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Year 1 Cardiology > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Beta adrenoreceptor agonists

A

Increase force, rate and cardiac output as well as O2 consumption
Reduce cardiac efficiency
Can cause disturbances in cardiac rhythm

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2
Q

Three Beta adrenoreceptor agonist

A

Dobutamine, Adrenaline, Noradrenaline

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3
Q

Adrenaline uses

A

Acute cardiac arrest, Anaphylactic shock

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4
Q

How can adrenaline be administered?

A

IM SC IV and IV infusion, in anaphylactic shock IM only IV if induced Cardiac arrest. Usually 500 micrograms

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5
Q

Adrenalines action

A

Beta 1 receptors positive inotropic chronotropic effect
Alpha 1 receptors vasoconstriction in gut skin
Beta 2 receptors dilation of coronary arteries

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6
Q

Adrenalines Half life

A

Roughly 2 minutes

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7
Q

Dobutamine uses

A

Acute potentially reversible heart failure, following cardiac surgery or during septic shock

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8
Q

How is dobutamine administered

A

IV infusion in high dependancy or critical units

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9
Q

Dobutamines action

A

Selective beta 1 agonist leads to increased contractile strength but not increased heart rate- unknown why
Rarely used only in short term

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10
Q

Three types of Beta antagonists

A

Non selective Propanol
Selective Atenolol Bisoprolol Metoprolol
Non selective partial agonists Alprenolol

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11
Q

Alprenolol and Non selective partial agonists

A

Weakly activate receptor yet prevent more potent agonist from binding, so slight rise in heart rate but block full effect

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12
Q

Effect of beta blockers at rest

A

Little effect as sinus rhythm, parasympathetic system, is dominant , Alprenolol will show slight rise

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13
Q

Beta blockers during exercise

A

reduced tolerance as rate force and CO are significantly lowered.

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14
Q

Overall effect of Beta blockers

A

Coronary Vessels constriction as B2 receptors blocked , however better oxygenation of myocardium as O2 requirement falls

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15
Q

Clincal usage of beta blockers

A

Arrythmias, Atrial fibrillation Supraventricular tachycardia , angina, and compensated heart failure.
With comorbidities e.g. angina can be first line for hypertension

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16
Q

Beta blockers in arrhythmia

A

Decrease excessive sympathetic drive to restore normal sinus rythm

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17
Q

Beta blockers in atrial fibrillation

A

Delays conduction through AV node preventing spread and helping restore normal sinus rhythm

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18
Q

Beta blockers in Angina

A

First line over Ca2+ blockers, helps reduce O2 consumption reducing waste product build up and in turn the symptoms

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19
Q

Beta blocker used in compensated heart failure treatment

A

Carvedilol, start low dose and increase slow

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20
Q

Carvedilol how does it work

A

Low dose reduces excessive sympathetic drive swell as alpha antagonist so vasodilation occurs less force required for same effect

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21
Q

Adverse effects of Beta blockers

A

Bronchospasms B2 receptor blockage, avoid asthmatics etc
Aggravation of non compensated heart failure as reliant or sympathetic drive for adequate CO
Hypoglycaemia B2 receptors activated release glucose from liver, no tachychardic warning signs either, avoid in poorly controlled diabetics
Fatigue CO reduced skeletal muscle perfusion B2 reduced
Cold extremities B2 mediated vasodilation

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22
Q

In what cases are the adverse effect negated if using selective agents e.g. atenolol

A

Bronchospasms and hypoglycaemia as use B2 receptors

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23
Q

Atropine

A

Non selective muscarinic ACh competative antagonist

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24
Q

Atropine clinical uses

A

Used to reverse symptomatic bradychardia as a result of a cardiac arrest
In anticholinesterase poisoning to reduce excessive parasympathetic activity

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25
Q

Atropine action

A

Increases heart rate at all but low doses
No effect on arterial BP as no parasympathetic innervation
No effect upon exercise resistance

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26
Q

Atropine for symptomatic bradycardia as a result of an cardiac arrest

A

300-600 microgram minimum dosage, titrate upwards. Too little has adverse slowing effect
Increased vagal tone as a result of cardiac arrest is reduced increasing heart rate
IV with constant monitoring for the adverse effects

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27
Q

Function of cardiac glycosides?

A

Increase contractility of the heart

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28
Q

Digoxin

A

Increases contractility of myocardium by increasing amount of Ca2+ in sarcoplasmic reticulum

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29
Q

Danger around digoxin

A

very low therapeutic ratio especially when coupled with low plasma K+
increases likely hood of ventricular fibrillation and tachycardia

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30
Q

Clinical use of digoxin

A

IV- acute heart failure
Oral in chronic heart failure if not responding to other drugs
Atrial fibrillation, as blocks of AV node preventing spread

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31
Q

Digoxin side effects

A

Can cause arrhythmias if lower AV conductance too low

Nausea, vomiting, colour vision disturbances

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32
Q

Levosimendan

A

Acute decompensated heart failure
Sensitises troponin C increasing contractility of myocardium
Dilates vascular smooth muscle by hyperpolarising membranes by opening k+ channels

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33
Q

Phosphodiesterase inhibitors

A

Amrinone and Milrinone

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34
Q

Action of Amrinone and milrinone

A

Inhibit PDE so increase conc of cAMP increasing contractility of the cardiac muscle
Reduced peripheral resistance

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35
Q

Clinical Usage of Amrinone and milrinone

A

Limited use as in long term increases mortality and morbidity, quality not quantity of life
IV for acute heart failure

