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PSA questions > Heart drugs > Flashcards

Heart drugs Flashcards

1
Q

How does digoxin work?

A

reduces heart rate and increases contractile force

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2
Q

What are the common indications for digoxin?

A

AF
atrial flutter
heart failure

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3
Q

What are some adverse reactions of digoxin?

A

bradycardia, rash, GI disturbance, dizziness, visual disturbances
digoxin toxicity = life threatening arrythmias
potassium disturbances

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4
Q

What are some warnings for digoxin?

A

heart block
ventricular arrythmias
renal failure

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5
Q

What are the important interactions of digoxin?

A

loop and thiazide diuretics - hypokalaemia increases risk of digoxin toxicity
CCB, amiodarone, spironolactone, quinine - increase chance of digoxin toxicity by increasing plasma conc.

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6
Q

What are the common indications of dalteparin/heparin?

A 
primary prevention (sometimes treatment) of VTE
in ACS with antiplatelet agents to reduce clot progressino or maintain revascularisation
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7
Q

What is the mechanism of action of heparin/dalteparin?

A

enhances anticoagulation of antithrombin (AT inactivates clotting factors).

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8
Q

What are the adverse effects of heparin/dalteparin?

A

haemorrhage, bruising at injection site

high K+

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9
Q

What are warning for heparin/dalteparin?

A

clotting disorders, uncontrolled hypertension, recent surgery/trauma, invasive procedures, renal impairment

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10
Q

What are important interactions of dalteparin/heparin?

A

combining with other antithrombotic drugs

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11
Q

What are common uses of aspirin?

A

treatment of acute coronary syndrome
long term secondary prevention of thrombotic arterial event
(used to be used to treat pain and fever but now NSAIDs)

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12
Q

How does aspirin work?

A

irreversibly inhibits COX which reduces platelet aggregation

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13
Q

What are important adverse effects of aspirin?

A

GI irritation, peptic ulceration, haemorrhage
bronchospasm (allergic)
tinnitus
overdose - hyperventilation, metabolic acidosis, hearing changes, confusion, cardiac and resp arrest

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14
Q

What are the warnings for aspirin?

A 
not for <16yrs 
aspirin hypersensitivity
third trimester of prenancy 
gout 
peptic ulcers
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15
Q

What are important interactions for aspirin?

A

antiplatelet or anticoagulant drugs

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16
Q

What are common indications of of statins?

A

primary or secondary prevention of cardiovascular events

primary hyperlipidaemia

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17
Q

What is the mechanism of action of statins?

A

inhibit HMG CoA - decrease cholestrol production in liver, decrease LDL and indirectly trigger increase in HDL

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18
Q

What are adverse effects of statins?

A

headache, GI disturbance, muscle (aches, myopathy, rhabdomyolysis), rise in liver enzyme ALT

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19
Q

What are warnings of statins?

A

hepatic impairment, renal impairment, pregnant/breastfeeding

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20
Q

What are important interactions with statins?

A

reduced by cytochrome P450 inhibitors (amiodarone, amlodpine etc)

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21
Q

What are the common uses of clopidogrel?

A

(+aspirin) - treatment of ACS, occlusion of artery stents, secondary prevention of thrombotic arterial events

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22
Q

How does clopidogrel work?

A

prevent platelet aggregation by binding irreversibly with ADP receptors

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23
Q

What are important adverse effects of clopidogrel?

A

bleeding
GI upset
thrombocytopenia

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24
Q

What are warnings of clopidogrel?

A

active bleeding
stop 7 days before surgery (takes longer to stop than NOAC)
renal and hepatic impairment

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25
Q

What are interactions with clopidogrel?

A

clopidogrel needs cytochrome P450 enzyme so effect is reduced by CYP inhibitors
avoid with other antiplatelet and anticoagulant drugs

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26
Q

What are the common indicators of warfarin?

A

secondary prevention of VTE

prevent arterial thrombolism in AF

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27
Q

What is the mechanism of action of warfarin?

A

Inhibits hepatic production of vit K dependant clotting factors - II, VII, IX, X

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28
Q

What are the important adverse affects of warfarin?

A

bleeding

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29
Q

What are the warnings for warfarin?

