Heart stuff Flashcards
Beta blocker:
- example
- mech action
- indication
- se
- contraind
- overdose: symptoms + mx
- example: bisoprolol
- mech action: class 2 rate control. antagonises on beta adrenoreceptors on heart decreasing hr + contractibility
- indication: HF, AF, migraine prophylaxis, anxiety
- se: bronchospasm, hypotension, ed, insommnia, cold peripheries
- contraind: asthma, non dihydropyridine ccb (asystole), bradycardia
- overdose: bradyc, hypotension, hf, syncope - atropine, glucagon if doesn’t work
Loop diuretics:
- example
- mech action
- indication
- se
- contraind
- example: furosemide
- mech action: inhibits nak2cl on thick ascending dec na hence h2o reab
- indication: oedema hf, resistant htn
- se: ototoxicity, hyponat/kal, hypotension, hypochlor alk, gout
- contraind: digoxin, renal failure
aldosterone rec antagonist:
- example
- mech action
- indication
- se
- example: spironolactone
- mech action: inhibits enac exp hence dec na/h20 reab and romk
- indication: hf, resistant htn, ascites
- se: hyperkal, gynaecomastia, addisons
aspirin:
- mech action
- indication
- se
- contraind
- mech action: cox1 inhibitor dec platelet aggregation via dec formation thromboaxane 2 + pgi2
- indication: acs, stroke/tia
- se: gi upset (ppi), renal failure, bronchospasm
- contraind: children (reyes), t3 preg, peptic ulcer, bleeding disorders
ADP rec antagonist:
- example
- mech action
- indication
- se
- contraind
- example: clopidogrel, pragusrel, tricagrelor
- mech action: inhibits p2y12 rec therefore inhibits gp11b/111a dec platelet activation hence aggregation
- indication: acs, stroke/tia
- se: diarrhea when starting, bleeding, gi upset, thrombocytopenia
- contraind: ppis omeprazole (cyp inhib)
discontinue 7 days before surgery
streptokinase/ altepase:
- mech action
- indication
- cont
- mech action: thrombolysis - breaks down plasminogen to plasmin which breaks down fibrin
- indication: pe, acs, stroke
- cont: pancreatitis, aneurysm, aortic dissection
Synthetic lmwh:
- example
- mech action
- indication
- se
- contraind
- example: fondaparinux
- mech action: inhibits antithrombin 3 hence factor xa decreasing the clotting cascade
- indication: stemi/nstemi
- se: anaemia, haemorrhage
- contraind: bleeding, endocarditis
Digoxin:
- class + mech action
- indications
- toxicity symptoms
- precipitating factors
- mx
Digoxin:
- class + mech action: cardiac glycoside - decreases conduction through AVN slowing ventricular rate, also inhibit nakatpase pump inc force cardiac muscle. Measure 6 hours after dose
- indications: rate control in AF, arrhythmias in HF
- toxicity symptoms (narrow therapeutic index): unwell, lethargy, n+v, anorexia, confusion, yellow-green vision, arrhythmias (av block, bradyc), gynaecomastia
- precipitating factors: hypokal, inc ae, renal failure, hypothyroidism, hypothermia, hypoalbumina, hypomag, hypercalc, hypernat, acidosis, amioda/verapamil/spironol/ciclosporin
- mx: digibind, monitor k, montior u+es if diuretics coprescribed
Amiodarone:
- class + mech action
- indications
- se
- monitoring
Amiodarone:
- class + mech action: class 3 K+ channel blocker. rhythm control where blocks K channels inc APD slowing refractory period hence AVN conduction
- indications: AF, VT
- se: pul fibrosis, photosensitivity, optic neuritis/corneal deposits, liver disease, thyroid dysfunction, thrombophlebitis (therefore ideally given in central veins), qt syndrome, p40 inhibitor, slate grey appearance, inc digoxin/warfarin levels
- monitoring: tft/lft/u+es/cxr prior, tft/lfts every 6 months
