Heart drugs Flashcards
How does digoxin work?
reduces heart rate and increases contractile force
What are the common indications for digoxin?
AF
atrial flutter
heart failure
What are some adverse reactions of digoxin?
bradycardia, rash, GI disturbance, dizziness, visual disturbances
digoxin toxicity = life threatening arrythmias
potassium disturbances
What are some warnings for digoxin?
heart block
ventricular arrythmias
renal failure
What are the important interactions of digoxin?
loop and thiazide diuretics - hypokalaemia increases risk of digoxin toxicity
CCB, amiodarone, spironolactone, quinine - increase chance of digoxin toxicity by increasing plasma conc.
What are the common indications of dalteparin/heparin?
primary prevention (sometimes treatment) of VTE in ACS with antiplatelet agents to reduce clot progressino or maintain revascularisation
What is the mechanism of action of heparin/dalteparin?
enhances anticoagulation of antithrombin (AT inactivates clotting factors).
What are the adverse effects of heparin/dalteparin?
haemorrhage, bruising at injection site
high K+
What are warning for heparin/dalteparin?
clotting disorders, uncontrolled hypertension, recent surgery/trauma, invasive procedures, renal impairment
What are important interactions of dalteparin/heparin?
combining with other antithrombotic drugs
What are common uses of aspirin?
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)
How does aspirin work?
irreversibly inhibits COX which reduces platelet aggregation
What are important adverse effects of aspirin?
GI irritation, peptic ulceration, haemorrhage
bronchospasm (allergic)
tinnitus
overdose - hyperventilation, metabolic acidosis, hearing changes, confusion, cardiac and resp arrest
What are the warnings for aspirin?
not for <16yrs aspirin hypersensitivity third trimester of prenancy gout peptic ulcers
What are important interactions for aspirin?
antiplatelet or anticoagulant drugs
What are common indications of of statins?
primary or secondary prevention of cardiovascular events
primary hyperlipidaemia
What is the mechanism of action of statins?
inhibit HMG CoA - decrease cholestrol production in liver, decrease LDL and indirectly trigger increase in HDL
What are adverse effects of statins?
headache, GI disturbance, muscle (aches, myopathy, rhabdomyolysis), rise in liver enzyme ALT
What are warnings of statins?
hepatic impairment, renal impairment, pregnant/breastfeeding
What are important interactions with statins?
reduced by cytochrome P450 inhibitors (amiodarone, amlodpine etc)
What are the common uses of clopidogrel?
(+aspirin) - treatment of ACS, occlusion of artery stents, secondary prevention of thrombotic arterial events
How does clopidogrel work?
prevent platelet aggregation by binding irreversibly with ADP receptors
What are important adverse effects of clopidogrel?
bleeding
GI upset
thrombocytopenia
What are warnings of clopidogrel?
active bleeding
stop 7 days before surgery (takes longer to stop than NOAC)
renal and hepatic impairment
What are interactions with clopidogrel?
clopidogrel needs cytochrome P450 enzyme so effect is reduced by CYP inhibitors
avoid with other antiplatelet and anticoagulant drugs
What are the common indicators of warfarin?
secondary prevention of VTE
prevent arterial thrombolism in AF
What is the mechanism of action of warfarin?
Inhibits hepatic production of vit K dependant clotting factors - II, VII, IX, X
What are the important adverse affects of warfarin?
bleeding
What are the warnings for warfarin?
haemorrhage e.g. post-surgery
liver disease
pregnancy
What are interactions with warfarin?
Any drug/substance that affects cytochrome P450
antibiotics
What are the indications of a NOAC and what are some examples?
apixiban, rivoroxaban, edoxaban, dabigatran
treatment or prevention of VTE
anti-thrombotic in AF
What is the mechanism of action of NOAC?
inhibit factor X, fibrin, thrombin formation
What are adverse reactions of NOAC?
bleeding, GI bleeding, GI upset, anaemia, dizziness, elevated liver enzymes
What are the warnings for NOAC?
hepatic or renal failure
pregancy, breastfeeding
bleeding
What are the interactions with NOAC?
other anticoagulants
CYP interactions
What are the common indicators of calcium channel blockers and what are some examples?
hypertension, stable angina, supraventricular arrhythmias
amlodopine, verapamil, nifidipine, diltiazem
What is the mechanism of calcium channel blockers?
decrease calcium entry into vascular and cardiac cells - relaxation and vasodilation of arterial smooth muscle = reduce myocardial contractility
What are some adverse reactions of CCB?
ankle swelling, flushing, headache, palpitations, constipation, bradycardia, heart block, cardiac failure
What are some warnings of CCB?
poor left ventricular function, AV nodal problems, unstable angina, severe aortic stenosis
What are some interactions with CCB?
beta blockers
What are indications for loop diuretics and what are some examples?
to treat acute pulmonary oedema, chronic heart failure and other oedemas
What is the mechanism of action of looop diuretics?
acts on loop of Henle to inhibit Na/K/Cl co-transporter to cause diuretic
also causes dilation of capacitance veins which reduces preload
What are some adverse reactions of loop diuretics?
electrolyte disturbance, dehydration, hypotension
hearing loss, tinnitus
What are some warnings for loop diuretics?
hypovolaemia, dehydration
hepatic encephalopathy
hyponatraemia, hypokalaemia
can worsen gout
What are some interactions for loop diuretics?
drugs metabolised by the kindeys - e.g. lithium, digoxin
What are the indications of nitrates?
to treat acute angina and chest pain associated with ACS
prophylaxis of angina
pulmonary oedema
What is the mechanism of action of nitrates?
relaxation of veins = reduction of cardiac preload
What are some adverse reactions of nitrates?
headache, flushing, hypotension, arrythmias, light-headedness, tolerance
What are some warnings of nitrates?
not with severe aortic stenosis or hymodynamic instability (especially hypotension)
What are some interactions with nitrates?
