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DRUGS > CARDIOVASCULAR > Flashcards

CARDIOVASCULAR Flashcards

1
Q

Furosemide

A

loop diuretic

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2
Q

mechinism of action of furosemide

A

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

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3
Q

indications for furosemide

A

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

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4
Q

contraindications for furosemide

A

not in those w hypovolaemia or dehydration
with caution inhepatic encephalopathy severe hypokal/natraemia

can worsen gout when taken chronically

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5
Q

side effects of furosemide

A

dehydration and hypotension

hearing loss and tinnitis

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6
Q

interactions of furosemide

A

loop diuretics can affect drugs exrecreted by the kidneys

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7
Q

bendroflumethiazide

A

thiazide diuretic

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8
Q

bendroflumethiazide mechanism

A

inhibit Na/Cl co transporter in distal convoluted tubule of nephron
= prevent reabsorption of water

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9
Q

indications for bendroflumethiazide

A

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

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10
Q

contraindications for bendroflumethiazide

A

avoided in patients with hypokal/natraemia

reduce uric acid secretion so may precipitate acute attakcs of gout

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11
Q

side effects of bendroflumethiazide

A 
hyponatraemia 
hypokalaemia
= cardiac arrhythmias
unmask type 2 diabetes
impotence in  men
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12
Q

interactions of bendroflumethiazide

A

effectiveness reduced by NSAIDs

combination of thiazides with other drugs that lower potassium conc should be avoided

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13
Q

spironolactone

A

potassium sparing diuretic /aldosterone antagonist

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14
Q

spironolactone mechanism of action

A

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

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15
Q

indications of spironolactone

A

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 `

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16
Q

contraindication for spironolactone

A

severre renal impairemtn
hyperkalaemia
addisons disease (addiosns deficit)

avoid in pregnant and lactating

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17
Q

side effects of spironolactone

A

hyperkalaemia
gynaecomastia
liver impairment and jaundice

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18
Q

interactions of spironolactone

A

when combined with potasssium elevating drugs (ACEi, ARB), can case hyperkalaemia

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19
Q

atenolol

A

beta blocker

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20
Q

mechanism of action of beta blockers

A

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

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21
Q

indications for beta blockers

A

ischaemic heart disease - first line option
chronic heart failure
atrial fibrillation
supraventricular tachycardia

in hypertension when others are insufficient or innapropriate

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22
Q

contraindications of beta blockers

A

asthma - life threatening brnchospasms
heart fialure, should be titrating up s,oely
avoid in haemodynamic instability
contraindicated in heart block

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23
Q

side effects of beta blockers

A 
fatigue
cold extremities
headache
GI disturbance  (nausea)
sleep disturbances and nightmares
impotence
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24
Q

interactions of beta blockera

A

not use with non-dihydropyridine calcium channel blockers

can cause heart failure, bradycardia and even astystole

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25
Q

amlodipine

A

calcium channel blocker

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26
Q

mode of action of amlodipine

A

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

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27
Q

indications for amlodipine

A

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

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28
Q

contraindications for amlopidine

A

unstable angina (due to vasodilation leading to contractility and tachy)

aortic stenosis - can provoke collapse

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29
Q

side effects of amlodipine

A 
ankle swelling
flushing
headache
palpitations
- caused by vasodilation and compensatory tachycardia
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30
Q

what kind of calcium channel blocker should not be used with beta blockers

A

non-dihudropyridin e

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31
Q

ramipril

A

ace inhibitor

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32
Q

mechanism of action of ramipril

A

blocking action of aldosterone
= reduce peripheral vascular resistance and lowers blood pressure
slows progression of CKS by dilating effect arteriole

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33
Q

inidcations for ramipril

A

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

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34
Q

contraindications for ramipril

A

renal artery stenosis
AKI
women pregnant or breastfeeding

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35
Q

side effects of ramipril/acei

A

hypotension after first dose
peristent dry cough
hyperkalaemia
can cause or worsen renal failure

