Cardiology: The Drugs that make it possible Flashcards
What are the 3 types of diuretic and how does their MOA differ?
Loop: Blocks Na/2Cl/K co-transporter in ascending loop
Thiazide: Blocks Na/Cl symporter in DCT
Potassium sparing: Block Na channels in DCT
Spironolactone, eplerenone and amiloride are all types of?
K+ sparing diuretics
Furosemide and bumetanide are what drugs?
Loop diuretics
What drug is metolozone? name another member of this class
Thiazide diuretic
indapamide
Which of the following drugs will not cause hypokalaemia?
Amiloride
Metolazone
Indapamide
Eplernone
furosemide
Eplernone
K+ Sparing only block Na+ reabsorption
Amenorrhea, gynaecomastia, decreased libido are features of which diuretic?
K+ sparing diuretics
Spares your potassium but not your sex life
What are the side effects of thiazide diuretics?
Gout, Glucose tolerance impaired, Getting it up
(making you pee costs you the 3 Gs)
Which diuretic causes your electrolytes to leave and not hear them go?
Loop diuretics
also remember hearing by induction LOOP
Ramipril and lisinopril are what class of drugs?
ACE inhibitor
Blocks conversion of AT1–>2 which:
Prevents vasoDILATION
Secretes aldosterone .’. retain sodium (water)
BOTH OF WHICH RAISE BP
Which of the following is NOT a contraindication to ramipril?
Pregnancy
Angioedema
Previous MI
Renal artery stenosis
Stroke
Previous MI
Stroke
SEs of ramipril: RAS, pregnancy, angioedema
How does the effect of -sartans differ from ACEIs?
Blocks AT1 receptor rather than conversion to AT2
Does not deactivate bradykinin so no less vasodilation
Compare the contraindications of losartan and lisinopril
Both RAS and pregnancy
Only losartan allowed in angioedema
What is the action of GTN/Isorboside mononitrate and how do they differ?
Vasodilation
NO causes downstream reduction in Ca2+ influx
GTN shorter acting while ISMN longer acting
What are the side effects of nitrate use?
Think of everything vasodilation would do
Hypotension
Tachycardia
Headaches
Flushing
Amlodipine and verapamil are what kind of drug?
Calcium channel blockers
-dipines are dihydropyridines
verapamil and diltiazem are not
Outline the action of nifedipine and verapamil
Both are CCBs so reduce contractile force
Verapamil, like diltiazem, is a ND-CCB so reduces AVN conduction to slow rate
What drug should NEVER be given with verapamil or diltiazem?
B-blockers
Bradycardia
How do the prolols work? why is propanolol special?
Block B receptors
Propanolol non selective
What are the side effects of B-blockers?
Bronchospasm
Cold peripheries
Fatigue
Sleep disturbances
ED
In which circumstances are B-blockers contraindicated?
Where bradycardia is BADycardia (HF, Sick sinus, + verapamil)
Asthma
Aspirin, tirofiban, clopidogrel, ticagrelor are all what?
Antiplatelets
Which of the following is not an antiplatelet?
Tirofiban
Ifetroban
Apixiban
Apixiban
Its an anticoagulant
If a patient with PMHx of gastric ulcers is found to have aspirin, what should be changed?
Aspirin to clopidogrel
If a patient has a thrombus, what blood altering medication should you give?
Depends if venous or arterial
Venous: Anticoagulant
Arterial: Antiplatelet
Compare the MOA of warfarin vs LMWH/OACs
Both anticoagulants
Warfarin is a vit K reductase inhibitor
Others either inhibit thrombin or Factor Xa
A patient has a major haemorrhage, what meds would help reverse:
Warfarin
LMWH
OACs
Warfarin: Vitamin K
Heparins: Protamine
DOAC: idarucizamab (dabigitran), andexanet alfa
Streptokinase, alteplase and duteplase are all what drugs?
Fibrinolytics
Break down fibrin via plasminogen activation
What are the main concerns with fibrinolytics?
Haemorrhage
Streptokinase allergy –> dont give following recent strep infection
How do simvastatin and atorvostatin work?
Statins
Reduce cholestrol formation through
HMG-CoA reductase inhibition
increased LDL receptor expression causing LDL clearance
What are the side effects of atorvostatin, simvastatin
Myopathies
Liver impairment so check 3 months the yearly
What 3 patient groups should a statin be avoided in?
