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308: Clinical Pharmacology and Therapeutics > Cardiology pharmacology > Flashcards

Cardiology pharmacology Flashcards

1
Q

Drug therapy for AF

A

Anticoagulation

Rate control strategy

Rhythm control strategy

‘Pill in the pocket’

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2
Q

Rate control strategy

A

Beta blocker

Rate lowering calcium antagonist (verapamil, diltiazem)

Digoxin

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3
Q

Rhythm control strategy

A

Structural heart disease: beta blocker or amiodarone

No structural heart disease: beta blocker, felcainide

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4
Q

‘Pill in the pocket’

A

Flecainide

Propafenone

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5
Q

Digoxin

A

Used to treat AF

Rhythm control- attempting to control sinus rhythm

Increases the force of contraction and reduces conductivity with the AV node

Only effective for controlling the ventricular rate at rest

Dose should be determined on ventricular rate at rest

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6
Q

Digoxin monitoring

A

Renally excreted

Regular monitoring of plasma digoxin concentration is not required

Toxic levels from 1.5-3mcg/l

Toxicity increased by AKI, hypokalaemia, hypercalcaemia, hypomagnesaemia

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7
Q

Signs of digoxin toxicity

A

Lethargy

Confusion

Vomiting

Loss of appetite

Diarrhoea

Visual changes

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8
Q

Digoxin dosing

A

Loading dose can be given on any ward

IM administration is not recommended

Adult loading: 750mcg-1mg in divided doses over 24 hours, reduce dose if elderly

Adult maintenance dose: 125-250mcg OD

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9
Q

Amiodarone dosing

A

Need 5-10g in total load

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10
Q

IV amiodarone dose

A

5mg/kg loading dose given over 20-120 minutes with ECG monitoring

Infusion 1.2g/24 hours preferred central administration

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11
Q

Oral amiodarone dose

A

200mg TDS for 1 week then

200mg BD for 1 week then

200mg OD as maintenance dose

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12
Q

Bloods to check on amiodarone

A

LFTs

TFTs

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13
Q

Cardiac amiodarone side effects

A

Worsen arrhythmia or new arrhythmia

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14
Q

Skin amiodarone side effects

A

Sensitive to the sun and/ or blue grey discolouration

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15
Q

Eyes amiodarone side effects

A

Corneal deposits in the eye; take care with night driving

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16
Q

Thyroid amiodarone side effects

A

Under active thyroid disease

Over active thyroid disease

Blood tests before and then every 6 months

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17
Q

Liver amiodarone side effects

A

Rarely causes abnormal liver tests

Need blood test before starting then every 6 months

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18
Q

Lung amiodarone side effects

A

Rarely can cause inflammation of lining of alveoli in lungs

19
Q

Calcium channel antagonists

A

Dihydropyridine

  • shorter acting
  • high affinity for blood vessels
  • antihypertensive effect

Non-dihydropyridine

  • long acting
  • high affinity for the heart
  • antiarrhythmic effect
20
Q

Dihydropyridine examples

A

Amlodipine

Felodipine

Nicardipine

Nifedipine

Nimodipine

21
Q

Non-dihydropyridine examples

A

Diltiazem

Verapamil

22
Q

MOAi

A

Inhibit calcium ions from entering slow or voltage gated channels

In vascular smooth muscle
- relaxation of blood vessels

In myocardium

  • reduces cardiac contractility
  • depress SA node activity
  • slow AC node conduction
23
Q

Side effects of MOAi

A

Constipation

Facial flushing

Headaches

Ankle swelling

Fatigue

Dizziness

24
Q

Heart failure definition

A

Clinical syndrome characterised by typical symptoms that may be accompanied by signs caused by structural and/ or functional cardiac abnormality

Results in reduced cardiac output and/ or elevated intracardial pressure at rest or during stress

25
Q

Heart failure with reduced ejection fraction

A

Left ventricle cannot contract adequately to eject blood into aorta

Lack oxygen rich blood to meet body’s need

Fraction of blood ejected is <40%

Predominantly caused by coronary artery disease

26
Q

Heart failure with preserved ejection fraction

A

Heart muscle becomes stiff and does not relax properly resulting in impaired filling process

Fraction of blood ejected is >50%

Predominantly caused by hypertension

27
Q

Causes of chronic heart failure

A

IHD

ACS

Hypertension

Valve disease

Arrhythmias

Cardiomyopathy

Myocarditis

28
Q

Typical symptoms of heart failure

A

Breathlessness

Orthopnoea

Paroxysmal nocturnal dyspnoea

Reduced exercise tolerance

Fatigue, tiredness, increased time to recover after exercise

Ankle swelling

29
Q

Specific signs

A

Elevated JVP

Hepatojugular reflux

Third heart sound

Laterally displaced apical impulse

30
Q

Managing HF with reduced EF <40%

A

ACEi/ARB/ARNi

Beta blocker

AA

Manage fluid status

31
Q

Physiological response to heart failure

A

Increase cardiac output

Increase catecholamine release

Activation of renin angiotensin system

Structural changes

32
Q

Compensatory mechanisms of HF

A

Starling’s Law

Sympathetic nervous system

RAAS

Endothelin, NO and prostaglandin

Vasopressin

Stretch and pressure response

33
Q

Drugs used in heart failure

A

Diuretics

ACEi/ ARB

Beta blockers

Mineralocorticoid receptor antagonists

Ivabradine

Digoxin

Nitrates

Sacubitril/ valsartan

34
Q

Diuretics and sites of action

A

Ascending LoH
- loop diuretics

Distal convoluted tubule
- thiazide diuretics

Later in distal convoluted tubule
- mineralocorticoid receptor antagonists

35
Q

Loop diuretics

A

e.g. furosemide, bumetanide

Side effects

  • fatigue
  • dizziness
  • electrolyte imbalance

40mg PO furosemide
1mg PO bumetainde

36
Q

Thiazide like diuretics

A

e.g. bendroflumethiazide, metolazone

Side effects
- may exacerbate gout

37
Q

Potassium sparing diuretics

A

e.g. spironolactone, eplerenone

Side effects

  • hyperkalaemia
  • gynaecomastia

Eplerenone in MI patients with EF<40%

38
Q

ACEi and ARB

A

First line treatment for ventricular HF

Improve signs, symptoms and exercise tolerance

Reduction in disease progression, hospitalisation and mortality

Start at low dose, titrate upwards every 2 weeks

Angiotensin 2 receptor antagonists in patients intolerance of ACEi

39
Q

Beta blockers

A

Should not be initiated during acute HF due to short term deterioration in LV systole

Start slowly and titrate upwards at maximum 2 weekly intervals

Experience temporary decrease in QoL due to lethargy and fluid retention

40
Q

Ivabradine

A

Licensed for chronic HF

5mg BD for 2 weeks then increase to 7.5mg BD
2.5mg BD if >75

41
Q

Side effects of ivabradine

A

Slow heart rate

Headache

Dizziness

Vision disturbance

42
Q

Nitrates

A

10mg BD titrated upwards to total of 120mg daily divided doses

Used ina cute LV HF causing pulmonary oedema

43
Q

Sacubitril valsartan

A

Neprilysin inhibitor and angiotensin 2 receptor blocker

44
Q

Lifestyle changes for heart failure

A

Monitor fluid intake

Monitor breathlessness and oedema

Smoking cessation

Optimise BP

Optimise diabetes management

Diet and reduced salt intake

Regular exercise providing condition is stable and doesn’t preclude this

Flu vaccination

Pneumococcal vaccination

Compliance with medication

308: Clinical Pharmacology and Therapeutics (14 decks)

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