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36
Q

possible interactions of ACEi

A

avoid perscribing with other ptassium elevating durgs

in combination with other diuretics, hypotension

NSAID + ACEi = increased risk of renal failure

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37
Q

losartan

A

ARB

angiotension II receptor antagonist

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38
Q

mode of action of losartan/ARB

A

similar to ACEi
reduces peripheral vascular resistance and lowers blood pressure

dilates efferent arteriole, reducing interglomerular pressure and slows progression of CKD

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39
Q

indications for Losartan/ARB

A

hypertension
chronic heart failure
ischaemic heart disease
diabetic nephropathy and CKD with proteinuria

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40
Q

contraindications of losartan/ARBs

A

avoid in patient siwth renal artery stneosis or AKI

women pregnant or breastfeeding

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41
Q

side effects of losartan/ARBs

A

hypotension on first dose
hyperkalaemia
renal fialure n

42
Q

interactions of ARBs

A

other potassium elevating drugs
in combo with other diuretics - profound first dose hypotension

+ NSAIDs = risk of kidney damage

43
Q

isosorbide mononitrate

A

nitrates

44
Q

mode of action of isosorbide mononitrate

A

relax vessels smooth muscle

= reduce cardiac work and myocardial oxygen demand

45
Q

indications of isosrobide mononitrate

A

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

46
Q

contraindications for isosorbide mononitrate

A

severe aortic stenosis - may cause cardiovascular collapse

haemodynamic instability (in particular hypotension)

47
Q

side effects of isosorbide mononitrtate

A

flushing, headaches, lightheadedness and hypotension

sustained use can lead to tolerance + reduced symptom releif despite conintued use

48
Q

interactions of nitrates

A

phosphodiesterase inhibitors - enhance and prolong hypotensive effect of nitrates.

antihypertensive medication - precipitate hypotension

49
Q

digoxin

A

cardiac glycoside

50
Q

digoxin mode of action

A

cardiac glycoside - increase the output force of the heart and increase its rate of contractions by acting on the cellular sodium-potassium ATPase pump.

51
Q

indications for digozin

A

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)

52
Q

contraindications of digoxin

A

second degree heart block and intermittent complete heart block

ventricular arrhymias

electrolyte abnromalities

53
Q

side effects of digoxin

A 
bradycardia, 
GI disturbance
rash
dizziness
visual disturbance (blurred or yellow vision)
arrhythmias in digoxin toxicity
54
Q

interactions of digoxin

A

loop and thiazide diuretics can increase risk fo digoxin toxicity = hypokalaemia

amiodarone, Ca channel blockers, spironolactone and quinine - icnrease palsma conc

55
Q

amiodarone

A

anti-dysrhythmic

56
Q

amiodarone mode of action

A

reduces ventricular rate in AF and Atrial flutter

57
Q

indications for amiodarone

A

management of wide range of tachyarrhythmias - AF, atrial flutter, SVT, VT, VF,

58
Q

contraindications for amiodarone

A

only used when risk benefit balance is justified as is potentially dangerous drug

avoid in severe hypotension, heart block and thyroid disease

59
Q

side effects of amiodarone

A

many when taken chronically - pnuemonitis, bradycardia, AV block, hepatitis, photosensitivity

thyroid problems

60
Q

aspirin

A

antiplatelet

61
Q

aspirin mode of action

A

irreversibly inhibits cyclooxygenase (COX) = reduce production of pro aggregatory factor thormboxane

= reduce platelet aggregation

62
Q

indications for aspirin

A

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

63
Q

contraindications of aspirin

A

<16 yo
allergy to NSAIDs
third trimester of preg
peptic ulceration and gout

64
Q

side effects of aspirin

A 
GI irritation
GI ulceration and haemoorhage
hypersensitivity reactions  inc bronchospasm
tinitus
life threatening in overdose
65
Q

interactions of aspirin

A

caution with other antiplatelet and anticoagulants

66
Q

clopidogrel

A

antiplatelet

67
Q

clopidogrel mode of action

A

prevetns plaelet aggregation and reduces risk of arterial occlusion

68
Q

indications of clopidogrel

A

ACS
prevent occlusion of coronary artery stents
prevention of thrombotic events
reduce risk of intracardiac thormbus and embolic stroke in AF

