Commonly used Cardiac Meds Flashcards
Treatment with HFrEF
1) ACEi/ABR and or beta blocker
2) Aldosterone antagonist OR hydralazine with nitrate OR ivabradine
3) cardiac resynchronisation therapy or digoxin
Drugs improving mortality in HF
ACEi
Beta blockers
Spironolactone
Hydralazine with nitrates
E.g of ACEi
Ramipril
lisinopril
enalapril
Adverse reactions of ACEi
Hypotension
Hyperkalaemia
Dry cough
Angioedema
ARB adverse reactions
hyperkalaemia
hypotension
less risk of angioedema than ACEi
MOA of spironolactone
- aldosterone ant (potassium sparing)
- stops Na+ reabsorption and K+ excretion
- hyperkalaemia
Adverse reaction of spironolactone
- gynaecomastia = if male high doses >100mg/day
Alternative to spironolactone
Eplerenone
Indication for beta blocker in HF
- chronic
- reduced EJ
- otherwise worsens acute HF
- not for use in asthmatics
Hydralazine with nitrate MOA
- hydralazine = arterial vasodilator = reduces afterload
- nitrate = venodilator
Ivabradine MOA
- inhibits funny channel present on pacemaker cells in SAN
- causes bradycardia
- no negative inotropic effect
- suitable for use in asthmatics
Drugs for HFpEF
- diuretics if fluid overload = furosemide and spironolactone
- manage co-morbidities
Co-morbidities treatment for HFpEF
- antiplatelet
- statin
- diabetes meds
- weight loss
- smoking cessation
- influenza and pneumococcal vaccs
Acute HF Treatment
- position
- oxygen
- IV furosemide
- monitor weight, renal function and UO
Loop diuretic mechanism
- inhibit Na-Cl-K cotransporter
- loss of Na+ in urine
Adverse effects of loop diuretics
- hyponatremia
- hypotension
- hypokalaemia
Indications for rate control in AF
- > 65
- history of IHD
Indications for rhythm control in AF
- <65
- first presentation
- congestive cardiac failure
- 2ndry to correctable precipitant
Drugs for AF rate control
- beta blockers
- CCB
- digoxin
Drugs for rhythm control in AF
- sotalol
- flecainide
- amiodarone
Other considerations in AF
- anticoagulation
Dihydropyridine CCB
amlodipine
nifedipine
(vascular selective)
Nondihydropiridines CCB
verapamil
diltiazem
(cardioselective)
Verapamil CI
If on beta blocker don’t use = heart block high risk
MOA of CCB
- inhibit voltage gated CC in SAN and AVN = decreased calcium influx in plateau phase = lowers HR
Digoxin MOA
- decreases conduction through AVN
- inhibits Na/K ATPase pump
- increases force of cardiac muscle contraction
- stimulates vagus nerve
Adverse effects of digoxin
Reduce dose in elderly as renally excreted
- toxicity increased by low potassium
- narrow therapeutic index
Amiodarone MOA
- block potassium channels which inhibit repol = prolong action potential
- long half life 20-100 days so need loading
- lengthen QT interval
Adverse effects of amiodarone
- interactions with many drugs
- thyroid dysfunction
- pulmonary fibrosis
- hepatitis
- corneal deposits
Stable angina treatment
- aspirin and statin
- GTN
- beta blocker or CCB