A

haemorrhage e.g. post-surgery
liver disease
pregnancy

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30
Q

What are interactions with warfarin?

A

Any drug/substance that affects cytochrome P450

antibiotics

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31
Q

What are the indications of a NOAC and what are some examples?

A

apixiban, rivoroxaban, edoxaban, dabigatran
treatment or prevention of VTE
anti-thrombotic in AF

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32
Q

What is the mechanism of action of NOAC?

A

inhibit factor X, fibrin, thrombin formation

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33
Q

What are adverse reactions of NOAC?

A

bleeding, GI bleeding, GI upset, anaemia, dizziness, elevated liver enzymes

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34
Q

What are the warnings for NOAC?

A

hepatic or renal failure
pregancy, breastfeeding
bleeding

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35
Q

What are the interactions with NOAC?

A

other anticoagulants

CYP interactions

36
Q

What are the common indicators of calcium channel blockers and what are some examples?

A

hypertension, stable angina, supraventricular arrhythmias

amlodopine, verapamil, nifidipine, diltiazem

37
Q

What is the mechanism of calcium channel blockers?

A

decrease calcium entry into vascular and cardiac cells - relaxation and vasodilation of arterial smooth muscle = reduce myocardial contractility

38
Q

What are some adverse reactions of CCB?

A

ankle swelling, flushing, headache, palpitations, constipation, bradycardia, heart block, cardiac failure

39
Q

What are some warnings of CCB?

A

poor left ventricular function, AV nodal problems, unstable angina, severe aortic stenosis

40
Q

What are some interactions with CCB?

A

beta blockers

41
Q

What are indications for loop diuretics and what are some examples?

A

to treat acute pulmonary oedema, chronic heart failure and other oedemas

42
Q

What is the mechanism of action of looop diuretics?

A

acts on loop of Henle to inhibit Na/K/Cl co-transporter to cause diuretic
also causes dilation of capacitance veins which reduces preload

43
Q

What are some adverse reactions of loop diuretics?

A

electrolyte disturbance, dehydration, hypotension

hearing loss, tinnitus

44
Q

What are some warnings for loop diuretics?

A

hypovolaemia, dehydration
hepatic encephalopathy
hyponatraemia, hypokalaemia
can worsen gout

45
Q

What are some interactions for loop diuretics?

A

drugs metabolised by the kindeys - e.g. lithium, digoxin

46
Q

What are the indications of nitrates?

A

to treat acute angina and chest pain associated with ACS
prophylaxis of angina
pulmonary oedema

47
Q

What is the mechanism of action of nitrates?

A

relaxation of veins = reduction of cardiac preload

48
Q

What are some adverse reactions of nitrates?

A

headache, flushing, hypotension, arrythmias, light-headedness, tolerance

49
Q

What are some warnings of nitrates?

A

not with severe aortic stenosis or hymodynamic instability (especially hypotension)

50
Q

What are some interactions with nitrates?

A

PDE inhibitors e.g. sildenafil

51
Q

What is the inidication of adenosine?

A

supraventricular tachycardia

52
Q

What is the mechanism of action of adenosine?

A

increases atrioventricular node refractories = breaks re-entry circuit to resume control of heart rate

53
Q

What are some adverse reactions of adenosine?

A

bradycardia, asystole
breathlessness
sense of impending doom, sinking feeling

54
Q

What are some warnings of adenosine?

A

coronary ischaemia, decompensating heart failure, hypotension. heart transplant
asthma, COPD

55
Q

What are some important interactions of adenosine?

A

dipyridamole (antiplatelet) - prolongs affect of amlodipine

theophylline, aminophylline - reduces effect

56
Q

What are common indications of amiodarone?

A

tachyarrhythmias

57
Q

What is mechanism of action of amiodarone?

A

reduce spontaneous depolarisation, slow conduction velocity

58
Q

What are adverse effects of amiodarone?

A 
hypotension, bradycardia, AV block
hepatitis 
pneumonitis 
photosensitivity
grey discolouration 
thyroid abnormalities
59
Q

What are warnings for amiodarone?

A

severe hypotension, heart block, active thyroid disease

60
Q

What are important interactions of amiodarone?

