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Y4 Cardio > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

what are the SEs of ACEI?

A

hypotension
renal failure
dry cough
hyperkalaemia

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2
Q

what causes the dry cough with ACEI?

A

since the breakdown of bradykinin is inhibited so there is an increase in bradykinin

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3
Q

what are CI for ACEI?

A

bilateral renal artery stenosis

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4
Q

can ACEI be given to young women?

A

no

- since they are of child bearing age so can be given b blockers instead

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5
Q

where is ACE produced?

A

pulmonary epithelial cells

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6
Q

what is Angiotensin II broken down by?

A

angiotensinase in RBCs

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7
Q

what b receptors are found in the heart and kidney?

A

B1

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8
Q

what b receptors are found in the bronchi, skeletal muscle, liver?

A

B2

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9
Q

what beta receptors are in adipose tissue?

A

B3

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10
Q

what are the SEs of b blockers?

A 
bronchospasm 
hypotension 
fatigue 
nightmares 
risk of new onset DM
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11
Q

what are CIs for beta blockers?

A 
asthma 
peripheral vascular disease 
severe bradycardia 
severe heart failure 
2/3rd heart block
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12
Q

does atenolol cross the BBB?

A

no

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13
Q

what b blocker crosses the BBB easily and causes CNS side effects (nightmares)?

A

propranolol

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14
Q

what type of medication is amlodipine?

A

CCB

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15
Q

what are the CI for nitrates?

A 
aortic stenosis 
mitral stenosis 
constrictive pericarditis 
tamponade
HOCM 
anaemia 
closed angle glaucoma 
increased ICP
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16
Q

what is the action of nicorandil?

A

K+ATP channel activator + nitrate component

Arterial and venous dilator

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17
Q

what is the action of ivabradine?

A

Inhibits ”funny” current in SA node
↓ pacemaker activity
↓ HR

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18
Q

what condition is nicorandil and ivabradine used for?

A

angina

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19
Q

what are the SEs of nicorandil?

A

headache, flushing, dizziness, GI ulcers

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20
Q

what are the SEs of ivabradine ?

A

visual changes

low HR

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21
Q

state the strength and speed of vaughan williams classification 1

A 
1a = fast 
1b = intermediate strong  
1c = slow weak
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22
Q

what type of medication is amiodarone?

A

K channel blocker

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23
Q

what is the action of digoxin?

A

inhibits myocyte Na+/K+ ATPase → ↑ Na+ & ↑Ca2+

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24
Q

what is the action of adenosine

A

Acts at A1 receptors in cardiac tissue → myocyte hyperpolarization

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25
Q

what anti arrhythmia medication work at the ventricles?

A

class 1B

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26
Q

what anti arrhythmia medication work at the atria and ventricles?

A

class 1A, 1C, amiodarone

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27
Q

what anti arrhythmia medication work at the artial sinus node?

A

adenosine
b blockers
verapamil
digoxin

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28
Q

what are the SEs of amiodarone?

A 
blue grey discolouration 
photosensitivity 
corneal micro deposits
hyper/hypothyroidism 
pulmonary fibrosis 
peripheral neuropathy
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29
Q

what are the SEs of digoxin?

A 
arrhythmias 
nausea 
xanthopsia 
confusion 
gynaecomastia
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30
Q

what ECG finding is seen with digoxin?

A

reverse tick sign

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31
Q

does amiodarone have a long or short half life?

A

long half life

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32
Q

does adenosine have a long or short half life?

A

short

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33
Q

what is the mechanism of action of clopidogrel?

A

inhibits ADP-induced fibrinogen binding to GPIIb/IIIa

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34
Q

what is the mechanism of action of dipyridamole ?

A

Phosphodiesterase inhibitor

- ↑cAMP inhibits plat aggregation

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35
Q

what is a SE of dipyridamole?

A

headache

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36
Q

what condition can dipyridamole not be used in?

A

myasthenia gravis

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37
Q

what is aspirin and clopidogrel used together to treat?

A

post STEMI/NSTEMI

not stroke

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38
Q

how long should clopidogrel be continued after NSTEMI

A

12month

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39
Q

how long should clopidogrel be continued after STEMI

A

1month

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40
Q

what is the presentation of aspirin overdose?

A

vomiting, dehydration, tinnitus, hyperventilation

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41
Q

what investigations should be done for aspirin overdose?

A

Salicylate and paracetamol level

U&Es, ABG, glucose, LFTs, INR

42
Q

what is the management for aspirin overdose within 1hr?

A

gastric lavage

43
Q

what is the management for aspirin overdose with a level >700mh/L or cardiac/renal failure?

A

haemodialysis

44
Q

can aspirin be used in children?

A

no

- only with kawasaki disease

45
Q

is atorvastatin more potent that simvastin ?

A

yes

46
Q

what is the action of statins?

A

HMG-CoA Reductase Inhibitors – block rate-limiting step in cholesterol synthesis

47
Q

what are SEs of statins?

A

myositis
deranged LFTs
GI upset

48
Q

what medication do statins interact with to increase the risk of myositis?

A 
fibrates
macrocodes
azoles 
grapefruit juice
protease inhibitors
cyclosporin 
nicotinic acid
49
Q

what are SEs of fibrates?

A

gall stones
GI upset
myositis
blood dyscrasias

50
Q

what is the action of orlistat?

A

Pancreatic lipase inhibitor

51
Q

what is a SE of nicotinic acid?

A

flushing

52
Q

what are the indications for statins?

A

Any known CVD DM (age >40)

10yr CVD risk ≥20%

53
Q

what factors does warfarin prevent the synthesis of?

A

2,7,9,10, C, S

54
Q

what factor is depleted first with warfarin?

A

protein S

55
Q

does warfarin have a long or short half life?

