Cardiology Medications

Question 1

Name some typical ACE-Is

Answer 1

Ramipril

Enalapril

Question 2

Why do these medications cause a dry cough in 10% of people? How is this remedied?

Answer 2

They prevent breakdown of bradykinin, which accumulates to give these symptoms
Replace with Angiotensin Receptor Block, Candesartan or Losartan.

Question 3

In which people are ACE-I and ARBs inefficacious?

Answer 3

Afro-carribean

Question 4

Drug interactions of ACE-I?

Answer 4

Lithium (sodium and potassium deviations (particularly Na).
mTOR inhibitors
NSAIDs (renal impairement- could accidentally cause an AKI).

Question 5

Other side effects of an ACE-I? Do ARBs have these?

Answer 5

Dizziness, postural hypotension and taste
(metallic) and electrolyte disturbances.

take before bed

Yes

Question 6

How do ACE-I affect potassium? how might this manifest??

Answer 6

hyperkalaemia

tachycardia

Question 7

Are ACE-I prone to hypersensitivity reactions?

Answer 7

In some people they can manifest as a rash

Question 8

Who should you avoid giving ACE-I to?

Answer 8

Afro-Car
Pregnant
Renal stenosis

NB: ACE I’s are nephrotoxic (because that is where they are metabolised, and if AKI already present there…), but also they’re nephroprotective at the same time due to cardiac remodelling that reduces renal HT.

Question 9

How do Calcium Channel Blockers act?

Answer 9

They bind to L type calcium channels on vascular smooth muscle and cardiac myocytes
These regulate contractions
The channels also regulate pacemaker cells and can decrease contraction through the AV node

Question 10

Two types of CCBs?

Answer 10

Dyhydropyridines: reduce smooth muscle contraction, decreasing afterload and LV force. Does not bind heart
Non-Dyhydropyridine: These slow down AV-conduction, thus having anti-arrythmic effects. Binds to the heart

overall they slow down contractility and conductivity

Question 11

What other conditions can CCBs be used for?

Answer 11

arrthymia

angina

Question 12

Examples of DHPs?

Answer 12

Amlodipine

nifedipine

Question 13

examples of Non-DHPs?

Answer 13

Verapamil

diltiazem

Question 14

Which CCB should you prescribe by brand?

Answer 14

dilitiazem; due to issues with bioavailability

Question 15

Side effects of CCBs?

Answer 15

(reduced oxygen demand)

lowered BP
bradycardia
could precipitate AV block
abdo pain
headache
peripheral oedema

Question 16

Drug interactions of CCBs?

Answer 16

avoid with beta blocker: asystole risk

Question 17

Examples of beta blockers??

Answer 17

Atenolol (beta 1 )

Propanolol (non-selective, therefore both 1 & 2)

Question 18

How do beta blockers act?

Answer 18

They target beta 1: a major cardiac component, blocking norepinephrine released by sympathetic adrenergic nerves

Question 19

Define the following:
Chronotropy:
Ionotropy
Dromotropy
Lusitropy

Answer 19

Components of sympathetic system, describing what hey stimulate
HR
contractility
electrical conduction
Relaxation

Question 20

What other conditions can beta blockers be used for?

Answer 20

arrthymia and UA

Question 21

Common side effects of beta blockers?

Answer 21

bronchospasms, fatigue, bradycardia, hypoglycaemia, acute heart failure aggravation
Sutolol associated with nightmares or vivid dreams!

Question 22

Common contraindications of beta blockers?

Answer 22

interaction with verapamil causing asystole
asthma 
HF/ block
uncontrolled diabetes
occluded extremities

Question 23

What are cardiac glycosides?

Answer 23

Digoxin. alters K and Na exchange and inhibits ATP-action, resulting in decreased heart contractility. Positive ionotrope, negative chronotrope. Also inhibits vagal impulse to reduce sympathetic tone

Question 24

When would you prescribe digoxin? Be cautious of what?

Counselling points for digoxin?

Answer 24

Congestive heart failure. Also supraventricular dysrhythmias,particularly atrial fibrillation
V good in v. young and sedentary people (elevations in HR problematic if active).
Narrow TW: caution in elderly and with thyroid disorders
Be very cautious with dosaging. Anorexia, nausea and
vomiting in babies you might see sinus bradycardia

CNS disturbances and dizziness, Visual disturbances
– blurred vision
• Nausea and vomiting
• Skin rashes- usually present together with
eosinophilia

Question 25

What are K channel agonists/activators?

Answer 25

Act by: Dilation of the arterial and venous return in some cases, smooth muscle in the hyperpolarised state relaxes.
• Nicorandil has no direct effect on myocardial contractility.
• Minoxidil is indicated for the treatment of severe hypertension.

Question 26

Prescribing Nicorandil or Minoxidil: what should you warn patient about?

Do not prescribe with…

Answer 26

Flushing and headaches and Dizziness
Salt and water retention
Feeling weak and Mouth ulcers- Nicorandil

• Sildenafil (synergy)

Question 27

What causes hypertension?

Answer 27

Primary : 90-95% of cases, unknown genetic factor likely
Secondary HT: renal disease, endocrine (cushing’s), vascular (renal artery stenosis)
Diet
Oestrogens
NSAIDs
Steroids

Question 28

What is bendroflumethiazide?

Answer 28

thiazide diuretic, it’s in the name you goon

Bendroflumethiazide is a thiazide diuretic which works by inhibiting sodium reabsorption at the beginning of the distal convoluted tubule (DCT). Water is lost as a result of more sodium reaching the collecting ducts. Bendroflumethiazide has a role in the treatment of mild heart failure although loop diuretics are better for reducing overload. The main use of bendroflumethiazide currently is in hypertension (part of the effect is due to vasodilation).

Question 29

Side effects of diuretics? When prescribing be mindful of what?

Answer 29

low K, hypoantremia, hypomagnesia, hypocalcaemia, headache, thirst, dizziness. Gynecomastia for spironolactone

Be aware that it can lead to inappropriate diuresis. Gynecomastia w spirinolactone. Postural hypotension. Increased AKI risk. Hypokalaemia w digoxin

Question 30

What conditions are diuretics fantastic for??

Answer 30

congestive heart failure
acute pulmonary oedema
ascites
(reduction of pre-load and afterload)