A

MANY

digoxin, ditiazem, verapamil

61
Q

What are some examples of ACE-i and how do they work?

A

ramipril, lisinopril, perindopril

prevent conversion of angiotension I to II - reduces peripheral vascular resistance - lowers BP

62
Q

What are indications of ACE-i?

A

hypertension, chronic heart failure, ischaemic heart disease

diabetic neuropathy, CKD with proteinuria

63
Q

What are important adverse effects of ACE-i?

A 
hypotension
DRY COUGH 
hyperkalaemia
renal failure 
angioedema, anaphylactoid reactions
64
Q

What are warnings of ACE-i?

A

renal artery stenosis, AKI, CKD

pregnancy, breastfeeding

65
Q

What are important interactions of ACE-i?

A

other potassium-elevating drugs

NSAIDs or other nephrotoxic drugs

66
Q

What are types of angiotensin receptor blockers and how do they work?

A

losartan, candesartan, irbesartan

block action of angiotensin II

67
Q

What are common indications of angiotensin receptor blockers?

A

hypertension
chronic heart failure, IHD
diabetic neuropathy
CKD with proteinuria

68
Q

What are adverse reactions of angiotensin receptor blockers?

A

hypotension
hyperkalaemia
renal failure

69
Q

What are warnings of angiotensin receptor blockers?

A

AKI, renal artery stenosis, CKD

pregnancy, breastfeeding

70
Q

What are important interactions with angiotensin receptor blockers?

A

other potassium elevating drugs

NSAIDs and other drugs which increase risk of nephrotoxicity

71
Q

What conditions mean a higher warfarin dose is needed?

A

alcoholics

hyperthyroidism

72
Q

What common drug should be avoided in people taking warfarin?

A

ibuprofen

73
Q

What electrolyte disturbance increases risk of digoxin activity?

A

low potassium

74
Q

What do you need to monitor with digoxin?

A

renal function

75
Q

What are examples of antimuscarinics used for cardiovascular and GI, what are they used for and how do they work?

A

atropine, hyoscine butylbromide, glycopyrronium
to treat bradycardia, IBS, copious respiratory secretions
they increase HR, reduce smooth muscle tone and reduce secretions

76
Q

What are some warnings and interactions of cardiovascular and GI antimuscarinics
?

A

angle-closure glaucoma, arrhythmias

don’t prescribe with other antimuscarinics effect drugs

77
Q

What are some beta blockers, what are they used for and how do they work?

A

bisoprolol, atenolol, propranolol, metoprolol, carvedilol
used for IHD, CHF, AF, SVT, hypertension
reduce force of contraction, and speed of conduction

78
Q

What are some adverse effects of beta blockers?

A

fatigue, cold extremities, headache, GI disturbance, sleep disturbace, nightmares, impotence

79
Q

What are some warnings and interactions of beta blockers?

A

don’t give in asthma, haemodynamic instability
caution in heart failure, hepatic failure
caution with calcium channel blockers

80
Q

What are some thiazide diuretics and what are they used for?

A

bendroflumethiazide, indapamide, chlortalidone

used for hypertension

81
Q

What are some adverse reactions of thiazide diuretics?

A

hyponatraemia, hypokalaemia
cardiac arrhythmias
impotence in men
low glucose

82
Q

What are some cautions and interactions of thiazide diuretics?

A

warnings - hypokalaemia and hyponatraemia
reduce uric acid excretion so can trigger attacks of gout
interactions - NSAIDs can reduce effectiveness, other drugs that lower Na or K

83
Q

What are some fibrinolytic drugs, what are they used for and how do they work?

A

alteplase, streptokinase
acute ischaemia stroke, acute STEMI, massive PE
they dissolve fibrinous clots

84
Q

What are some adverse effects of fibrinoytic drugs?

A

nausea, vomiting, bruising, hypotension
serious bleeding, allergic reaction, cardiogenic shock, cardaic arrest
cerebral oedema, arrhythmia

85
Q

What are some warnings and interactions with fibrinolytic drugs?

A

don’t give if predisoposed to bleeding, haven’t excluded intracranial haemorrhge, have had streptokinase treatment
Interactions - anticoagulants, antiplatelets, ACE-i increase risk of antiphylaxis

PSA questions (14 decks)

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