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CPT - Other Drugs > Cardiovascular System > Flashcards

Cardiovascular System Flashcards

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1
Q

Name two thiazide/thiazide-like diuretics

A

Bendroflumethiazide

Indapamide

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2
Q

What is the mechanism of action of thiazide diuretics?

A

Inhibit Na+/Cl- cotransporter in DCT

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3
Q

What are some ADRs of thiazides?

A
  • Loss of Na+ and water
  • Hypokalaemic metabolic alkalosis (loss of H+ via Na+- H+ transporter (Na+ reabsorbed later on due to high conc ) and more K+ loss later in tubule due to more Na+)
  • Increased Ca2+ reabsorption (hypercalcaemia)
  • Gout
  • Erectile dysfunction

HyperGLUC

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4
Q

Name two loop diuretics.

A

Bumetanide and Furosemide

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5
Q

What is the mechanism of action of loop diuretics?

A

Inhibit Na+/K+/2Cl- cotransporter in loop of Henle

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6
Q

What are some ADRs of loop diuretics?

A
  • Loss of Na+ and water - hyponatraemia
  • Hypokalaemic metabolic alkalosis (increased loss of H+ and increased loss of K+ later on, due to more Na+ in tubule)
  • Increased Ca2+ loss (loss of positive luminal membrane as less K+ transported back into tubule via ROMK, so no driving force for divalent cation reabsorption)
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7
Q

What is an example of a potassium sparing diuretic?

A

Amiloride

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8
Q

What is the mechanism of action of amiloride?

A

Block ENaC at luminal surface of renal tubule

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9
Q

What are some ADRs specific to furosemide?

A
  • Ototoxicity
  • Gout
  • Alkalosis
  • Raised LDL and TG
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10
Q

What is an ADR specific to bumetanide?

A

Myalgia

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11
Q

What is an example of an aldosterone antagonist?

A

Spironolactone

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12
Q

What is the mechanism of spironolactone?

A

Competes with aldosterone at mineralocorticoid receptor in DCT/CD

(normally aldosterone upregulates ENaC channels)

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13
Q

What are common indications for diuretics and which classes are used?

A
  • Hypertension - thiazides, spironolactone
  • HF - loop, spironolactone
  • Decompensated liver disease - spironolactone, loop
  • Nephrotic syndrome - Loop, thiazides, amiloride
  • CKD - loop
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14
Q

What are the concerns of using ACEi and K+ sparing diuretics together?

A

Increased hyperkalaemia risk - cardiac problems

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15
Q

What are the concerns of using aminoglycosides and loop diuretics together?

A
  • ototoxicity

* nephrotoxicity

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16
Q

What are the concerns of using digoxin and thiazide/loop diuretics together?

A
  • Hypokalaemia
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17
Q

What are the concerns of using beta blockers and thiazides together?

A
  • Hyperglycaemia
  • Hyperlipidaemia
  • Hyperuricaemia
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18
Q

What are the concerns of using steroids and thiazide/loop diuretics together?

A

Hypokalaemia risk increased

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19
Q

What are the concerns of using lithium and thiazide/loop diuretics together?

A
  • Lithium toxicity (thiazides)

* Reduced lithium levels (loop)

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20
Q

What are the concerns of using carbamezepine and thiazides together?

A

Increased risk of hyponatraemia

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21
Q

What is an example of a class IB anti-arrhythmic?

A

Lidocaine

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22
Q

What is an example of a class IC anti-arrhythmic?

A

Flecainide

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23
Q

When is flecainide indicated?

A
  • Supraventricular tachycardia
  • Ventricular arrhythmia
  • WPW syndrome
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24
Q

What are the ADRs of flecainide?

A
  • Pro-arryhthmic
  • Flecainide flutter - increased ventricular response
  • GI and CNS effects
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25
Q

What is the effect of flecainide?

A

Decreased phase 0

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26
Q

Give two examples of beta-blockers used as anti-arrhythmics.

A

Bisoprolol and metoprolol

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27
Q

What are the effects of bisoprolol and metoprolol on the heart? and on the ECG?

A

Increased APD and refractory period in the AVN

Decreased phase 4 depolarisation

Increased PR and decreased HR

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28
Q

What are the uses for bisoprolol and metoprolol?

A

Treat sinus and catecholamine dependent tachycardias

Cardioconvert reentrant arrhythmias at AVN

Protect ventricles in atrial flutter/fibrillation or flecainide flutter

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29
Q

What are some ADRs of bisoprolol and metoprolol?

A
  • Bronchospasm

* Hypotension

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30
Q

What are two examples of class III anti-arrhythmics?

A

Amiodarone and sotalol

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31
Q

What are some ADRs of amiodarone?

