Drug Treatment for IHD and HF Flashcards

1
Q

Digoxin is a cardiac glycosidic drug that is able to increase inotropic force and reduce HR, what is the mechanism of action of digoxin?

A
  • inhibition of Na+/K+ ATPase
  • Na+ cannot leave and ⬆️ inside cell
  • Na+ leaves through Na+/Ca2+ cotransporter
  • Ca2+ inside cell increases
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2
Q

Digoxin is able to increase Ca2+ inside cardiac cells. What is the effect of this?

A
  • increased inotrophic force
  • increased vagal tone so reduces HR
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3
Q

Although digoxin can be used to treat cardiac output in heart failure and does not decrease the BP, BUT it can cause side effects, what are these?

A
  • low therapeutic window
  • causes arrtymias
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4
Q

In heart failure what would the aim of the targeting the circled areas in the image, namely:

  • blood volume
  • preload
  • inotrophy
  • systemic vasuclar resistance
A
  • blood volume = reduce to improve oedema
  • preload = reduce to stop oedema
  • inotrophy = increase or decrease
  • systemic vasuclar resistance = reduce this
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5
Q

In angina what would the aim of the targeting the circled areas in the image, namely:

  • heart rate
  • preload
  • inotrophy
  • systemic vasuclar resistance
A
  • heart rate = reduce workload
  • preload = reduce venous blood flow
  • inotrophy = reduce workload
  • systemic vasuclar resistance = reduce and reduce workload on heart
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6
Q

What is the first line of defence drug used to treat oedema and its mechanims of action?

A
  • loop diuretic
  • furosemide
  • inhibits Na+/K+/Cl- symporter
  • reduces Na+/K+/Cl- and H2O reducing oedema
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7
Q

Although furoesmide is very effective over 6 hours, there are some side effects, what are the most common?

A
  • dehydration
  • renal impairment
  • hypokalaemia (K+)
  • hyponatraemia (Na+)
  • hypocalcaemia (Ca2+)
  • hypomagnesaemia (Mg+)
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8
Q

ACE inhibitors, namely Ramipril is able to act on the RAAS, what are the main effects?

A
  • vasoconstriction = decreasing afterload
  • venodilation = increased preload
  • inhibit aldosterone and ADH = reduced Na+ and H2O
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9
Q

Are ACE inhibitors able to reduce mortality?

A
  • yes
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10
Q

In addition to inhibiting the conversion of angitensin I to II, ACE inhibitors also do what?

A
  • inhibit the breakdown of bradykinin
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11
Q

What are the common side effects of ACE inhibitors?

A
  • cough due to high levels of bradykinin
  • renal impairment
  • hyperkalaemia (K+)
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12
Q

If a patient cannot be prescribed an ACE inhibitor, what could be an alternative?

A
  • angiotensin II inhibitor Losartan
  • similiar effects as ACE inhibitors
  • doesnt cause dry cough
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13
Q

What is the role of aldosterone in the RAAS?

A
  • released by adrenal gland
  • increases Na+ and H2O retention
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14
Q

What aldosterone inhibitor do we need to know about?

A
  • spirolactone
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15
Q

Spirolactone is an effective aldosterone inhibitor, but what are the side effects?

A
  • gynaecomastia (man boobs)
  • hyperkalaemia (K+)
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16
Q

Are adrenergive agonists a good thing in heart failure, essentially making the heart pump harder?

A
  • no
  • associated with increased mortality

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17
Q

In heart failure why would beta 1 blockers be used?

A
  • reduce HR
  • reduce inotrophic force
  • reduce renin release
18
Q

What are some common side effects of beta 1 blockers?

A
  • fatigue
  • bradycardia
  • breathlessness
  • cold hands
  • erectile dysfunction
19
Q

Which beta 1 blocker do we need to know about for heart failure?

A
  • bisoprolol
20
Q

What is the principle aim of angina treatment?

A
  • reduce O2 demand
  • increase O2 supply
21
Q

What are the common drugs that are used in combination to treat angina?

A
  • beta 1 blockers (bisoprolol) = ⬇️ inotrophic force and HR
  • Ca2+ channel blockers (diltazem or amalodapine) = ⬇️ SVR
  • GTN = vasodilation of blood vessels
22
Q

What are the effects of glyceryl trinitrates (GTN)?

A
  • vasodilate veins and arteries
  • reduces pre and after load
23
Q

What is the secondary messenger that nitrates are able to activate?

A
  • guanylyl cycllase = increased cGMP
  • reduces Ca2+
  • induces vasodilation
24
Q

What are some of the common side effects of nitrates?

A
  • Headache
  • Hypotension / dizziness
25
Q

What is the mechanism of action of Ca2+ channel blocker?

A
  • inhibit L-type Ca2+ channels
  • reduces Ca2+ and contraction
26
Q

What effects do Ca2+ channel blockers have on the body?

A
  • arterial dilation
  • reduced iontrophic force
  • reduced SA and AV node activation
  • reduce HR
27
Q

What are the 3 Ca2+ channel blockers we need to know about, using DAV?

A
  • D = Diltiazem
  • A = Amolodapine (most commonly used)
  • V = Verapamil
28
Q

What is the most common side effect of Ca2+ channel blockers?

A
  • ankle swelling
  • increased pre capillary pressure
  • more fluid leaves capillaries
29
Q

What are the 3 drugs that are used most commonly together in patients with heart failure?

A
  • ACE-inhibitors (Ramipril) = reduce SVR
  • Beta-blockers (Bisoprolol) = reduce CO
  • Aldosterone antagonists (Spironolactone) = reduce fluid
30
Q

In addition to the 3 common drugs (ACE inhibitor, Beta 1 blocker and aldosterone inhibitors), but some may need other drugs. What others drugs may be used?

A
  • loop diuretcis (furosemide)
  • cardiac glycosides (digoxin)
31
Q

What drugs are commonly given in combination to patients with ischaemic heart disease, following a stent and is stable?

A
  • Antiplatelet drugs (Aspirin, Clopidogrel) = reduce clotting risk
  • ACE-inhibitors (Ramipril) / AR-II blocker (Losartan) = reduced SVR
  • Statin (Atorvastatin) = reduced lipids
32
Q

What drugs are commonly given in combination to patients with angina?

A
  • Beta-blockers (Bisoprolol)
  • Calcium channel blockers (Diltiazem, Amlodipine)
  • Nitrates (GTN spray, Isosorbide mononitrate)