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Clinical pharmacology and therapeutics > Cardiovascular drugs 1 > Flashcards

Cardiovascular drugs 1 Flashcards

1
Q

Describe the pathophysiology of atrial fibrillation

A

Chaotic atrial electrical activity

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2
Q

What is fibrosis and loss of atrial wall muscle mass related to?

A

Age
Chamber dilation
Inflammation
Genetic

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3
Q

List the risk factors of atrial fibrillation

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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4
Q

Describe the classification of atrial fibrillation

A

Lone AF
Paroxysmal <7 days
Persistent >7 days
Permanent >7 days and cardioversion

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5
Q

List the clinical features of atrial fibrillation

A 
Asymptomatic
Palpatiations 
SOB 
Chest pain 
Syncope
Pre-syncope
Heart failure
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6
Q

Describe the aims of treatment of AF

A

Anticoagulation
Rate control
Rhythm control

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7
Q

How is compromised AF treated?

A

DC shock

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8
Q

How is uncompromised AF treated?

A

Pharmacotherapy

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9
Q

How is AF <48hrs treated?

A

Attempt rhythm control

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10
Q

How is AF>48hrs treated?

A

Rate control

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11
Q

When is rhythm control preferred in the treatment of AF?

A

Symptom improvement
Younger patient
Heart failure related to AF
Adequacy of rate control

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12
Q

Describe rate control of acute AF without heart failure

A

Beta blocker or CCB

Add digoxin

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13
Q

Describe rate control of acute AF with heart failure

A

Digoxin

Amiodarone

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14
Q

Describe rate control of permanent or paroxysmal AF

A

Beta blocker or CCB

Digoxin

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15
Q

Describe rhythm control of AF with acute cardioversion in a normal heart

A

Flecainide, sotalol

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16
Q

Describe rhythm control of AF with acute cardioversion in an abnormal heart

A

Amiodarone

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17
Q

Describe rhythm control of AF when maintaining sinus rhythm in a normal heart

A

Flecainide, sotalol

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18
Q

Describe rhythm control of AF when maintaining sinus rhythm in an abnormal heart

A

Amiodarone

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19
Q

Name some non-cardioselective beta blockers

A

Propanolol
Carvedilol
Sotalol

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20
Q

Name some cardioselective beta blockers

A 
Atenolol 
Bisoprolol 
Esmolol 
Metoprolol 
Nebivolol
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21
Q

Name some vasodilatory beta blockers

A

Labetalol

Carvedilol

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22
Q

Name some rate limiting calcium channel blockers

A

Verapamil

Diltiazem

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23
Q

Name some dihydropyridine calcium channel blockers

A 
Amlodipine 
Nifedipine 
Felodipine
Lercanidipine 
Nimodipine
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24
Q

What score is used to calculate the need for anticoagulation?