A
  • pulmonary fibrosis
  • hepatic injury
  • increased LDL cholesterol
  • thyroid disease
  • photosensitivity
  • optic neuritis
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32
Q

What are the cardiac effects of amiodarone?

A 
Increased ADP and refractory period 
Decreased phase 0 and conduction 
Increased threshold
Decreased phase 4
Decreased AVN conduction

varying class effects

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33
Q

What are the effects of amiodarone on an ECG?

A

Increased PR, QT and QRS

Decreased HR

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34
Q

What are the uses for sotalol?

A

Wide spectrum: supraventricular tachycardias and ventricular tachycardias

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35
Q

What are the cardiac effects of sotalol?

A

Increased ADP and refractory period in atrial and ventricular tissue

Slowed phase 4 (beta blocker part of it)

Slowed AVN conduction

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36
Q

Which drugs are good for AF?

A

Rate and rhythm control

Rate: Bisoprolol/verapamil/diltiazem +/- digoxin

Rhythm: Sotalol/Flecainide + bisoprolol/amiodarone

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37
Q

Which drug do you give via IV for VT?

A

Metoprolol/lidocaine/amiodarone

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38
Q

Should flecainide be used alone in atrial flutter?

A

No - give with a AVN blocking drug to reduce ventricular rates in atrial flutter e.g. bisoprolol

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39
Q

Whats the best treatment for WPW? Which type of drugs should you avoid?

A

Flecainide

avoid AVN blocking drugs due to risk of exacerbating the symptoms

40
Q

Which drugs can you use for ectopic beats?

A

First line: bisoprolol

then calcium channel blockers

41
Q

Which drugs can you use to treat sinus tachycardia?

A

Ivabradine - no drop in BP

Bisoprolol/verapamil - more tolerated? can use in pregnancy

42
Q

Which drugs can you use in re-entrant NCT acutely and chronically?

A

Acutely (IV) - adenosine, verapamil if asthmatic or fleciainide if above fails

Chronically (oral) - Bisoprolol/verapamil, if not then… sotalol, flecainide, amiodarone

43
Q

What are some ADRs of sotalol?

A
  • pro-arrhythmic
  • fatigue
  • insomnia
44
Q

What are two examples of non-dihydropyridine CCBs/class IV anti-arrhythmics?

A

Verapamil and diltiazem

45
Q

What are the ADRs of class IV anti-arrhythmics?

A
  • Asystole if use with beta-blocker
  • Hypotension
  • Decreased CO/sick sinus
  • Constipation
46
Q

What are the cardiac effects of class IV anti-arrhythmics?

A

Slow conduction through AVN (preventing Ca2+ influx)

Increased refractory period at AVN

Increase slope of phase 4 in SA - slows HR

47
Q

What effect does adenosine have on the heart?

A

Binds to A1 receptors and blocks adenylyl cyclase - reduced cAMP - activated K+ currents in the AVN and SAN - hyperpolarisation - reduced HR

48
Q

What is the mechanism of action of ivabradine?

A

Blocks If ion current at SAN - slows the SAN but doesn’t effect BP

49
Q

What are some ADRs of ivabradine?

A
  • flashing lights

* unknown if teratogenic

50
Q

When is ivabradine used?

A

Reduce HR in heart failure (no effect on BP)

51
Q

What is the mechanism of action of digoxin as an anti-arrhythmic?

A

Increases vagal activity (Increased K+ currents, decreased Ca2+ currents, increased refractory period)

Slows AV conduction and hence HR

52
Q

What is atropine?

A

a selective muscarinic antagonist

53
Q

What is the mechanism of action of atropine?

A

blocks vagal activity so speeds AV conduction increased HR

54
Q

When is atropine used?

A

In vagal bradycardia

55
Q

When is digoxin used?

A

In Afib and flutter and to reduce ventricular rates

56
Q

What are two examples of alpha adrenoreceptor blockers?

A

Doxazosin and tamsulosin

57
Q

What are 3 examples of beta-blockers used for hypertension?

A

Atenolol
Labetalol
Propanolol

58
Q

What are two ACEi’s?

A

Ramipril

Lisinopril

59
Q

What are two ARBs?

A

Losartan

Candesartan

60
Q

How do nitrates like glyceryl trinitrate and isorbide mononitrate work?

A

Activate guanylyl cyclase - increase in cGMP - leads to vasodilation

61
Q

Name the two dihydropyridine CCBs

A

Amlodipine

Nimodipine

62
Q

Name the two non-dihydropyridine CCBs

A

Verapamil

Diltiazem

63
Q

Which calcium channels do the CCBs block?

A

L-type calcium channels

64
Q

What is the mechanism of action of warfarin?

