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Year 3 Drugs + Core Conditions > Cardiovascular Drugs > Flashcards

Cardiovascular Drugs Flashcards

1
Q

How does furosemide work?

A

inhibits Na+/K+/2Cl- transporter on loop of Henle
prevents water resorption into cells
dilates capitance veins - improves contractile function

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2
Q

Indications for furosemide use?

A

Relief of oedematous states, e.g. SoB in pulmonary oedema sure to LVF failure

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3
Q

side effects of furosemide?

A

postural hypotension, dehydration, electrolyte disturbance - hypokalaemia, hyperglycaemia
Oto/nephrotoxicity - when combined with other ototoxic drugs, e.g. aminoglycosides

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4
Q

risks of prescribing furosemide with digoxin?

A

hypokalaemia

increased effects of digoxin and risk of dysrhythmias, toxicity

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5
Q

Give an example of a thiazide diuretic

A

Bendroflumethiazide

Indapamide, Chortalidone

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6
Q

How do thiazide diuretics work?

A

Inhibit Na+/Cl- transporter in distal tubule

over time peripheral resistance reduced

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7
Q

side effects of thiazide diuretics?

A

hyponatraemia
hypokalaemia
postural hypotension
increased conc of glucose, cholesterol

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8
Q

What type of diuretic is spironolactone, and give some combi-names

A

Potassium sparing diuretic

Amiloride, Co-amilofruse

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9
Q

How does spironolactone work?

A

Aldosterone antagonist in collecting duct
decreases resorption of Na+ and water
limits K+ excretion

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10
Q

Give some examples of beta-blockers

A

Atenolol, bisoprolol, propranolol, metoprolol

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11
Q

How do beta-blockers work?

A

block beta1 adrenergic receptors on heart muscle
reduce force of contraction and speed of conduction
reduces renin secretion

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12
Q

Indications for beta blockers?

A

Ischaemic heart disease
chronic heart failure
atrial fibrillation
SVT, hypertension, MI prophylaxis

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13
Q

indications for use of spironolactone?

A

oedema, ascites (cirrhosis), nephrotic syndrome, congestive HF

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14
Q

contraindication for prescribing beta-blockers

A

asthma - life threatening bronchospasm
low dose in HF as can impair cardiac function
heart block

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15
Q

which beta-blockers are cardioselective, i.e. just block B1

A

atenolol, propranolol, carvedilol

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16
Q

important interactions of beta-blockers

A

verapamil, diltiazem - can cause heart failure, bradycardia, asystole

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17
Q

name 2 calcium agonists

A

Diltiazem (verapamil)
Amlodipine
Non-dihydropyridine calcium channel blocker

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18
Q

How does diltiazem work?

A

inhibits Ca influx into vascular smooth muscle&raquo_space; relaxation

slows sino-atrial node

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19
Q

What is diltiazem (verapamil) used for?

A

Angina treatment / prophylaxis
hypertension
dysrhythmias

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20
Q

Contraindications of calcium channel blockers

A

severe bradycardia, heart failure, heart block

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21
Q

Side effects of CCBs?

A

postural hypotension, bradycardia, ankle swelling, dizziness

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22
Q

Describe the action of ramipril

A

Blocks the action of ACE
prevents vasoconstriction and aldosterone secretion
reduces peripheral resistance
dilates efferent glomerular arteriole

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23
Q

Why cant you prescribe ramipril in renal artery stenosis

A

Pt relies on constriction of efferent glomerular arteriole to maintain glomerular filtration

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24
Q

Potential side effects of ramipril?

A 
First dose hypotension
persistent dry cough
hyperkalaemia (due to low aldosterone)
renal failure
angioedema
25
Q

what is losartan and how does it work?

A

Angiotensin receptor 1 blocker (ARB)

blocks action of angiotensin II on AT1 receptor

26
Q

Indications to prescribe losartan

A

HTN control, where ACEi not tolerated due to cough

27
Q

How does isosorbide mononitrate work

A

nitrates converted to NO
reduces intracellular Ca2+
causes relaxation of vascular smooth muscle
improves coronary perfusion

28
Q

Indications for isosorbide mononitrate

A

acute angina and chest pain, relief and prophylaxis

29
Q

contraindications for the use of nitrates

A

severe aortic stenosis, as heart cannot increase CO sufficiently to get blood through narrowed valve

30
Q

what type of drug is Digoxin, and how does it work?

