Meds Flashcards
mechanism of ACEi
inhibit angiotensin 1 –> angiotensin II
name of ACEis
-pril eg lisinopril
SE ACEi (3)
cough // angioedema // hyperkalaemia
what conditions are ACEi contraindicated in (3)
pregnancy // renovascular disease // aortic stenosis
what K levels would indicate seeking advice before starting ACEi
> 5
interactions with ACEi (1)
high dose diuretic –> hypotension
what needs to be monitored after changing or increasing ACEi
U+E’s
what creatine and potassium rise is OK in ACEi
serum up to 30% and K up to 5.5
what would significant renal impairment after starting ACEi indicate
bilateral renal artery stenosis
mechanism of ARBs
block angiotensin II at angiotensin receptor
exampls of ARBs
-sartan, losartan, candesartan
when are ARBs used
2nd line to ACEi - usually if patient develops a cough
cautions (1) and SE (2) of ARBs
caution - renovascular disease // SE - hypotension + hyperkalaemia
what is an iontropic effect on the heart
increases contractility –> increased CO
what are the 2 main classes of CCBs + what do they do
dihydropyridines (relax blood vessels) eg nifidpine, amlodipine // non-dihydropyridines (highly negatively inotropic) eg verapamil or dilitiazem
mechanism verapamil
highly negatively inotropic
indications verapamil
angina, hypertension, arrhythmia
interaction verapamil
do not give with BB as can cause heart block
SE and cautions with verapamil
HF!! // constipation // hypotension // bradycardia // flushing
indications for diltiazem
angina or hypertension
interactions dilitiazem
BBs –> HF
SE and cautions diltiazem
hypotension // bradycardia // HF // ankle swelling!!!
indication nifidepine, amlodipine, felodipine (dihydropyridines) (3)
hypertension // angina // reynaulds
why are dihydropyridines more likely to cause ankle swelling
peripheral vascular smooth muscle dilated
SE and cautions dihydropyridines
flushing // headache // ankle swelling
SE nifedipine
reflex tachycardia
what is the rate control drug of choice in Afib
BB
SE of BBs (5)
bronchospasm // cold peripheries // fatigue // sleep disturbance // ED
contraindications BB (3)
uncontrolled HF // asthma // sick sinus
what drug should BB never be given with
verapamil –> bradycardia / heart block / HF
mechanism of loop diuretics
inhibit NaKCl in ascending thick loop of henle –> reduce absorption of NaCl
what dosing adjustment may be required for kidney patients on loop diuretics
increasing doses so a sufficient concentration in kidneys is achieved
main indications for loop diuretics
HF or resistant hypertension
SE loop diuretics
hyponatraemia // hypokalaemia + magnesia // alkalosis // otoxic // hypocalcaemia // AKI // gout
mechanism of thiazide diuretics
inhibit NaCl in distal convuluted tubule
what is lost in thiazide diuretics
K + na
common side affects of thiazides (6)
dehydration // hyponatraemia, hypokalaemia, hypercalceamia // gout // reduced glucose tolerance // impotence// pancreatitis
what drug does potassium sparing diuretics need to be given with caution
ACEi –> hyperkalaemia
examples of potassium sparing diuretics
amiloride (usually with another diuretic // spironolactone
what type of drug is amiodarone
class III antiarrhythmic (for atrial, nodal, and V tach)
mechanism of amiodarone
blocking K channels which lengthens AP
how should amiodarone be administered and why
into central veins as can cause thrombophlebitis
what drugs does amiodarone interact with (2)
p450 inhibitors eg warfarin –> increased INR // increases digoxin
how is amiodarone monitored
TFT and LFT every 6 months
SE of amiodatone (7)
thyroid issues // corneal depositis // liver + pulmonary fibrosis // peripheral neoropathy // photosensitive // gray appearance // bradycardia + lengthen QT
when is adenosine indicated
sinus tachycardia
when should adenosine be avoided
asthmatics –> bronchospasm
mechanism of adenosine
agonsit of A1 receptor in AV node –> increased efflux of K –> hyperpolarisation
how should adenoise be administered
large cannula (short half life)
SE adenosine (3)
chest pain // bronchospasm // transient flusing
mechanism of statin
inhibits HMG -CoA reductase (RLS in cholesterol synthesis)
contraindications for statins (2)
macrolides eg erythromycin and clarithromycin // pregnancy // (watch LFTs as well)
who gets statins
everyone with CVD or with a 10 year CVD risk >10%
statin dose for primary CVD prevention
atorvatatin 20mg
statin dose for secondary CVD prevention
atorvastatin 80mg
effect of nitrates
vasodilating (+ reduce venous return –> reduce ventricular work)
indication for nitrates
angina + acute heart failure
SE nitrates
hypotension, tachycardia, headache, flushing
what dosing advice is given for isosorbide nitrate
have 10-14 nitrate free hours // ie take second dose after 8 hours
when is nicorandil indicated + what is the mechanism
angina (K channel activator –> vasodilation)
SE nicorandil
GI + anal ulcers // headache and flushing
contraindications nicorandil
left ventricular failure
