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Cardiology > Drugs > Flashcards

Drugs Flashcards

1
Q

How do organic nitrates work? Give two examples

A

Relax all types of smooth muscle

  • Glyceryltrinitrate (short acting)
  • Isosorbide mononitrate (long acting)
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2
Q

How is GTN given?

A

Sublingual - tablet or spray in stable angina

IV in unstable angina/MI

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3
Q

How is ISMN given?

A

Orally for prophylaxis of angina

- take in morning and at lunch in order to have ‘nitrate low period’ for rest of day to avoid tolerance

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4
Q

What are some side effects of nitrates?

A 
Headaches
Hypotension and fainting
Reflex tachycardia (co-administer beta-blocker)
Tolerance
Formation of methaemoglobin (rare)
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5
Q

How do CCBs work?

A

Block Ca entry into cells, therefore reducing muscle contraction
Act on L-type Ca channels found in heart, smooth muscle and other locations

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6
Q

Which conditions are CCBs used in?

A

Hypertension
Stable angina
HR control in supra ventricular arrhythmias

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7
Q

Give 3 examples of CCBs and what is their selectivity for different channels?

A

Verapamil –> relatively selective for cardiac channels
Diltiazem –> intermediate selectivity
Amlodipine –> relatively selective for smooth muscle

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8
Q

Which CCBs are preferred for use in hypertension and angina, and why?

A

Drugs selective for smooth muscle
e.g. Amlodipine and nifedipine
To minimise unwanted cardiac effects

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9
Q

In which cardiac conditions should CCBs be avoided/stopped?

A

Heart failure

Heart block

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10
Q

Having which two conditions concurrently makes CCBs particularly useful?

A

Hypertension and angina

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11
Q

What are the side effects of CCBs?

A

hypotension
dizziness
flushing
ankle oedema

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12
Q

How do CCBs help in supraventricular arrhythmias? Which CCB is usually used?

A

Suppress conduction through the AV node

Verapamil

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13
Q

What is angiotensin converting enzyme (ACE) and what effects does it have?

A

Enzyme on surface on endothelial cells

  • converts angiotensin I to angiotensin II –> vasoconstriction
  • inactivates bradykinin (vasodilator)
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14
Q

What is the mode of action of ACE inhibitors?

A

Block conversion of angiotensin I to angiotensin II

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15
Q

What is the mode of action of angiotensin receptor blockers (ARBs)?

A

Block action of angiotensin II

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16
Q

What are some side effects of ACE inhibitors?

A 
Initial hypotension (especially if taking diuretics)
Dry cough (bradykinin in the lungs)
Hyperkalaemia
Angioedema
Renal dysfunction
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17
Q

What are some side effects of ARBs?

A

Same as ACE inhibitors but
NO DRY COUGH
–> as no effect on bradykinin

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18
Q

Can ACE inhibitors or ARBs be given in pregnancy?

A

NO –> foetal toxicity

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19
Q

Can ACE inhibitors/ARBs be used in renal disease?

A

Should not be used in bilateral renal artery stenosis
BUT
ACE inhibitors good in diabetic nephropathy

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20
Q

What are the clinical uses of ACE inhibitors and ARBs?

A

Hypertension
Heart failure
Post MI

21
Q

Give some examples of beta-blockers used in CVD and why?

A

Atenolol, bisoprolol

–> cardioselective (Beta-1 adrenoceptors)

22
Q

Give some examples of non-selective beta-blockers and their use?

A

Propranolol, carvedilol

–> thyrotoxicosis, migraine

23
Q

What are some side effects of beta-blockers?

A

Bronchospasm –> CI in severe asthma/COPD
Can worsen HR in the short term
Fatigue
Cold peripheries

24
Q

Give two examples of potassium channel openers and their uses:

A

Nicorandil:
- used in angina refractory to other treatments

Minoxidil:
- last resort in severe hypertension but causes
reflex tachycardia (prevented by beta blocker)
salt and water retention (alleviated by diuretic)

25
Q

Give two examples of alpha blockers:

A

Prazosin

Doxazosin

26
Q

What are the clinical uses of alpha blockers?

A

Resistant hypertension

Symptomatic relief in BPH

27
Q

Which group of patients are alpha blockers particularly useful in?

A

Patients with hypertension AND benign prostatic hyperplasia (BPH)

28
Q

Give some examples of beta-adrenoceptor agonists

A

Dobutamine
Adrenaline
Noradrenaline
(catecholamines)

29
Q

What are the clinical uses of adrenaline?

A 
Cardiac arrest (IV)
Anaphylactic shock (IM)
30
Q

What are the clinical uses of dobutamine?

A

Acute but potentially reversible HF

e.g. following cardiac surgery, cardiogenic or septic shock

31
Q

Name some selective and non-selective beta-blockers

A

Non-selective –> propranolol

Selective –> atenolol, bisoprolol, metoprolol

32
Q

What are the clinical uses of beta-blockers?

A

Arrhythmias (reduce sympathetic drive, delay AVN conduction)
Angina (alternative to CCBs)
HF (compensated) - low dose to improve morbidity and mortality
Hypertension (no longer first line)

33
Q

What are the adverse effects of beta-blockers?

A

Bronchospasm
Aggravation of HF (can be used low dose in compensated HF)
Bradycardia
Hypoglycaemia in patients with poorly controlled DM
Fatigue
Cold extremities

34
Q

What is atropine and how does it work?

A

Non selective muscarinic ACh receptor antagonist

–> blocks parasympathetics so increases HR

35
Q

What are the clinical uses of atropine?

A

Severe or symptomatic bradycardia (first line)
- glycopyrronium is an alternative

Anticholinesterase poisoning

36
Q

What are the clinical uses of digoxin?

A

Heart failure –> increases cardiac contractility
AF –> rate control

Particularly useful in HF + AF

37
Q

Which electrolyte imbalance can dangerously enhance the effects of digoxin?

A

Hypokalaemia

38
Q

What are some of the adverse effects of digoxin?

A 
Heart block
Propensity to cause arrhythmias
Nausea and vomiting
Diarrhoea
Disturbance of colour vision
39
Q

Which AADs are used for rate control?

A

Class II e.g. propranolol, atenolol (beta-blockers)

Class IV e.g. verapamil, diltiazem (CCBs)

40
Q

Which AADs are used for rhythm control?

A

Class I e.g. flecainide, propafenone, lignocaine, quinidine

Class III e.g. amiodarone, sotalol, dronedarone

41
Q

Which anti-arrhythmic drugs are only used in supra ventricular arrhythmias?

A

Adenosine
Digoxin
Verapamil

42
Q

What is the clinical use of adenosine?

A

To terminate paroxysmal SVT

43
Q

What is the anti arrhythmic use of digoxin?

A

Rate control in AF

44
Q

What are the anti arrhythmic uses of verapamil?

A

AF and atrial flutter

45
Q

What is the clinical use of lignocaine?

A

Treatment of ventricular arrhythmias post MI

46
Q

What is the clinical use of flecainide?

A

Prophylaxis of paroxysmal AF

47
Q

What is the clinical use of amiodarone?

A

Pharmacological cardioversion in SVT and VT

48
Q

What are the adverse effects of amiodarone?

A

Pulmonary fibrosis
Thyroid disorders
Photosensitivity reactions
Peripheral neuropathy

Cardiology (14 decks)

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