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Year 3 - CR > Commonly used cardiac medications > Flashcards

Commonly used cardiac medications Flashcards

1
Q

Name the type of diuretics

A
  • Thiazide
  • metolazone
  • loop
  • Potassium sparing
  • Aldosterone antagonists
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2
Q

Name examples of loop diuretics

A

– Bumetanide - slightly quicker onset of action

– Furosemide

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3
Q

Name examples of potassium sparing diuretics

A

– Amilioride

– Triamterine

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4
Q

Name examples of aldosterone antagonists

A

– Spironolactone

– eplenerone

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5
Q

How do you treat acute left ventricular failure

A
  • Nitrate infusion
  • IV loop diuretics - furosemide - acts as a powerful vasodilator rather than a diuretic
  • IV diamorphine - dilates veins in pulmonary circulation and helps the heart failure
  • Oxygen
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6
Q

What does nitrate infusion do in left ventricular failure

A

– Cause veno relaxation; reduce pre load
– Smaller effect on after load

– Metabolized and release nitric oxide  Increase cGMP
 Activates protein kinase G

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7
Q

What is the negatives of nitrate infusion

A
  • Headaches

- Hypotension

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8
Q

Name the mechanisms of loop diuretics

A
  • Inhibit transport of NaCl from ascending loop of henle into the instititial fluid
  • act on the Cl binding site
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9
Q

What is lost when taking loop diuretics

A
  • Na loss (wanted)
  • potassium
  • magnesium (unwanted)
  • calcium loss - hypocalemia
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10
Q

When do loop diuretics have decreased absorption

A
  • Gut oedema

- Ascites

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11
Q

What system to the loop diuretics stimulate

A

renin angiotensin system

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12
Q

Name some ACE inhibitors

A

Ramipril
perindopril
lisinopril

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13
Q

Do ACE inhibitors improve prognosis

A

Yes - only improve mortality if there is a reduced ejection fraction

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14
Q

Name the side effects of ACE inhibitors

A
  • Dry cough
  • angioedema
  • high potassium
  • contradicted in bradycardia
  • contradicted in renal impairment
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15
Q

Describe the mechanism of ARBs

A

Block the A2 angiotensin receptor

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16
Q

describe the side effects of ARBs

A
  • Rise in potassium

- Contradicted in renal impairment

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17
Q

Name some examples of ARBs

A
  • Losarten
  • Valsarten
  • Irbesarten
  • Candarsarten
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18
Q

How does spironolactone work

A

Aldosterone antagonists

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19
Q

What is the side effects of spironolactone

A
  • gynacomastia due to oestrogen effects (gynacomastia in the men)
  • high potassium
  • eplenerone less oestrogen effects
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20
Q

Does spironolactone improve prognosis

A

Yes - with reduced ejection fraction

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21
Q

beta blockers do not

A

help diuresis

22
Q

What are the effects of beta blockers

A
  • asthma - bronchoconstriction

- can cause diabetes

23
Q

Who should beta blockers be given to

A
  • women of child bearing age
  • increased sympathetic tone
  • those who ACE and ARB do not work
24
Q

When should beta blockers be given

A
  • only given when the patient is stable as can cause an acute left ventricular failure
25
Q

Name some types of beta blockers

A

Bisoprolol
carvedilol
metoprolol

26
Q

What does ivrabadine do

A
  • causes a bradycardia

- inhibits funny channels so slows pacemaker in SA node

27
Q

Who can you give ivrabadine to that you cant give a beta blocker to

A
  • Can give it to an asthmatic - no bronchoconstriction
28
Q

Beta blockers have…

A

no negative ionotrophic effect

29
Q

What is the mechanism of action of Sacubitril

A
  • Neprilysin inhibitor
  • Increases the bioavailability of ANP, BNP bradykinin, and substance P
  • causes naturesis and vasodialtation
  • lowers blood pressure
30
Q

What other drug is only sacubitril available with

A

Valsarten

31
Q

What do you use if you cannot get then on an ACE or an ARB or spinolactone due to renal impairment what can you use

A

Hydralazine

- powerful vasodilator and can helps to reduce the load and can be used

32
Q

what symptoms do you get with atrial fibrillation

A
  • Palpitations

- or they could present with heart failure

33
Q

How fast is the atrial fibrillation

A

300-400 in atrium

120 in ventricle - some of the conduction is blocked by the AV node

34
Q

Why does heart failure occur in atrial fibrillation

A
  • ventricles are not filling properly due to the atrial fibrillation
35
Q

How does digoxin work

A
  • increases the AV block to slow down the ventricle
  • rate control
  • blocks the sodium potassium pump
36
Q

What are the two things do you have to address in atrial fibrillation

A
  • What are you going to do about the anticoagulation

- what are you going to do about the atrial fibrillation (rate or rhythm (back to sinus rhythm) control)

37
Q

What are the downside of digoxin

A
  • not very good in controlling exercise induced tachycardia

- can get digoxin toxicity - causes nausea and vomiting and arrythmias

38
Q

Describe aspects of digoxin

A
  • long half life - may need loading dose
  • renally excreted - increased in all elderly have renal impairment
  • narrow therapeutic index
39
Q

what is digoxin toxicity increased by

A

increased by low potassium

40
Q

What happens in digoxin toxicity

A

nausea and vomiting and arrythmias

41
Q

What is digoxin mainly used for

A

mainly uses as an anti-arrythmic to control atrial fibrillation and flutter

42
Q

What is amiodarone used for

A
  • Treat atrial and ventricular arrythmias
43
Q

Describe the side effects of amiodarone

A
  • can cause bradycardias
  • hepatic problems irreversible (hepatitis)
  • pulmonary fibrosis (irreversible)
  • photosensitive skin rashes
  • corneal deposits
  • may cause hypo or hyper thyroidism as it contains iodine
44
Q

How do you give amiodarone

A
  • Has a very long half life due to protein binding
  • 6 weeks in normal volunteers - higher in patients who have renal impairment
  • must give loading
45
Q

How do you manage angina

A
  • beta blockers
  • calcium channel blockers
  • nitrates - oral, sublingual, patches
  • nicorandil
  • ivradibine
  • aspirin and statins
46
Q

How do nicorandil works

A
  • it is a potasium channel activation and NO donor
47
Q

Where does ivradibine act

A
  • Acts on the sinus node to cause bradycardia
48
Q

What two calcium channel blockers are consdiered to be anti-arrythmics

A
  • Verapamil

- Dilitiazem

49
Q

name some calcium channel blockers

A

Anti -arrythmics

  • Verapamil
  • Dilitiazem

Dihydropyridines

  • Amlodipine
  • nifedipine
50
Q

Name the Dihydropyridines type calcium channel blockers

A
  • Amlodipine

- nifedipine

51
Q

What do calcium channel blockers do

A

– Anti anginal

– Anti hypertensive

52
Q

What are the side effects for calcium channel blockers

A

– Bleeding gums
– Amlodipine ankle swelling
– Verapamil constipation

Year 3 - CR (44 decks)

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