69
Q

contraindications of clopidogrel

A

significant active bleeding
stopped 7 days before elective surgery
caution in renal and hepatic impairment

70
Q

side effects of clopidogrel

A

bleeding, in particular, GI

71
Q

tissue type plasminogen activator

A

thrombolytic - alteplase

72
Q

mode of action of tissue plasminogen activator

A

catalyses conversion of plasminogen to plasmin - major enzyme repsonsible for clot breakdown

73
Q

indications for thrombolytics

A

6-12 hrs of symptom onset of STEMI, PE, acute sichaemic stroke

occluded central venous access devices

74
Q

contraindications for thrombolytics

A 
recent haemorrhage
trauma
surgery 
coagulation defects
aortic dissection
aneurysm
coma
heavy vaginal bleeding
severe hypertension
75
Q

side effects of thrombolytics

A

nausea and vomiting and bleeding

in MI, repurfuion arrhythmias, recurrent ischaemia and angina may occur

cerebral and pulmonary oedema

76
Q

enoxaparin

A

low molecular weight heparin

= anticoagulant

77
Q

low molecular weight heparin

A

anticoagulant

78
Q

mode of action of heparin

A

inhibiting thrombin and factor Xa = prevent formation and propogation of blood clots

79
Q

mode of action of LMWH

A

inhibit factor Xa

= prevent blood clots

80
Q

indications for LMWH

A

venous thromboembolism VTE

acute coronary syndrome (ACS)

81
Q

contraindications of LMWH

A

increased risk of bleedng
clotting disorders
hypertension (severe)
invasive procedures

82
Q

side effects of LMWH

A

bleeding

injection site reactions

83
Q

warfarin

A

oral anticoagulant

84
Q

mode of action of warfarin

A

inhibits production of vit K dependent coagulation factors

= prevents clotting

85
Q

indications for warfarin

A

prevent VTE
prevent embolic complications in AF (stroke)
prevent embolic complications after valve replacements

86
Q

why not use warfarin in arterial thrombosis (MI, thrombotic stroke)?

A

driven by platelet aggregation = prevented by antiplateletsw not by anticoagulants

87
Q

contraindications for warfarin

A

risk of haemorrhage
liver disease
pregnancy

88
Q

side effects of warfarin

A

bleeding
increased risk of abnormalities - peptic ulcers
epistaxis r retroperitoneal haemorrhage

89
Q

contraindications of warfarin

A

cytochrome P450 inhibitors
cytochrome P450 inducers
some antibitoics

90
Q

rivaroxaban

A

novel anticoagulant

91
Q

mode of action of rivaoxaban

A

inhibits factor Xa in prothrombinase complex = interrupts blood coagulantion cascade

= inhibit thrombin formation

92
Q

inidcations for rivaoxaban

A

prevent VTE

prevent embolic complications in AF and after heart valve replcaments

93
Q

contraindications of rivaoxaban

A

immediate risk of haemorrhage - truam, childbirth and requiring surgery

94
Q

side effects of rivaoxaban

A

bleeding

95
Q

antidote for warfarin

A

vitamin K

96
Q

intercactions for rivaroxaban

A

cytochrome P450 inhibitors and inducers as hepatic impaiemnt

97
Q

simvastatin

A

statin

98
Q

mode of action of statins

A

decrease cholesterol production by liver and increase clearance of LDL cholesterol from the blood

reduce triglcerises and increase HDL cholesterol levels

99
Q

indications for statins

A

primary and secondary prevention of CVS disease

primary hyperlipidaemia

100
Q

contraindications for statins

A

hepatic impairment
renal imparemnt
pregnant women and breastfeeding

101
Q

interactions of statins

A

cytochrome P450 inhibitors and amlodipine

= stop/reduce dose whilst on these

DRUGS (13 decks)

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