Cardiology Drugs Flashcards
Give examples of anti platelet medications.
aspirin
clopidogrel
tricagrelol
When are anti platelets used?
in secondary prevention of coronary artery disease
How is acute coronary syndrome treated?
dual anti platelet therapy for 6 months
- aspirin
- clopidogrel
How is stable coronary artery disease treated?
single antiplatelet therapy: aspirin or clopidogrel
What are the contraindications of anti platelets?
recent GI bleeding
intracranial bleeding
bleeding disorders
thrombocytopenia
What are the potential side effects of anti platelets? And what can be done to overcome this?
GI bleeding (consider co-prescribing with a PPI such as omeprazole)
What are the different types of anticoagulants?
oral anticoagulants:
vitamin K antagonists - warfarin
DOACs - apixiban
direct thrombin inhibitor - dabigatran
parental anticoagulants:
- unfractioned heparin
- fondaparinux
How are low molecular weight heparins administered? And unfractioned heparin?
low molecular weight heparins have a long half life so are administered as a once daily dose
unfractioned heparin has a short half life so needs to be administered via an IV bolus
What is the advantage of DOACs over warfarin?
do not require frequent blood tests/ INR monitoring
When are anticoagulants used?
acute coronary syndrome
atrial fibrillation or flutter (to prevent stroke)
metallic prosthetic valve (only warfarin is used here)
When can you not give anticoagulants?
recent GI or intracranial bleeding
bleeding disorders
thrombocytopenia
end stage renal failure
What are the side effects of anticoagulants?
bleeding
heparin induced thrombocytopenia
What are the reversal agents of anticoagulants?
warfarin - vitamin k
unfractioned heparin - protamine
direct factor Xa inhibitors - adexanet Alda
Give examples of lipid lowering therapies
statins
ezetimibe
evolocumab
fibrates
When are lipid lowering therapies prescribed?
primary prevention of cardiovascular disease in type 2 diabetes, CKD, familial hypercholesterolaemia
secondary prevention of CVD
When can you not give lipid lowering therapies?
acute liver disease
pregnancy and breast feeding
What are the potential side effects of lipid lowering therapies?
GI disturbances
muscles aches
rhabdomyolysis
In what cases are RAAS antagonists prescribed?
chronic heart failure (ACE/ ARB + spironolactone)
hypertension (ACE/ ARB)
post MI secondary prevention (ACE/ ARB)
Give examples of ACEi, angiotensin receptor blockers and mineralocorticoid receptor antagonists.
ACEi = ramipril, enalapril
ARBs = losartan, candesartan
MRA = spironolactone, epleronone
When can you not prescribe ACEi/ARBs?
severe aortic stenosis
bilateral renal artery stenosis
pregnancy
What are the side effects of RAAS antagonists?
renal impairment
hyperkalaemia
ACEi can cause angioedema, first dose hypertension, dry cough (as it increases the amount of bradykinin)
When can SGLT2 inhibitors be given? Give an example of this drug class.
in type 2 diabetes
heart failure
e.g., dapaglifozin
Give examples of loop diuretics, thiazide diuretics and potassium diuretics.
loop diuretics - furosemide, bumetanide
thiazide diuretics - bendroflumethiazide, indapamide
potassium sparing diuretics - amiloride, triamterene
When would you give a diuretic?
decompensated heart failure
hypertension
What are the side effects of diuretics?
loop - hypovolaemia, hyponatraemia, hypokalaemia
potassium sparing - hyperkalaemia
renal impairment
What must be monitored while a patient is on diuretics?
potassium
sodium
creatinine
When are beta blockers prescribed?
angina
chronic heart failure
post - MI secondary prevention
atrial fibrillation
suppression of ventricular and supra ventricular arrhythmias
When can beta blockers not be given?
2nd/3rd degree heart block
severe peripheral vascular disease
asthma/ bronchospasm
patients on verapamil
What are the side effects of beta blockers?
bradycardia
hypotension
fatigue
bronchospasm
sleep disturbance
Give examples of calcium channel blockers.
amlodipine
felodipine
verapamil
diltiazem
When are calcium channel blockers prescribed.
hypertension
angina
atrial fibrillation
When would you not give calcium channel blockers?
hypotension
severe aortic stenosis
AV block
heart failure
patients on beta blockers
What are the potential side effects of calcium channel blockers?
bradycardia
hypotension
ankle oedema
constipation
When are nitrates prescribed?
angina
acute heart failure
When can you not give nitrates?
aortic stenosis
HOCM
patients on sildenafil/ viagra
What are the potential side effects of nitrates?
hypotension
headache
When might ivabradine be prescribed? What are the potential side effects?
to reduce heart rate in patients in sinus rhythm
if patients do not tolerate beta blockers chronic heart failure
side effects - bradycardia, visual symptoms