PDE inhibitors e.g. sildenafil
What is the inidication of adenosine?
supraventricular tachycardia
What is the mechanism of action of adenosine?
increases atrioventricular node refractories = breaks re-entry circuit to resume control of heart rate
What are some adverse reactions of adenosine?
bradycardia, asystole
breathlessness
sense of impending doom, sinking feeling
What are some warnings of adenosine?
coronary ischaemia, decompensating heart failure, hypotension. heart transplant
asthma, COPD
What are some important interactions of adenosine?
dipyridamole (antiplatelet) - prolongs affect of amlodipine
theophylline, aminophylline - reduces effect
What are common indications of amiodarone?
tachyarrhythmias
What is mechanism of action of amiodarone?
reduce spontaneous depolarisation, slow conduction velocity
What are adverse effects of amiodarone?
hypotension, bradycardia, AV block hepatitis pneumonitis photosensitivity grey discolouration thyroid abnormalities
What are warnings for amiodarone?
severe hypotension, heart block, active thyroid disease
What are important interactions of amiodarone?
MANY
digoxin, ditiazem, verapamil
What are some examples of ACE-i and how do they work?
ramipril, lisinopril, perindopril
prevent conversion of angiotension I to II - reduces peripheral vascular resistance - lowers BP
What are indications of ACE-i?
hypertension, chronic heart failure, ischaemic heart disease
diabetic neuropathy, CKD with proteinuria
What are important adverse effects of ACE-i?
hypotension DRY COUGH hyperkalaemia renal failure angioedema, anaphylactoid reactions
What are warnings of ACE-i?
renal artery stenosis, AKI, CKD
pregnancy, breastfeeding
What are important interactions of ACE-i?
other potassium-elevating drugs
NSAIDs or other nephrotoxic drugs
What are types of angiotensin receptor blockers and how do they work?
losartan, candesartan, irbesartan
block action of angiotensin II
What are common indications of angiotensin receptor blockers?
hypertension
chronic heart failure, IHD
diabetic neuropathy
CKD with proteinuria
What are adverse reactions of angiotensin receptor blockers?
hypotension
hyperkalaemia
renal failure
What are warnings of angiotensin receptor blockers?
AKI, renal artery stenosis, CKD
pregnancy, breastfeeding
What are important interactions with angiotensin receptor blockers?
other potassium elevating drugs
NSAIDs and other drugs which increase risk of nephrotoxicity
What conditions mean a higher warfarin dose is needed?
alcoholics
hyperthyroidism
What common drug should be avoided in people taking warfarin?
ibuprofen
What electrolyte disturbance increases risk of digoxin activity?
low potassium
What do you need to monitor with digoxin?
renal function
What are examples of antimuscarinics used for cardiovascular and GI, what are they used for and how do they work?
atropine, hyoscine butylbromide, glycopyrronium
to treat bradycardia, IBS, copious respiratory secretions
they increase HR, reduce smooth muscle tone and reduce secretions
What are some warnings and interactions of cardiovascular and GI antimuscarinics
?
angle-closure glaucoma, arrhythmias
don’t prescribe with other antimuscarinics effect drugs
What are some beta blockers, what are they used for and how do they work?
bisoprolol, atenolol, propranolol, metoprolol, carvedilol
used for IHD, CHF, AF, SVT, hypertension
reduce force of contraction, and speed of conduction
What are some adverse effects of beta blockers?
fatigue, cold extremities, headache, GI disturbance, sleep disturbace, nightmares, impotence
What are some warnings and interactions of beta blockers?
don’t give in asthma, haemodynamic instability
caution in heart failure, hepatic failure
caution with calcium channel blockers
What are some thiazide diuretics and what are they used for?
bendroflumethiazide, indapamide, chlortalidone
used for hypertension
What are some adverse reactions of thiazide diuretics?
hyponatraemia, hypokalaemia
cardiac arrhythmias
impotence in men
low glucose
What are some cautions and interactions of thiazide diuretics?
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
What are some fibrinolytic drugs, what are they used for and how do they work?
alteplase, streptokinase
acute ischaemia stroke, acute STEMI, massive PE
they dissolve fibrinous clots
What are some adverse effects of fibrinoytic drugs?
nausea, vomiting, bruising, hypotension
serious bleeding, allergic reaction, cardiogenic shock, cardaic arrest
cerebral oedema, arrhythmia
What are some warnings and interactions with fibrinolytic drugs?
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
