CVS Flashcards
Thiazide diuretics: use and e.g.
- to relieve oedema due to chronic heart failure
- in HTN (part of step-wise approach)
e.g. bendroflumethiazide
Loop diuretics: use and e.g.
in pulmonary oedema due to left ventricular failure and in patients with chronic heart failure
e.g. furosemide
Beta blockers: mechanism, uses (8) and e.g.s
- block effect of adrenaline (block sympathetic drive)
- uses: HTN, angina, MI, arrythmias, heart failure, thyrotoxicosis, anxiety, migraine prevention
e.g. cardioselective - atenolol, bisoprolol, metoprolol;
non-selective - propranolol, carvedilol
Beta blockers: Side effects (5) and CIs (3-4)
S/E: fatigue, cold extremities, sleep disturbance, bronchospasm, erectile dysfunction
CI: severe asthma and COPD; 2nd/3rd degree heart block, unstable heart failure
Caution: DM
ACE inhibitors mechanism (5 points)
- inhibit angiotensin-converting enzyme (which causes vasoconstriction)
- –> vasodilation –> reduced BP, reduced preload + afterload
- down regulates sympathetic adrenergic activity
- promotes renal excretion of Na + water (natriuritic + diuretic) by blocking angiotensin II effects and blocking stimulation of aldosterone secretion –> reduction in blood volume, venous + arterial pressure
- inhibits cardiac and vascular remodelling associated with chronic HTN, heart failure and MI
ACE inhibitor uses (3) and e.g.s
HTN, heart failure, post-MI
e.g. ramipril, lisinopril, enalapril, benazepril, captopril, etc
ACE inhibitor side effects (5) + CIs
S/E: dry cough (10%), hypotension, angioedema (life-threatening airway swelling + obstruction), hyperkalaemia, urticaria
CI: eGFR <60
Caution: Afro-Caribbean (may respond less well), others
What do antiplatelets do?
decrease platelet aggregation and inhibit thrombus formation in the arterial circulation, because in faster-flowing vessels, thrombi are composed mainly of platelets with little fibrin
Antiplatelets: uses (4) and e.g.s (5)
Uses
- primary prevention of CVD (aspirin)
- secondary prevention of CVD
- acute ischaemic events - coronary/cerebral
- AF
e.g. aspirin, clopidogrel, prasugrel, dipyridamole, glycoprotein IIb/IIIa antagonists (e.g. abciximab)
Antiplatelet S/Es (1) and CIs (3)
S/E: depends on drug, all can cause GI bleeds
CI: those at high risk of bleeding, hypersensitive/allergic, SOME asthmatics (20%)
What do oral anticoagulants do?
The main use of anticoagulants is to prevent thrombus formation or extension of an existing thrombus in the slower-moving venous side of the circulation, where the thrombus consists of a fibrin web enmeshed with platelets and red cells
Oral anticoagulats: uses (loads) and e.g.s
Uses
- PE/DVT
- prophylaxis of VTE
- mitral stenosis or regurg in high risk patients
- inherited thrombophilia (aymptomatic)
- antiphospholipid syndrome
- AF
- cardioversion
- mural thrombus
- dilated cardiomyopathy
- arterial grafts
- coronary thrombosis
- artificial valves
e.g. warfarin, dabigatran, rivaroxaban, apixaban
Warfarin CIs (11)
- known hypersensitivity
- haemorrhagic stroke
- clinically significant bleeding
- within 72h major surgery with risk of severe bleeding
- within 48h post-partum
pregnancy (congenital malformations + fetal death) - drug interactions with sig. bleeding risk
- uncorrected major bleeding disorder
- potential bleeding lesions e.g. oesophageal varices
- uncontrolled severe HTN
- unreliable patient
- risk of repeated falls
Statins: uses and e.g.s
Uses
- primary prevention of CVD/atheroma-related disease
- secondary prevention of CVD/atheroma-related disease
- hyperlipidaemia
e.g. simvastatin, atorvastatin
Statins: Side effects
- nosebleeds
- sore throat
- runny/blocked nose
- headache
- nausea
- constipation, diarrhoea, indigestion, flatulence
- myalgia and arthralgia
- myositis, rarely rhabdomyolysis
- hyperglycaemia
- increased risk of DM
- increased transaminases e.g. ALT
- increase creatine kinase
4 classes of anticoagulants
- Vitamin K antagonists (coumarin anticoagulants) e.g. warfarin
- Low molecular weight heparins (LMWH) and heparin e.g. enoxaparin, deltaparin; heparin
DOACs (direct oral anticoagulants):
- Direct thrombin inhibitors e.g. dabigatran
- Factor Xa Inhibitors e.g. apixaban, rivaroxaban, fondaparinux
Thiazide diuretics: side effects (5)
- low K
- high Ca
- low Mg
- high urate ± gout
- impotence
Loop diuretics: side effects (5)
- dehydration
- low Na
- low K
- low Ca
- ototoxic
Calcium antagonists (calcium channel blockers/CCBs): Uses (3) and e.g.s
Uses:
- HTN
- angina
- dysarrythmias
e.g. nifedipine, amlodipine, verapamil, diltiazem
CCB: action, side effects (5), CI
antagonise Ca channels –> coronary and peripheral vasodilation + reduction in myocardial oxygen consumption
S/E: flushes, headache, ankle oedema (unresponsive to diuretics), reduced LV function, gingival hypertrophy
CI: heart block
Vasodilators: Uses (3), e.g.s (4)
Uses:
- heart failure
- IHD
- HTN
e.g. nitrates (GTN - short acting, isosorbide mononitrate - long acting), hydralazinem prazosin (alpha blocker)
Digoxin: uses (2), side effects (5), CI (2)
Uses
- to slow HR in fast AF
- heart failure
S/E:
- any arrythmia
- nausea
- decreased appetite
- yellow vission
- confusion
- gynaecomastia
CI:
- HCM (hypertrophic cardiomyopathy)
- WPW syndrome
What is amiodarone?
anti-arrythmic
What are sodium channel blockers?
anti-arrythmics
