Cardioresp PPT Flashcards
name some thiazide diuretics
bendroflumethiazide, indapamide
indications of thiazide diuretics
hypertension, sometimes chronic heart failure
MOA of thiazide diuretics
inhibit the Na+/Cl- co-transporter on DCT, preventing reabsorption of Na+ and H2O
side effects of thiazide diuretics
Hyponatraemia
Hypokalaemia
Cardiac arrhythmias
gout
name some loop diuretics
furosemide (IV & oral), bumetanide (oral)
indications of loop diuretics
acute pulmonary oedema, chronic heart failure, resistant hypertension
MOA of loop diuretics
inhibit the Na+/K+/2Cl- pump in ascending loop which results in water retention. Also have a vasodilative effect
side effects of loop diuretics
Dehydration
Hypotension
Almost any low electrolyte state
name some potassium sparing diuretics and aldosterone antagonists
amiloride, spironolactone (AA), eplerenone (AA)
indications of potassium sparing diuretics and aldosterone antagonists
prevention of hypokalaemia with use of other diuretics, primary hyperaldosteronism, severe heart failure
MOA of potassium sparing diuretics
act at DCT to prevent reabsorbtion of Na+ and water, but spare K+
MOA of aldosterone antagonists
competitive inhibitors of aldosterone at collecting duct and prevent it causing Na+ reabsorption and K+ excretion
side effects of potassium sparing diuretics and aldosterone antagonists
GI upset
Hypotension
gynaecomastia (AA)
urinary symptoms
name some beta blockers
propranolol, bisoprolol, atenolol, metoprolol and carvedilol
indications of beta blockers
angina, MI, hypertension, arrhythmia, heart failure, anxiety
MOA of beta blockers
block beta-1 receptors on the heart and reduce force of contraction and speed of conduction. Non-cardioselective ones inhibit release of renin from kidneys.
side effects of beta blockers
Cold extremities
bronchospasm
fatigue
warnings of beta blockers
cause bronchospasm in asthmatics
contraindicated in heart block
name some calcium channel blockers
amlodipine, diltiazem, verapamil
indications of calcium channel blockers
hypertension, angina, arrhythmias
MOA of calcium channel blockers
decrease Ca2+ entry into vascular and cardiac cells. This causes relaxation and vasodilation in arterial smooth muscle. It suppresses cardiac conduction and slows heart rate
side effects of calcium channel blockers
amlodipine - oedema, headaches, palpitations
verapamil - constipation, heart block, gum hypertrophy
diltiazem - any of the above
warnings of calcium channel blockers
don’t use amlodipine in unstable angina
verapamil and diltiazem shouldn’t be used with beta blockers
name some ACEi’s
ramipril, enalapril, captopril
indications of ACEi’s
hypertension, chronic heart failure, ischaemic heart disease, diabetic nephropathy
MOA of ACEi’s
blocks action of ACE, preventing conversion of angiotensin 1 to angiotensin 2. Angiotensin 2 is a vasoconstrictor and stimulates aldosterone production
side effects of ACEi’s
hypotension
hyperkalaemia
persistnet dry cough
renal failure
warnings of ACEi’s
avoid in renal artery stenosis, AKI
Don’t use antacids at same time
Alcohol amplifies its effects
name some ARBs
lorsartan, candesartan, valsartan
indications of ARBs
hypertension, chronic heart failure, ischaemic heart disease, diabetic nephropathy
MOA of ARBs
block the action of angiotensin 2 on it’s receptor. Prevents it causing vasocontriction and stimulating aldosterone release
side effects of ARBs
hypotension
hyperkalaemia
renal failure
warnings of ARBs
avoid in renal artery stenosis and AKI
name some alpha 1 receptor antagonists
doxazosin, tamulosin
indications of alpha 1 receptor antagonists
resistant hypertension
benign prostatic hyperplasia
MOA of alpha 1 receptor antagonists
act on alpha-1 adrenoceptors which are present on smooth muscle of blood vessels and urinary tract. Blockage of these allows vasodilation and reduced resistance to bladder outflow
name some statins
simvastatin, atorvastatin
indication of statins
prevention of cardiovascular disease
MOA of statins
inhibit HMG coA reductase which is involved in making cholesterol. They decrease cholesterol production and increase LDL clearance
side effects of statins
myalgia
headaches
hepatitis
rhabdomyolysis
name some fibrates
fenofibrate, ciprofibrate
indications of fibrates
hypertriglyceridaemia
MOA of fibrates
activation of transcriptionfactors called PPARs which help regulate genes that control lipid metabolism. Increase HDL and reduce LDL
side effects of fibrates
GI upset
pruritis
headache
name a specific cholesterol absorption inhibitor
ezetimibe
indication of specific cholesterol absorption inhibitor
prevention of cardiovascular disease
MOA of specific cholesterol absorption inhibitors
Act on brush border of small intestine to reduce absorption of cholesterol
side effects of specific cholesterol absorbtion inhibitors
GI upset
unpalatability of drug
warnings of specific cholesterol absorption inhibitors
interact with absorption of acidic drugs e.g. warfarin, digoxin
name some heparins
unfractionated heparin, deltaparin (LMWH), fondaparinux (not a heparin but similar)
indications of heparins
thromboembolism, acute coronary syndrome (ACS)
MOA of heparins
activates antithrombin which inactivates thrombin and factor Xa, which are key in the common coagulation pathway.
