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Medicine - Year 2 > Heart and Lung pharmacology > Flashcards

Heart and Lung pharmacology Flashcards

1
Q

What 4 drugs are used for treatment of a NSTEMI?

What do they work on?

A

Anti platelet (for a thrombus)
LMWH (for a thrombus)
Statin (for cholesterol plaques)
Beta blocker/nitrates (anti-ischaemic)

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2
Q

Give 2 examples of anti-platelets

A

Clopidogrel

Aspirin

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3
Q

Give 3 non-pharmacological treatments of a STEMI

Give 2 pharmacological treatments

A
  • PCI (primary percutaneous coronary intervention)
  • Thrombolysis
  • Angioplasty (place a stent through the radial artery or/and suck clots out)

Aggressive anti thrombotic and anti platelet

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4
Q

3 treatments for heart block

A

Atropine: Stimulates AVN (not in cardiac transplant)
Isoprenaline: B1 agonist like adrenaline
Pacemaker

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5
Q

How do you treat digoxin toxicity?

What disease process is this relevant to?

A

Digoxin specific antibody fragments

Heart block

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6
Q

How do you treat beta blocker/calcium toxicity?

What disease process is this relevant to?

A

Glucagon

Heart block

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7
Q

Pharmacological treatments for atrial fibrillation (3)

Examples

A

Ventricular rate control (B blockers, digoxin, verapamil)
Antithrombotics (warfarin or NOAC - not aspirin)
Anticoagulation in those who benefit (risky peeps)

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8
Q 
Give 3 examples of class 1 anti-arrhythmic drugs
What class of drugs are they?
What phase do they work on?
A

a. Disopyramine
b. Lidocaine
c. Flecadinine

Na channel blocker
Works on phase 0

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9
Q

What effect does Disopyramide have on the heart’s electrical activity?
What is its clinical use?

A

Increases AP duration

SVT/VT

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10
Q

What effect does Lidocaine have on the heart’s electrical activity?
What is its clinical use?

A

Decreases AP duration

VT

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11
Q

What effect does Flecadinine have on the heart’s electrical activity?
What is its clinical use?

A

No effect on AP duration

SVT/VT

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12
Q 
Give 2 examples of class 2 anti-arrhythmic drugs
What class of drugs are they?
What phase do they work on?
A

Atenolol, Sotalol

Beta blockers
Works on phase 4

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13
Q

Explain the MOA of beta blockers

A

Block SAN and block sympathetic activation to reduce ventricular contractility and slow heart rate
Also improves myocardial oxygen demand:supply ratio
Negative chronotropic and inotropic

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14
Q

What is the clinical use of beta blockers? (5 e.g.)

A

SVT

Arrhythmia’s, hypertension, stable heart failure, ischaemic heart disease, reduce mortality after MI

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15
Q

7 side effects of beta blockers

A

Bronchospasm, Can worsen heart failure, Cold extremities, Fatigue, Impotence, Nightmares, Wheeze

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16
Q

5 contraindications of beta blockers

A

Asthma (B2), AV block, Carconogenic shock, Hypotension, PVD, Untreated phaeochromocytoma

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17
Q

Give 2 examples of class 3 anti-arrhythmic drugs

What class of drugs are they?
What phase do they work on?
What do they do to the electrical activity of the heart?
2 clinical uses
A

Amiodarone, Sotalol

Potassium channel blocker
Works on phase 3
Increased AP duration and refractory period
SVT/VT

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18
Q

7 side effects of Amiodarone

A 
Abnormal cardiac rhythm
Blue-grey skin discolouration
Corneal microdeposits 
Hypo/hyper thyroidism (contains iodine)
Lung fibrosis
Photosensivity reactions
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19
Q

Pharmacokinetics of amiodarone

  • How long does it take to work?
  • Vd and t1/2
A

Takes a week to work

High Vd and half life (lipid soluble)

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20
Q

When is Lidocaine used?

