Heart stuff

Question 1

Beta blocker:
- example
- mech action
- indication
- se
- contraind
- overdose: symptoms + mx

Answer 1

• 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

Question 2

Loop diuretics:

• example
• mech action
• indication
• se
• contraind

Answer 2

• 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

Question 3

aldosterone rec antagonist:

• example
• mech action
• indication
• se

Answer 3

• example: spironolactone
• mech action: inhibits enac exp hence dec na/h20 reab and romk
• indication: hf, resistant htn, ascites
• se: hyperkal, gynaecomastia, addisons

Question 4

aspirin:

• mech action
• indication
• se
• contraind

Answer 4

• 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

Question 5

ADP rec antagonist:

• example
• mech action
• indication
• se
• contraind

Answer 5

• example: clopidogrel, pragusrel, tricagrelor
• mech action: inhibits p2y12 rec therefore inhibits gp11b/111a dec platelet activation hence aggregation
• indication: acs, stroke/tia
• se: bleeding, gi upset, thrombocytopenia
• contraind: ppis omeprazole (cyp inhib)

discontinue 7 days before surgery

Question 6

streptokinase/ altepase:

• mech action
• indication
• cont

Answer 6

• mech action: thrombolysis - breaks down plasminogen to plasmin which breaks down fibrin
• indication: pe, acs, stroke
• cont: pancreatitis, aneurysm, aortic dissection

Question 7

Synthetic lmwh:

• example
• mech action
• indication
• se
• contraind

Answer 7

• example: fondaparinux
• mech action: inhibits antithrombin 3 hence factor xa decreasing the clotting cascade
• indication: stemi/nstemi
• se: anaemia, haemorrhage
• contraind: bleeding, endocarditis

Question 8

Digoxin:
- class + mech action
- indications
- toxicity symptoms
- precipitating factors
- mx

Answer 8

Digoxin:
- class + mech action: cardiac glycoside - decreases conduction through AVN slowing ventricular rate, also inhibit nakatpase pump inc force cardiac muscle
- 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

Question 9

Amiodarone:
- class + mech action
- indications
- se
- monitoring

Answer 9

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

Question 10

LMWH:
- examples
- mech action
- se

Answer 10

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

Question 11

Unfractionated heparin:
- mech
- se
- monitoring

Answer 11

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

Question 12

Atropine:
- mech
- indications

Answer 12

Atropine:
- mech: musc Ach rec antagonist
- indications: bradycardia, organophosphate poisoning

Question 13

Adenosine:
- mech action
- indication
- se

Answer 13

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

Question 14

DOAC:
- examples
- mech
- indic
- Se
- contraind

Answer 14

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
- contraind: renal imp <15, preg

Question 15

Non dihydropyridine ccb:
- examples
- mech action
- indications
- se
- contraind

Answer 15

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

Question 16

flecainide:
- class + mech action
- indic
- se
- contraind

Answer 16

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