unfractionated heparin inhibits both equally
LMWH inhibits factor Xa preferentially
Fondaparinux inhibits factor Xa only
side effects of heparins
bleeding
thrombocytopenia
reaction around injection site
name some DOACs
apixaban, rivaroxaban
indications of DOACs
thromboembolism treatment and prophylaxis
MOA of warfarin
Inhibits an enzyme that reactivates vitamin K. This prevents synthesis of vitamin K dependent coagulation factors
MOA of non-vitamin K dependent DOACs
they reversibly bind to factor Xa and inhibit it’s action. This causes quick onset anticoagulation
side effects of warfarin
haemorrhage
teratogenic effects on foetus
alopecia
warnings of warfarin
broad spectrum antibiotics can increase its anticoagulant effect. CYP450 inhibitors increase risk of bleeding e.g. NSAIDs, amiodarone, SSRIs
side effects of non-vitamin K dependent DOACs
haemorrhage
nausea
name some fibrinolytic drugs
alteplase, tenecteplase, streptokinase
indications of fibrinolytic drugs
acute stroke (alteplase can be given upto 4.5hrs after), STEMI, thrombolysis of thromboembolism
MOA of fibrinolytic drugs
catalyses conversion of plasminogen to plasmin which dissolves clots and re-canalises occluded vessels.
side effects of fibrinolytic drugs
bleeding
hypotension
cardiac arrest
N&V
name vitamin K as a drug
phytomenadione
indications of phytomeandione (vit K)
reverse the anticoagulant effect of warfarin,
used in newborns
MOA of phytomenadione (vit K)
supplies vitamin K for the synthesis of vitamin K dependent clotting factors
side effects of phytomenadione(vit K)
occasionally anaphylaxis
name a prothrombin complex concentrate
beriplex
indications of prothrombin complex concentrate
reverse the anticoagulant effect of warfarin and vit K antagonists
what drug causes reversal of anticoagulation from DOACs
idarucizamab
name some nitrates
isosorbide mononitrate, glyceryl trinitrate
indications of nitrates
acute angina, ACS (both use glyceryl trinitrate), prophylaxis of angina (isosorbide), pulmonary oedema
MOA of nitrates
converted to NO which helps reduce intracellular Ca2+ in vascular smooth muscle, helping them relax. This reduces cardiac work and myocardial oxygen demand
side effects of nitrates
frequent headaches
postural hypotension
dizziness
tolerance
name a potassium channel opener
nicorandil
indications of potassium channel openers
angina
MOA of potassium channel openers
they open ATP-inhibited potassium channels, allowing outflow of K+ and hyperpolarisation (-ve potential). Also activates guanylyl cyclase which increases cGMP to further decrease Ca2+. This results in vasodilation which helps reduce myocardial oxygen demand
side effects of potassium channel openers
skin, eye and GI ulcers
flushing
headaches
side effects of sinus node inhibitors
blurred vision & ocular symptoms
ventricular ectopics
heart block