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Billy Week 126 > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

GTN MOA?

A

NO release
Activates and increases cGMP
cGMP causes smooth muscle relaxation -> cardiac vasodilation

This reduces venous return (and therefore cardiac output) and therefore reduces LV workload

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2
Q

Beta blocker MOA?

A

Reduces sympathetic drive -> reduced HR and contractility

Reduced workload = improved exercise tolerance and symptomatic relief

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3
Q

Dihydropyridine MOA?

A

Smooth muscle relaxation by inhibiting calcium influx -> coronary and peripheral vascular smooth muscle relaxation

(SM relaxation = vasodilation = reduced VR = decreased CO / LV workload)

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4
Q

Non-dihydropyridine aka “rate limiting” MOA

A

Smooth muscle relaxation by inhibiting calcium influx -> coronary and peripheral vascular smooth muscle relaxation

(SM relaxation = vasodilation = reduced VR = decreased CO / LV workload)

AND SLOWS CONDUCTION AT AV NODE THEREFORE RATE LIMITING EFFECT

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5
Q

Isosorbide mononitrate MOA?

A

Release of NO -> release and activation of cGMP -> smooth muscle relaxation and subsequent cardiac vasodilation

= reduced VR, CO and therefore LV workload

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6
Q

Nicorandil MOA?

A

Potassium channel activator

  1. NO donor to activate cGMP causing arterial and venous vasodilation
  2. K+ channels open causing K+ efflux which hyperpolarises cell, and reduces Ca entry. This all causes smooth muscle relaxation.
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7
Q

Ivabradine MOA

A

Blocks a “pacemaker” or “funny” current channel in SAN

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8
Q

Ranolazine MOA

A

Inhibits “late” sodium channels to reduce calcium overload, leading to smooth muscle relaxation

(calcium overload through sodium dependent calcium currents causes myocardial ischaemia)

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9
Q

What is the first line treatment for chronic stable angina?

A

Beta blockers

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10
Q

What is the first line treatment for chronic stable angina where beta blockers are contra-indicated?

A

Non-dihydropyridine (rate limiting) beta blockers

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11
Q

Calcium channel blockers examples?

A

Dihydropyridines

-dipines

Non-dihydropyridines

Verapamil
Diltiazem

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12
Q

What is added in as second-line to beta-blocker therapy?

A

Dihydropyridine calcium channel blocker

di-pines

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13
Q

What can be added it to beta-blocker therapy for SYMPTOM CONTROL?

A

Longer-acting nitrates

e.g. isosorbide mononitrate, GTN sustained release or transdermal patches

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14
Q

Which drug would only be started by a cardiologist as an add-on therapy after all else isn’t working?

A

Ranolazine

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15
Q

A/Es of GTN

A

Hypotension
Headache
Flushing

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16
Q

Contraindications of GTN

A

Hypotension
Aortic or mitral stenosis
Hypertrophic cardiomyopathy

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17
Q

A/Es of beta blockers

A 
Bronchospasm
Bradycardia
Cold extremities
Numbness
Sleep disturbance
Fatigue
ED
18
Q

What is first line beta blocker for someone suffering with beta blocker sleep disturbance?

A

Atenolol

19
Q

Contraindications of beta blockers?

A 
Asthma
Bradycardia
Uncontrolled heart failure
2nd/3rd degree heart block
Severe peripheral arterial disease
20
Q

Which anti-anginal causes constipation?

A

Verapamil

21
Q

Which calcium channel blocker(s) should you not give with a beta-blocker?

A

Rate limiting:

  • Do not give verapamil with a beta blocker
  • Take care with diltiazem with a beta blocker
22
Q

Adverse effects of dihydropyridine calcium channel blockers?

A 
Flushing
Headache
Dizziness
Ankle swelling
Hypotnesion
23
Q

Which drugs cause ankle swelling?

A

Dihydropyridine calcium channel blockers

24
Q

There is a drug class which causes ankle swelling. Which drug of that class is least likely to cause ankle swelling? (e.g. switch a patient to it if they experience bad ankle swelling)

A

Calcium channel blockers

Amlodipine is best

25
Q

A/Es isosorbide mononitrate?

A

Hypotension shortly after dose

Headache, flushing

Tolerance - ensure nitrate-free period

26
Q

Which anti-anginal is tolerance a problem with?

A

Isosorbide mononitrate

27
Q

A/Es nicorandil

A

Headache
Hypotension
Gi mucosal irritation

28
Q

Contraindications of isosorbide mononitrate?

A

Hypotension
Aortic and mitral stenosis
HOCM
Closed-angle glaucoma

29
Q

Contraindications of dihydropyridine calcium channel blockers?

A

Uncontrolled heart failure
Within 1 month of MI (nifed/felod)
Significant aortic stenosis

30
Q

Contraindications of rate-limiting calcium channel blockers?

A

Heart failure
Bradycardia
2nd/3rd degree heart block

31
Q

Ivabradine interactions?

A

Diltiazem
Fluconazole
Macrolides

32
Q

Nicorandil contraindications?

A

LV failure

Hypotension

33
Q

When should someone be started on a statin?

A

If their 10 year risk is above 10% (or 20%)

34
Q

Which statin needs a reduced dose with certain drugs? What drugs?

A

Simvastatin requires half dose (20mg) with:

  • Amlodipine
  • Diltiazem
  • Verapamil
35
Q

When would a patient be considered for an ACE inhibitor?

A

Angina with coexisting:

  • HTN
  • DM
  • Heart failure
  • Previous MI
36
Q

Treatment pathway for angina?

A

Start with BB or CCB
Add in BB or CCB (not rate limiting CCB!)

Isosorbide mononitrate is an alternative

Refer to cardiologist if 2 drugs do not control, or if symptoms worsen

37
Q

What is the risk of using a rate limiting CCB with a BB?

A

Heart block

38
Q

Patient is not experiencing relief from 2 drugs… now what?

A

Refer to cardiologist.

3rd drug is not shown to improve symptom control - PCI may.

39
Q

AEs of ivabradine

A

Visual disturbances
Bradycardia
1st degre eheart block
Headache and diziness

40
Q

AEs of ranolazine

A

Constipation
N&V
Dizziness and headache

Billy Week 126 (2 decks)

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