Pregnancy
Macrolide users
Previous IC bleed
What do bezafibrate and gemfibrozil do?
Fibrates
Reduce cholestrol
By upregulating PPARa related genes
Put the following drugs into their correct class
Quinidine
Lidocaine
Procainamide
Disopyramide
Flecanide
All sodium channel blockers
Flecainide: Slow acting
Lidocaine: Fast acting
Others: Medium acting
What drugs are class II antiarrhythmics?
B-blockers
What is amiodarone and what are its side effects?
Potassium channel blocker
Side effects:
Pulmonary fibrosis
Photosensitivity
Peripheral neuropathy
Thyroid problems
What is the effect of digoxin?
Reduces rate
Increases force
What are the side effects of digoxin and how do you look out for them?
Heart block, arrhythmias
Not routinely monitored but measure 8-12 hours after last dose
What does atropine do?
Speeds up the heart
Blocks muscarnic inhibition of heart rate
Ivabradine: How?
Reduces cardiac rate
Through blocking ‘funny’ current in SA node
Altered light vision, headache and bradys are caused by what cardiac drug?
Ivabradine
How does the INR for warfarin differ between A-fib and VTE/
- 5 for both
- 5 if VTE recurrent
Which of the following does not reduce warfarin’s effect?
Amiodarone
NSAIDS
Cranberry juice
Ciprofloxacin
Clindamycin
Clopidogrel
Clopidogrel
P450 inhibition: Amiodarone, cipro (ALSO LIVER DISEASE)
NSAIDS: Inhibit platelet function and displace warfarin
What tests should be performed prior to amiodarone therapy?
TFTs, CXR, U+Es, LFTs
Breathlessness with fever and a new murmur points towards what cardiac condition?
Infective endocarditis
For endocarditis, what pathogen is most assoicated with
Being the most common
Poor dental hygiene
People with IVs
Colorectal cancer
S. aureus
S. Viridans
S. Epidermidis
S. bovis
What are the major Duke Criteria and how many do you need for IE diagnosis?
Postiive blood cultures x 2
Positive Echo for regurg/oscillating structures/abscess formation
2 major (or 1 major, 3 minor)
What are the minor criteria for IE and how many are needed for diagnosis?
Positive cultures x1
Prior heart condition or IVDU
Fever >38 degrees
Vasuclar changes (eg emboli)
Immunoligical history
Need 5 minor
What is the blind and targeted therapy for native endocarditis
B: Amox +/- gent
T: Flucloxicillin
What is the blind and targeted therapy for prosthetic valve endocarditis?
B: Vanc + Gent + rifampicin
T: Swap vanc to fluclox
Who gets prophylactic therapy for endocarditis?
At risk populations taking antimicrobials for GI/GU stuff
What investigations are performed in suspected endocarditis?
Blood cultures
TT echo <24hrs, TOE if -ve
+ US abdo for splenic infarcts
How can you tell aortic stenosis and mitral regurgitation apart?
AS: Ejection systolic, crescendo-decrescendo murmur, slow rising pulse
MR: Pan-systolic murmur, high pitched, mid-systolic click worse on squatting
Differentiate mitral stenosis and aortic regurgitation
MS: Mid-diastolic, low-rumbling. Malar flush and A-fib
AR: Early diastolic, soft murmur, collapsing pulse
Match the pulse to its murmur
Collapsing
wide pulse pressure
narrow pulse pressure
Aortic regurgitation
Aortic regurgitation
Aortic stenosis
What does raised JVP, hypotension and muffled heart sounds indicate?
Beck’s triad
Cardiac tamponade
What does this show and what condition is it seen in?
Electrica alternans
Cardiac tamponade
How can you differentiate chronic pericarditis from cardiac tamponade using
JVP waveform
Raised JVP on inspiration (Kussmaul’s)
Inspiratory fall in pulse pressure (pulsus paradoxus)
Pericardial calcification on CXR
CT // CP
X // X+Y
Rare // present
Present // Absent
No // Yes
How do you treat a cardiac tamponade?
Pericardiocentesis
Breathlessness, raised JVP, pansystolic murmur and hepatosplenomegaly in a chronic lung disease patient indicates what and how is it treated
Cor pulmonale
Manage underlying cause
