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3rd Year > Cardiovascular Drugs > Flashcards

Cardiovascular Drugs Flashcards

1
Q

Name a loop diuretic?

A

Ferusomide

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2
Q

How do loop diuretics work?

A

Inhibit action of Na/K/2Cl pump in ascending loop of Henle

Inhibits reabsorption of Na, K and water

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3
Q

When is ferusomide indicated?

A

Pulmonary oedema
Chronic heart failure
Oliguria secondary to renal failure

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4
Q

What risk is there when furosemide is used with aminoglycosides?

A

Ototoxicity

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5
Q

Which diuretics are more effective?

A

Loop diuretics (ferusomide)

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6
Q

Name a thiazide diuretic?

A

Bendroflumethiazide

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7
Q

What are the indications for thiazide diuretics?

A

Hypertension
heart failure
Oedema
Prophylaxis of Ca containing renal stones

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8
Q

How do thiazide diuretics work?

A

Inhibit Na/Cl reabsorption in distal tube

Increases Na/Cl/water excretion

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9
Q

What is spironalactone?

A

A potassium sparing diuretic

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10
Q

How does spironalactone work?

A

Aldosterone anatgonist

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11
Q

Name a Beta blocker?

A

Atenolol

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12
Q

How do Beta blockers work?

A

Act on B1 receptor in the heart to decrease heart rate and force of contraction, this reduces workload of the heart.
Reduces Rennin production by the kidneys to reduce blood pressure.
Decreases conduction/Ap initiation in the heart to give an antiarryhythmic effect

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13
Q

When are beta blockers used?

A 
hypertension
angina
Supraventricular dysrhythmias
MI prophylaxis
Migraine prophylaxis
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14
Q

What are the contra-indications for Beta blocker use?

A 
Asthma
HF
2nd/3rd degree heart block
Bradycardia
COPD
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15
Q

What drug class is Diltiazem?

A

Calcium channel blocker

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16
Q

How do calcium channel antagonists work?

A

Relaxation of vascular smooth muscle
Decrease myocardial contractility
Decrease conduction at AV node (increase refractory period)
Decrease afterload and heart rate (reduces 02 consumption)

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17
Q

What are the indications for Calcium antagonists?

A

Angina treatment/prophylaxis
Hypertension
Dysrhythmias

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18
Q

Severe bradycardia, heart failure, 2nd/3rd degree heart block and pregnancy/breast-feeding are contra-indications for what cardiovascular drugs class?

A

Calcium antagonist

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19
Q

Name an ACE inhibitor?

A

Ramipril

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20
Q

How do ACE inhibitors work?

A

Inhibiting the angiotensin converting enzyme results in decreased angiotensin 2 synthesis and increase in bradykinin accumulation. Reduced angiotensin 2 reduces peripheral resistance/fluid overload. Increased bradylinin causes peripheral vasodilation.

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21
Q

Indications for ACE inhibitors?

A

Hypertension
Heart failure
Post MI
Diabetic nephropathy

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22
Q

Common side effects of ACE-i?

A

Postural hypertension
Dry cough
Rash

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23
Q

When should patients take their first dose of an ACE-i and why?

A

Before bed to avoid 1st dose hypotension

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24
Q

What is losartan?

A

An angiotensin receptor blocker

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25
Q

Why would a ARB blocker be used instead of an ACE-i?

A

No dry cough as associated with ACE-i

26
Q

What drug class is Isosorbide mononitrite?

A

Nitrate

27
Q

What is the mechansism of nitrates?

A

Vascular smooth muscle relaxation

Coronary artery/systemic vein vasodilation

28
Q

Indications for nitrate use?

A

Angina

Heart failure

29
Q

What is the most common cardiac glycoside?

A

Digoxin

30
Q

What does digoxin do?

A

Increases force of heart contraction by increasing intracellular Na concentration.
Increases vagal activity

31
Q

Indications for digoxin?

A 
Heart failure
Supraventricular arrhythmias (especilly AF)
32
Q

Does digoxin improve symptoms or mortality in heart failure?

A

Symptoms not mortality

33
Q

What is amiodarone?

A

An anti-dysrhythmic

34
Q

How does amiodarone work?

A

Prolongs refractory period in all parts of conduction system.
Reduces speed of conduction through the heart

35
Q

Indications for amiodarone?

A

Supraventricular/ventricular arrhythmias

36
Q

What is the most common antiplatelet agent?

A

Aspirin

37
Q

How does clopidogrel work

A

Inhibits platelet aggregation by preventing ADP release preventing activation of glycoprotein gp11b/11a complexes

38
Q

Indications for clopidopgrel?

A

Prevention of atherosclerotic events in acute coronary syndrome/peripheral arterial disease
Post MI/ischaemic stroke

39
Q

How does aspirin work?

A

Inactivates COX by acetylating a serine residue in its active site
Reduces TXA2 synthesis (substance that promotes platelet aggregation

40
Q

What is aspirin indicated for?

A

CVA/MI prophhylaxis

41
Q

Contra-indications for aspirin?

A

Active bleeding
Peptic ulcer
Haemophilia
Breastfeeding

42
Q

What is streptokinase?

A

Thrombolytic

43
Q

When are thrombolytics indicated?

A 
Acute MI
Thromboembolitic events (DVT/PE/arterial thrombosis)
44
Q

When is streptokinase contra-indicated?

A

Recent haemorrhage/trauma/surgery
Coagulation defects
Aortic dissection/aneurysm
Acute pancreatitis

45
Q

Why can streptokinase not be used used twice in the same year?

A

Body generates antibodies to streptokinase

46
Q

How soon after an MI should streptokinase be given?

A

Within 12 hours of MI (best effect within 3hrs)

47
Q

When is amiodarone contra-indicated?

A 
Sinus bradychardia
SA block
Sinus node disease
Thyroid dysfunction
Iodine sensitivity (contains iodine)
Pregnancy/breastfeeding
48
Q

Name a heparin (low molecular weight heparin)

A

Enoxaparin

49
Q

What is the mechanism of heparins?

A

Cause higher anti-factor Xa to antithrombin activities (anti-factor 2a) ration than heparin which may prevent thrombosis

50
Q

Indications for heparin

A

DVT
PE
MI
Unstable angina

51
Q

What drug can be used to reverse heparin effect?

A

IV protamine sulphate

52
Q

Contra indications for heparin use?

A 
Haemophilia/haemorrhagic disorders
Thrombocytopenia
Recent cerebral bleed
Severe liver disease
Peptic ulcer disease
53
Q

What is warfarin?

A

Oral anticoagulant

54
Q

How does warfarin work?

A

Inactivates vitamin K in hepatic microsomes

Interferes with formation of vitamin K dependent clotting factors (prothrombin, II, VII, IX and X)

55
Q

Why does warfarin have a delayed onset?

A

Long prothrombin half life (48-72 hours)

56
Q

Indications for warfarin?

A

Prophylaxis of embolism on AF, prosthetic heart valves, rheumatic heart disease
Prophylaxis of DVT/PE
TIAs

57
Q

When is warfarin contra-indicated?

A 
Peptic ulcer
Endocarditis
Haemorrhagic stroke
Sever hypertension
Pregancy
58
Q

Name a commonly prescribed statin

A

simvastatin

59
Q

How do statins work?

A

Reversibly inhibits HMG CoA reductase, the rate limiting enzyme in cholesterol synthesis by the liver
Liver responds by increasing LDL receptor expression taking in more LDL to reduce plasma cholesterol

60
Q

Contraindications to statin use?

A

Active liver disease/persistently deranged LFTs

Preganancy/breastfeeding

3rd Year (18 decks)

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