxicity signs

A

Lethargy

Confusion

Vomiting

Loss of appetite

Diarrhoea

Visual changes

19
Q

Amiodarone dosing

A

Loading= 5-10g

Oral= 200 rule

  • 200mg TDS for 1 week
  • 200mg BD for 1 week
  • 200mg OD maintenance

IV
- Loading= 5mg/ Kg over 20-120mins

  • Infusion 1.2g/ 24hrs centrally
20
Q

Diltiazem

  • Drug type/ mechanism
  • Indications
  • Side effects
  • Contraindications/ Caution
  • Pregnancy + breastfeeding
A

Non-DHP calcium channel blocker

  • Longer acting
  • Cardioselective
  • Vasodilation
  • Antiarrhythmic

Indications

  • AF
  • Hypertension
  • Angina prophylaxis

Side effects

  • Constipation
  • Facial flushing
  • Headaches
  • Ankle swelling
  • Fatigue
  • Dizziness
21
Q

Apixaban

  • Drug type/ mechanism
  • Indications
  • Side effects
  • Contraindications/ Caution
  • Pregnancy + breastfeeding
A

DOAC
- Factor X inhibitor

Indication
- Thrombosis prophylaxis= stroke

Side effects
- Bleeds

Contraindications/ caution

  • Active bleeding
  • Low weight (>61)= hald dose
  • Elderly, >80= half dose
  • Serum Cr 133/ 15-29ml/min = half dose
22
Q

Furosemide

  • Drug type/ mechanism
  • Indications
  • Side effects
  • Contraindications/ Caution
  • Pregnancy + breastfeeding
A

Loop diuretic
- Inhibits Na+ and water reabsorption in ascending loop of henle

Indications

  • Resistant Hypertension
  • Oedema

Side effects

  • Dehydration
  • Hypotension: dizziness, fatigue
  • Electrolyte imbalance= hypokalaemia
  • Renal function abnormalities
  • Metaboic alkaolosis

Caution/ contraindication

  • Elderly (lower dose)
  • Urinary retention in large prostate

Pregnancy and breastfeeding

  • Not used in pregnancy because of hypovalaemia
  • Okay in breastfeeding, may inhibit lactation
23
Q

Furosemide dosing

A

40mg-80mg PO

  • Lower dose for oedema
  • 40-80 for HTN
  • 80-120 for resistant oedema
24
Q

Bendroflumethiaide

  • Drug type/ mechanism
  • Indications
  • Side effects
  • Contraindications/ Caution
  • Pregnancy + breastfeeding
A

Thiazide like diuretic
- Inhibits Na, Cl- reabsorption in distal convoluted tubule.

Indications

  • Hypertension (third line after ARB/ ACEi and CCB)
  • Oedema

Side effects

  • Exacerbates gout
  • Dizziness/ fatigue/ orthostatic hypotension
  • Hypokalaemia
  • Alkalosis hypochloraemia

Contraindications/ caution

  • Kidney function= not used in eGFR <30
  • Weight
  • Monitor electrolyes

Pregnancy and breastfeeding

  • Not used in pregnancy because of hypovalaemia
  • Okay in breastfeeding, may inhibit lactation
25
Q

Spironolactone

  • Drug type/ mechanism
  • Indications
  • Side effects
  • Contraindications/ Caution
  • Pregnancy + breastfeeding
A

Aldosterone receptor antagonist (K+ sparing diuretic)
- Blocks aldosterone receptor on distal convoluted tubule= retention of K+, Na and water excretion

Indications

  • Resistant hypertension
  • Ascites
  • Primary hyperaldosteronism

Side effects

  • Gynaecomastia
  • Hyperkalaemia
  • Dizziness, fatigue

Contraindications and caution

  • Hyperkalaemia, Addison’s
  • Elderly
  • Avoid in renal impairment

Pregnancy and breastfeeding

  • Can use in pregnancy if benefits outweigh risk
  • Okay in breastfeeding
26
Q

Ivabradine

  • Drug type/ mechanism
  • Indications
  • Side effects
  • Contraindications/ Caution
  • Pregnancy + breastfeeding
A

Acts on funny channel (pacemaker potential)
- Slows than current in SAN= slower HR

Indications
- Chronic HF

Side effects

  • Dizziness, headache
  • Visual disorder
  • Arrhythmias, AV block

Caution/ contraindication

  • Caution in elderly, AF.
  • HR <70, heart block, severe hypotension, acute MI

Pregnancy + breastfeeding
- Avoid

27
Q

Rivaroxaban

  • Drug type/ mechanism
  • Indications
  • Side effects
  • Contraindications/ Caution
  • Pregnancy + breastfeeding
A

DOAC- Factor Xa inhibitor

Indications

  • Thrombolysis, stroke prophylaxis
  • Treatment for DVT, PE

Side effects

  • Bleeding
  • GI discomfort

Contraindications/ caution

  • Elderly
  • Low body weight <60
  • Avoid in CrCl <15
28
Q

Warfarin

  • Drug type/ mechanism
  • Indications
  • Side effects
  • Contraindications/ Caution
  • Pregnancy + breastfeeding
A