A

CHA2DS2VASC

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25
Describe the CHA2DS2VASC score
``` C - congestive heart failure - 1 H- hypertension - 1 A2 - Age >75 - 2 D- diabetes - 1 S2 - previous stroke, TIA or thromboembolism - 2 Vascular disease - 1 Age - 65-74 - 1 Sc - Sex category (female gender) - 1 ```
26
What CHA2DS2VASC score indicates warfarin or direct oral anticoagulant?
> 2
27
What must be considered when deciding on anticoagulation in AF?
The risk benefit ratio
28
What scoring system is used to determine bleeding risk?
HASBLED
29
Describe the HASBLED scoring system
``` H- hypertension - 1 A- abnormal renal/liver function - 1 point each S- stroke in the past - 1 B - bleeding history - 1 L- Labile INR - 1 E- elderly - 1 D - drugs/alcohol - 1 point each ```
30
What HASBLED score indicates a significant risk of bleeding?
Greater than 3
31
List some non pharmacological treatments of AF
Radiofrequency catheter Cyro-ablation Left atrial appendage occlusion (LAAO)
32
Describe the classification of stroke
Ischaemic | Haemorrhagic
33
What are the aims of stroke treatment?
Lipid modification | Treat hypertension
34
List some secondary causes of increased lipids
``` Excess alcohol Uncontrolled diabetes Hypothyroidism Liver disease Nephrotic syndrome ```
35
When do you refer to a lipid specialist?
Total cholesterol > 7,5mmol/L and family history of premature coronary artery disease Total serum cholesterol >9mmol/L
36
Describe lipid modification in primary prevention
Offer atorvastatin to - People who have greater than a 10% chance of developing CVD in 10 years - Adults with type 1 diabetes - People with chronic kidney disease
37
Describe lipid modification in secondary prevention
Offer atorvastatin in secondary prevention of CVD in any patient who has had a stroke or MI
38
Describe Ezetimibe
Monotherapy for treating primary (heterozygous familial or non familial) hypercholesterolemia in adults in whom initial statin therapy is contraindicated or not tolerated May be appropriate to co administer with initial statin therapy
39
Name some proprotein convertase subtilisin/kexin type 9 inhibitors (PCSKi)
Alirocumab | Evolocumab
40
Describe the pathophysiology of heart failure
Activation of sympathetic system - Vasoconstriction | Renin angiotensin aldosterone system - Sodium and fluid retention
41
What are the treatment aims of heart failure
Relieve symptoms | Relieve mortality
42
List the types of treatment for heart failure
Lifestyle measures - exercise, decrease alcohol, stop smoking Drugs Devices Surgery
43
List some classes of drugs used to treat heart failure
``` Diuretics ACE inhibitors Beta blockers Aldosterone antagonists ARBs Hydralazine/Nitrates Digoxin ```
44
List the different types of diuretic
Loop Thiazide K+ sparing
45
Give examples of loop diuretics
Furosemide
46
Give examples of thiazide diuretics
Bendroflumethiazide | Metolazone (thiazide like)
47
Give examples of K+sparing diuretics
Spironolactone | Amiloride
48
Where do loop diuretics act?
Na/K/Cl symporter
49
Where do thiazide diuretics act?
Na/Cl symporter
50
Where do the K sparing diuretics act?
Epithelial Na channel
51
Describe diuretics
Provide symptom control Reduces cardiac preload Side effects
52
Describe ACE inhibitors
Increases life expectancy Effect more marked in patients with more severe LV dysfunction Benefit for all NYHA classes Reduces risk of hospitalisation
53
List some examples of ACE inhibitors
``` Ramipril Lisinopril Enalapril Perindopril Captopril ```
54
List some examples of ARBs
Losartan Candersartan Valsartan
55
Describe the ARBs
Reduces mortality Symptom of control - increases QOL Used in patients who cannot tolerate ACE inhibitors
56
Describe beta blockers
Increase life expectancy All NYHA classes Reduces hospitalisation Low dose, titrate up, monitor BP, HR and clinical progression
57
List some examples of beta blockers
Bisoprolol Carvedilol Metoprolol
58
Describe spironolactone
``` Patients with severe heart failure Increases life expectancy Reduces hospital admission Low dose (12.5-25mg) Prevent aldosterone secretion ```
59
List the treatment for chronic heart failure
Diuretics ACE inhibitors (ARBs) Beta blockers Spironolactone
60
Describe ivabradine
Used with or in place of beta blcokers if heart rate is too high > 75bpm
61
Describe the use of hydralazine and nitrate
Used if ARBs and ACEi not tolerated or contraindicated or in people of african origin
62
Describe SGLT2 inhibitors
Inhibitors of sodium glucose cotransporter 2 Dapagliflozin S1 segment proximal tubule where 90% glucose reabsorption occurs
63
Describe the basic measures of treating acute heart failure
Sit patient upright | High dose oxygen
64
Describe the initial drug treatment of acute heart failure
Intravenous loop diuretics - Causes venodilation and diuresis Intravenous opiates and opioids (morphine/diamorphine)) - Reduces anxiety and preload Intravenous/buccal/sublingual nitrates - Reduce preload and afterload, ischaemia and pulmonary pressures Continue beta blockers but do not initiate
65
List some non pharmacological treatments of heart failure
Coronary revascularisation Cardiac resynchronisation therapy Cardiac transplantation

Clinical pharmacology and therapeutics (27 decks)

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