Passmed Cardiology Medications Flashcards
For patients with poor renal function, what changes should be made to their loop diuretics?
Increase the dose
-> Loop diuretics must be filtered into the tubules by the glomerulus in order to have an effect
What are the adverse effects of loop diuretics?
Hypotension
Hyponatraemia
Hypokalemia and hypomagnaesemmia
Ototoxicity
Hyperglycaemia
What is the action of ticagrelor?
REVERSIBLE ADP antagonist
-> It leads to impaired clearance of adenosine which can result in dyspnoea
Which medication should clopidogrel avoid being prescribed with?
Clopidogrel should avoid being prescribed with PPIs like Omeprazole because they have anti-platelet effect.
What is a contraindication of ticagrelor?
Severe hepatic dysfunction and patients at high risk of bleeding. Due to effects of dyspnoea, it is cautioned in asthma.
Which bet blocker is most lipid soluble?
Propanolol which is likely to cause side-effects like sleep disturbance.
What are the common side effects of beta blockers?
Bronchospasm
Cold peripheries
Fatigue
Sleep disturbances
Erectile dysfunction
Which conditions should beta blockers be contraindicated?
Uncontrolled heart failure
Asthma
Sick sinus syndrome
Verapamil use
Which medication should beta blockers be avoided with?
Verapamil due to the risk of severe bradycardia
How are ACE inhibtors activated?
Phase 1 metabolism in the liver
What are common side effects of ACE inhibitors?
First dose hypotension which is more common in patients taking diuretics
Hyperkalemia
Angioedema
Cough due to increased bradykinin levels
What should be monitored with ACE inhibtiors?
Urea and electrolytes
-> There may be increase in creatinine and potassium once started, but signficant renal impairment may occur
Which patients taking ACE inhibitors are at risk for signficant renal impairment?
Those with bilateral renal artery stenosis
Which ACE inhibtiors are active without undergoing phase 1 metabolism?
Captopril and lisinopril
What do beta blockers exacerbate?
Peripheral vascular disease
-> Beta blockers restrict blood flow in skeletal muscle by preventing vasodilation
Which medication reduce the anti-hypertensive effect of ACE inhibtiors?
NSAIDs
How does alcohol affect ACE inhibtiors?
Increases the hypotensive effects
What are common adverse effects of electrolyte in thiazide diuretics?
Hypokalemia
Hyponatraemia
Hypercalcaemia
Hypocalciuria which reduces renal stone formation
What are common adverse effects of thiazide diuretics?
Dehydration due to hypercalcaemia
Postural hypotension
GOUT
Hyperglycaemia
What is the pharmacological of amiodarone?
It has a long half life because it is highly lipophilic and widely absorbed by tissue.
It requires a prolonged loading regime to achieve stable therapeutic levels
What should thiazide diuretics be avoided with?
PPIs as there is risk of Hyponatraemia
What is the actin of hydralazine?
Increases levels of cyclic GMP by increasing intracellular calcium and causing arteriole smooth muscle relaxation
What should hydrasalazine be avoided in?
Systemic lupus erythematous
Ischaemic heart disease
What is tirofiban?/
GPiib/IIIa antagonist which inhibits platelet aggregation
What are the primary GPiib/IIa antagonists
Abciximab
Eptifibatide
Tirofiban
What is the action of ivabradine?
Used in heart failure to reduce heart rate, by acting on SAN funny current to reduce activity.
What are the common side effects of ivabradine?
Visual effects
Headache
Bradycardia and heart block
What drug does amiodarone interact wih
It decreases warfarin metabolism and increases the risk of bleeeding
How should amiodarone be adminsitered?
Central veins due to risk of thrombophlebitis
How does amiodarone adversely affect ECG?
Prolongs the QT interval
What should be avoided in pulmonary oedema?
Nicorandil, a vasodilator which will exacerbate pulmonary congestion
What is the action of adenosine?
Agonist of A1 receptor in AV node which inhibits adenylyl cyclase to reduce cAMP and causes hyperpolarisation blocking conduction through the node
What is the action of beta blockers on the kidneys?
Suppresses renin release
What is a common side effects of statins?
Myalgia
Liver impairment
Rhabdomyolysis
What increases risk of myalgia with statins?
Female
Low BMI
Older age
Diabetes
What are the lipophilic statins?
Simvastatin
Atorvastatin
-> these are at higher risk of myopathy
What are the hydrophilic statins?
Fluvastatin
Rosuvastatin
Pravastatin
What increases the risk of statin induced rhabdomyolysis?
Amiodarone
What food item should be avoided with Ramipril?
Antacids
What is the volume of distribution of warfarin?
It is protein bund and has a large volume of distribution
What is the
What are the adverse effects of amiodarone?
Thyroid dysfunction
Corneal EPO sits
Pulmonary fibrosis
Liver fibrosis
Peripheral neuropathy
Slate grey appearance
