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MRCP Part 1 > Cardiology: The Drugs that make it possible > Flashcards

Cardiology: The Drugs that make it possible Flashcards

1
Q

What are the 3 types of diuretic and how does their MOA differ?

A

Loop: Blocks Na/2Cl/K co-transporter in ascending loop
Thiazide: Blocks Na/Cl symporter in DCT
Potassium sparing: Block Na channels in DCT

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2
Q

Spironolactone, eplerenone and amiloride are all types of?

A

K+ sparing diuretics

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3
Q

Furosemide and bumetanide are what drugs?

A

Loop diuretics

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4
Q

What drug is metolozone? name another member of this class

A

Thiazide diuretic

indapamide

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5
Q

Which of the following drugs will not cause hypokalaemia?

Amiloride

Metolazone

Indapamide

Eplernone

furosemide

A

Eplernone

K+ Sparing only block Na+ reabsorption

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6
Q

Amenorrhea, gynaecomastia, decreased libido are features of which diuretic?

A

K+ sparing diuretics

Spares your potassium but not your sex life

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7
Q

What are the side effects of thiazide diuretics?

A

Gout, Glucose tolerance impaired, Getting it up

(making you pee costs you the 3 Gs)

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8
Q

Which diuretic causes your electrolytes to leave and not hear them go?

A

Loop diuretics

also remember hearing by induction LOOP

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9
Q

Ramipril and lisinopril are what class of drugs?

A

ACE inhibitor

Blocks conversion of AT1–>2 which:

Prevents vasoDILATION

Secretes aldosterone .’. retain sodium (water)

BOTH OF WHICH RAISE BP

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10
Q

Which of the following is NOT a contraindication to ramipril?

Pregnancy

Angioedema

Previous MI

Renal artery stenosis

Stroke

A

Previous MI

Stroke

SEs of ramipril: RAS, pregnancy, angioedema

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11
Q

How does the effect of -sartans differ from ACEIs?

A

Blocks AT1 receptor rather than conversion to AT2

Does not deactivate bradykinin so no less vasodilation

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12
Q

Compare the contraindications of losartan and lisinopril

A

Both RAS and pregnancy

Only losartan allowed in angioedema

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13
Q

What is the action of GTN/Isorboside mononitrate and how do they differ?

A

Vasodilation

NO causes downstream reduction in Ca2+ influx

GTN shorter acting while ISMN longer acting

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14
Q

What are the side effects of nitrate use?

A

Think of everything vasodilation would do

Hypotension

Tachycardia

Headaches

Flushing

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15
Q

Amlodipine and verapamil are what kind of drug?

A

Calcium channel blockers

-dipines are dihydropyridines

verapamil and diltiazem are not

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16
Q

Outline the action of nifedipine and verapamil

A

Both are CCBs so reduce contractile force

Verapamil, like diltiazem, is a ND-CCB so reduces AVN conduction to slow rate

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17
Q

What drug should NEVER be given with verapamil or diltiazem?

A

B-blockers

Bradycardia

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18
Q

How do the prolols work? why is propanolol special?

A

Block B receptors

Propanolol non selective

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19
Q

What are the side effects of B-blockers?

A

Bronchospasm

Cold peripheries

Fatigue

Sleep disturbances

ED

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20
Q

In which circumstances are B-blockers contraindicated?

A

Where bradycardia is BADycardia (HF, Sick sinus, + verapamil)

Asthma

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21
Q

Aspirin, tirofiban, clopidogrel, ticagrelor are all what?

A

Antiplatelets

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22
Q

Which of the following is not an antiplatelet?

Tirofiban

Ifetroban

Apixiban

A

Apixiban

Its an anticoagulant

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23
Q

If a patient with PMHx of gastric ulcers is found to have aspirin, what should be changed?

A

Aspirin to clopidogrel

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24
Q

If a patient has a thrombus, what blood altering medication should you give?

A

Depends if venous or arterial

Venous: Anticoagulant

Arterial: Antiplatelet

25
Q

Compare the MOA of warfarin vs LMWH/OACs

A

Both anticoagulants

Warfarin is a vit K reductase inhibitor

Others either inhibit thrombin or Factor Xa

26
Q

A patient has a major haemorrhage, what meds would help reverse:

Warfarin

LMWH

OACs

A

Warfarin: Vitamin K

Heparins: Protamine

DOAC: idarucizamab (dabigitran), andexanet alfa

27
Q

Streptokinase, alteplase and duteplase are all what drugs?

A

Fibrinolytics

Break down fibrin via plasminogen activation

28
Q

What are the main concerns with fibrinolytics?

A

Haemorrhage

Streptokinase allergy –> dont give following recent strep infection

29
Q

How do simvastatin and atorvostatin work?

