Cardiology Pharmacology Flashcards
1
Q
ACEi Indications and added effect
A
HTN
Chronic heart failure
CKD
- Also reduces circulating aldosterone levels
2
Q
ACEi - Name 2 drugs
A
Ramipril
Enalapril
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
4
Q
ACEi CI
A
Renal artery stenosis
AKI
5
Q
ARB indications
A
used if ACEi CI Chronic heart failure HTN CKD Diabetic nephropathy
6
Q
ARB
- Receptor acted on
- S/E
- CI
A
- Angiotensin-1 receptor
- Hypotension
Hyperkalaemia
Renal dysfunction
Rash - Pregnancy
Breastfeeding
7
Q
Name 3 ARB’s
A
Losartan
Candesartan
Valsartan
8
Q
What is the function of Ca2+
A
Peripheral vasoconstriction
Blockage –> Vasodilation
9
Q
CCB indications
A
HTN
Arrhythmias
IHD - Angina
10
Q
Name 3 CCB
A
Amlodopine
Verapamil
Felodipine
11
Q
What channel do CCB’s act on
A
L-type Ca2+ channel blockers
12
Q
Name the 3 categories of CCBs
A
Dihydropyridines
Phenylalkylamines
Benzothiozepines
13
Q
Dihydropyridines action and examples
A
- Amlodopine + Felodopine
Act on vascular SM - peripheral artery vasodilators
14
Q
Phenylalkylamines action and examples
A
-Verapamil
Act on the heart
Decrease HR + Force of contraction
15
Q
Benzothiozepines
A
Diltiazem
Heart and peripheral vascular effects
16
Q
CCB S/E
A
- Dihydropyridines
Flushing
headache
Ankle oedema
2. Phenyalkylamines Bradycardia AV Block Constapation** Postural hypotension * -ve ionotropic = worsens HF
17
Q
Beta - blockers indications
A
Angina - IHD
HF
HTN
Arrythmia
18
Q
Name 3 beta blockers in order of selectivity
A
B1 - Bisoprolol
Atenolol
B1+2 - Propanolol
19
Q
Beta-blockers MOA
A
B1 -
Negative chronotropic and ionotropic
Decrease speed of AVN conduction
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
21
Q
B-blockers S/E
A
Fatigue cold extremities nightmares hypotension bradycardia erectile dysfunction
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
23
Q
Diuretics indications
A
HTN
HF
24
Q
Diuretics classes
A
Thiazides
Loops
K+ sparing
25
Thiazides
- Acting channel
- Name 1
- Sodium chloride transport channel in DCT
| - Bendroflumethiazide
26
Loop
- Acting channel
- Name 2
```
V. powerful and potent
Rapidly acting
- NKCC2 transporter
- Furosemide
- Butenamide
```
27
K+ sparing diuretics
- Name 1
- Added effect
Spirinolcatone
| - Can be Aldosterone antagonist
28
Diuretics S/E
```
Hypotension
Hypovolemic
Hypokalaemia
Raised uric acid --> Gout
Erectile dysfunction
Electrolyte disturbance - LOW: Na+/K+/Mg2+/Ca2+
```
29
```
Other Anti-HTN
Name a:
- Alpha1 - adrenorecptor blocker
- Centrally acting
-Direct renin inhibitor
```
1. Doxazosin
2. Methyldopa
3. Aliskiren
30
Signs of acute HF
Pleural oedema
31
Signs of chronic HF
Ankle oedema
| Abdominal ascites
32
What vasodilatory therapy is used in the tx of HF
Neurohormonal blockade
| - RAAS + Sympathetic NS
33
Why are B-blockers used in HF
Block reflex sympathetic responses which stress the failing heart
34
HF 1st line tx
ACEi
B-blockers
*Low dose and slow titration up
35
HF 2nd line tx
Aldosterone antagonist
| ACEi intolerant --> ARB
36
HF 3rd line tx
Consider digoxin
37
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
38
What metabolises CNP
Neprilysin
39
Name a Neprilysin inhibitor and when it would be indicated
Sacubitril --> Vasodilation in HF
40
Nitrates MOA + Indications
- Arterial and venous vasodilators
Decrease Preload and Afterload
Decrease BP
- HF
IHD - Angina
41
Name 3 Nitrates
Isosorbide mononitrate
| Glyceryl Trinitrate - Infusion and Spray
42
Nitrates S/E
Headache
GTN spray syncope
Potential tolerance
43
Describe Stable angina
```
Pain: Neck,Jaw,Arm,Chest
Predicatable pain
Brought on by excercise
Relieved by GTN Spray + rest
Infrequent
```
44
Describe Unstable angina/NSTEMI
Frequent + Unpredicatable
Pain at rest
Not relieved by GTN spray
45
Describea STEMI
Pain:Chest,Jaw,Arm,Neck
Unpredictable
Persistent pain
46
Stable angina Secondary prevention
- Antiplatelet therapy
Asprin + Clopidogrel
- Lipid lowering therapy
Simvastatin/Atorvostatin
- GTN spray
47
Anti-anginal medication
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
What should you not combine with B-clockers
Non-dihydropyridines - Verapamil or Diltiazem
| As they both work on lowering heart rate
49
What classification is used for Anti-arrhythmics
Vaugham Williams classification
- Class 1+3 - Rhythm control
- Class 2+4 - Rate control
50
Class 1 Anti-arrhtmic
Na+ channel blocker - FLECAINIDE
51
Class 2 Anti-arrhythmic
B-blockers
52
What makes propanolol the most effective B-blocker post MI
Also blocks Na+ channels
53
Class 3 Anti-Arrhthmics
- Prolong A.P
| AMIODARONE
54
Class 4 Anti-arrhthics
CCB's
- Verapamil
- Diltiazem
- Amlodopine
55
Why is Verapamil more effectine than amlodopine as an anti-arrhythmic
No effect on Ca2+ channels at rest
56
What worsens arrhthmias
Sympathetic drive - Adrenaline
57
Amiodarone S/E
```
Grey skin
Photosensitivity
Hyperthyroidism
Hypothyroidism
QT prolongation --> Ventricular arrhytmia-->Arrest
Ventricular tachycardia
Optic neuropathy
```
58
Digoxin MOA
Cardiac glycoside
| - Inhibits Na+/K+ pump
59
Digoxin effects
- Bradycardia
- +ve Ionotropic
- Negatively Chronotropic
- Increase ectopic activity --> Minor arrhythmias triggered
60
Digoxi S/E
Narrow theraputic range
- Nausea
-V+D
Confusion
61
Digoxin indication
AF - reduces ventricular response rate
HF - Positve Ionotropic effect
62
HTN tx
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
