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Drugs > Digoxin - > Flashcards

Digoxin - Flashcards

1
Q

Digoxin effects on heart rate / contraction

A

Negatively chronotrophic - reduces rate

Positively inotrophic - increased force of contraction

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2
Q

How does digoxin work in AF

A

Increases Vagal parasympathetic tone

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3
Q

Digoxin effect in heart failure

A

Inhibits NaKATPase pumps -> Na accumulates in cell -> ca accumulation -> increased force

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4
Q

Digoxin adverse effects

A

Bradycardia, GI disturbance, rash, dizziness, visual disturbance

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5
Q

Important to remember about digoxin therapeutic dose

A

Close to toxic -> arrythmias

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6
Q

Who can never have digoxin

A

Second degree heart block
Intermittent complete heart block
Ventricular arrythmias

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7
Q

Which electrolyte abnormalities increase risk of digoxin toxicity

A

Hypokalaemia
Hypomagnesia
Hypercalcaemia

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8
Q

Under which circumstance should digoxin dose be reduced

A

Renal failure

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9
Q

Eg if drugs causing hypokalaemia -> increased risk of digoxin toxicity

A

Loop and thiazide diuretics

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10
Q

Need a rapid effect of digoxin - how prescribed

A

Loading dose 500micrograms

Followed by 250-500 micrograms 6 hours later

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11
Q

Usual maintenance dose of digoxin

A

125-250 micrograms

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12
Q

What is the reverse tick sign on ECG

A

St depression from therapeutic digoxin

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13
Q

Dipyridamole uses

A

first line TIA , second line ischemic stroke (if clopidogrel contraindicated)
Induce tachycardia for myocardial perfusion scan

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14
Q

What’s normally given with dipyridamole in second line ischemic stroke

A

Aspirin

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15
Q

Mechanism of dipyridamole

A

Antiplatelet and vasodilator

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16
Q

Dipyridamole adverse effects

A

Headache, flushing, dizzy, GI

Risk of bleeding, thrombocytopenia

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17
Q

Caution using dipyridamole in who

A

Ischemic heart disease, aortic stenosis, heart failure

As may exacerbate

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18
Q

Dipyridamole interactions (2 types)

A

Inhibits uptake of adenosine -> risk of cardiac arrest

Increased bleeding with other antiplatelets / anticoagulants

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19
Q

Loop diuretics egs

A

Furosemide

Bumetanide

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20
Q

Loop diuretic uses

A

Relive breathlessness in pulmonary oedema

Treatment of fluid overload eg. Heart / liver / renal failure

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21
Q

Loop diuretics mechanism (2)

A

Loop or henle - inhibit Na/K/2Cl co transporter

Dilation of capacitance veins

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22
Q

Loop diuretics adverse effects

A

Headache and dehydration.
Low electrolyte states
Hearing loss and tinnitus

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23
Q

Why do loop diuretics cause hearing problems

A

NaKCl transporter is used in regulating endolymph composition in inner ear

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24
Q

Who should never get loop diuretics

A

Hypovolemia

Dehydration

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25
Q

Loop diuretics use in caution when

A

Risk of hepatic encephalopathy

Hypokalaemia , hyponatraemia and gout

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26
Q

What drugs to loop diuretics effect

A

Any that are excreted by the kidneys
Eg Lithium levels increase due do reduced excretion
Digoxin toxicity due to hypokalaemia
Increase ototoxicity / nephrotoxicity of aminoglycosides

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27
Q

Eg loop diuretics prescription for acute pulmonary oedema

A

Furosemide IV 40mg

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28
Q

Eg of potassium sparing diuretic

A

Amiloride (co-amilofruse / Co-amilozide)

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29
Q

Why are potassium sparing diuretics often used with other diuretics

A

They are weak diuretics and used with stinger to counteract potassium loss

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30
Q

Where does amiloride act

A

Distal convoluted tubules

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31
Q

Who should not get potassium sparing diuretics

A

Renal impairment

Hyperkalaemia

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32
Q

Which drugs should not be given with potassium sparing diuretics

A

Potassium elevating - oral supplements / aldosterone antagonists

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33
Q

When might use amiloride over spirolactone

A

Hypertension due to hyperaldosteronism (conns) has amiloride directly effects ENaC channels
When spirolactone adverse effects eg gynaecomastia are not acceptable

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34
Q

Thiazide like diuretic egs

A

Bendroflumethazide, indapamide, chlortalidone

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35
Q

Thiazide diuretics uses

A

Alternative first line for hypertension where CCBs otherwise used.
Add on treatment for hypertension

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36
Q

When are CCBs not used in hypertension

A

Oedema / heart failure

37
Q

Mechanism of thiazides

A

Inhibit Na/Cl co transporter in distal convoluted tubule

Vasodilation

38
Q

Thiazide diuretics adverse effects

A

Hyponatraemia , hypokalaemia -> arrythmias

Impotence

39
Q

Who should never get thiazide diuretics ?

Avoid in?