A

Vitamin K antagonist - inhibits vitamin K epoxide reductase

65
Q

What are the vitamin K dependent clotting factors?

A

10, 9, 7 and 2

66
Q

Why is warfarin’s onset of action delayed?

A

Due to the circulation of already produced clotting factors

67
Q

Which drugs potentiate warfarin?

A

Antibiotics that reduce vitamin synthesis by bacteria in the gut e.g. cephalosporins

CYP2C9 inhibitors - amiodarone, clopidogrel

NSAIDs displace warfarin from plasma albumin

68
Q

How do you monitor warfarin?

A

Measuring the INR - lower means thicker blood (less anti coagulated), higher means thinner blood (more anti-coagulated) - aiming for around 2.5-3

69
Q

What does unfractionated heparin do?

A

Inhibit Xa and IIa (thrombin)

For Xa needs to bind to only ATIII
For IIa needs to bind to ATIII and IIa

70
Q

Give two examples of LMWHs

A

Dalteparin

Enoxaparin

71
Q

What is LMWH’s mechanism of action?

A

Inhibit factor Xa by enhancing ATIII activity

72
Q

What is fondaparinux?

A

Synthetic heparin pentasaccharide - inhibits Xa by binding to ATIII

73
Q

What drug can be used for heparin reversal?

A

Protamine sulphate - binds to heparin forming an inactive compound

74
Q

What can be used for warfarin reversal?

A

Vitamin K1 or prothrombin complex concentrate - they promote the production of clothing factors

75
Q

Which DOACs work on inhibiting Xa?

A

Apixaban
Edoxaban
Rivaroxaban

76
Q

Which DOAC work on inhibiting IIa?

A

Dabagitran

77
Q

How does aspirin work as an antiplatelet drug?

A

Reduced TXA2 synthesis by COX-1 inhibition

78
Q

What is an example of a phosphodiesterase inhibitor?

A

Dipyridamole

79
Q

What is the mechanism of action of a phosphodiesterase inhibitor?

A

Inhibits phosphodiesterase so prevents cAMP degradation so inhibits the expression of GPIIb/IIa

Also Inhibits cellular reuptake of adenosine, so increased adenosine plasma conc - so inhibits platelet aggregation via A2 receptors

80
Q

What are three ADRs of dipyridamole?

A

Vomiting
Diarrhoea
Dizziness

81
Q

When is dipyridamole used?

A
  • Secondary prevention of ischaemic stroke and TIA

* Adjunct for thromboembolism prophylaxis

82
Q

What are three examples of ADP receptors antagonists?

A

Clopidogrel
Prasugrel
Ticagrelor

83
Q

Which of the ADP receptor antagonists bind irreversibly and are prodrugs?

Which have a faster onset of action?

A

Clopidogrel and Prasugrel

Prasugrel and Ticagrelor

84
Q

When are Prasugrel/Ticagrelor used?

A

With aspirin in ACS patients undergoing PCI for up to 12 months

85
Q

What class of drug is Abciximab?

A

Glycoprotein IIb/IIIa inhibitor (GPIIb/IIIa)

86
Q

What are the two fibrinolytic drugs?

A

Alteplase

Streptokinase

87
Q

What is the antifibrinolytic drug and when is it used?

A

Tranexamic acid

Nose bleeds
Heavy painful periods

88
Q

Name two statins

A

Atorvastatin

Simvastatin

89
Q

Name a fibrate

A

Fenofibrate

90
Q

What is the mechanism of action of fenofibrate?

A

Activates nuclear transcription factor PPAR-alpha - factor that regulates expression of genes that control lipoprotein metabolism - increased LPL production

91
Q

What are some ADRs of fenofibrate?

A
  • Cholelithiasis
  • GI upset
  • Myositis
92
Q

What is a DDI of fenofibrate?

A

Warfarin - increased anticoagualtion when taking with fenofibrate

93
Q

What is an example of a cholesterol absorption inhibitor?

A

Ezetimibe

94
Q

What is the mechanism of action of ezetimibe?

A

Inhibits the NPC1L1 transporter in the brush border of the gut - so reduced cholesterol absorption

It’s a prodrug and has enterohepatic circulation

95
Q

What are the ADRs of ezetimibe?

A
  • Abdo pain

* GI upset

96
Q

DDIs of ezetimibe?

A

Caution with statins - increased risk of rhabdomyolysis

Ciclosporin increased levels of ezetimibe

97
Q

What drug class is Alirocumab? And hence mechanism of action?

A

PCSK9 inhibitor

Monoclonal antibody that inhibits the PCSK9 enzyme, so prevents degradation and internalisation of LDL-R

CPT - Other Drugs (11 decks)

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