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308: Clinical Pharmacology and Therapeutics > Cardiovascular drugs 1 > Flashcards

Cardiovascular drugs 1 Flashcards

1
Q

Atrial fibrillation- pathophysiology

A

Chaotic atrial electrical activity

Fibrosis and loss of atrial muscle mass related to:

  • ageing
  • chamber dilatation
  • inflammation
  • genetic
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2
Q

AF risk factors

A

Hypertension

Valvular heart disease

Coronary artery disease

Cardiomyopathy

Congenital heart disease

Previous cardiac surgery

Pericarditis

Lung disease- PE, pneumonia, COPD

Hyperthyroidism

Alcohol

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3
Q

AF classification

A

Lone AF

Paroxysmal (<7 days)

Persistent (>7 days)

Permanent (>7 days ± cardioversion)

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4
Q

AF clinical features

A

Asymptomatic

Palpitations

SOB

Chest pain

Pre-syncope

Heart failure

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5
Q

AF treatment

A

Rate control

Rhythm control

Anticoagulation

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6
Q

When rhythm control is prefered

A

Symptom improvement

Younger patient

Heart failure related to AF

Adequacy of rate control

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7
Q

Rate control

  • acute
  • without heart failure
A

1st line

  • beta blocker OR
  • CCB (diltiazem, verapamil)

2nd line
- add digoxin

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8
Q

Rate control

  • acute
  • heart failure
A

1st line

  • digoxin
  • amiodarone

2nd line
- amiodarone

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9
Q

Rate control

  • permanent
  • paroxysmal
A

1st line

  • beta blocker OR
  • CCB

2nd line
- add digoxin

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10
Q

Rate control

  • acute cardioversion
  • normal heart
A

Flecainide

Sotalol

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11
Q

Rate control

  • acute cardioversion
  • abnormal heart
A

Amiodarone

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12
Q

Rate control

  • maintain sinus rhythm
  • normal heart
A

Flecainide

Sotalol

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13
Q

Rate control

  • maintain sinus rhythm
  • abnormal heart
A

Amiodarone

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14
Q

Non cardioselective beta blockers

A

Propanolol

Carvedilol

Sotalol

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15
Q

Cardioselective beta blockers

A

Atenolol

Bisoprolol

Esmolol

Metoprolol

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16
Q

Vasodilatory beta blockers

A

Labetolol

Carvedilol

17
Q

Rate limiting calcium channel blockers

A

Verapamil

Diltiazem

18
Q

Dihydropyridine CCB

A

Amlodipine

Nifedipine

Nimodipine

19
Q

Stroke drug treatment

A

Fibrinolysis

Antithrombotics

  • aspirin
  • clopidogrel
  • warfarin or DOACs

Lipid modification

Treat hypertension

20
Q

Lipid modification

A

For primary and secondary prevention

Exclude secondary causes of increase lipids

21
Q

Lipid modification

- primary prevention

A

Offer atorvastatin for primary prevention of CVD

  • people who have 10% of greater 10 year risk of developing CVD
  • adults with T1DM
  • people with chronic kidney disease
22
Q

Lipid modification

- secondary prevention

A

Offer atorvastatin in any patient who has had a stroke or MI

23
Q

Heart failure treatment aims

A

Relieve symptoms

Reduce mortality

24
Q

HF treatment

A

Lifestyle measures

  • exercise
  • decrease alcohol
  • smoking cessation

Drugs

Devices

Surgery

25
Q

Loop diuretics

A

Furosemide

26
Q

Thiazide diuretics

A

Bendroflumethiazide

Metolazone (thiazide like)

27
Q

K+ sparing diuretics

A

Spironolactone

Amiloride

28
Q

HF ACE inhibitors

A

Increase life expectancy vs placebo

Effect more marked in patients with more severe LV dysfunction

Benefit for all NYHA classes

Reduces risk of hospitalisation

29
Q

ACE inhibitors

A

Ramipril

Lisinopril

Enalapril

Perindopril

Captopril

30
Q

HF ARBs

A

Losartan, candestartan, valsartan

Reduces mortality

Some date of QOL, symptom control

Used in patients who cannot tolerate ACEi

31
Q

HF beta blockers

A

Increase life expectancy vs placebo

All NYHA classes

Reduces hospitalisation

32
Q

HF- spironolactone

A

Patients with severe heart failure

Increases life expectancy

Reduces hospital admission

Low dose

33
Q

Chronic HF- ivabradine

A

Used with or in place of beta blocker if heart rate too high (>75bpm)

34
Q

Chronic HF- hydrazaline and nitrate

A

Used if ACEi/ ARB not tolerate or contraindicated or in people of African origin

35
Q

Other HF therapy

A

Coronary revascularisation

Cardiac resynchronisation therapy

Cardiac transplantation

308: Clinical Pharmacology and Therapeutics (14 decks)

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