A

Hypokalaemia

Hyponatraemia , gout

40
Q

Bendroflumethazide prescription

A

2.5mg daily

41
Q

Why are thiazides good for combo with ACEi

A

Thiazide -> hypokalaemia (RASS system)
ACEi -> hyperkalaemia (block it )

Have a synergistic blood pressure lowering effect

42
Q

Eg of dopaminergic drugs for Parkinson’s

A

Levodopa as (co-careldopa, co-beneldopa), ropinirole, pramipexol

43
Q

Which dopaminergic drugs used for early vs late Parkinson’s

A

Early - ropinirole, pramipexol (as dopamine agonists)

Late - levodopa

44
Q

What and where is there a deficiency of in Parkinson’s

A

Dopamine in nigrostriatal pathway

45
Q

Dopaminergic adverse effects

A

Nausea, dizzy, confusion, hallucinations, hypotension

46
Q

Major issue with Levodopa

A

Wearing off effect - symptoms get worse at end of dosage interval.
Increasing dose / frequency -> dyskenesias (movements)

With both called on-off effect

47
Q

Cautions with dopaminergic drugs

A

Existing cognitive / psychiatric disease
Elderly
Cardiovascular disease

48
Q

Which drugs have opposite effect to levodopa

A

Antipsychotics, metoclopramide

49
Q

Digoxin uses

A

AF / flutter (usually less effective than b blocker / ccb)

Heart failure

50
Q

How do emollients work

A

Replace water in dry skin and have oils that prevent water loss

51
Q

Emollients uses

A

Dry skin conditions eg eczema / psoriasis

52
Q

Adverse effects of emollients

A

Greasy skin

Worsen acne vulgaris / folliculitis by blocking pores

53
Q

Egs of fibrinolytic drugs

A

Alteplase, streptokinase

54
Q

Fibrinolytic drug uses

A

Acute ischemic stroke (within 4.5 hours)
Acute STEMI
Pulmonary embolism with haemodynamic instability

55
Q

What gives better results than fibrinolytic drugs for STEMIs

A

PCI

56
Q

Other word for fibrinolytic drugs

A

Thrombolytic

57
Q

Mechanism of thrombolytics

A

Dissolve fibrinous clots -> re canalise vessels

58
Q

Fibrinolytic drugs adverse effects

A

Nausea vomiting bruising bleeding

Hypotension

59
Q

What can reperfusion of brain / heart tissue ->

A

Cerebral oedema

Arrythmias

60
Q

Why shouldn’t streptokinase be given as a repeat prescription

A

Development of anti streptokinase antibodies

61
Q

Contraindications to fibrinolytic treatment

A

Bleeding (disorders, recent surgery / trauma, hypertension, peptic ulcers…)

62
Q

When using fibrinolytic treatment for stroke what must be ruled out

A

Intracranial haemorrhage

63
Q

Gabapentin and pregabalin uses ? Specific use for each ?

A

Focal epilepsies (w or w/o 2 generalisation)
Neuropathic pain
Gabapentin - migraine prophylaxis
Pregabalin - generalised anxiety disorder

64
Q

Mechanism of Gabapentin

A

Bunds to voltage gated ca channels -> inhibits neurotransmitter release

65
Q

Gabapentin / pregabalin side effects

A

Drowsy, dizzy, ataxia (usually improve after few weeks)

66
Q

Gabapentin / pregabalin reduced dose in

A

Renal impairment (as eliminated )

67
Q

Gapapentin / pregabalin interactions

A

Effects may be enhanced when combined with other sedating drugs eg bendodiazepines

68
Q

Prescription of Gabapentin

A

Start at low dose and titrated up to mink use adverse effects

69
Q

H2 antagonist eg

A

Ranitidine

70
Q

H2 antagonist uses

A

Peptic ulcer disease

GORD and dyspepsia

71
Q

What is often preferred to h2 antagonists

A

PPIs

72
Q

Mechanism of h2 antagonists

A

Reduce gastric acid secretion

73
Q

Warning with h2 antagonists

A

Can disguise symptoms of gastric cancer (remember not to just treat symptoms )

74
Q

What is benefit of h2 antagonists over PPIs and eg?

A

Faster action - suppress acid secretion pre op

75
Q

Egs of heparins

A

Enoxaparin, dalteparin, unfractioned heparin

76
Q

Uses of heparins and fondaparinux

A

Venous thromboembolism VTE prophylaxis and treatment of DVT / PE ( LMW Heparin)

Acute coronary syndrome

77
Q

2 key components of final common coagulation pathway

A

Thrombin

Factor Xa

78
Q

How does unfractioned heparin work

A

Activates antithrombin -> inactivates Xa and thrombin

79
Q

Eg of LMW heparins

A

Dalteparin, enoxaparin

80
Q

Fondaparinux mechanism

A

Inhibits Xa

81
Q

Adverse effects of heparins and fondaparinux

A

Bleeding

Injection site reactions

Heparin induced thrombocytopenia

82
Q

When should anticoagulants be used cautiously

A

Clotting disorders, severe hypertension, recent surgery / trauma, renal impairment

83
Q

Drug for reversing anticoagulation

A

Protamine

84
Q

Precribing for VTE prophylaxis

A

Enoxaparin 40mg sc daily /

Dalteparin 5000 units so daily

85
Q

Where should sc drugs be given

A

Sub cut tissue of abdominal wall

86
Q

What is APTR ? Usual target?

A

Activated partial thromboplastin ratio

1.5-2.5

87
Q

What is the APTR Usually measuring ? How often should it be checked

A

Anticoagulant effect of UFH .

6hrly

88
Q

How are patients diagnosed with VTE treated ? Why?

A

LMW heparin and warfarin
Because warfarin inhibits protein C / S (anticoagulants) before inhibiting clotting factors. LMW heparin provides cover period during this time

Drugs (5 decks)

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