Commonly used cardiac medications Flashcards
Name the type of diuretics
- Thiazide
- metolazone
- loop
- Potassium sparing
- Aldosterone antagonists
Name examples of loop diuretics
– Bumetanide - slightly quicker onset of action
– Furosemide
Name examples of potassium sparing diuretics
– Amilioride
– Triamterine
Name examples of aldosterone antagonists
– Spironolactone
– eplenerone
How do you treat acute left ventricular failure
- 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
What does nitrate infusion do in left ventricular failure
– Cause veno relaxation; reduce pre load
– Smaller effect on after load
– Metabolized and release nitric oxide Increase cGMP
Activates protein kinase G
What is the negatives of nitrate infusion
- Headaches
- Hypotension
Name the mechanisms of loop diuretics
- Inhibit transport of NaCl from ascending loop of henle into the instititial fluid
- act on the Cl binding site
What is lost when taking loop diuretics
- Na loss (wanted)
- potassium
- magnesium (unwanted)
- calcium loss - hypocalemia
When do loop diuretics have decreased absorption
- Gut oedema
- Ascites
What system to the loop diuretics stimulate
renin angiotensin system
Name some ACE inhibitors
Ramipril
perindopril
lisinopril
Do ACE inhibitors improve prognosis
Yes - only improve mortality if there is a reduced ejection fraction
Name the side effects of ACE inhibitors
- Dry cough
- angioedema
- high potassium
- contradicted in bradycardia
- contradicted in renal impairment
Describe the mechanism of ARBs
Block the A2 angiotensin receptor
describe the side effects of ARBs
- Rise in potassium
- Contradicted in renal impairment
Name some examples of ARBs
- Losarten
- Valsarten
- Irbesarten
- Candarsarten
How does spironolactone work
Aldosterone antagonists
What is the side effects of spironolactone
- gynacomastia due to oestrogen effects (gynacomastia in the men)
- high potassium
- eplenerone less oestrogen effects
Does spironolactone improve prognosis
Yes - with reduced ejection fraction
beta blockers do not
help diuresis
What are the effects of beta blockers
- asthma - bronchoconstriction
- can cause diabetes
Who should beta blockers be given to
- women of child bearing age
- increased sympathetic tone
- those who ACE and ARB do not work
When should beta blockers be given
- only given when the patient is stable as can cause an acute left ventricular failure
Name some types of beta blockers
Bisoprolol
carvedilol
metoprolol
What does ivrabadine do
- causes a bradycardia
- inhibits funny channels so slows pacemaker in SA node
Who can you give ivrabadine to that you cant give a beta blocker to
- Can give it to an asthmatic - no bronchoconstriction
Beta blockers have…
no negative ionotrophic effect
What is the mechanism of action of Sacubitril
- Neprilysin inhibitor
- Increases the bioavailability of ANP, BNP bradykinin, and substance P
- causes naturesis and vasodialtation
- lowers blood pressure
What other drug is only sacubitril available with
Valsarten
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
Hydralazine
- powerful vasodilator and can helps to reduce the load and can be used
what symptoms do you get with atrial fibrillation
- Palpitations
- or they could present with heart failure
How fast is the atrial fibrillation
300-400 in atrium
120 in ventricle - some of the conduction is blocked by the AV node
Why does heart failure occur in atrial fibrillation
- ventricles are not filling properly due to the atrial fibrillation
How does digoxin work
- increases the AV block to slow down the ventricle
- rate control
- blocks the sodium potassium pump
What are the two things do you have to address in atrial fibrillation
- 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)
What are the downside of digoxin
- not very good in controlling exercise induced tachycardia
- can get digoxin toxicity - causes nausea and vomiting and arrythmias
Describe aspects of digoxin
- long half life - may need loading dose
- renally excreted - increased in all elderly have renal impairment
- narrow therapeutic index
what is digoxin toxicity increased by
increased by low potassium
What happens in digoxin toxicity
nausea and vomiting and arrythmias
What is digoxin mainly used for
mainly uses as an anti-arrythmic to control atrial fibrillation and flutter
What is amiodarone used for
- Treat atrial and ventricular arrythmias
Describe the side effects of amiodarone
- 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
How do you give amiodarone
- 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
How do you manage angina
- beta blockers
- calcium channel blockers
- nitrates - oral, sublingual, patches
- nicorandil
- ivradibine
- aspirin and statins
How do nicorandil works
- it is a potasium channel activation and NO donor
Where does ivradibine act
- Acts on the sinus node to cause bradycardia
What two calcium channel blockers are consdiered to be anti-arrythmics
- Verapamil
- Dilitiazem
name some calcium channel blockers
Anti -arrythmics
- Verapamil
- Dilitiazem
Dihydropyridines
- Amlodipine
- nifedipine
Name the Dihydropyridines type calcium channel blockers
- Amlodipine
- nifedipine
What do calcium channel blockers do
– Anti anginal
– Anti hypertensive
What are the side effects for calcium channel blockers
– Bleeding gums
– Amlodipine ankle swelling
– Verapamil constipation