LMWH:
- examples
- mech action
- se
LMWH:
- examples: dalteparin, enoxaparin given as sc
- mech action: binds to antithrombin III causing changes to inhibit factor Xa preventing conversoion of prothrombin to thrombin hence reducing blood clotting
- SE: bleeding, low risk of HIT (ab against complexes of platelet factor 4 + heparin causing thrombosis + reduced platelets >50% + skin allergy - change to argatroban), osteoporosis
- Cont: egfr <30, clotting disorders
Unfractionated heparin:
- mech
- se
- monitoring
Unfractionated heparin:
- mech: activates antithrombin III which then inhibits thrombin, factors xa/ixa/xia/xiia via IV
- se: bleeding, HIT, osteoporosis, hyperkal
- monitoring: APTT - in overdose use protamine sulphate
- uses: used when high risk of bleeding bc can terminate rapidly, renal failure
Atropine:
- mech
- indications
Atropine:
- mech: musc Ach rec antagonist
- indications: bradycardia, organophosphate poisoning
Adenosine:
- mech action
- indication
- se
Adenosine:
- mech action: causes transient heart block in avn via inhibiting adenyl cyclase inc k efflux causing inc hyperpolarisation
- indication: supraventric tachyc
- se: impending doom chest pain, bronchospasm (not is asthmatics!!), transient flushing
DOAC:
- examples
- mech
- indic
- Se
- contraind
DOAC:
- examples: apixaban, rivaroxaban
- mech: inhibits factor xa therefore dec free factor xa/those bound to antithrombin 3 inhib clotting cascade
- indic: pe/vte, af
- Se: bleeding, rapid fall in drug levels (short half life) means bad if forget to take
- contraind: renal imp <15, preg
Non dihydropyridine ccb:
- examples
- mech action
- indications
- se
- contraind
Non dihydropyridine ccb:
- examples: diltiazem, verapamil
- mech action: class 3 ccb rate control acts on myocardial tissue to decrease san dec contract + HR
- indications: AF, angina, htn
- SE: hypotension, bradycardia, hf, ankle swelling, constip, flushing
- contraind: b blocker, angina
flecainide:
- class + mech action
- indic
- se
- contraind
flecainide:
- class + mech action: na 1c class 1 channel blocker, slows upstroke, rhythm control (widens qrs + pr)
- indic: AF, WPW
- se: sudden death, gastrointestinal upset, bradyc, oral paraesthesia, visual disturbance
- contraind: post MI, struct HD
Warfarin:
- class + mech action
- indications
- monitoring
- interactions
- SE
- Mx high INR
Warfarin:
- class + mech action: oral anticoag, inhibits VKOR epoxide reductase which activates vitamin K which then inhibits clotting factors 2,7,9,10 and protein C
- indications: mech HV (3 aortic, 3.5 mitral), second line VTE (2.5/ 3.5 recurrent)/ AF (2.5)
- monitoring: INR (prothrombin time)
- interactions: liver disease, cranberry juice, nsaids, p450 inhib (inc INR) (amiodarone, ciprofloxacin)
- SE: haemorrhage, teratogenic, skin necrosis, purple toes
- mx high INR:
Major bleed: stop, vit K 5mg, pcc
INR>8 + minor bleed: stop, vit k 3mg, restart when <5
INR>8: stop, oral vit k
INR5-8 + bleed minor: stop, iv vit k
INR 5-8: withold 1-2 doses
Adrenaline doses
anaphylaxis: 0.5mg - 0.5ml 1:1000 IM
cardiac arrest: 1mg - 10ml 1: 10000 IV
Glyceral trinitrate:
- indic
- contraind
- se
- monitoring
- indic: angina, mi, fissure
- contraind: aortic stenosis, cardiac tamponade, pericarditis, hypotension, cardiomyopathy, hypovol, HF caution
- se: tolerance, arrythmia, weakness, dizzy, drowsy, flushing, headache, hypotension
- monitoring: bp + hr during infusion. avoid abrupt withdrawal
if symptoms can repeat 5 mins after first dose but if no relief after 2nd dose then ambulance
