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Pharmacolog Flashcards

1
Q

What is furosemide

A

A loop diuretic

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2
Q

What’s it used for

A

Relieve symptoms of breathlessness in pulmonary odema

Chronic heart failure to reduce fluid overload

Reduce fluid overload in renal and liver failure

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3
Q

What is given with it in pul oedema

A

Oxygen and nitrates

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4
Q

Contraindications

A 
Dehydration 
Severe hypovolemia 
Hepatic encepathology
Hyponatremia 
Hypokaleamia
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5
Q

Side effects

A

Dehydration
Loss of calcium hydrogen ions magnesium sodium potassium and chloride Ions
Hypotension

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6
Q

Mechanism of action

A

Ascending loop of henle
Inhibits na k cL cotransporter

Reduces
Preload in cardiac failure by diltationn of capacitance vessels and increases contractile function

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7
Q

Interactions

A

Reduced excretion of lithium
With aminglycosides causing ototoxity snd nephrotoxicty

Digoxin toxicity due to hypokalaemia

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8
Q

Patient info for furosemide

A

Overload of water in body
Water tablets to remove this excess water
May make you need toilet more often due to increase in flow

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9
Q

name a thiazide diuretic?

A

benzdroflumethhiazide, indapamide

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10
Q

uses of thiazide diuretics ?

A

[1] hypertension as an alternative when CCB cannt be used
[[2] heart failure
[3] add on for hypertension when ACEi/ARB and CCB aren’t enough

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11
Q

known as?

A

water tablet

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12
Q

moa?

A

inhibit na reabsorption at the distal covulated tubule but inhibiting the NA CL cotransporter
owrks to compensate hypertension with vasodilation

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13
Q

AE

A

hyponatremia
hypokalamia, arrythmias
may cause spike in glucose, LDL, cholesterol and triglyceride

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14
Q

contradicated?

A

those with hypokalaemia and natraemia

those with gout due to reduced uric acid excretion

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15
Q

interactions

A

may be reduced effectiveness by NSAIDS

combining with other potassium lowering drugs such as loop diuetircs are best avoided

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16
Q

what can be given for hypertension?

A

Both ACEi/arb and thiazide dieuetic to maintain K balance since ACEi inhibits RAS system and can cause hyperkalamia and thiaziside diuruetics activate RAS and increase risk of hypokalammeia

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17
Q

What is atenolol

A

Beta-blocker

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18
Q

Indications for use

A
  1. For ischemic heart disease both angina and acute coronary syndrome
  2. Hypertension in conjunction with other medications -usually I last line resort
  3. Heart failure but start on low-dose
  4. Atrial fibrillation
  5. Supraventricular tachycardia
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19
Q

Mechanism of action

A

Beta receptors are on the heart smooth-muscle and beta-1 receptors on smooth-muscle of vessels
Works by increasing cardiac function by reducing oxygen demand reducing contraction of the heart and improving prognosis
Reducing cardiac work and increasing profusion
For hypertension it works by reducing renin and inhibiting ras activity

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20
Q

Adverse affects

A 
Nausea sleep and gi  disturbances
Headache 
Cold extremities 
Nightmares 
Impotency in men
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21
Q

