CARDIOVASCULAR Flashcards
Furosemide
loop diuretic
mechinism of action of furosemide
loop diureticc - act on ascending loop of henle - inhbiit Na/K/Cl co trnsporter so prevents wter reabsorption
cause dilation of capacitance veins = reduces preload and improves contractility of overstretched heart
indications for furosemide
relief of breathlessness in acute pulmonary oedema in conjunction with oxygen and nitrates
symptomatic treatment of lfuid overload in chronic heart failure
symptomatic treatmnet of fluid overload in other oedematous states - renal diseaswe or liver failure
contraindications for furosemide
not in those w hypovolaemia or dehydration
with caution inhepatic encephalopathy severe hypokal/natraemia
can worsen gout when taken chronically
side effects of furosemide
dehydration and hypotension
hearing loss and tinnitis
interactions of furosemide
loop diuretics can affect drugs exrecreted by the kidneys
bendroflumethiazide
thiazide diuretic
bendroflumethiazide mechanism
inhibit Na/Cl co transporter in distal convoluted tubule of nephron
= prevent reabsorption of water
indications for bendroflumethiazide
alternative first line treatment for hypertension (instead of calcium channel blocker - cant due to oedema or heart failure)
add on treatment for hypertension in those not adequatel controlled by calcium channel blocker + ACEi/ARB
contraindications for bendroflumethiazide
avoided in patients with hypokal/natraemia
reduce uric acid secretion so may precipitate acute attakcs of gout
side effects of bendroflumethiazide
hyponatraemia hypokalaemia = cardiac arrhythmias unmask type 2 diabetes impotence in men
interactions of bendroflumethiazide
effectiveness reduced by NSAIDs
combination of thiazides with other drugs that lower potassium conc should be avoided
spironolactone
potassium sparing diuretic /aldosterone antagonist
spironolactone mechanism of action
inhibits effwect of aldosterone by competitielvy binding to aldosterone receptor
this increases sodium and water excretion and potassium retention
their effect is greatest in primary hyper aldosteronism or when circulating aldosterone is released
indications of spironolactone
ascites and oedema due to liver cirrhosis - spironolactone is first line diuretic
chronic heart failure - in addition to beta blocker and ace inhibitor
primary hyperaldosteronism `
contraindication for spironolactone
severre renal impairemtn
hyperkalaemia
addisons disease (addiosns deficit)
avoid in pregnant and lactating
side effects of spironolactone
hyperkalaemia
gynaecomastia
liver impairment and jaundice
interactions of spironolactone
when combined with potasssium elevating drugs (ACEi, ARB), can case hyperkalaemia
atenolol
beta blocker
mechanism of action of beta blockers
block beta1receptors = reduce force of contraction and speed of conduction in the heart
slow ventricular rate in AF mainly by prolonging the refractory period of the AV node
indications for beta blockers
ischaemic heart disease - first line option
chronic heart failure
atrial fibrillation
supraventricular tachycardia
in hypertension when others are insufficient or innapropriate
contraindications of beta blockers
asthma - life threatening brnchospasms
heart fialure, should be titrating up s,oely
avoid in haemodynamic instability
contraindicated in heart block
side effects of beta blockers
fatigue cold extremities headache GI disturbance (nausea) sleep disturbances and nightmares impotence
interactions of beta blockera
not use with non-dihydropyridine calcium channel blockers
can cause heart failure, bradycardia and even astystole
amlodipine
calcium channel blocker
mode of action of amlodipine
decrease Ca entry into vascular and cardiac cells, reducing intracellular conc.