A

When amiodarone is contraindicated/ineffective

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21
Q 
Give 4 examples of class 4 anti-arrhythmic drugs
What class of drugs are they?
What phase do they work on?
A

Verapamil, Diltiazem, Amlodipine, Nifedipine

Calcium channel blocker
Works on phase 2

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22
Q

Explain the mechanism of action of calcium channel blockers

A

Reduces ventricle contraction, dilates vessels and reduces myocardial oxygen demand
Block AVN and SAN

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23
Q

What is the clinical use of calcium channel blockers?

A

SVT

Hypertension, Angina, Arrhythmia

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24
Q

8 side effects of calcium channel blockers

A

ankle oedema, increased appetite, drowsy, flushed, gastro-oesophageal reflux, reduced blood pressure, reduced heart rate, lightheaded

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25
Q

4 contraindications of calcium channel blockers

A

Carcinogenic shock, Moderate/severe heart failure, Pregnancy, Severe bradycardia

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26
Q

What are the 4 anti-arrhythmic drugs not included in the V-W classification?

A

Adenosine
Digoxin
Magenium
Atropine

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27
Q

What is the MOA of Adenosine?

  • What effect does it have on electrical action?
  • What is its clinical use?
A

Potassium channel activation
Slows AVN and pacemaker conduction
SVT

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28
Q

Explain the MOA of digoxin

What is its effect on the electrical activity of the heart?

A

Blocks the Na/K pump to reduce Na into mysoctes
This increases N/Ca pump to increase Na in and Ca out of myocytes
Reduce heart contractility (positive inotropic effect)

Also blocks the AVN

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29
Q

3 clinical uses of digoxin

A

AF, Atrial flutter and end stage congestive heart failure

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30
Q

What is the MOA of Magnesium?

- What is its clinical use?

A

Calcium channel blocker

VF and digoxin toxicity

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31
Q

What is the MOA of Atropine?

  • What effect does it have on electrical action?
  • What is its clinical use?
A

Antimuscarinic
Increases SAN and AVN conduction
Bradycardia

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32
Q

Pharmacokinetics of digoxin

  • Therapeutic index
  • Loading dose
  • Vd and t1/2
A

Small therapeutic index but needs a high loading dose

Has a large vD and half life

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33
Q

6 side effects of digoxin

2 cautions

A
  • Arrhythmia
  • Alter electrolytes (caution)
  • CNS (confusion, nightmares, agitation)
  • GI effects
  • Renal toxicity (not metabolised) (caution with CKD)
  • Yellow and blurred vision
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34
Q

3 drugs which digoxin interacts with

A

Amoidarone and Verapamil (increase digoxin levels)

Diuretics (reduce Na and Mg)

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35
Q

What are the 4 drugs used to treat hypertension?

A

ACEi
Beta blockers
Ca antagonists
Diuretics

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36
Q

What are the 2 classes of calcium antagonists?

A

Dihydropyridines

Non-hydropyridines

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37
Q

2 examples of dihydropyridines
What is their MOA?
What drug do you combine them with?

A

Amlodipine and Nifedipine
Vasodilation and smooth muscle contraction
Use with a beta blocker

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38
Q

2 examples of non-hydropyridines
What is their MOA?
What are they also useful to treat

A

Verapamil and Diltiazem
Slow heart rate
(Angina)

39
Q

4 side effects of dihydropyridines

A

Ankle oedema, flushing, tachycardia, worse angina

40
Q

What is the MOA of Monoxiail?

What drugs do you combine it with?

A

Opens potassium channels causing vasodilation
Reduces peripheral resistance causing increased CO and fluid retention
MUST use with a diuretic/beta blocker

41
Q

What is the MOA of alpha blockers?
What are they used to treat?
Example

A

Block A1 receptors > sympathetic vasoconstriction
Treats hypotension
e.g. Doxazoin

42
Q

What is the MOA of clonidine/methylDOPA?
What is it used to treat?
2 side effects

A

Stimulate A1 receptors > reduced sympathetic outflow
Treats hypertension
Sedation and dry mouth

43
Q

What are the 5 drugs which can be used in the treatment of pulmonary oedema?

