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Phase 2a > Cardiology Pharmacology > Flashcards

Cardiology Pharmacology Flashcards

1
Q

ACEi Indications and added effect

A

HTN
Chronic heart failure
CKD

  • Also reduces circulating aldosterone levels
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2
Q

ACEi - Name 2 drugs

A

Ramipril

Enalapril

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3
Q

ACEi S/E

A 
- Decreased Angiotensin II formation 
Hypotension 
Hyperkalaemia 
Diabetic nephropathy 
Acute renal failure 
-Excess ACEi --> Kidney detects low BP --> Renin relased --> Renal failure
  • Increased Kinin production
    Dry chronic cough
    Rash
    Anaphalactoid reaction
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4
Q

ACEi CI

A

Renal artery stenosis

AKI

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5
Q

ARB indications

A 
used if ACEi CI 
Chronic heart failure 
HTN 
CKD 
Diabetic nephropathy
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6
Q

ARB

  • Receptor acted on
  • S/E
  • CI
A
  • Angiotensin-1 receptor
  • Hypotension
    Hyperkalaemia
    Renal dysfunction
    Rash
  • Pregnancy
    Breastfeeding
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7
Q

Name 3 ARB’s

A

Losartan
Candesartan
Valsartan

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8
Q

What is the function of Ca2+

A

Peripheral vasoconstriction

Blockage –> Vasodilation

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9
Q

CCB indications

A

HTN
Arrhythmias
IHD - Angina

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10
Q

Name 3 CCB

A

Amlodopine
Verapamil
Felodipine

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11
Q

What channel do CCB’s act on

A

L-type Ca2+ channel blockers

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12
Q

Name the 3 categories of CCBs

A

Dihydropyridines
Phenylalkylamines
Benzothiozepines

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13
Q

Dihydropyridines action and examples

A
  • Amlodopine + Felodopine

Act on vascular SM - peripheral artery vasodilators

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14
Q

Phenylalkylamines action and examples

A

-Verapamil
Act on the heart
Decrease HR + Force of contraction

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15
Q

Benzothiozepines

A

Diltiazem

Heart and peripheral vascular effects

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16
Q

CCB S/E

A
  1. Dihydropyridines
    Flushing
    headache
    Ankle oedema
2. Phenyalkylamines 
Bradycardia 
AV Block 
Constapation** 
Postural hypotension 
* -ve ionotropic = worsens HF
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17
Q

Beta - blockers indications

A

Angina - IHD
HF
HTN
Arrythmia

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18
Q

Name 3 beta blockers in order of selectivity

A

B1 - Bisoprolol

Atenolol

B1+2 - Propanolol

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19
Q

Beta-blockers MOA

A

B1 -
Negative chronotropic and ionotropic
Decrease speed of AVN conduction

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20
Q

B-blockers MOA in
- Myochardial ischaemia

  • HF
A
  • Decrease cardiac workload and O2 demand
    Increase Myocardial perfusion
  • Protects heart from effects of chronic sympathetic stimulation
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21
Q

B-blockers S/E

A 
Fatigue 
cold extremities 
nightmares 
hypotension 
bradycardia 
erectile dysfunction
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22
Q

B-blockers CI

A
  • Asthma
    Only use B1 but selectivity is dose dependent
    If non selective –> Results in bronchospasms and airway constriciton worsening asthma
  • Heart block
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23
Q

Diuretics indications

A

HTN

HF

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24
Q

Diuretics classes

A

Thiazides
Loops
K+ sparing

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25
Q

Thiazides

  • Acting channel
  • Name 1
A
  • Sodium chloride transport channel in DCT

- Bendroflumethiazide

26
Q

Loop

  • Acting channel
  • Name 2
A 
V. powerful and potent 
Rapidly acting 
- NKCC2 transporter 
- Furosemide 
- Butenamide
27
Q

K+ sparing diuretics

  • Name 1
  • Added effect
A

Spirinolcatone

- Can be Aldosterone antagonist

28
Q

Diuretics S/E

A 
Hypotension 
Hypovolemic
Hypokalaemia 
Raised uric acid --> Gout 
Erectile dysfunction 
Electrolyte disturbance - LOW: Na+/K+/Mg2+/Ca2+
29
Q 
Other Anti-HTN 
Name a:
- Alpha1 - adrenorecptor blocker 
- Centrally acting 
-Direct renin inhibitor
A
  1. Doxazosin
  2. Methyldopa
  3. Aliskiren
30
Q