= relaxation and vasodilation in arteries = lower pressure
in heart, reduce myocardial contractility
suppress cardiac conduction, slowing ventricular rate
reduced cardiac rate, contractility and afterload reduce myocardial oxygen demand preventing angina
indications for amlodipine
amlodipine as first or secodn line for hypertension, reduce risk of stroke, MI and death from caridovascular disease
cpntrol sumptoms in patients with stable angina - beta blockers are main alternative
control rate in those w supraventricular arrhythmias inc supraventricular tachy, AF and Afl
contraindications for amlopidine
unstable angina (due to vasodilation leading to contractility and tachy)
aortic stenosis - can provoke collapse
side effects of amlodipine
ankle swelling flushing headache palpitations - caused by vasodilation and compensatory tachycardia
what kind of calcium channel blocker should not be used with beta blockers
non-dihudropyridin e
ramipril
ace inhibitor
mechanism of action of ramipril
blocking action of aldosterone
= reduce peripheral vascular resistance and lowers blood pressure
slows progression of CKS by dilating effect arteriole
inidcations for ramipril
hypertension - first or second line treatment - reduce risk of stroke, MI and death
chronic heart failure - first line treamtnet
ischaemic heart disease - reduce risk of subsequent MI and stroke etc
diabetic nephropathy and CKD with proteinuria - reduce proteinuria and progression of nephropathy
contraindications for ramipril
renal artery stenosis
AKI
women pregnant or breastfeeding
side effects of ramipril/acei
hypotension after first dose
peristent dry cough
hyperkalaemia
can cause or worsen renal failure
possible interactions of ACEi
avoid perscribing with other ptassium elevating durgs
in combination with other diuretics, hypotension
NSAID + ACEi = increased risk of renal failure
losartan
ARB
angiotension II receptor antagonist
mode of action of losartan/ARB
similar to ACEi
reduces peripheral vascular resistance and lowers blood pressure
dilates efferent arteriole, reducing interglomerular pressure and slows progression of CKD
indications for Losartan/ARB
hypertension
chronic heart failure
ischaemic heart disease
diabetic nephropathy and CKD with proteinuria
contraindications of losartan/ARBs
avoid in patient siwth renal artery stneosis or AKI
women pregnant or breastfeeding
side effects of losartan/ARBs
hypotension on first dose
hyperkalaemia
renal fialure n
interactions of ARBs
other potassium elevating drugs
in combo with other diuretics - profound first dose hypotension
+ NSAIDs = risk of kidney damage
isosorbide mononitrate
nitrates
mode of action of isosorbide mononitrate
relax vessels smooth muscle
= reduce cardiac work and myocardial oxygen demand
indications of isosrobide mononitrate
long acting for prophylaxis of angina where bblocker and/or calcium channel blocker are insufficient or not tolerated
IV used to treat pulmonary oedema with furosemide nad oxygen
short acting for treatment of acute angina and chest pain associated with ACS - GTN spray
contraindications for isosorbide mononitrate
severe aortic stenosis - may cause cardiovascular collapse
haemodynamic instability (in particular hypotension)
side effects of isosorbide mononitrtate
flushing, headaches, lightheadedness and hypotension
sustained use can lead to tolerance + reduced symptom releif despite conintued use
interactions of nitrates
phosphodiesterase inhibitors - enhance and prolong hypotensive effect of nitrates.
antihypertensive medication - precipitate hypotension
digoxin
cardiac glycoside
digoxin mode of action
cardiac glycoside - increase the output force of the heart and increase its rate of contractions by acting on the cellular sodium-potassium ATPase pump.
indications for digozin
AF or atrial flutter - to reuce ventricular rate (bblocker or calcium channel blocker more effective tho)
severe heart failure - third line treatment ( ACEi, bblocker, aldosterone antagonist)
contraindications of digoxin
second degree heart block and intermittent complete heart block
ventricular arrhymias
electrolyte abnromalities
side effects of digoxin
bradycardia, GI disturbance rash dizziness visual disturbance (blurred or yellow vision) arrhythmias in digoxin toxicity
interactions of digoxin
loop and thiazide diuretics can increase risk fo digoxin toxicity = hypokalaemia
amiodarone, Ca channel blockers, spironolactone and quinine - icnrease palsma conc
amiodarone
anti-dysrhythmic
amiodarone mode of action
reduces ventricular rate in AF and Atrial flutter
indications for amiodarone