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36
Q

Clinical use of organic nitrates

A

Acute angina, chest pain from acute MI, alongside other drugs treatment of pulmonary oedema

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37
Q

Action of organic nitrates

A

Broken-down in NO which activates guanylate cyclase, converts GTP into cGMP- relaxation pathway

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38
Q

Clinical use of Ca2+ channel blockers

A

Treat hypertension, stable angina ( beta blockers are first line)

39
Q

Ca2+ channel blocker side effects

A

Due to action on nodal tissue AV and SA node suppression can cause atrial fibrillation and flutter

40
Q

Verapamil

A

Selective for cardiac L type Ca2+ blocker

41
Q

Amlodipine

A

Smooth muscle L type Ca 2+ blockers

42
Q

Verapamil side effects

A

Avoid with beta blockers slow heart down to much

43
Q

Amlodipine side effects

A

Ankle oedema

44
Q

Statins

A

Simvastatin and atorvastatin

45
Q

Statins uses

A

Hypercholesterolemia, diabetes, angina, MI strokes , high risk of MI

46
Q

Statins side effects

A

Myopathy, Rhabdomyolysis- muscular tissue breakdown which can lead to renal failure

47
Q

Fibrates

A

Bezafibrate

48
Q

Fibrates uses

A

Hypertriglyceridemia, low HDL cholesterol

49
Q

Bezafibrate side effects

A

decreased appetite, GI disturbances

50
Q

For those unable to tolerate statins

A

Ezetimibe

51
Q

Ezetemibe function

A

blocks cholesterol absorption

52
Q

Ezetemibe side effects

A

GI discomfort diarrhoea

53
Q

PCSK-9 inhibitors

A

Alirocumab and evolucumab

54
Q

PCSK-9 inhibitor uses

A

Hypercholesterolemia- more effective than statins reduce cholesterol by up to 60%

55
Q

PCSK-9 side effects

A

Nasopharyngeal complaints pain congestion etc

56
Q

Thiazide Diuretics

A

Bendroflumethiazide

57
Q

Bendroflumethiazide

A

Reduce oedema, reduce hypertension

58
Q

Bendroflumethiazide side effects

A

Hyperkalaemia , arrhythmias , hyperglycaemia, gout , impotence , diabetes

59
Q

Cardioselective B1 bockers

A

Atenolol, bisoprolol

60
Q

Atenolol abd bisoprolol uses

A

Angina, acute coronary syndrome, MI hypertension

61
Q

Non selective B1 and B2 blockers

A

Propranolol

62
Q

Propranolol uses

A

Hypertension, thyrotoxicosis, migraines

63
Q

Beta blocker side effects

A

Bronchospasms, tired, cold peripheries, can acutely worsen heart failure.

64
Q

ACE inhibitors

A

Lisinopril

65
Q

Lisinopril uses

A

Hypertension, haemodynamically stable short term post MI patients, Supraventricular arrhythmias

66
Q

Lisinopril side effects

A

Dry cough, renal dysfunction, angioneurotic oedema,

67
Q

When should lisinopril NEVER be used

A

Pregnancy

68
Q

Angiotensin receptor blockers

A

Losartan

69
Q

Losartan uses

A

Hypertension, MI patients if ACE inhibitors aren suitable

70
Q

Losartan side effects

A

Cough diarrhoea dizziness hypotension

71
Q

Alpha 1 blockers

A

Doxazosin

72
Q

Doxazosin uses

A

Hypertension, prostatic hyperplasia

73
Q

Doxazosin side effects

A

Postural hypertension

74
Q

Mineral corticoid antagonists

A

Spironolactone

75
Q

Spironolactone uses

A

Oedema due to congested heart failure, hypertension, moderate to severe heart failure

76
Q

Spironolactone side effects

A

Gynaecomastia- male breast tissue develops, hyperkalaemia,

77
Q

Isosorbride Mononitrate uses

A

Angina acute heart failure

78
Q

Isosorbide mononitrate side effect

A

Headache hypertension/collapse

79
Q

issues surrounding nitrate use

A

Tolerance can build up so introducing nitrate free period during the day helps prevent this

80
Q

GTN or glyceryl trinitrate uses

A

Angina, hypertension and myocardial ischaemia during and after cardiac surgery

81
Q

GTN side effects

A

Headache flushing vomiting nausea arrythmias

82
Q

Nicorandil

A

used in angina, head aches mouth and GI ulcers so avoid

83
Q

Ivabradine

A

If channel modulator, used in angina, slow HR in sinus rhythm, not in atrial fibrillation

84
Q

Ranolazine

A

effective for refractory angina

85
Q

Antiplatelet Aspirin

A

Clopidogrel, Prasugrel, ticagrelor

86
Q

Asprinin uses

A

Angina, MI, strokes

87
Q

Aspirin side effects

A

Haemorrhage, peptic ulcer, asthma

88
Q

Anticoagulants

A

Heparine IV warfarin Oral, rivaroxaban

89
Q

Anticoagulant uses

A

DVT PE atrial fibrillation

90
Q

Anticoagulant side effects

A

haemorrhage hypotension

91
Q

Fibrinolytic drugs

A

Streptokinase breaks up fibrin

92
Q

Streptokinase uses

A

PE stroke

93
Q

Streptokinase side effects

A

Haemorrhage, avoid in trauma, peptic ulcers

Year 1 Cardiology (17 decks)

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