A 
Diamorphine
Oxygen
Diuretic
IV nitrate
Dobutamine
44
Q

Why do you give diamorphine?

A

Reduces anxiety and vasodilates

45
Q

Why do you need to keep increasing the dose of IV nitrate?

A

Patients become pharmacologically tolerant very quickly

46
Q

Why is dobutamine given?

When is it given?

A

Inotropic support

Only if the patient is in shock as can > arrhythmias

47
Q

What are the 2 potassium sparing diuretics?

How do they work?

A

Amiloride: Blocks Na/K exchanger (old)
Spironolactone: Mineralocorticoid receptor antagonist blocking aldosterone

48
Q

3 examples of thiazide diuretics
What is their MOA?
2 ‘problems’

A

Bendrofluazine, Metolazone, Chlorthialidone
Blocks Na/Cl transporter in DCT
Metabolically upsetting to ions and low ceiling (reduced dose = same effect)

49
Q

3 examples of loop diuretics
What is their MOA?
2 ‘problems’

A

Furosemide, Bumetanide, Torasemide
Block Na/K/Cl cotransporter in ascending LoH
Metabolically upsetting to ions and high ceiling (increased dose = increased effect)

50
Q

What are the 5 classes of drugs used in chronic heart failure treatment?

A
  1. Diuretics
  2. ACE inhibitors
  3. Mineralocorticoid receptor antagonists
  4. ARB blockers
  5. Beta blockers
51
Q

Positive and negative for diuretics

A

Improve symptoms but not prognosis

52
Q

Define euvolemic

A

Fluid balance

53
Q

Which ACEi is used in chronic heart failure?

A

Enalapril

54
Q

Explain ACE escape

A

ACE is not the only enzyme which converts ANG 1 > ANG 2

55
Q

7 effects of ANG

A

Aldosterone, Efferent arteriole constriction, Myocardial hypertrophy, Na retention, Thirst, Vasoconstrict, Vessel hypertrophy,

56
Q

3 effects of ACEi

A

Vasodilate, Na excretion, Increase kinins

57
Q

6 side effects of ACEi

A

Angio-oedema, Cough, Hypotension, Increased K and creatinine, Rash, Reduced Hb, Renal artery stenosis

58
Q

Which clinical trial showed ACEi benefit?

A

Consensus

59
Q

What do you need to monitor when using ACEi?

A

Potassium

60
Q

What is the MOA of mineralocorticoid receptor antagonists?

Why are they needed?

A

Block aldosterone

Not fully supresssed by ACEi due to ACE escape

61
Q

Give 2 examples of mineralocorticoid receptor antagonists
Which is selective/non-selective?
2 side effects?

A

Spironolactone: non-selective (inreased K and testosrerone)
Eplerenone: selective

62
Q

Give 3 examples of ARB Blockers

What is their MOA?

A

Losartan, Valsartan, Candesartan

Angiotension receptor blocker

63
Q

Explain the advantages (2) and disadvantages (3) of ARB blockers

A

Advantages:

  • Overcome ACE escape
  • No cough

Disadvantages:

  • Same effects on renal function
  • No effect on mortality (but decreases hospital admissions)
  • ACE breaks down kinins so blocking ACE increases kinins > vasodilation (good for heart failure) - ARB’s miss this
64
Q

What is ISA and why is it bad for heart failure?

A

Intrinsic symathomimetic activity

Stimulates sympathetic activity before blocking

65
Q

Give 5 examples of beta blockers without ISA

Which are selective and which are non-selective?

A

Atenolol, Bisprolol, Metoprolol (selective)

Timolol, Pronanolol (non-selective)

66
Q

Give 2 examples of alpha blocking beta antagonists

A

Carvedilol

Lavetolol

67
Q

What is the MOA of Ivabradine

Who is the drug prescribed in?