A

long 40hrs

56
Q

how long until after taking warfarin does the INR change?

A

16hrs

peak effect at 2-3days

57
Q

what is the action of warfarin ?

A

Inhibits Vit K epoxide reductase

Prevents recycling of Vit K → functional Vit K deficiency

58
Q

what conditions is warfarin used for?

A 
VTE
AF
mechanical heart valve 
large anterior MI 
dilated cardiomyopathy
59
Q

what SE can protein S deficiency cause ?

A

skin necrosis

60
Q

what are CI for warfarin?

A

pregnancy
severe HTN
Peptic ulcer disease

cation
- severe hepatic/renal impairment, alcoholics, recent surgery, risk of falls

61
Q

what is the INR target for DVT prophylaxis?

A

2-2.5

62
Q

what is the INR target for calf DVT

A

2.5

63
Q

what is the INR target for PE

A

2.5

64
Q

how long should warfarin be given for calf DVT

A

Cause known: 6wks No cause: 3mo

65
Q

how long should warfarin be given for above knee DVT

A

Cause known: 3mo No cause: 6mo

66
Q

how long should warfarin be given for PE

A

Cause known: 3mo No cause: 6mo

67
Q

how long should warfarin be given for AF?

A

indefinite

68
Q

how long should warfarin be given for anti-phospholipid syndrome?

A

indefinite

69
Q

what is the INR target for AF?

A

2.5

70
Q

what is the INR target for metal valves?

A

3.5

71
Q

what is the INR target for anti-phospholipid syndrome?

A

3.5

72
Q

state how to give warfarin in the 1st 8 days ?

A

Day 1-4: warfarin 5mg OD @ 6pm

 Day 5: check INR and adjust dose according to table

 Day 8: check INR and adjust dose according to table

> Day 8: check INR every 4 days and dose accordingly

73
Q

what is the management for major bleeding on warfarin?

A

Stop warfarin
Vi t K IV
 Prothrombin complex concentrate
 FFP 15ml/kg if unavailable

74
Q

if INR is raised the warfarin should be stopped and restarted after it has reached what level?

A

INR <5

75
Q

who would be high risk of VTE on long haul flight?

A

Surgery under GA w/i last 1mo

76
Q

who would be moderate risk of VTE on long haul flight?

A

Previous VTE, GA w/i last 1-2mo

77
Q

what is the management for low risk VTE prophylaxis?

A

avoid dehydration, regularly flex ankles

78
Q

what factor does LMWH and fondaparinux inhibit?

A

10

79
Q

what factor does heparin inhibit?

A

Co-factor for ATIII: inhibits factors 2, 10, 11 and 12.

80
Q

what are the risks of unfractionated heparin?

A

Heparin-induced thrombocytopenia (HIT)
- immune mediated, develops after 6 days
osteoporosis
hyperkalaemia

81
Q

why does heparin cause hyperkalaemia?

A

inhibits aldosterone

82
Q

what are the CIs of heparin?

A 
Bleeding disorders 
 Plats <60 
 Previous HIT 
 PU
Cerebral haemorrhage Severe HTN 
Neurosurgery
83
Q

what is the prophylaxis dose of LMWH?

A

20-40mg

84
Q

what is the treatment dose of LMWH?

A

1.5mg/kg/24hr

85
Q

what is the dose for unfractionated heparin

A

5000iu bolus IV over 30min

86
Q

state two thrombolytics?

A

streptokinase

Rh-TPA (Recombinant Human Tissue Plasminogen Activator)

87
Q

how is streptokinase given?

A

infusion over 1hr

88
Q

why can streptokinase only be used once?

A

Development of Abs

89
Q

state some examples of Rh-TPA and how they are given?

A

Tenectaplase, reteplase: bolus

 Alteplase: infusion

90
Q

what is the management for acute unstable angina?

A

emergency cardioversion

91
Q

what is the treatment for persistent AF (>7days)?

A

rhythm control if

  • symptomatic
  • age <65yrs
  • 1st time presenting
  • secondary
92
Q

how is the rhythm controlled with persistent AF?

A

transthoracic echocardiography (TTE) to check for structural abnormalities

anticoagulate with warfarin for >3weeks

sotalol or amiodarone for >4 weeks if increased risk of failure

93
Q

what is 1st line and 2nd line for maintenance for persistent AF?

A

1st: β-B (e.g. bisoprolol, metoprolol).
2nd: amiodarone

94
Q

what is the management for rate control in AF?

A

1st line: β-B or rate-limiting CCB (NOT both!)

 2nd line: add digoxin (don’t use as monotherapy) 

3rd line: consider amiodarone

95
Q

what is the 1st,2nd,3rd line for chronic heart failure?

A

1 = ACEi/ARB (lisinorpil or candesartan) + b blockers + loop diuretic (frusemide)

2 = spironolactone, ACEI + ARB, vasodilators

3 = digoxin

96
Q

what medication should be avoided in chronic heart failure?

A

Avoid verapamil, diltiazem and nifedipine (short

acting)

97
Q

what are indications for treatment for HTN?

A

<80yrs, stage 1 HTN + one of
- target organ damage, 10yrs CV risk >20%, established CVD, DM, renal disease

stage 2 HTN

severe/malignant HTN

<40yrs, stage 1 HTN

98
Q

what are the BP targets for >80yrs and <80yrs?

A

 Under 80yrs: <140/90 (<130/80 in DM)

 Over 80yrs: <150/90

99
Q

what CCB should be used to treat HTN?

A

nifedipine MR 30-60mg

100
Q

what thiazide like diuretic should be used to treat HTN?

A

chlortalidone 25-50mg OD

101
Q

in step 2 for blacks, what A should be used?

A

use ARB over ACEi in blacks.

Y4 Cardio (10 decks)

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