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Top 100 Drugs > Cardiovascular system > Flashcards

Cardiovascular system Flashcards

1
Q

list some alpha blockers? (3)

A

doxazosin

tamsulosin

alfuzosin

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2
Q

common indications for alpha blockers? (2)

A
  1. improve symptoms in benign prostatic enlargement
  2. add on therapy in resistant hypertension
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3
Q

MOA of alpha blockers?

A

most are highly selective for alpha 1 adreoreceptor found in smooth muscle i.e. blood vessels and urinary tract

stimulation causes constriction so therefore,

blockade with alpha1 blockers cause vasodilation and a fall in BP and reduced resistance to bladder outflow

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4
Q

adverse effects of alpha blockers?

A

postural hypotension

dizziness

syncope

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5
Q

alpha blockers should be avoided in what pt group?

A

those with existing postural hypotnesion

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6
Q

which of the alpha blockers doxazosin or tamsulosin are licensed for benign prostatic enlargement only?

A

tamsulosin

doxasozin is licensed for benign prostatic enlargement and hypertension

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7
Q

when in the day should doxasozin be taken?

A

at night time due to the BP lowering effect (at least initially)

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8
Q

how could you communicate the use of alpha blockers to the pt?

A

treatment for their urinary symptoms/ blood pressure

advise that it may cause dizziness when standing (particularly after first dose) so should take at night time

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9
Q

in hypertension doxasozin is typically reserved for pts who do not respond to other drug classes.

why in some men is it considered a lot earlier in treatment?

A

many men with hypertension also have benign prostatic enlargement

can treat both with a single drug

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10
Q

adenosine is the first line diagnostic and therapeutic agent in which heart condition?

A

supreventricular tachycardia (SVT)

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11
Q

MOA of adenosine?

A

agonist of adeonsine receptors

increases AV node refractoriness- this breaks re-entry circuit allowing normal depolarisations from SAN to resume normal HR (cardioversion)

when circuit does not involve AVN i.e. Atrial flutter adenosine will not induce cardioversion

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12
Q

adverse effects of adenosine?

A

bradycardia

asystole

(sinking feeling in chest, breathlessness and impending doom described by the patient however this feeling in only breif )

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13
Q

pts with which medical conditions cannot be given adenosine?

A

hypotension

coronary ischameia

decompensated HF

asthma/COPD

heart transplant

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14
Q

which antiplatelet agent can block the uptake of adenosine?

A

dipyramidole (dose of adeonsine must be halved)

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15
Q

how is adenosine prescribed?

A

IV followed by sodium chloride flush

only by expereinced doctors

Resus should be on stand by

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16
Q

how could you communicate adenosine use to the pt?

A

treatment to hopefully ‘reset’ their heart back to normal rythym

will feel horrible but will only last 30 seconds

continue to talk to pt during administration

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17
Q

following administratioin of adenosine how should the pt be monitored?

A

continous cardiac rythym strip

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18
Q

adrenaline is also known as?

A

epinephrine

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19
Q

common indications for adrenaline? (3)

A
  1. cardiac arrest
  2. anaphylaxis
  3. local vasoconstriction in tissues
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20
Q

MOA of adrenaline?

A

potent agonist of alpha 1, 2 and Beta 1, 2 adrenoreceptors

vasoconstriction of vessels supplying skin/mucosa (a1) whilst increasing HR and contraction force (B1). vasodilation of blood vessels supplying heart (B2) also bronchodilatioin

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21
Q

treatment with which drug can result in widespread vasoconstriction if given adrenaline?

A

B- blockers

(a1 vasoconstricting effect of adrenaline is not opposed by B2 medicated vasodilation)

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22
Q

adrenaline is given after the third shock in which cardiac arrest rhythms?

A

Ventricular fibrillation (VF) or pulseless Ventricular tachycardia (VT)

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23
Q

how should adrenaline be administered in 1) cardiac arrest and 2) anaphylaxis?

A
  1. pre-filled syringe IV followed by flush of sodium chloride
  2. IM injection into thigh halfway between hip and knee
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24
Q

name aldosterone antagonists?

A

spironolactone, eplerenone

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25
Q

common indications for aldosterone antagonists? (3)

A
  1. ascites and oedema due to liver cirrhosis
  2. chronic heart failure
  3. primary hyperaldosteronism
26
Q

MOA of aldosterone antagonists?

A

inhibit the effect of aldosterone by competitively binding to the aldosterone recpetor

increases sodium and water excretion and potassium retention

27
Q

adverse effects of aldosterone antagonists?

A

hyperkalaemia → muscle weakness, arrhythmias

gynaecomastia (spironolactone)

28
Q

aldosterone antagonists are contraindicated in pts with which exisiting medical conditions? (3)

A

severe renal impairment

hyperkalaemia

addisons disease

29
Q

are aldosterone antagonists safe in pregnancy?

