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Cardiology > Lecture 10: Clinical Pharmacology > Flashcards

Lecture 10: Clinical Pharmacology Flashcards

1
Q

What is the only -ve chronotrope AND +ve inotrope?

A

Glycosides e.g. digoxin

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2
Q

What do positive inotropes do?

A

Increase contractility (so increase stroke volume and decrease need for reflex increases in rate)

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3
Q

How does digoxin work?

A

Na/K pump inhibitor

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4
Q

What are some ways digoxin acts as a -ve chronotrope?

A

Stimulates vagus, increases AV refractoriness, slows SA depolarisation, decreases sympathetic tone

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5
Q

Why should you be careful giving digoxin to fat dogs?

A

Lipophilic, long elimination half life

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6
Q

What are some GI effects of digoxin?

A

Anorexia, pain, vomiting, diarrhoea

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7
Q

What causes the GI toxicity in digoxin?

A

Vagal effects

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8
Q

Which arrhythmias can digoxin cause?

A

Any

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9
Q

What should you do in digoxin toxicity?

A

stop giving drug, anti-arrhythmics if life threatening, antibodies, activated charcoal

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10
Q

Which drugs can digoxin interact with?

A

Those which cause electrolyte changes, those which affect GI absorption, those which cause changes in cardiac cell activity

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11
Q

Which drugs can digoxin increase plasma concentrations of?

A

Ca blockers, ACE inhibitors, anti-arrhythmics, diuretics

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12
Q

Which drugs can digoxin decrease plasma concentrations of?

A

Thyroid hormones

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13
Q

Which drugs can cause additive depression of AV conduction along with digoxin?

A

Ca blockers, PS-mimetics

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14
Q

How does B1 affect heart?

A

increased force of contraction, increased heart rate

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15
Q

How does B2 affect heart?

A

vasodilation in skeletal muscles

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16
Q

How does a1 affect heart?

A

vasoconstriction

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17
Q

Which sympathomimetic has the lowest potential for arrhythmias?

A

Dobutamine

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18
Q

In what conditions do you give dobutamine?

A

CHF or increasing contractility

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19
Q

How long can the effects of dobutamine last?

A

Weeks

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20
Q

What are some side effects of sympathomimetics?

A

Arrhythmias, hypoK, increased peripheral resistance, GI stasis, dysuria, restlessness.

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21
Q

Which drugs given with sympathomimetics cause Increased risk of arrhythmias
?

A

Anaesthetics, glycosides, anything disturbing electrolytes

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22
Q

Which drugs can enhance the sympathetic effects of sympathomimetics?

A

Anti-cholinergics, PDE inhibitors, thyroid supplementation

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23
Q

What is pimobendan?

A

A PDE inhibitor

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24
Q

How do you give pimobendan?

A

IV or orally

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25
Q

How do PDE inhibitors work?

A

Ca sensitizer, increased force of contraction, reduced pre-load and afterload, +ve inotrope

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26
Q

How do methyxanthines work?

A

PDE inhibition, adenosine receptor antagonism (so vasodilatory)

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27
Q

What are the effects of methyxanthines?

A

relax vascular smooth muscles, CNS stimulation, stimulate cardiac muscle, weak diuretics, bronchodilation

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28
Q

What are signs of methyxanthine toxicity?

A

restlessness, agitation, excitement, tachycardia, gastric irritation, seizures

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29
Q

How do you treat methyxanthine toxicity?

A

CHarcoal, diazepam toxicity (seizures), propranolol (tachycardia)

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30
Q

What are signs of chronic methyxanthine toxicity?

A

vomiting, anxiety, restlessness, cardiac extrasystoles, seizures

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31
Q

How do nitrates e.g. nitroglycerine work?

A

Vasodilators

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32
Q

What are methods of administration of nitrates?

A

Tablets, topical patches, ointments

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33
Q

What are two side effects of nitroglycerine?

A

Hypotension, methaemoglobinaemia, dermatitis

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34
Q

Which drugs can nitrates interfere with?

A

Sympathomimetics, heparin, vasodilators, diuretics, beta blockers

35
Q

What are side effects of nitroprusside?

A

excessive vasodilation and hypotension,
nausea, vomiting, loss of consciousness, reflex tachycardia, accumulation of thiocyanate with prolonged use (toxic psychosis, metabolic acidosis, MM pink)

36
Q

How does hydralazine work?

A

vasodilator (reflex tachycardia, relaxes smooth muscle, increases heart rate and stroke volume)

37
Q

What are side effects of hydralazine?

A

Hypotension, constipation, diarrhoea, lupus-like syndrome

38
Q

Which drugs reduce effects of hydralazine?

A

NSAIDs, oestrogens, sympathomimetics

39
Q

Which drugs enhance effects of hydralazine?