A

Blocks the SAN pacemarker current to reduce blood pressure

Used in patients with a heart rate above 70bpm despite a maximum dose of beta blockers

68
Q

What is the MOA of Sacubitril and Valsartan?

A

Sacubitril is an NEP inhibitor (breaks down naturietic peptides to increase sodium and water levels)
Vlasartan is an angiotensin receptor blocker

69
Q

What is the MOA of Candozatril?

Is it still used?

A

Blocked NEP but NEP also breaks own ANG2 so levels increased

Early drug - didn’t work

70
Q

What is the MOA of Omapatrilat?

Is it still used?

A

Blocks ACEi and NEP but increases kinins

Early drug

71
Q

What does digoxin do to the starling curve?

A

Moves it up and to the left

72
Q

What effect does digoxin have on the carotid sinus?

A

Sympathetic and vagotonic

  • reduces heart rate
  • reduces AVN conduction
73
Q

What 4 drugs should you avoid when treating chronic heart failure?

A

Ca antagnists
Positive inotrops e.g. digoxin (unless end stage)
Anti-arrhythmic’s
Variable evidence on statins and aspirin

74
Q

Give 3 examples of new heart failure drugs

A

AVP antagonists
Calcium sensitisers
Nesiritide

75
Q

What drugs are used to treat cancers with an ALK or ROS1 mutation?
What is the suffix for the drug?

A

Translocation inhibitors

e.g. nib

76
Q

What drugs are used to treat cancers with a PD1/PDL1 antigen on the Tcell/tumour?
What is the suffix for the drug?

A

Monoclonal antibodies

e.g. mab

77
Q

2 examples of antibiotics used to treat mycoplasma pneumoniae infection

A

Macrolide and Tetracycline

78
Q

2 examples of antibiotics used to treat legionella pneumophilia infection

A

Macrolide and Quinolone

79
Q

What antibiotics do you usually use to treat HAP?

A

Macrolide

80
Q

What is the MOA of Rifampicin?

A

Inhibits RNA synthesis

81
Q

What is the MOA of Isoiazid?

A

Inhibits cell wall synthesis

82
Q

What is the MOA of Pyrazinamide?

A

Disrupts plasma membrane and energy metabolism

83
Q

What is the MOA of Ethambutole?

A

Inhibits cell wall synthesis

84
Q

What is the TB treatment schedule?

A

All (+/-) E for 2 months

Then R and I for 4 months

85
Q

What drug is given as a supplement when starting on TB medication?

A

Pyridoxine

86
Q

What are the new drugs given towards asthma

A

Monoclonal antibodies against IL5 to switch off eosinophils

e.g. ‘-zumab’

87
Q

Give 2 drugs used for the management of IPF

A

Anti fibrotic medication e.g. Pirfenidone

Tyrosine kinase inhibitors e.g. Nintedanib

88
Q

What drug can be used to reduce breathlesness?

A

Opiates

89
Q

What is the MOA of beta agonists?

A

Reverse bronchoconstriction

90
Q

What is the MOA of steroids in the lungs?

A

Increase B2 receptor synthesis to suppress cytokines

91
Q

What is the MOA of montelukast?

Is it more or less effective than steroids?

A

Leukotrine receptor antagonist
Blocks bronchoconstriction
Less effective than steroids

92
Q

Give 2 examples of LABA

A

Formeterol

Salmeterol

93
Q

What is the MOA of theophylline?

What other disease can it be used to treat?

A

Bronchodilator and immune modulator

Treatment of heart block in MI, transplant, spinal injury

94
Q

Give 3 drugs used to treat COPD

What is their MOA?

A

Salbutamol and Ipatropium (short acting bronchodilators)

Tiotropium (long acting bronchodilator

Medicine - Year 2 (19 decks)

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