A

Statins

Reduce cholestrol formation through

HMG-CoA reductase inhibition

increased LDL receptor expression causing LDL clearance

30
Q

What are the side effects of atorvostatin, simvastatin

A

Myopathies

Liver impairment so check 3 months the yearly

31
Q

What 3 patient groups should a statin be avoided in?

A

Pregnancy

Macrolide users

Previous IC bleed

32
Q

What do bezafibrate and gemfibrozil do?

A

Fibrates

Reduce cholestrol

By upregulating PPARa related genes

33
Q

Put the following drugs into their correct class

Quinidine

Lidocaine

Procainamide

Disopyramide

Flecanide

A

All sodium channel blockers

Flecainide: Slow acting

Lidocaine: Fast acting

Others: Medium acting

34
Q

What drugs are class II antiarrhythmics?

A

B-blockers

35
Q

What is amiodarone and what are its side effects?

A

Potassium channel blocker

Side effects:

Pulmonary fibrosis

Photosensitivity

Peripheral neuropathy

Thyroid problems

36
Q

What is the effect of digoxin?

A

Reduces rate

Increases force

37
Q

What are the side effects of digoxin and how do you look out for them?

A

Heart block, arrhythmias

Not routinely monitored but measure 8-12 hours after last dose

38
Q

What does atropine do?

A

Speeds up the heart

Blocks muscarnic inhibition of heart rate

39
Q

Ivabradine: How?

A

Reduces cardiac rate

Through blocking ‘funny’ current in SA node

40
Q

Altered light vision, headache and bradys are caused by what cardiac drug?

A

Ivabradine

41
Q

How does the INR for warfarin differ between A-fib and VTE/

A
  1. 5 for both
  2. 5 if VTE recurrent
42
Q

Which of the following does not reduce warfarin’s effect?

Amiodarone

NSAIDS

Cranberry juice

Ciprofloxacin

Clindamycin

Clopidogrel

A

Clopidogrel

P450 inhibition: Amiodarone, cipro (ALSO LIVER DISEASE)

NSAIDS: Inhibit platelet function and displace warfarin

43
Q

What tests should be performed prior to amiodarone therapy?

A

TFTs, CXR, U+Es, LFTs

44
Q

Breathlessness with fever and a new murmur points towards what cardiac condition?

A

Infective endocarditis

45
Q

For endocarditis, what pathogen is most assoicated with

Being the most common

Poor dental hygiene

People with IVs

Colorectal cancer

A

S. aureus

S. Viridans

S. Epidermidis

S. bovis

46
Q

What are the major Duke Criteria and how many do you need for IE diagnosis?

A

Postiive blood cultures x 2

Positive Echo for regurg/oscillating structures/abscess formation

2 major (or 1 major, 3 minor)

47
Q

What are the minor criteria for IE and how many are needed for diagnosis?

A

Positive cultures x1

Prior heart condition or IVDU

Fever >38 degrees

Vasuclar changes (eg emboli)

Immunoligical history

Need 5 minor

48
Q

What is the blind and targeted therapy for native endocarditis

A

B: Amox +/- gent

T: Flucloxicillin

49
Q

What is the blind and targeted therapy for prosthetic valve endocarditis?

A

B: Vanc + Gent + rifampicin

T: Swap vanc to fluclox

50
Q

Who gets prophylactic therapy for endocarditis?

A

At risk populations taking antimicrobials for GI/GU stuff

51
Q

What investigations are performed in suspected endocarditis?

A

Blood cultures

TT echo <24hrs, TOE if -ve

+ US abdo for splenic infarcts

52
Q

How can you tell aortic stenosis and mitral regurgitation apart?

A

AS: Ejection systolic, crescendo-decrescendo murmur, slow rising pulse

MR: Pan-systolic murmur, high pitched, mid-systolic click worse on squatting

53
Q

Differentiate mitral stenosis and aortic regurgitation

A

MS: Mid-diastolic, low-rumbling. Malar flush and A-fib

AR: Early diastolic, soft murmur, collapsing pulse

54
Q

Match the pulse to its murmur

Collapsing

wide pulse pressure

narrow pulse pressure

A

Aortic regurgitation

Aortic regurgitation

Aortic stenosis

55
Q

What does raised JVP, hypotension and muffled heart sounds indicate?

A

Beck’s triad

Cardiac tamponade

56
Q

What does this show and what condition is it seen in?

A

Electrica alternans

Cardiac tamponade

57
Q

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

A

CT // CP

X // X+Y

Rare // present

Present // Absent

No // Yes

58
Q

How do you treat a cardiac tamponade?

A

Pericardiocentesis

59
Q

Breathlessness, raised JVP, pansystolic murmur and hepatosplenomegaly in a chronic lung disease patient indicates what and how is it treated

A

Cor pulmonale

Manage underlying cause

MRCP Part 1 (32 decks)

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