Cardiovascular Flashcards
what type of drug is furosemide?
loop diuretic
how do loop diuretics work?
Inhibit reabsorption of Na+, K+ and Cl- (and therefore water) from the ascending limb of the loop on Henle in the renal tubule
also dilate capacitance veins - very useful in heart failure. reduces preload on heart and improves contractile function
what are the indications to take furosemide?
oedema, resistant hypertension, heart failure
what are the contraindications to taking furosemide?
dehydration
hypokalaemia/ hyponatraemia
gout - inhibit uric acid excretion
what are the side-effects of furosemide?
dehydration + hypovolaemia
any low electrolyte state
hearing loss/ tinnitus
what are the interactions with furosemide?
any drug excreted by the kidney e.g. lithium, digoxin
aminoglycosides - increase oto/nephrotoxicity
what type of drug is spironolactone?
potassium sparing diuretic
how do potassium sparing diuretics work?
act on distal convoluted tubules
inhibit Na uptake (and therefore water)
this causes potassium retention
often used in conjunction with other diuretics as weak on its own
what are the indications to take spironolactone?
oedema, hypokalaemia as a result of other diuretics
what are the contraindications to taking spironolactone?
Hyperkalaemia, anuria and Addison’s disease
what are the side effects of spironolactone?
GI upset, hypotension, dizziness, electrolyte disturbance
what are the interactions with spironolactone?
other potassium elevating drugs
digoxin, lithium (affects clearance of these)
what type of drug is bendroflumethiazide?
thiazide diuretic
how do thiazide diuretics work?
inhibit the sodium-chloride transporter in the distal tubule and therefore water. this lowers potassium as sodium is retained by the aldosterone pump
what are the indications to take thiazide diuretics?
Hypertension
what are the contraindications to taking thiazide diuretics?
hypokalaemia/ hyponatraemia
gout
what are the side effects of thiazide diuretics?
hyponatraemia/ hypokalaemia
this may then lead to cardiac arrhythmia
inc plasma glucose
impotence in men
what are the interactions with thiazide diuretics?
NSAIDs reduce effect
other potassium lowering drugs
other hypotensive drugs - greater effect
why are thiazides particularly useful in hypertension?
main adverse effects of thiazides is hypokalaemia,
main adverse effects of ACE inhibitors and ARBs is hyperkalaemia.
synergistic blood pressure lowering effect: thiazides activate the renin–angiotensin system, while ACE inhibitors/ARBs block it.
combination of a thiazide and an ACE inhibitor/ARB is very useful in practice to improve BP control and to maintain neutral potassium balance.
what type of drug is atenolol?
beta blocker
how do beta blockers work?
B1 - block receptor to reduce force and contraction speed of the heart. this reduces ischaemia by reducing cardiac workload
also lower BP by renin secretion inhibition
what are the indications to take beta blockers?
IHD CHF AF SVT hypertension
what are the contrindications to taking beta blockers?
Asthma - can cause bronchospasm (act on B2 receptors)
COPD (only use B1 selective e.g. atenolol, bisoprolol rather than non selective e.g propanolol)
heart block
haemodynamic instability
what are the side effects of beta blockers?
fatigue, cold extremities, headache, GI upset, sleep disturbance, impotence in men
what are the interactions with beta blockers?
calcium channel blockers - can cause heart failure, bradycardia and asystole
theophylline decreases effect
how do calcium channel blockers work?
decrease Ca2+ entry into vascular and cardiac cell
relaxation and vasodilation in arterial smooth muscle
reduce myocardial contractility, suppress cardiac conduction
Reduced cardiac rate, contractility and afterload reduce myocardial oxygen demand, preventing angina
what are the two types of calcium channel blocker?
Dihydropyridines (amlodipine and nifedipine) - relatively selective for the vasculature
Non-dihydropyridines (verapamil, diltiazem) are more selective for the heart.
what are the indications to take calcium channel blockers?
Prophylaxis and treatment of STABLE angina, hypertension (amplodipine), supraventricular arrhythmia (diltazem)
what are the contraindications to taking calcium channel blockers?
poor left ventricular function - lead to HF
AV nodal conduction delay - may provoke complete heart block
unstable angina
severe aortic stenosis
what are the side effects of calcium channel blockers?
ankle swelling, flushing, headache, palpitations,
constipation, bradycardia, heart block and cardiac failure
what are the interactions with calcium channel blockers?
β-blockers - together may cause heart failure, bradycardia, and even asystole.
what type of drug are Ramipril, lisinopril and perindopril?
ACE inhibitor
how do ACEi work?
prevent the conversion of angiotensin I to angiotensin II
Angiotensin II is a vasoconstrictor and stimulates aldosterone secretion.
Blocking its action reduces peripheral vascular resistance (afterload), which lowers blood pressure
works particularly well on renal arteries so good for CKD
what are the indications to take ACEi?
hypertension
CHF
IHD
diabetic neuropathy and CKD
what are the contraindications to taking ACEi?
AKI, renal artery stenosis
what are the side effects of taking ACEi?
hypotension, persistent dry cough, renal failure, angioedema and anaphylaxis
what are the interactions with ACEi?
potassium-elevating drugs e.g. potassium sparing diuretics
NSAID - increase risk of renal failure
what type of drug is losartan?
Angiotensin receptor blockers (ARB)
how do Angiotensin receptor blockers work?
similar effect to ACEi - block action of angiotensin II on receptor