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2a Pharmacology > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

Aldosterone Antagonists

Examples

A
  • Spironolactone

- Eplerenone

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2
Q

Aldosterone Antagonists

MofA

A

Competitively bind to the aldosterone receptor, increasing sodium and water excretion, and potassium retention in distal convoluted tubules

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3
Q

Aldosterone Antagonists

Uses

A
  • Ascites / oedema in liver cirrhosis –> 1st line = Spironolactone
  • Congestive heart failure - in addition to Beta-blockers or ACE-I or ARB
  • Primary hyperaldosteronism
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4
Q

Aldosterone Antagonists

Side effects

A
  • Hyperkalaemia (leading to muscle weakness, arrhythmia)

- Spironolactone –> can cause gynaecomastia (enlargement of mans breast)

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5
Q

Aldosterone Antagonists

Contraindications

A
  • Pregnancy or lactating women!!!
  • Severe renal impairment
  • Hyperkalaemia
  • Addison’s disease
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6
Q

Aldosterone Antagonists

Interactions

A
  • ACE-I’s and ARB’s - both increase serum potassium

- Potassium supplements

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7
Q

Alpha-blockers

Examples

A
  • Doxazosin

- Tamulosin

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8
Q

Alpha-blockers

MofA

A

Block alpha-1 adrenoreceptors in smooth muscle, inducing relaxation
Causes vasodilation and reduced resistance to bladder outflow

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9
Q

Alpha-blockers

Uses

A
  • Benign prostatic hyperplasia

- Resistant hypertension (only doxazosin)

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10
Q

Alpha-blockers

Side effects

A
  • Postural hypertension
  • Dizziness
  • Tamsulosin –> 3 D’s (Dizziness, Drowsiness, Depression)
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11
Q

Alpha-blockers

Contraindications

A
  • Existing postural hypertension
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12
Q

ACE-Inhibitors

Examples

A

End in PRIL

  • Ramipril
  • Lisinopril
  • Enalapril
  • Perindopril
  • Trandolapril
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13
Q

ACE-Inhibitors

MofA

A

Block ACE, so prevent the conversion of angiotension 1 to angiotensin 2, lowering the peripheral vascular resistance - especially the efferent glomerular arteriole

Also block breakdown of bradykinin

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14
Q

ACE-Inhibitors

Uses

A
  • 1st line for hypertension
  • 1st line for chronic heart failure
  • Ischaemic heart disease
  • Diabetic nephropathy and CKD with proteinuria
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15
Q

ACE-Inhibitors

Side effects

A
  • Hypotension
  • Cough (due to increased bradykinin)
  • Hyperkalaemia
  • Angioedema
  • Acute renal failure (if excess ACE-I given)
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16
Q

ACE-Inhibitors

Contraindications

A
  • Renal artery stenosis
  • AKI
  • Pregnancy !!!
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17
Q

ACE-Inhibitors

Interactions

A
  • Potassium supplements
  • Potassium sparing diuretics
  • Combining with NSAID’s increases risk of renal failure
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18
Q

Angiotensin receptor blockers

Examples

A

End in SARTAN

  • Candesartan
  • Losartan
  • Valsartan
  • Irbesartan
  • Telmisartan
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19
Q

Angiotensin receptor blockers

MofA

A
  • Block action of angiotensin 2 on the AT1 receptor
  • Reduces peripheral vascular resistance
  • Reduces aldosterone levels –> promoting sodium and water excretion, helping reduce venous preload –> HF
20
Q

Angiotensin receptor blockers

Uses

A
  • 2nd line for hypertension
  • 2nd line for chronic heart failure
  • Ischaemic heart disease
  • Diabetic nephropathy and CKD with proteinuria
21
Q

Angiotensin receptor blockers

Side effects

A
  • Hypotension
  • Hyperkalaemia
  • Renal failure - people most at risk have renal artery stenosis and rely on constriction of the efferent arterioles to maintain glomerular filtration
    (NOTE - no angioedema and cough - so may be preferred to ACI-inhibitors)
22
Q

Angiotensin receptor blockers

Contraindications

A
  • Renal artery stenosis
  • AKI
  • Pregnancy !!!
23
Q

Angiotensin receptor blockers

Interactions

A
  • Potassium supplements
  • Potassium sparing diuretics
  • Combining with NSAID’s increases risk of renal failure
24
Q

