Pharmacology Flashcards
1
Q
what are the SEs of ACEI?
A
hypotension
renal failure
dry cough
hyperkalaemia
2
Q
what causes the dry cough with ACEI?
A
since the breakdown of bradykinin is inhibited so there is an increase in bradykinin
3
Q
what are CI for ACEI?
A
bilateral renal artery stenosis
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
5
Q
where is ACE produced?
A
pulmonary epithelial cells
6
Q
what is Angiotensin II broken down by?
A
angiotensinase in RBCs
7
Q
what b receptors are found in the heart and kidney?
A
B1
8
Q
what b receptors are found in the bronchi, skeletal muscle, liver?
A
B2
9
Q
what beta receptors are in adipose tissue?
A
B3
10
Q
what are the SEs of b blockers?
A
bronchospasm hypotension fatigue nightmares risk of new onset DM
11
Q
what are CIs for beta blockers?
A
asthma peripheral vascular disease severe bradycardia severe heart failure 2/3rd heart block
12
Q
does atenolol cross the BBB?
A
no
13
Q
what b blocker crosses the BBB easily and causes CNS side effects (nightmares)?
A
propranolol
14
Q
what type of medication is amlodipine?
A
CCB
15
Q
what are the CI for nitrates?
A
aortic stenosis mitral stenosis constrictive pericarditis tamponade HOCM anaemia closed angle glaucoma increased ICP
16
Q
what is the action of nicorandil?
A
K+ATP channel activator + nitrate component
Arterial and venous dilator
17
Q
what is the action of ivabradine?
A
Inhibits ”funny” current in SA node
↓ pacemaker activity
↓ HR
18
Q
what condition is nicorandil and ivabradine used for?
A
angina
19
Q
what are the SEs of nicorandil?
A
headache, flushing, dizziness, GI ulcers
20
Q
what are the SEs of ivabradine ?
A
visual changes
low HR
21
Q
state the strength and speed of vaughan williams classification 1
A
1a = fast 1b = intermediate strong 1c = slow weak
22
Q
what type of medication is amiodarone?
A
K channel blocker
23
Q
what is the action of digoxin?
A
inhibits myocyte Na+/K+ ATPase → ↑ Na+ & ↑Ca2+
24
Q
what is the action of adenosine
A
Acts at A1 receptors in cardiac tissue → myocyte hyperpolarization
25
what anti arrhythmia medication work at the ventricles?
class 1B
26
what anti arrhythmia medication work at the atria and ventricles?
class 1A, 1C, amiodarone
27
what anti arrhythmia medication work at the artial sinus node?
adenosine
b blockers
verapamil
digoxin
28
what are the SEs of amiodarone?
```
blue grey discolouration
photosensitivity
corneal micro deposits
hyper/hypothyroidism
pulmonary fibrosis
peripheral neuropathy
```
29
what are the SEs of digoxin?
```
arrhythmias
nausea
xanthopsia
confusion
gynaecomastia
```
30
what ECG finding is seen with digoxin?
reverse tick sign
31
does amiodarone have a long or short half life?
long half life
32
does adenosine have a long or short half life?
short
33
what is the mechanism of action of clopidogrel?
inhibits ADP-induced fibrinogen binding to GPIIb/IIIa
34
what is the mechanism of action of dipyridamole ?
Phosphodiesterase inhibitor
| - ↑cAMP inhibits plat aggregation
35
what is a SE of dipyridamole?
headache
36
what condition can dipyridamole not be used in?
myasthenia gravis
37
what is aspirin and clopidogrel used together to treat?
post STEMI/NSTEMI
not stroke
38
how long should clopidogrel be continued after NSTEMI
12month
39
how long should clopidogrel be continued after STEMI
1month
40
what is the presentation of aspirin overdose?
vomiting, dehydration, tinnitus, hyperventilation
41
what investigations should be done for aspirin overdose?
Salicylate and paracetamol level
| U&Es, ABG, glucose, LFTs, INR
42
what is the management for aspirin overdose within 1hr?
gastric lavage
43
what is the management for aspirin overdose with a level >700mh/L or cardiac/renal failure?
haemodialysis
44
can aspirin be used in children?
no
| - only with kawasaki disease
45
is atorvastatin more potent that simvastin ?
yes
46
what is the action of statins?
HMG-CoA Reductase Inhibitors – block rate-limiting step in cholesterol synthesis
47
what are SEs of statins?
myositis
deranged LFTs
GI upset
48
what medication do statins interact with to increase the risk of myositis?
```
fibrates
macrocodes
azoles
grapefruit juice
protease inhibitors
cyclosporin
nicotinic acid
```
49
what are SEs of fibrates?
gall stones
GI upset
myositis
blood dyscrasias
50
what is the action of orlistat?
Pancreatic lipase inhibitor
51
what is a SE of nicotinic acid?
flushing
52
what are the indications for statins?