ContraIndicated

A

Asthma, hepatic failure , heart Failure . Heart block

Those who are haemodynaically unstable

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22
Q

Interruptions

A

Non-dihydropyridine
Such as Ccb
Verapamil diltiazem

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23
Q

Whatczn it cause with these medications

A

Heart failure bradycardia asystole

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24
Q

Name an arb. What does it stand for

A

Angiotensin receptor blocker

Losartan

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25
Indication
Hypertension Chronic heart failure Ischaemic heart disease Diabetic nephropathy and ckd with proteinuria
26
Moa
Similar to acei except | Blocks angiotensin 11 onto the at1 receptor
27
Side effects
Hypotension especially first dose Hyperkalaemia Renal failure
28
What can increase renal failure risk
NSAIDs | Renal artery stenosis
29
Contraindicated
``` Renal artery stenosis Aki Renal failure Consider lower dose in ckd and monitor Pregnancy and breast feeding ```
30
Interactions
Other potassium elevating drugs NSAIDs Potassium sparing diuretics Potassium Supplements
31
Difference between acei and arb
Does not cause cough | Doesn't interfere with bradykinin metabolism
32
Give an example of a nitrate
Isosorbide mononitrate
33
Uses
Short acting for treatment of angina and chest pain in acute coronary syndrome Long acting for prophylaxis of angina when CCb and beta blocker are not sufficient or tolerated Pulmonary odema with oxygen and furosemide IV administration
34
Moa
Nitrate converted to nitric oxide which increases cGMP and reduced ca2+ causing relaxation This causes a decrease in cardiac preload cardiac work and oxygen demand. Stimulates vessel dilation and relieves vasospasm
35
Side effects
``` Hypotension Flushing Light headedness Headache Tolerance ```
36
What can be done to prevent tolerance
Give a period without medication during day. Usually overnight when not needed
37
Contraindications
Aortic stenosis Hypotension Haemodynamically unstable
38
Interactions
Other anti hypertensives | Phosphodiesterase inhibitors
39
name a potassium sparing diuretics?
spironolactone
40
uses
ascites and odema as a first line chronic heart failure - if mod to severe. often given with acei, beta blockers primary hyperaldonesterone
41
moa
a mineracosteriod produced from adrenal cortex, acts on mina. receptors on the surface of distal tubules in the kidney to increase water and sodium retention and potassium loss. aldosterone agagonists compete with receptor and this effectively increases na and water loss and prevent K loss.
42
contraindicated
severe liver impairment pregnancy addision hyperkalaemia
43
sde effects
hyperkalaemia, muscle wasting, arythmias, steven Johnson syndrome(bullous lesions), gynaecomastica, jaundice, liver impairment
44
interactions
acei, arbs, k supplements
45
name 4 calcium channel blockers
verapamil diltazem amlodipine nifedipine
46
uses
[1] amlodipine used as first line in hypertension, nifedipine as alternative [2] all can be used for stable angina [3] verapamil and diltazem used for supraventricular arrythimas such as tachycardia, atrial flutter, atrial fibrillation
47
moa
``` decreases ca entry into cell, decreased intracellular ca2+ causes vasodilation and relaxation reduced arterial pressure reduce oxygen demand as reduce contractility and conduction ```
48
SE and contraindications
amlodipine and nifedipine - ankle swelling, odema, headache, flushing not for use in those with aortic stenosis-> cv collapse or unstable angina diltazem and verapamil-constipation - - NOT FOR USE IN WEAKENED LEFT VENTRICULAR FUNCTION may worsen heart failure
49
interactions
not with beta blockers- may cause bradycardia, heart failure asystole
50
what is ramapril?
an acei
51
uses
1. hypertension 1st line treatment 2. chronic heart filure also 1st line 3. diabetic neuropathy and ckd with proteinuria 4. ihd to prevention of TIA/Stroke
52
MOA
inhibits activity of RAS- preventions conversion of angiotensin 1 and angiotensin 2 this decreases resistance and increases dilation of the arterioles prevents aldosterone sitmulation thus stimulates h20 and na excretion
53
contraindications
hyperkalaemia AKI pregnancy renal failure-lower doses
54
side effects
dry cough hypotension -esp with first dose hyperkalaemia angioedema
55
DI
other K elevating drugs NSAIDS increase rsk of renal failure other antihypertensives or diuetics- hypotension
56
What is clopidgrel given for
Treatment of acute coronary syndrome Prevention of occlusion on coronary syndrome Long term secondary prevention of thrombolitic arterial event in patients with cvd pvd and cerebrevascular disease Reduce thrombosis and stroke risk in Af patients when warfarin can't be given
57
Mechanism of action
Clopidgrel prevents platelet aggregation and reduces risk of occlusion by binding onto the ADP receptor on the platelet surface
58
Side effects