management of wide range of tachyarrhythmias - AF, atrial flutter, SVT, VT, VF,
contraindications for amiodarone
only used when risk benefit balance is justified as is potentially dangerous drug
avoid in severe hypotension, heart block and thyroid disease
side effects of amiodarone
many when taken chronically - pnuemonitis, bradycardia, AV block, hepatitis, photosensitivity
thyroid problems
aspirin
antiplatelet
aspirin mode of action
irreversibly inhibits cyclooxygenase (COX) = reduce production of pro aggregatory factor thormboxane
= reduce platelet aggregation
indications for aspirin
acute coronary syndrome and acute ischaemic stroke
prevention of thrombotic arterial events in those w cardiovascula r, cerebrovacular and PAD
reduce risk of intracardiac thrombus and embolic stroke in AF where warfarin and others are contraindicated
control pain and fever
contraindications of aspirin
<16 yo
allergy to NSAIDs
third trimester of preg
peptic ulceration and gout
side effects of aspirin
GI irritation GI ulceration and haemoorhage hypersensitivity reactions inc bronchospasm tinitus life threatening in overdose
interactions of aspirin
caution with other antiplatelet and anticoagulants
clopidogrel
antiplatelet
clopidogrel mode of action
prevetns plaelet aggregation and reduces risk of arterial occlusion
indications of clopidogrel
ACS
prevent occlusion of coronary artery stents
prevention of thrombotic events
reduce risk of intracardiac thormbus and embolic stroke in AF
contraindications of clopidogrel
significant active bleeding
stopped 7 days before elective surgery
caution in renal and hepatic impairment
side effects of clopidogrel
bleeding, in particular, GI
tissue type plasminogen activator
thrombolytic - alteplase
mode of action of tissue plasminogen activator
catalyses conversion of plasminogen to plasmin - major enzyme repsonsible for clot breakdown
indications for thrombolytics
6-12 hrs of symptom onset of STEMI, PE, acute sichaemic stroke
occluded central venous access devices
contraindications for thrombolytics
recent haemorrhage trauma surgery coagulation defects aortic dissection aneurysm coma heavy vaginal bleeding severe hypertension
side effects of thrombolytics
nausea and vomiting and bleeding
in MI, repurfuion arrhythmias, recurrent ischaemia and angina may occur
cerebral and pulmonary oedema
enoxaparin
low molecular weight heparin
= anticoagulant
low molecular weight heparin
anticoagulant
mode of action of heparin
inhibiting thrombin and factor Xa = prevent formation and propogation of blood clots
mode of action of LMWH
inhibit factor Xa
= prevent blood clots
indications for LMWH
venous thromboembolism VTE
acute coronary syndrome (ACS)
contraindications of LMWH
increased risk of bleedng
clotting disorders
hypertension (severe)
invasive procedures
side effects of LMWH
bleeding
injection site reactions
warfarin
oral anticoagulant
mode of action of warfarin
inhibits production of vit K dependent coagulation factors
= prevents clotting
indications for warfarin
prevent VTE
prevent embolic complications in AF (stroke)
prevent embolic complications after valve replacements
why not use warfarin in arterial thrombosis (MI, thrombotic stroke)?
driven by platelet aggregation = prevented by antiplateletsw not by anticoagulants
contraindications for warfarin
risk of haemorrhage
liver disease
pregnancy
side effects of warfarin
bleeding
increased risk of abnormalities - peptic ulcers
epistaxis r retroperitoneal haemorrhage
contraindications of warfarin
cytochrome P450 inhibitors
cytochrome P450 inducers
some antibitoics
rivaroxaban
novel anticoagulant
mode of action of rivaoxaban
inhibits factor Xa in prothrombinase complex = interrupts blood coagulantion cascade
= inhibit thrombin formation
inidcations for rivaoxaban
prevent VTE
prevent embolic complications in AF and after heart valve replcaments
contraindications of rivaoxaban
immediate risk of haemorrhage - truam, childbirth and requiring surgery
side effects of rivaoxaban
bleeding
antidote for warfarin
vitamin K
intercactions for rivaroxaban
cytochrome P450 inhibitors and inducers as hepatic impaiemnt
simvastatin
statin
mode of action of statins
decrease cholesterol production by liver and increase clearance of LDL cholesterol from the blood
reduce triglcerises and increase HDL cholesterol levels
indications for statins
primary and secondary prevention of CVS disease
primary hyperlipidaemia
contraindications for statins
hepatic impairment
renal imparemnt
pregnant women and breastfeeding
interactions of statins
cytochrome P450 inhibitors and amlodipine
= stop/reduce dose whilst on these