A

can cross the placenta and appear in breast milk so should be avoided in pregnant or lactating women

30
Q

which drugs can increase the risk of hyperkalaemia if used with aldosterone antagonists?

A

potassium elevating drugs i.e. ACE inhibitors and ARBs

31
Q

how should aldosterone antagonists be monitored?

A

symptos and clinical findings

potassium levels and renal function should be regularly checked with FBC

32
Q

why is spironolactine usually prescribed in combination with a loop or thiazide diuretic?

A

it is a relatively weak diuretic and can take several days to start havign an effect

33
Q

common indications for amiodarone?

A

tachyarrhythmias including AF, SVT, VT and VF

used when other drugs or cardioversion are ineffective or innapropriate

34
Q

MOA of amiodarone?

A

blockade of Na, Ca and K channels and antagonism of alpha and beta receptors

interferes with AVN reducing ventricular rate in AF and atrial flutter

may break the circuit in SVT

35
Q

amiodarone should be avoided in pts with which conditions?

A

severe hypotension

heart block

active thyroid disease

36
Q

how could you communicate use of amiodarone to the pt?

A

offering a treatment to try and correct their fast or irregular heart rhythm

37
Q

what should pts be told to avoid in their diet following amiodarone?

A

grapefruit juice

38
Q

when prescribing amiodarone why should you not just repeat the previous prescription?

A

this could have been a loading dose- need to check if on lonterm therapy and should be a maintanence dose

39
Q

list ACE inhibitors?

A

ramipril

lisinopril

perindopril

40
Q

common indications for ACE inhibitors? (4)

A
  1. hypertension
  2. chronic HF
  3. Ischaemic heart disease
  4. diabetic nephropathy and CKD with proteinuria
41
Q

MOA of ACE inhibitors?

A

prevent conversion of angiotensin I to angiotensin II

angiotensin II is a vasoconstrictor and stimulates aldosterone secretion (blocking it therefore reduces BP and dilates efferent glomerular arteriole, reducing intraglomerular pressure slowing CKD progression)

42
Q

common adverse effects of ACE inhibitors? (4)

A

hypotension

persistnet dry cough

hyperkalaemia

worsen renal failure

43
Q

ACE inhibitors shoul dbe avoided in pts with which conditions?

A

renal artery stenosis

acute kidney injury (AKI)

pregnancy/ breastfeeding

44
Q

ACE inhibitors should not be prescribed alongisde which other drugs?

A

potassium elevating drugs i.e. aldosterone antagonists

45
Q

how could you explain the use of ACE inhibitors to the patient?

A

offering Tx to improve BP and reduce strain on their heart

need to come in for blood tests to monitor their kidney function and potassium

advise to avoid ibuprofen due to risk of kidney damage

46
Q

how should ACE inhibitors be monitored?

A

symtpoms and BP

renal function

47
Q

why should ACE inhbitors be started at a low dose and titrated up?

A

can cause profound hypotension following first dose especially if on other diuretics

48
Q

list some ARBs (3)

A

losartan

candesartan

irbesatran

49
Q

common indications for ARBs? (4)

A
  1. hypertension
  2. chronic heart failure
  3. ischaemic heart disease
  4. diabetic nephropathy and CKD with proteinuria
50
Q

MOA of ARBs?

A

block the action of angiotensin II on the angiotensin type 1 receptor

similar effects as ACE inhibitor (low BP, slow CKD prgression)

51
Q

adverse effects of ARBs?

A

hypotension

hyperkalaemia

renal failure

52
Q

what causes the dry cough in ACE inhbitors but not with ARBs?

A

bradykinin

53
Q

ARBs should be avoided in pts with which conditions?

A

renal artery stenosis

AKI

pregnancy/breastfeeding

54
Q

what drugs should be avoided when prescribing ARBs?

A

other potassium elevating drugs i.e. aldosterone antagonsits

55
Q

antimuscarinics used in cardio (3)

A

atropine

hyoscine butylbromide

glycopyrronium

56
Q

common indications for antimuscarinics in cardio? (2)

A
  1. atropine used to treat bradycardia
  2. care of dying pt (hyoscine butylbromide is useful fro reducing respiratory secretions
57
Q

MOA of antimuscarinic drugs?

A

competitive inhibitor of acetylcholine

increase heart rate, reduce smooth muscel tone and reduce secretions from resp and gi tract

58
Q

adverse effects of antimuscarinics?

A

tachycardia

dry mouth

constipation

can cause urinary retention in those with BPE

blurred vision due to pupillary dilation

59
Q

antimuscarinics should be used with caution in pts with which conditions?

A

those susceptible to angle-closure glaucoma

risk of arrhythmias

60
Q

atropine is the preffered treatment for which cardiac symtpom?

A

bradycardia

61
Q

why must the initial dose of atropine be no less than 600mcg?

A

low-dose atropine may transiently slow HR

Top 100 Drugs (13 decks)

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