Any known CVD DM (age >40)
| 10yr CVD risk ≥20%
53
what factors does warfarin prevent the synthesis of?
2,7,9,10, C, S
54
what factor is depleted first with warfarin?
protein S
55
does warfarin have a long or short half life?
long 40hrs
56
how long until after taking warfarin does the INR change?
16hrs
peak effect at 2-3days
57
what is the action of warfarin ?
Inhibits Vit K epoxide reductase
| Prevents recycling of Vit K → functional Vit K deficiency
58
what conditions is warfarin used for?
```
VTE
AF
mechanical heart valve
large anterior MI
dilated cardiomyopathy
```
59
what SE can protein S deficiency cause ?
skin necrosis
60
what are CI for warfarin?
pregnancy
severe HTN
Peptic ulcer disease
cation
- severe hepatic/renal impairment, alcoholics, recent surgery, risk of falls
61
what is the INR target for DVT prophylaxis?
2-2.5
62
what is the INR target for calf DVT
2.5
63
what is the INR target for PE
2.5
64
how long should warfarin be given for calf DVT
Cause known: 6wks No cause: 3mo
65
how long should warfarin be given for above knee DVT
Cause known: 3mo No cause: 6mo
66
how long should warfarin be given for PE
Cause known: 3mo No cause: 6mo
67
how long should warfarin be given for AF?
indefinite
68
how long should warfarin be given for anti-phospholipid syndrome?
indefinite
69
what is the INR target for AF?
2.5
70
what is the INR target for metal valves?
3.5
71
what is the INR target for anti-phospholipid syndrome?
3.5
72
state how to give warfarin in the 1st 8 days ?
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
what is the management for major bleeding on warfarin?
Stop warfarin
Vi t K IV
Prothrombin complex concentrate
FFP 15ml/kg if unavailable
74
if INR is raised the warfarin should be stopped and restarted after it has reached what level?
INR <5
75
who would be high risk of VTE on long haul flight?
Surgery under GA w/i last 1mo
76
who would be moderate risk of VTE on long haul flight?
Previous VTE, GA w/i last 1-2mo
77
what is the management for low risk VTE prophylaxis?
avoid dehydration, regularly flex ankles
78
what factor does LMWH and fondaparinux inhibit?
10
79
what factor does heparin inhibit?
Co-factor for ATIII: inhibits factors 2, 10, 11 and 12.
80
what are the risks of unfractionated heparin?
Heparin-induced thrombocytopenia (HIT)
- immune mediated, develops after 6 days
osteoporosis
hyperkalaemia
81
why does heparin cause hyperkalaemia?
inhibits aldosterone
82
what are the CIs of heparin?
```
Bleeding disorders
Plats <60
Previous HIT
PU
Cerebral haemorrhage Severe HTN
Neurosurgery
```
83
what is the prophylaxis dose of LMWH?
20-40mg
84
what is the treatment dose of LMWH?
1.5mg/kg/24hr
85
what is the dose for unfractionated heparin
5000iu bolus IV over 30min
86
state two thrombolytics?
streptokinase
| Rh-TPA (Recombinant Human Tissue Plasminogen Activator)
87
how is streptokinase given?
infusion over 1hr
88
why can streptokinase only be used once?
Development of Abs
89
state some examples of Rh-TPA and how they are given?
Tenectaplase, reteplase: bolus
Alteplase: infusion
90
what is the management for acute unstable angina?
emergency cardioversion
91
what is the treatment for persistent AF (>7days)?
rhythm control if
- symptomatic
- age <65yrs
- 1st time presenting
- secondary
92
how is the rhythm controlled with persistent AF?
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
what is 1st line and 2nd line for maintenance for persistent AF?
1st: β-B (e.g. bisoprolol, metoprolol).
2nd: amiodarone
94
what is the management for rate control in AF?
1st line: β-B or rate-limiting CCB (NOT both!)
2nd line: add digoxin (don’t use as monotherapy)
3rd line: consider amiodarone
95
what is the 1st,2nd,3rd line for chronic heart failure?
1 = ACEi/ARB (lisinorpil or candesartan) + b blockers + loop diuretic (frusemide)
2 = spironolactone, ACEI + ARB, vasodilators
3 = digoxin
96
what medication should be avoided in chronic heart failure?
Avoid verapamil, diltiazem and nifedipine (short
| acting)
97
what are indications for treatment for HTN?
<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
what are the BP targets for >80yrs and <80yrs?
Under 80yrs: <140/90 (<130/80 in DM)
Over 80yrs: <150/90
99
what CCB should be used to treat HTN?
nifedipine MR 30-60mg
100
what thiazide like diuretic should be used to treat HTN?
chlortalidone 25-50mg OD
101
in step 2 for blacks, what A should be used?
use ARB over ACEi in blacks.