Beta Blockers

Examples

A

A lot end in OLOL

B1 = Heart:

  • Bisoprolol
  • Metoprolol

Middle:
- Atenolol

B1/B2 = Lungs (non-selective):

  • Propanolol
  • Nadolol
  • Carvedillol
25
Q

Beta Blockers

MofA

A
  • Block the B1 adrenergic receptor located mainly in the heart - reduce force of contraction and speed of conduction
  • Relieves cardiac ischaemia, by reducing work and oxygen demand, and increasing perfusion
  • Prolongs refractory period of AV node
  • Reduces renin secretion by kidney - B1 receptors
26
Q

Beta Blockers

Uses

A
  • 1st line for IHD - improves symptoms and prognosis with angina and ACS
  • 1st line for chronic heart failure
  • 1st line for SVT - for patients without circulatory compromise to restore sinus rhythm
  • Hypertension when not CCB’s or ACE-I’s
27
Q

Beta Blockers

Side effects

A
  • Fatigue
  • Cold extremities
  • Headache
  • Nausea
  • Sleep disturbances and nightmares
28
Q

Beta Blockers

Contraindications

A
  • Asthma (life-threatening bronchospasm when B2 airway receptors are blocked)
  • COPD (choose cardio selective beta blocker)
  • HF - start at low dose and up-titrate as they may initially impair cardiac function
  • Heart block
  • Reduce dose in hepatic failure
29
Q

Beta Blockers

Interactions

A
  • Non-dihydropyridine CCB’s (diltiazem, verapamil) can cause heart failure and bradycardia
30
Q

Calcium channel blockers

Types and examples

A 
1. Dihydropyridines - vascular selective
End in PINE
- Amlodipine
- Nifedipine
- Felodipine
- Lacidopine
  1. Non-dihydropyridines - cardiac selective
    - Diltiazem
    - Verapamil
31
Q

Dihydropyridine CCB’s

MofA

A

Decrease calcium entry into vascular and cardiac cells, causing vasodilation, lowering BP

32
Q

Dihydropyridine CCB’s

Uses

A
  • Hypertension - 2nd line

- Stable angina - 2nd line to BB

33
Q

Dihydropyridine CCB’s

Side effects

A
  • Flushing
  • Ankle oedema
  • Headache
  • Palpitations
34
Q

Dihydropyridine CCB’s

Contraindications

A
  • Unstable angina - vasodilation causes a reflex increase in contractability and tachycardia, which increases myocardial oxygen demand
  • Severe aortic stenosis
35
Q

Dihydropyridine CCB’s

Interactions

A
  • Beta-blockers (negatively inotropic and chronotropic)
36
Q

Non-dihydropyridine CCB’s

MofA

A

In the heart.
They suppress cardiac conduction by blocking Ca channels, particularly across the AV node, reducing cardiac rate and oxygen demand

37
Q

Non-dihydropyridine CCB’s

Uses

A
  • Supraventricular arrhythmia’s (incl. AF and flutter)

- Stable angina - 2nd line to BB

38
Q

Non-dihydropyridine CCB’s

Side effects

A
  • Constipation
  • Bradycardia
  • Heart block
  • Heart failure
  • POSTURAL HYPERTENSION
39
Q

Non-dihydropyridine CCB’s

Contraindications

A
  • Poor left ventricular function

- AV nodal conduction delay

40
Q

Non-dihydropyridine CCB’s

Interactions

A
  • Beta-blockers (negatively inotropic and chronotropic)
41
Q

Adenosine

MofA

A

Agonist of adenosine receptors on cell surfaces

Activation in the heart reduces automatically, slowing sinus rate

42
Q

Adenosine

Uses

A
  • 1st line for SVT (Supraventricular tachycardia)

Increases refractoriness in the AV node which breaks the re-entry circuit

43
Q

Adenosine

Side effects

A
  • Bradycardia

- Feels like a sinking feeling in chest/sense of impending doom - short lived as plasma half-life = 10 seconds

44
Q

Adenosine

Contraindications

A
  • Patients who will not tolerate transient bradycardiac effects - hypotension, IHD, HF
  • Asthma and COPD - bronchospasm
45
Q

Adenosine

Interactions

A
  • Half dose if on dipyridamole (blocks cellular uptake so prolongs effect)
  • Theophylline and caffeine reduce effect

2a Pharmacology (9 decks)

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