Vitamin K antagonist

  • Anticoagulant
  • Inhibits formation of factors in the intrinsic pathway: Factors 2,7,9, 10

Indications
- Thrombosis prophylaxis: PE, DVT, Stroke, AF, prosthetic valves

Side effects
- Bleeding

Contraindications/ caution

  • Active bleeding
  • Other anticoagulants/ antiplatelets
  • Elderly

Pregnancy + breastfeeding

  • TERATOGENIC- especially first and third trimester
  • Safe for breastfeeding
29
Q

Isosorbide mononitrate

  • Drug type/ mechanism
  • Indications
  • Side effects
  • Contraindications/ Caution
  • Pregnancy + breastfeeding
A

Nitrate?
- Vasodilator

Indicator

  • Angina
  • HF

Side effects
- Dizziness, drowsiness, hypotension

Contraindications

  • Hypotension
  • constrictive heart disease/ obstructive heart faiure
  • Raised ICP

Caution

  • Recent MI
  • In elderly, stopp if persistent postural hypotension

Pregnancy
- Avoid unless benefits> risk.

30
Q

Indapamide

  • Drug type/ mechanism
  • Indications
  • Side effects
  • Contraindications/ Caution
  • Pregnancy + breastfeeding
A

Thiazide-like diuretic
- Blocks Na+ reabsorption in distal tubule

Indications
- Essential hypertension

Side effects

  • Hypokalaemia
  • Dizziness, fatigue, headaches
  • Alkalosis hypochloaemia

Contraindications/ caution

  • Elderly
  • Addison’s
  • Hypokalaemia
  • Hyponatraemia

Pregnancy and breastfeeding
- Avoid

31
Q

Folliculitis

  • Description
  • Most common causative agents
  • Presentations
A

Infection of the hair follicle
- Most commonly caused by staph aureus

Superficial
- Presents with tender/ painless pustule with hair shaft

symptoms

  • Pustules
  • Pruritis
  • Tenderness
32
Q

Cellulitis

  • Description
  • Most common causative agents
  • Presentation
  • Complications
A

Infection of the connective tissue: especially dermis and subcutaneous fat
- Most commonly caused by S pyogenes, S aureus

Symptoms

  • Red, hot and painful area with increasing margins overtime
  • Fever, chills

Complications

  • Abscess
  • Fasciitis
  • Sepsis
  • Osteomyelitis
33
Q

Impetigo treatment

  • Local infection
  • Widespread infection
A

Local
- Topical fusidic acid (7 days)

Widespread
- Oral flucloxacillin/ clarithromycin

34
Q

Cellulitis treatment

  • First line
  • Severe
A

First line

  • Flucloxacillin
  • Clarithromycin/ doxycycline if penicillin allergy
  • Erythromycin if prengnant

If near eyes/ nose

  • Co-amoxiclav
  • clarithromycin with metronidazole if allergy

Severe

  • Co-amoxiclav
  • Clindamycin
  • IV cefuroxime
35
Q

Class 1 cellulitis

  • Description
  • Treatment
A

Infection with no systemic signs or uncontrolled co-morbidities

Treatment
- Flucloxacillin 500-100mg QDS, 7 days

Alternatives

  • Clarithromycin 500mg BD
  • Doxycycline 200mg, then 100mg OD
  • If pregnant, erythromycin 500 QDS
36
Q

Severe cellulitis treatment

A
  1. Co-amoxiclav
    or clindamycin/ IV cefuroxime

Add IV vancomycin if MRSA

37
Q

Erysipelas

  • Description
  • Presentation
  • Most common causative agents
A

Bacterial infection of the upper dermis

  • Extends to subcutaneous lymphatic vessels
  • More superficial than cellulitis

Presentation

  • Red, hot lesion
  • Lethery, rough skin
  • Well-defined margins

Causative agent
- Beta-hameolytic Strep (S pyogenes)

38
Q

Furuncles
- Description
- Causative organism
-

A

Deep folliculitis

  • Deep infection of the hair follicle
  • Most common caused by Staph aureus

Presenation

  • Swollen area, due to accumulation of pus/ dead tissue
  • Boils= pus filled.
39
Q

Necrotising fasciitis

  • Description
  • Causative organism
  • Presentation
  • Management
A

Infection of the deep soft tissue

  • Causing destruction of muscle fascia and subcutaneous fat
  • Typically caused by S.pyogenes

Presentation

  • Affects extremities, progresses rapidly
  • Starts off with red tissue, which progresses rapidly

Management

  • Surgical removal of necrotic tissue (debridement)
  • Amputation if limb is compromised
  • Antibiotics= broad spectrum IV antibiotics
40
Q

Necrotising fasciitis antibiotic treatment

A

IV Tazocin (piperacillin- tazobactam) + clandamycin

Benylpenicillin+ clindamycin + gentamicin

308: Clinical pharmacology and therapeutics (13 decks)

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