Cardiology Pharmacology Flashcards
ACEi Indications and added effect
HTN
Chronic heart failure
CKD
- Also reduces circulating aldosterone levels
ACEi - Name 2 drugs
Ramipril
Enalapril
ACEi S/E
- 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
ACEi CI
Renal artery stenosis
AKI
ARB indications
used if ACEi CI Chronic heart failure HTN CKD Diabetic nephropathy
ARB
- Receptor acted on
- S/E
- CI
- Angiotensin-1 receptor
- Hypotension
Hyperkalaemia
Renal dysfunction
Rash - Pregnancy
Breastfeeding
Name 3 ARB’s
Losartan
Candesartan
Valsartan
What is the function of Ca2+
Peripheral vasoconstriction
Blockage –> Vasodilation
CCB indications
HTN
Arrhythmias
IHD - Angina
Name 3 CCB
Amlodopine
Verapamil
Felodipine
What channel do CCB’s act on
L-type Ca2+ channel blockers
Name the 3 categories of CCBs
Dihydropyridines
Phenylalkylamines
Benzothiozepines
Dihydropyridines action and examples
- Amlodopine + Felodopine
Act on vascular SM - peripheral artery vasodilators
Phenylalkylamines action and examples
-Verapamil
Act on the heart
Decrease HR + Force of contraction
Benzothiozepines
Diltiazem
Heart and peripheral vascular effects
CCB S/E
- Dihydropyridines
Flushing
headache
Ankle oedema
2. Phenyalkylamines Bradycardia AV Block Constapation** Postural hypotension * -ve ionotropic = worsens HF
Beta - blockers indications
Angina - IHD
HF
HTN
Arrythmia
Name 3 beta blockers in order of selectivity
B1 - Bisoprolol
Atenolol
B1+2 - Propanolol
Beta-blockers MOA
B1 -
Negative chronotropic and ionotropic
Decrease speed of AVN conduction
B-blockers MOA in
- Myochardial ischaemia
- HF
- Decrease cardiac workload and O2 demand
Increase Myocardial perfusion - Protects heart from effects of chronic sympathetic stimulation
B-blockers S/E
Fatigue cold extremities nightmares hypotension bradycardia erectile dysfunction
B-blockers CI
- Asthma
Only use B1 but selectivity is dose dependent
If non selective –> Results in bronchospasms and airway constriciton worsening asthma - Heart block
Diuretics indications
HTN
HF
Diuretics classes
Thiazides
Loops
K+ sparing
Thiazides
- Acting channel
- Name 1
- Sodium chloride transport channel in DCT
- Bendroflumethiazide
Loop
- Acting channel
- Name 2
V. powerful and potent Rapidly acting - NKCC2 transporter - Furosemide - Butenamide
K+ sparing diuretics
- Name 1
- Added effect
Spirinolcatone
- Can be Aldosterone antagonist
Diuretics S/E
Hypotension Hypovolemic Hypokalaemia Raised uric acid --> Gout Erectile dysfunction Electrolyte disturbance - LOW: Na+/K+/Mg2+/Ca2+
Other Anti-HTN Name a: - Alpha1 - adrenorecptor blocker - Centrally acting -Direct renin inhibitor
- Doxazosin
- Methyldopa
- Aliskiren
Signs of acute HF
Pleural oedema
Signs of chronic HF
Ankle oedema
Abdominal ascites
What vasodilatory therapy is used in the tx of HF
Neurohormonal blockade
- RAAS + Sympathetic NS
Why are B-blockers used in HF
Block reflex sympathetic responses which stress the failing heart
HF 1st line tx
ACEi
B-blockers
*Low dose and slow titration up
HF 2nd line tx
Aldosterone antagonist
ACEi intolerant –> ARB
HF 3rd line tx
Consider digoxin
Actions of Cardiac natiuretic peptides + why are they released
- 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
What metabolises CNP
Neprilysin
Name a Neprilysin inhibitor and when it would be indicated
Sacubitril –> Vasodilation in HF
Nitrates MOA + Indications
- Arterial and venous vasodilators
Decrease Preload and Afterload
Decrease BP - HF
IHD - Angina
Name 3 Nitrates
Isosorbide mononitrate
Glyceryl Trinitrate - Infusion and Spray
Nitrates S/E
Headache
GTN spray syncope
Potential tolerance
Describe Stable angina
Pain: Neck,Jaw,Arm,Chest Predicatable pain Brought on by excercise Relieved by GTN Spray + rest Infrequent
Describe Unstable angina/NSTEMI
Frequent + Unpredicatable
Pain at rest
Not relieved by GTN spray
Describea STEMI
Pain:Chest,Jaw,Arm,Neck
Unpredictable
Persistent pain
Stable angina Secondary prevention
- Antiplatelet therapy
Asprin + Clopidogrel - Lipid lowering therapy
Simvastatin/Atorvostatin - GTN spray
Anti-anginal medication
- B-blockers or CCB- Amlodopine
If intolerant can switch or if not controlled combine - If intolerant and uncontolled combine with LAN
Isosorbide mononitrate
What should you not combine with B-clockers
Non-dihydropyridines - Verapamil or Diltiazem
As they both work on lowering heart rate
What classification is used for Anti-arrhythmics
Vaugham Williams classification
- Class 1+3 - Rhythm control
- Class 2+4 - Rate control
Class 1 Anti-arrhtmic
Na+ channel blocker - FLECAINIDE
Class 2 Anti-arrhythmic
B-blockers
What makes propanolol the most effective B-blocker post MI
Also blocks Na+ channels
Class 3 Anti-Arrhthmics
- Prolong A.P
AMIODARONE
Class 4 Anti-arrhthics
CCB’s
- Verapamil
- Diltiazem
- Amlodopine
Why is Verapamil more effectine than amlodopine as an anti-arrhythmic
No effect on Ca2+ channels at rest
What worsens arrhthmias
Sympathetic drive - Adrenaline
Amiodarone S/E
Grey skin Photosensitivity Hyperthyroidism Hypothyroidism QT prolongation --> Ventricular arrhytmia-->Arrest Ventricular tachycardia Optic neuropathy
Digoxin MOA
Cardiac glycoside
- Inhibits Na+/K+ pump
Digoxin effects
- Bradycardia
- +ve Ionotropic
- Negatively Chronotropic
- Increase ectopic activity –> Minor arrhythmias triggered
Digoxi S/E
Narrow theraputic range
- Nausea
-V+D
Confusion
Digoxin indication
AF - reduces ventricular response rate
HF - Positve Ionotropic effect
HTN tx
- <55y/o –> High renin –> ACEi/ARB
>55y/o or African –> Low renin –> CCB - ACEi/ARB + CCB
- ACEi/ARB + CCB + Thiazide diuretic
- Resistant HTN
consider adding: Alpha/Beta - blocker
Spirinolactone
High dose thiazide like diuretic
