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LS - cardio CC > Pharmacolog > Flashcards

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
Q

Indication

A

Hypertension
Chronic heart failure
Ischaemic heart disease
Diabetic nephropathy and ckd with proteinuria

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26
Q

Moa

A

Similar to acei except

Blocks angiotensin 11 onto the at1 receptor

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27
Q

Side effects

A

Hypotension especially first dose
Hyperkalaemia
Renal failure

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28
Q

What can increase renal failure risk

A

NSAIDs

Renal artery stenosis

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29
Q

Contraindicated

A 
Renal artery stenosis 
Aki 
Renal failure 
Consider lower dose in ckd and monitor
Pregnancy and breast feeding
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30
Q

Interactions

A

Other potassium elevating drugs

NSAIDs

Potassium sparing diuretics

Potassium
Supplements

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31
Q

Difference between acei and arb

A

Does not cause cough

Doesn’t interfere with bradykinin metabolism

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32
Q

Give an example of a nitrate

A

Isosorbide mononitrate

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33
Q

Uses

A

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

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34
Q

Moa

A

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

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35
Q

Side effects

A 
Hypotension 
Flushing 
Light headedness
Headache 
Tolerance
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36
Q

What can be done to prevent tolerance

A

Give a period without medication during day. Usually overnight when not needed

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37
Q

Contraindications

A

Aortic stenosis
Hypotension
Haemodynamically unstable

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38
Q

Interactions

A

Other anti hypertensives

Phosphodiesterase inhibitors

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39
Q

name a potassium sparing diuretics?

A

spironolactone

40
Q

uses

A

ascites and odema as a first line
chronic heart failure - if mod to severe. often given with acei, beta blockers
primary hyperaldonesterone

41
Q

moa

A

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
Q

contraindicated

A

severe liver impairment
pregnancy
addision
hyperkalaemia

43
Q

sde effects

A

hyperkalaemia, muscle wasting, arythmias, steven Johnson syndrome(bullous lesions), gynaecomastica, jaundice, liver impairment

44
Q

interactions

A

acei, arbs, k supplements

45
Q

name 4 calcium channel blockers

A

verapamil
diltazem
amlodipine
nifedipine

46
Q

uses

A

[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
Q

moa

A 
decreases ca entry into cell,
decreased intracellular ca2+
causes vasodilation and relaxation 
reduced arterial pressure 
reduce oxygen demand as reduce contractility and conduction
48
Q

SE and contraindications

A

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
Q

interactions

A

not with beta blockers- may cause bradycardia, heart failure asystole

50
Q

what is ramapril?

A

an acei

51
Q

uses

A
  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
Q

MOA

A

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
Q

contraindications

A

hyperkalaemia
AKI
pregnancy
renal failure-lower doses

54
Q

side effects

A

dry cough
hypotension -esp with first dose
hyperkalaemia
angioedema

55
Q

DI

A

other K elevating drugs
NSAIDS increase rsk of renal failure
other antihypertensives or diuetics- hypotension

56
Q

What is clopidgrel given for

A

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
Q

Mechanism of action

A

Clopidgrel prevents platelet aggregation and reduces risk of occlusion by binding onto the ADP receptor on the platelet surface

58
Q

Side effects

A

Bleeding
Gi upset which is diarrhoea abdo pain and dyspepsia
Thrombocytopenia

59
Q

Contraindications

A

Hepatic and renal impairment
Surgery
Elective surgeries may neeed to stop a week before
Active bleeding

60
Q

Interactions

A

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
Q

what is digoxin used for?

A

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
Q

MOA

A

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
Q

SE

A 
bradycardia
rash 
dizziness 
visual disturbances
toxicity due to small therapeutic index--> arrhythmias 
GI disturbances
64
Q

DI

A

loop and thiazide durietics increases toxicity

amidorone, ccb and spiraolone and quinines

65
Q

CI

A 
patients with renal failure
hypomag, cal, kalemia
2 degree heart block
complete heart block
ventricular arrthymias
66
Q

What is warfarin used for

A

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
Q

How does it work

A

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
Q

Side effects

A

Bleeding
Spontaneous haemorrhage
Epistaxis

69
Q

Contraindications

A

Pregnancy as of foetal abnormalities

Those at risk of thrombosis and haemorrhage such as liver disease

70
Q

Drug interactions

A

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
Q

what is tissue plasminogen activator?

A

fibrinolytic

converts plasminogen to plasmin to aid thrombus breakdown

72
Q

side effects

A

bleeding – gum nose brain
hypotension
angina

73
Q

CI

A 
haemorrhage stroke
trauma
hypotension 
enlarged left atrium
AF
74
Q

DI

A

anticoagulants

ACEi

75
Q

what is heparin used for?

A

VTE
prophylaxis of PE and DVT
Acute Coronary syndrome- unstable angina, non STEMI

76
Q

MOA

A

it inhibits Xa and thrombin in clotting casacade

this prevents clot formation

77
Q

SE

A

bleeding
hypersensitivity reaction at injection site/ in general with urticarial
long term use-alopecia
heparin induced thrombocytopenia

78
Q

CI and caution

A

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
Q

DI

A

anti-platelets drugs such as clopidogrel and aspirin

warfarin

80
Q

what can be given to reverse

A

protamine

81
Q

name some statins

A

simvastatin

atorvastatin

82
Q

uses

A

primary prevention of CVD
secondary prevention of CVD alongside lifestyle changes

hyperlipidemia treatment 1st line

83
Q

what is a key thing to bear In minute with hyperlipidemia

A

check it is not caused by hypothyroidism

84
Q

moa

A

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
Q

AE

A

headache
GI disturbances
muscle aches–> myopathy and rhabdmyolysis
ALT elevated

86
Q

CI

A

Renal and hepatic impairment

pregnancy and breast feeding - cholesterol is essential for foetal development

87
Q

DI

A

reduced efficacy by p450 inhibitors such as macrolides, diltazem, protease inhibitors this increase statin and can increase AE
amlodipine

88
Q

when to give
patient tips
things to do before

A

oral tablet daily in the evening
ensure TFT LFT are done at start
avoid grapefruit juice

89
Q

what can hhappen if given in pt with hypothyroidism

A

increase risk of myositis

90
Q

NOAC name some

A

rivaroxaban

dabigatran

91
Q

uses

A

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
Q

what is good about it

A

very similar to warfarin but has less need for monitoring and less side effect risk
however expensive

93
Q

MOA

A

inhibits Xa in the clotting cascade reducing thrombin formation

94
Q

se

A

bleeding - esp in though at high risk of haemorrhage and going for surgery

95
Q

CI

A

aovid in hepatic impairment and those who are going for surgery or at risk of bleeding

96
Q

DI

A

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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