Commonly used cardiac medications

Question 1

Name the type of diuretics

Answer 1

• Thiazide
• metolazone
• loop
• Potassium sparing
• Aldosterone antagonists

Question 2

Name examples of loop diuretics

Answer 2

– Bumetanide - slightly quicker onset of action

– Furosemide

Question 3

Name examples of potassium sparing diuretics

Answer 3

– Amilioride

– Triamterine

Question 4

Name examples of aldosterone antagonists

Answer 4

– Spironolactone

– eplenerone

Question 5

How do you treat acute left ventricular failure

Answer 5

• 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

Question 6

What does nitrate infusion do in left ventricular failure

Answer 6

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

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

Question 7

What is the negatives of nitrate infusion

Answer 7

• Headaches

- Hypotension

Question 8

Name the mechanisms of loop diuretics

Answer 8

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

Question 9

What is lost when taking loop diuretics

Answer 9

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

Question 10

When do loop diuretics have decreased absorption

Answer 10

• Gut oedema

- Ascites

Question 11

What system to the loop diuretics stimulate

Answer 11

renin angiotensin system

Question 12

Name some ACE inhibitors

Answer 12

Ramipril
perindopril
lisinopril

Question 13

Do ACE inhibitors improve prognosis

Answer 13

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

Question 14

Name the side effects of ACE inhibitors

Answer 14

• Dry cough
• angioedema
• high potassium
• contradicted in bradycardia
• contradicted in renal impairment

Question 15

Describe the mechanism of ARBs

Answer 15

Block the A2 angiotensin receptor

Question 16

describe the side effects of ARBs

Answer 16

• Rise in potassium

- Contradicted in renal impairment

Question 17

Name some examples of ARBs

Answer 17

• Losarten
• Valsarten
• Irbesarten
• Candarsarten

Question 18

How does spironolactone work

Answer 18

Aldosterone antagonists

Question 19

What is the side effects of spironolactone

Answer 19

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

Question 20

Does spironolactone improve prognosis

Answer 20

Yes - with reduced ejection fraction

Question 21

beta blockers do not

Answer 21

help diuresis

Question 22

What are the effects of beta blockers

Answer 22

• asthma - bronchoconstriction

- can cause diabetes

Question 23

Who should beta blockers be given to

Answer 23

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

Question 24

When should beta blockers be given

Answer 24

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

Question 25

Name some types of beta blockers

Answer 25

Bisoprolol carvedilol metoprolol

Question 26

What does ivrabadine do

Answer 26

- causes a bradycardia | - inhibits funny channels so slows pacemaker in SA node

Question 27

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

Answer 27

- Can give it to an asthmatic - no bronchoconstriction

Question 28

Beta blockers have...

Answer 28

no negative ionotrophic effect

Question 29

What is the mechanism of action of Sacubitril

Answer 29

- Neprilysin inhibitor - Increases the bioavailability of ANP, BNP bradykinin, and substance P - causes naturesis and vasodialtation - lowers blood pressure

Question 30

What other drug is only sacubitril available with

Answer 30

Valsarten

Question 31

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

Answer 31

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

Question 32

what symptoms do you get with atrial fibrillation

Answer 32

- Palpitations | - or they could present with heart failure

Question 33

How fast is the atrial fibrillation

Answer 33

300-400 in atrium | 120 in ventricle - some of the conduction is blocked by the AV node

Question 34

Why does heart failure occur in atrial fibrillation

Answer 34

- ventricles are not filling properly due to the atrial fibrillation

Question 35

How does digoxin work

Answer 35

- increases the AV block to slow down the ventricle - rate control - blocks the sodium potassium pump

Question 36

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

Answer 36

- 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)

Question 37

What are the downside of digoxin

Answer 37

- not very good in controlling exercise induced tachycardia | - can get digoxin toxicity - causes nausea and vomiting and arrythmias

Question 38

Describe aspects of digoxin

Answer 38

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

Question 39

what is digoxin toxicity increased by

Answer 39

increased by low potassium

Question 40

What happens in digoxin toxicity

Answer 40

nausea and vomiting and arrythmias

Question 41

What is digoxin mainly used for

Answer 41

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

Question 42

What is amiodarone used for

Answer 42

- Treat atrial and ventricular arrythmias

Question 43

Describe the side effects of amiodarone

Answer 43

- 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

Question 44

How do you give amiodarone

Answer 44

- 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

Question 45

How do you manage angina

Answer 45

- beta blockers - calcium channel blockers - nitrates - oral, sublingual, patches - nicorandil - ivradibine - aspirin and statins

Question 46

How do nicorandil works

Answer 46

- it is a potasium channel activation and NO donor

Question 47

Where does ivradibine act

Answer 47

- Acts on the sinus node to cause bradycardia

Question 48

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

Answer 48

- Verapamil | - Dilitiazem

Question 49

name some calcium channel blockers

Answer 49

Anti -arrythmics - Verapamil - Dilitiazem Dihydropyridines - Amlodipine - nifedipine

Question 50

Name the Dihydropyridines type calcium channel blockers

Answer 50

- Amlodipine | - nifedipine

Question 51

What do calcium channel blockers do

Answer 51

– Anti anginal | – Anti hypertensive

Question 52

What are the side effects for calcium channel blockers

Answer 52

– Bleeding gums – Amlodipine ankle swelling – Verapamil constipation