A

other vasodilators, diazoxide and other hypertensive drugs

40
Q

In which conditions is hydralazine used?

A

congestive heart failure
severe mitral regurgitation
reduction of left atrial enlargement

41
Q

How does prazosin work?

A

α1-antagonist

reduces mean arterial pressure

42
Q

What are some side effects of prazosin?

A

Hypotension, loss of consciousness, tachycardia

43
Q

When do you use prazosin?

A

To reduce afterload

44
Q

Why is prazosin not commonly used?

A

Get tolerance, poor long-term response

45
Q

What is the most common ACE-inhibitor?

A

Benazepril

46
Q

What are three effects of ACE inhibitors?

A

reduce arterial resistance, reduce venous tension, reduce aldosterone secretion

47
Q

In what condition should you reduce dose of ACE inhibitors?

A

Renal failure - reduce by 50%

48
Q

What impairs absorption of ACE inhibitors?

A

Food

49
Q

In which condition do you use ACE inhibitors?

A

CHF

50
Q

What are some side effects of ACE inhibitors?

A

GI issues, hypotension, hyperK, neutropenia, preoteinuria, hypersensitivity, renal failure

51
Q

Which drugs interact with ACE inhibitors?

A

Diuretics, beta blockers, NSAIDs, oestrogens, sympathomimetics, K supplements

52
Q

What are three mechanisms of thiazide diuretics?

A

Block facilitated Na/Cl co-transport, K-wasting effect, increased distal tubule Ca reabsorption

53
Q

In which patients should you not use thiazide diuretics?

A

HyperCa

54
Q

What are five side effects of thiazine diuretics?

A

electrolyte imbalances,
agranulocytosis,
allergic reactions,
hyperuremia, thrombocytopenia,

55
Q

How long do thiazide diuretics act for?

A

6-12 hours

56
Q

What are some clinical uses of thiazine diuretics?

A

Oedema from CHF, hepatic cirrhosis, oestrogen therapy, udder oedema, DI

57
Q

What are some clinical uses of furosemide?

A

Oedema from CHF, hepatic cirrhosis, renal disease

58
Q

Which diuretic may be more appropriate in hepatic cirrhosis?

A

Spironolactone

59
Q

What will loop diuretics eventually result in?

A

HypoK

60
Q

Which conditions reduce oral bioavailability of loop diuretics?

A

Renal failure and CHF

61
Q

What is half life of loop diuretics?

A

1-2 hours

62
Q

What prolongs half life of loop diuretics?

A

Hepatic and renal disease

63
Q

What are some side effects of loop diuretics?

A

Electrolyte imbalance, allergies, ototoxicity, pancreatitis, leukopenia, agranulocytosis, thrombocytopenia

64
Q

Which drugs reduce effects of loop diuretics?

A

NSAIDs

65
Q

Which drugs do loop diuretics potentiate?

A

ACE inhibitors, NMJ blockers

66
Q

Which drugs do loop diuretics potentiate the oto or nephrotoxic effects of?

A

amphotericin B, aminoglycosides etc

67
Q

Along with which drugs do loop diuretics potentiate hypoK?

A

amphotericin B, mineralocorticoids, some penicillins

68
Q

Which drugs do loop diuretics decrease activity of?

A

anti-coagulants, enzymes, insulin

69
Q

What are two examples of K-sparing diuretics?

A

Spironolactone, triamterene

70
Q

How can K-sparing diuretics work in CHF?

A

Limit aldosterone effects rather than direct diuretic effect

71
Q

WHich drugs can K-sparing diuretics interact with?

A

Other affecting Na/K balance

72
Q

What are two clinical uses of K-sparing diuretics?

A

Decrease hypoK from other diuretics, oedema and ascites from cirrhosis and portal hypertension

73
Q

What are some side effects of K-sparing diuretics?

A

Adrenal and sex hormone effects with long-term use, electrolyte imbalances

74
Q

What is the active ingredient of activyl?

A

Indoxacarb

75
Q

What is the problem with activyl?

A

Only does fleas

76
Q

What is active ingredient of stronghold?

A

Selamectin

77
Q

What is active ingredients of stronghold plus?

A

Selamectin and sarolaner

78
Q

What is active ingredient of bravecto?

A

Fluralaner

79
Q

What is the problem with bravecto?

A

Epileptogenic

80
Q

Which species is permethrin toxic to?

A

Cats and fish

81
Q

What other disease should you consider if fleas?

A

Tapeworm, as fleas intermediate host

82
Q

How can humans catch dipylidium?

A

Eating a flea

83
Q

Which breed can get severe immune-mediated reaction following potentiated sulphonamides?

A

Doberman

Cardiology (9 decks)

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