Bleeding Gi upset which is diarrhoea abdo pain and dyspepsia Thrombocytopenia
59
Contraindications
Hepatic and renal impairment Surgery Elective surgeries may neeed to stop a week before Active bleeding
60
Interactions
Efficacy may be reduced by cytochrome inhibitors such as ppi For that reason lansoprazole and pantropraole and preferred to omeprazole Coprescription with aspirin nsaid and hepatic increase bleeding risk
61
what is digoxin used for?
it is used for atrial fibrillation and atrial flutter to reduce ventricular rate it can also be used for severe heart failure when beta blockers are not effective
62
MOA
negatively chronotropic (reduces heart rate) positively iontrophic - increases force of contract reduces AVN contraction in HF, inhibits NA K ATPase pump causing Na build up causing calcium to stay in cell and this causes contractile force
63
SE
``` bradycardia rash dizziness visual disturbances toxicity due to small therapeutic index--> arrhythmias GI disturbances ```
64
DI
loop and thiazide durietics increases toxicity | amidorone, ccb and spiraolone and quinines
65
CI
``` patients with renal failure hypomag, cal, kalemia 2 degree heart block complete heart block ventricular arrthymias ```
66
What is warfarin used for
To prevent emboli complications in af and in heart valve replacement Also used to prevent clot recurrence and extension in dvt and pul embolism
67
How does it work
Vitamin k dependent coagulation factors need reduced vitamin k. Reduced vitamin k turns into gamma glutamyl to produce clotting factors 2 7 9 10. When it is in the oxidised form it then uses vitamin k epoxide reductase to reactivAte bsck into vitamin k in a reduced form. Warfarin inhibits the enzyme
68
Side effects
Bleeding Spontaneous haemorrhage Epistaxis
69
Contraindications
Pregnancy as of foetal abnormalities Those at risk of thrombosis and haemorrhage such as liver disease
70
Drug interactions
Reduced metabolism therefore increased bleeding risk with p450 inhibitors such as mAcrolides fluconaZole and protease inhibitors Increased metabolism with p450 inducers such as carbamazepine and rifampicin Antibiotics killing gut flora which makes vitamin k can increase anticogulation in these patients
71
what is tissue plasminogen activator?
fibrinolytic | converts plasminogen to plasmin to aid thrombus breakdown
72
side effects
bleeding -- gum nose brain hypotension angina
73
CI
``` haemorrhage stroke trauma hypotension enlarged left atrium AF ```
74
DI
anticoagulants | ACEi
75
what is heparin used for?
VTE prophylaxis of PE and DVT Acute Coronary syndrome- unstable angina, non STEMI
76
MOA
it inhibits Xa and thrombin in clotting casacade | this prevents clot formation
77
SE
bleeding hypersensitivity reaction at injection site/ in general with urticarial long term use-alopecia heparin induced thrombocytopenia
78
CI and caution
not lisecened but seems safe in pregnancy?? elderly use with caution CI- clotting disorders, recent surgery or trauma or upcoming surgery, thrombocytopenia, RENAL IMPAIRMENT UNCONTROLED HYPERTENSION
79
DI
anti-platelets drugs such as clopidogrel and aspirin | warfarin
80
what can be given to reverse
protamine
81
name some statins
simvastatin | atorvastatin
82
uses
primary prevention of CVD secondary prevention of CVD alongside lifestyle changes hyperlipidemia treatment 1st line
83
what is a key thing to bear In minute with hyperlipidemia
check it is not caused by hypothyroidism
84
moa
reduce LDL cholesterol, increase HDL and reduce triglyceride increases LDL clearance by liver works by inhibiting HMGCO reductase - 3-hydroxy 3 methyl glutaryl coenzyme A
85
AE
headache GI disturbances muscle aches--> myopathy and rhabdmyolysis ALT elevated
86
CI
Renal and hepatic impairment | pregnancy and breast feeding - cholesterol is essential for foetal development
87
DI
reduced efficacy by p450 inhibitors such as macrolides, diltazem, protease inhibitors this increase statin and can increase AE amlodipine
88
when to give patient tips things to do before
oral tablet daily in the evening ensure TFT LFT are done at start avoid grapefruit juice
89
what can hhappen if given in pt with hypothyroidism
increase risk of myositis
90
NOAC name some
rivaroxaban | dabigatran
91
uses
prophylaxis and prevention of recurrence/extension of clots in PE/DVT Prevention of emboli complications in heart valve replacement and AF such as stroke
92
what is good about it
very similar to warfarin but has less need for monitoring and less side effect risk however expensive
93
MOA
inhibits Xa in the clotting cascade reducing thrombin formation
94
se
bleeding - esp in though at high risk of haemorrhage and going for surgery
95
CI
aovid in hepatic impairment and those who are going for surgery or at risk of bleeding
96
DI
same as warfarin so efficacy reduced by p450 inhibitors but increased risk of side effects by p450 inducers

LS - cardio CC (5 decks)

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