Commonly used Cardiac Meds

Question 1

Treatment with HFrEF

Answer 1

1) ACEi/ABR and or beta blocker
2) Aldosterone antagonist OR hydralazine with nitrate OR ivabradine
3) cardiac resynchronisation therapy or digoxin

Question 2

Drugs improving mortality in HF

Answer 2

ACEi
Beta blockers
Spironolactone
Hydralazine with nitrates

Question 3

E.g of ACEi

Answer 3

Ramipril
lisinopril
enalapril

Question 4

Adverse reactions of ACEi

Answer 4

Hypotension
Hyperkalaemia
Dry cough
Angioedema

Question 5

ARB adverse reactions

Answer 5

hyperkalaemia
hypotension
less risk of angioedema than ACEi

Question 6

MOA of spironolactone

Answer 6

• aldosterone ant (potassium sparing)
• stops Na+ reabsorption and K+ excretion
• hyperkalaemia

Question 7

Adverse reaction of spironolactone

Answer 7

• gynaecomastia = if male high doses >100mg/day

Question 8

Alternative to spironolactone

Answer 8

Eplerenone

Question 9

Indication for beta blocker in HF

Answer 9

• chronic
• reduced EJ
• otherwise worsens acute HF
• not for use in asthmatics

Question 10

Hydralazine with nitrate MOA

Answer 10

• hydralazine = arterial vasodilator = reduces afterload

- nitrate = venodilator

Question 11

Ivabradine MOA

Answer 11

• inhibits funny channel present on pacemaker cells in SAN
• causes bradycardia
• no negative inotropic effect
• suitable for use in asthmatics

Question 12

Drugs for HFpEF

Answer 12

• diuretics if fluid overload = furosemide and spironolactone
• manage co-morbidities

Question 13

Co-morbidities treatment for HFpEF

Answer 13

• antiplatelet
• statin
• diabetes meds
• weight loss
• smoking cessation
• influenza and pneumococcal vaccs

Question 14

Acute HF Treatment

Answer 14

• position
• oxygen
• IV furosemide
• monitor weight, renal function and UO

Question 15

Loop diuretic mechanism

Answer 15

• inhibit Na-Cl-K cotransporter

- loss of Na+ in urine

Question 16

Adverse effects of loop diuretics

Answer 16

• hyponatremia
• hypotension
• hypokalaemia

Question 17

Indications for rate control in AF

Answer 17

• > 65

- history of IHD

Question 18

Indications for rhythm control in AF

Answer 18

• <65
• first presentation
• congestive cardiac failure
• 2ndry to correctable precipitant

Question 19

Drugs for AF rate control

Answer 19

• beta blockers
• CCB
• digoxin

Question 20

Drugs for rhythm control in AF

Answer 20

• sotalol
• flecainide
• amiodarone

Question 21

Other considerations in AF

Answer 21

• anticoagulation

Question 22

Dihydropyridine CCB

Answer 22

amlodipine
nifedipine
(vascular selective)

Question 23

Nondihydropiridines CCB

Answer 23

verapamil
diltiazem
(cardioselective)

Question 24

Verapamil CI

Answer 24

If on beta blocker don’t use = heart block high risk

Question 25

MOA of CCB

Answer 25

- inhibit voltage gated CC in SAN and AVN = decreased calcium influx in plateau phase = lowers HR

Question 26

Digoxin MOA

Answer 26

- decreases conduction through AVN - inhibits Na/K ATPase pump - increases force of cardiac muscle contraction - stimulates vagus nerve

Question 27

Adverse effects of digoxin

Answer 27

Reduce dose in elderly as renally excreted - toxicity increased by low potassium - narrow therapeutic index

Question 28

Amiodarone MOA

Answer 28

- block potassium channels which inhibit repol = prolong action potential - long half life 20-100 days so need loading - lengthen QT interval

Question 29

Adverse effects of amiodarone

Answer 29

- interactions with many drugs - thyroid dysfunction - pulmonary fibrosis - hepatitis - corneal deposits

Question 30

Stable angina treatment

Answer 30

- aspirin and statin - GTN - beta blocker or CCB