A

Cardiac glycoside
increases parasympathetic (vagal) tone, reducing contraction at AV node, ventricular rate
causes accumulation of Ca2+, increasing contractile force

31
Q

Indications for digoxin

A

Atrial fibrillation, flutter

severe heart failure (3rd line)

32
Q

contra-indications of digoxin

A

heart block as may worsen conduction

electrolyte abnormalities increase risk of toxicity

33
Q

what is the effect of digoxin toxicity and what can cause it?

A

arrhythmias, due to narrow therapeutic window

loop/thiazide diuretics (hypokalaemia)

34
Q

how does Amiodarone work?

A

blocks sodium, calcium and potassium channels

antagonist of alpha/beta adrenergic receptors

35
Q

what is the overall effect of amiodarone

A

anti-dysrhythmic
reduce spontaneous depolarisation
slow conduction
resistance to depolarisation

36
Q

Indications for amiodarone

A

tachyarrhythmias
e.g. AF, SVT, VT
increases time before a heart cell can contract again

37
Q

what are the side effects of amiodarone

A

lung toxicity - pneumonitis
severe bradycardia
hepatitis, skin photosensitivity, thyroid problems

38
Q

why does amiodarone have so many interactions

A

inhibits the action of CyP450s, reducing the clearance of many drugs

39
Q

How does aspirin work?

A

Inhibits COX enzymes, preventing production of prostaglandins (pain) and thromboxane (anti-platelet)

40
Q

key ingredient in aspirin?

A

acetylsalycylic acid

ASA

41
Q

Contra-indications for aspirin

A 
under 16s - Reye's syndrome
Aspirin hypersensitivity
3rd trimester pregnancy
Peptic ulcer disease
gout
42
Q

How does clopidogrel work?

A

binds to receptors on surface of platelets, prevents platelet aggregation

43
Q

How does streptokinase work?

A

Thrombolytic

converts plasminogen to plasmin, which lyses fibrin within thrombus

44
Q

How does heparin/fondaparinux work?

A

Inhibits thrombin and factor Xa in coagulation pathway

45
Q

How can heparin be reversed?

A

Protamine, to reverse anticoagulation

46
Q

Give examples of LMWH

A

dalteparin and enoxaparin
preferentially inhibit factor Xa
don’t need laboratory monitoring

47
Q

Mechanism of action of warfarin

A

inhibits vitamin K epoxide reductase

48
Q

Can warfarin be used to prevent arterial thrombosis

A

No, as this is driven by platelet aggregation

49
Q

Contraindications of warfarin

A

surgery, bleed risk,
liver disease as cannot metabolise
Pregnancy - foetal malformations

50
Q

examples of CyP450 inhibitors

A

amiodarone, diltiazem, fluconazole, macrolides, protease inhibitors

51
Q

examples of CyP450 inducers

A

phenytoin, carbamazepine, rifampicin

52
Q

How do antibiotics and warfarin interact?

A

can increase anticoagulation by killing gut flora which synthesis vitamin K

53
Q

describe Warfarin’s therapeutic window

A

Narrow therapeutic window

low therapeutic index

54
Q

How does Rivaroxaban work?

A

selective factor Xa inhibitor

affects both intrinsic and extrinsic coagulation pathways

55
Q

How are warfarin and Rivaroxaban reversed

A

Warfarin - large dose vitamin K

Rivaroxaban cannot be reversed

56
Q

How does simvastatin work?

A

inhibits HMG CoA reductase

decreases cholesterol production, increases LDL clearance from the blood

57
Q

contraindications for statins

A

hepatic and renal impairment - dose reduction

avoid in pregnancy

58
Q

why should you not suddenly withdraw diltiazem

A

may exacerbate angina

59
Q

which drugs may increase potassium levels

A

ACEi, NSAIDs, ARB, potassium salts

Year 3 Drugs + Core Conditions (23 decks)

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