CVS

Question 1

ACE Inhibitors

Answer 1

Ramipril, Captopril

MoA:
Inhibits conversion of angiotensin I to II. Blocks vasoconstriction.

Indication:
HTN, diabetic nephropathy, HF

Side Effects:
Cough, hyperkalemia

Interactions:
Lithium, NSAIDs

Question 2

ARB

Answer 2

Losartan, Valsartan

MoA:
Blocks angiotensin-renin system.

Indication:
HTN, diabetic nephropathy, HF

Side Effects:
Hypotension, fatigue

Interactions:
Diuretics

Question 3

Anticoagulants - direct Factor Xa inhibitor

Answer 3

Apixaban, Edoxaban, Rivaroxaban

MoA:
Inhibition of Factor Xa

Indication: Prophylaxis of stroke from AF and DVT

Side Effects:
Abnormal bleeding

Question 4

Anticoagulants - heparins

Answer 4

Dalteparin, Tinzaparin, Enoxaparin (low molecular weight)

MoA:
Inactivation of thrombin and Factor Xa via complexing antithrombin III.

Indication:
Prophylaxis of VTE and PE

Side Effects:
Abnormal bleeding

Question 5

Class I - Na+ channel blockers

Answer 5

Disopyramide, Quinidine (Class 1a)
Lidocaine (Class 1b)
Flecainide, Propafenone (Class 1c)

MoA:
Voltage-sensitive Na+ channel blockade. (Prolong QT interval, increase QRS duration).

Indications:
Ventricular and supraventricular arrhythmias (Class 1a)
CPR (Class 1b - used IV)
Paraoxysmal AF and ventricular ectopic beats (Class 1c)

Side Effects:
Oedema

Question 6

Class III - K+ channel blockers

Answer 6

Amiodarone, Dronedarone, Sotalol

MoA:
K+ channel blockade, also evidence of beta blocker and Ca2+ channel blocker properties - prolong QT interval

Indication:
Supraventricular, nodal and ventricular tachyarrythmias, AF (CPR - used IV)

Side Effects:
Nausea, Vomiting

Question 7

Class IV - Ca2+ channel blockers (phenylalkylamine & benzothiazepine subclasses)

Answer 7

Verapamil, Diltiazem (for arrythmia)

MoA:
Cardiac Ca2+ channel blockade - reduction of action potential & cardiac output.

Indication:
SVT (especially paraoxysmal SVT)

Side Effects:
Hypotension (verapamil)
Constipation (diltiazem)

Question 8

Adenosine

Answer 8

Adenosine

MoA:
Activates adenosine receptors - causes hyperpolarization, slows conduction through AV node

Indication:
SVT

Side Effects:
Nausea
*contraindicated in obstructive airway disease

Question 9

Antimuscarinic

Answer 9

Atropine

MoA:
Blockade of vagal muscarinic acetylcholine receptors

Indication:
Emergency Bradycardia

Side Effects:
Urinary Retention

Question 10

Magnesium

Answer 10

Magnesium sulphate (IV)

MoA:
Unclear - possible alteration of Na+, K+ and Ca2+ ion balance via ion channels and transporters

Indication:
Emergency arrythmia (also used IV for emergency asthma)

Side Effects:
Electrolyte irregularities