Signs of acute HF

A

Pleural oedema

31
Q

Signs of chronic HF

A

Ankle oedema

Abdominal ascites

32
Q

What vasodilatory therapy is used in the tx of HF

A

Neurohormonal blockade

- RAAS + Sympathetic NS

33
Q

Why are B-blockers used in HF

A

Block reflex sympathetic responses which stress the failing heart

34
Q

HF 1st line tx

A

ACEi
B-blockers

*Low dose and slow titration up

35
Q

HF 2nd line tx

A

Aldosterone antagonist

ACEi intolerant –> ARB

36
Q

HF 3rd line tx

A

Consider digoxin

37
Q

Actions of Cardiac natiuretic peptides + why are they released

A
  • Released due to stretch of atria/ventricles and by increased pressure
  • Effects:
    Increase renal Na+ and H20 excretion
    Relax Vascular SM (except efferent arteriole)
    Inhibits: Aldosterone, Angiotensin II, Endothelin and ADH release
38
Q

What metabolises CNP

A

Neprilysin

39
Q

Name a Neprilysin inhibitor and when it would be indicated

A

Sacubitril –> Vasodilation in HF

40
Q

Nitrates MOA + Indications

A
  • Arterial and venous vasodilators
    Decrease Preload and Afterload
    Decrease BP
  • HF
    IHD - Angina
41
Q

Name 3 Nitrates

A

Isosorbide mononitrate

Glyceryl Trinitrate - Infusion and Spray

42
Q

Nitrates S/E

A

Headache
GTN spray syncope
Potential tolerance

43
Q

Describe Stable angina

A 
Pain: Neck,Jaw,Arm,Chest 
Predicatable pain 
Brought on by excercise 
Relieved by GTN Spray + rest 
Infrequent
44
Q

Describe Unstable angina/NSTEMI

A

Frequent + Unpredicatable
Pain at rest
Not relieved by GTN spray

45
Q

Describea STEMI

A

Pain:Chest,Jaw,Arm,Neck
Unpredictable
Persistent pain

46
Q

Stable angina Secondary prevention

A
  • Antiplatelet therapy
    Asprin + Clopidogrel
  • Lipid lowering therapy
    Simvastatin/Atorvostatin
  • GTN spray
47
Q

Anti-anginal medication

A
  1. B-blockers or CCB- Amlodopine
    If intolerant can switch or if not controlled combine
  2. If intolerant and uncontolled combine with LAN
    Isosorbide mononitrate
48
Q

What should you not combine with B-clockers

A

Non-dihydropyridines - Verapamil or Diltiazem

As they both work on lowering heart rate

49
Q

What classification is used for Anti-arrhythmics

A

Vaugham Williams classification

  • Class 1+3 - Rhythm control
  • Class 2+4 - Rate control
50
Q

Class 1 Anti-arrhtmic

A

Na+ channel blocker - FLECAINIDE

51
Q

Class 2 Anti-arrhythmic

A

B-blockers

52
Q

What makes propanolol the most effective B-blocker post MI

A

Also blocks Na+ channels

53
Q

Class 3 Anti-Arrhthmics

A
  • Prolong A.P

AMIODARONE

54
Q

Class 4 Anti-arrhthics

A

CCB’s

  • Verapamil
  • Diltiazem
  • Amlodopine
55
Q

Why is Verapamil more effectine than amlodopine as an anti-arrhythmic

A

No effect on Ca2+ channels at rest

56
Q

What worsens arrhthmias

A

Sympathetic drive - Adrenaline

57
Q

Amiodarone S/E

A 
Grey skin 
Photosensitivity 
Hyperthyroidism 
Hypothyroidism 
QT prolongation --> Ventricular arrhytmia-->Arrest
Ventricular tachycardia
Optic neuropathy
58
Q

Digoxin MOA

A

Cardiac glycoside

- Inhibits Na+/K+ pump

59
Q

Digoxin effects

A
  • Bradycardia
  • +ve Ionotropic
  • Negatively Chronotropic
  • Increase ectopic activity –> Minor arrhythmias triggered
60
Q

Digoxi S/E

A

Narrow theraputic range
- Nausea
-V+D
Confusion

61
Q

Digoxin indication

A

AF - reduces ventricular response rate

HF - Positve Ionotropic effect

62
Q

HTN tx

A
  1. <55y/o –> High renin –> ACEi/ARB
    >55y/o or African –> Low renin –> CCB
  2. ACEi/ARB + CCB
  3. ACEi/ARB + CCB + Thiazide diuretic
  4. Resistant HTN
    consider adding: Alpha/Beta - blocker
    Spirinolactone
    High dose thiazide like diuretic

Phase 2a (11 decks)

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