Pharmacology - Cardiology Flashcards
Frusemide
20-40mg OD (in the morning) PO or IV
Bumetanide
1mg PO BD
- *Indications:** Pulmonary oedema 2ndary to LVF, Chronic heart failure, Oedema (cirrhosis/renal impairment/nephrotic syndrome), Resistant HTN
- *MOA:** LOOP DIURETICS - inhibit the Na/K/Cl triple transporter in the thick ascending limb of the loop of Henle - inhibuts NaCl reabsorption
- *S/E’s:** Low Na/K/Mg/Ca, High urate (gout), dehydration, postural hypotension, tinnitus/deafness, intrahepatic cholestasis, acute urine retention
- *CI’s:** Severe hypokalaemia/hyponatraemia, anuria (renal failure)
- *Interactions**: Increased toxicity with digoxin, NSAID’s, gentamicin, lithium, ACEi
- *Other info**: Increase doses in renal impairment, monitor U+E’s, can add K sparing diuretic to decrease K loss. Act within one hour orally or peak effect at 30mins IV.
Bendroflumethiazide (use for CCF 5-10mg OD (am))
Metolazone
Chlortalidone (use in HTN)
Indapamide (use in HTN 2.5mg OD)
- *Indications:** HTN, Oedema from chronic CCF
- *MOA:** THIAZIDE diuretics –> block the NaCl symporter in the distal convoluted tubules increasing NaCl excretion.
- *S/E’s:** Low Na/K. High Ca/urate (gout)/glucose/lipids. Postural hypotension, impotence. GI disurbances.
- *CI’s:** Hypokalaemia, hyponatraemia, addison’s, gout, severe liver/renal failure (GFR<30)
- *Interactions:** Increased toxicity with digoxin, lithium
- *Other info:** Remember to lower dose in elderly pts. Take early in the day so diuresis does not interfere with sleep.
Spironolactone (100-400mg daily)
Eplerenone
Amiloride (10mg daily)
Indications: Oedema/ascites 2ndary to cirrhosis, severe CCF, nephrotic syndrome, 1*hyperaldosteronism, refractory HTN
- *MOA:** K+ sparing diuretics –> aldosterone receptor antagonists –> Increased Na excretion, decreased K+ and H+ excretion
- *S/E’s:** Hyperkalaemia, GIT disturbance
- *CI’s:** Hyperkalaemia, hyponatraemia, anuria, addison’s, pregnancy
- *Interactions:** Increased toxicity with digoxin and lithium, increased risk of hyperkalaemia with ACEi/ARB
- *Other info:** Lower doses of spironolactone for HF compared to diuresis. Amiloride can be used as an adjunct with loop/thiazide diuretics to conserve K.
Acetazolamide
- *Indications:** Open/closed angle glaucoma, weak diuretic (rarely used though)
- *MOA:** Carbonic anhydrase inhibitor –> Increased HCO3 excretion. Decreases aqueous production therefore decreases intra occular pressure.
- *S/E’s:** N/V/D, peripheral tingling, rash = EM +/- SJS!
- *CI’s:** Hypokalaemia, hyponatraemia, sulphonamide hypersensitivity, long term use
- *Interactions:** Amiodarone
- *Other info:** Monitor electrolytes
Mannitol
IV infusion over 45mins, 0.25-2g/kg
Indications: Cerebral oedema (Increased ICP), Increased intra occular pressure
MOA: Osmotic diuretic –> cannot be reabsorbed by the kidney –> increased tubular fluid osmolarity - pulls in H20
S/E’s: Hypotension, fluid/electrolyte disturbance
CI’s: Severe cardiac failure, severe pulmonary oedema, intracranial bleeding, anuria, severe dehydration
Interactions:
Other info: 200mg/kg test dose first. Extravasation causes thrombophelbitis. Monitor U+E’s
Enalapril
Captopril
Ramipril
Lisinopril
Perindopril
- *Indications:** Heart failure (all grades), HTN, diabetic nephropathy, post MI, angina, prophylaxis of cardiovascular events
- *MOA:** ACEi -->inhibits ACE –> do not produce angiotensin2 therefore dont get vasoconstriction. Get vasodilation, decreased Na reabsorption (decreased circulating volume) therefore decreases BP.
- *S/E’s:** Postural hypotension, renal impairment, hyperkalemia, dry cough (2ndary to increased bradykinin), angioedema.
- *CI’s:** Suspected or confirmed bilateral renal artery stenosis, hypersensitivity to ACEi or pregnancy.
- *Interactions:** Increased risk of renal failure with NSAIDs, risk of v low BP with diuretics, TCA’s/Antipsychotics.
- *Other info:** Monitor U+E’s - if Cr increases by >30% do an MRA. Titrate the dose. Avoid in young woman that may become pregnant. Lower dose in renal failure.
Losartan (short t1/2)
Irbesartan (long t1/2)
Candesartan (long t1/2)
- *Indications:** Heart failure (all grades), HTN, diabetic nephropathy, post MI, angina, prevention of cardiovascular events
- *MOA:** Angiotensin II receptor antagonists. Do not inhibit kinin breakdown therefore no cough!
- *S/E’s:** postural hypotension, renal impairment, hyperkalaemia, angioedema
- *CI’s:** Renal artey stenosis, pregnancy
- *Interactions:** Increased risk of renal failure with NSAID’s, risk of v low BP with diuretics, TCA’s/antipsychotics. Decreased lithium excretion.
- *Other info:**
Bisoprolol
Atenolol
Metoprolol
Esmolol
Nebivolol
Indications: Angina, acute MI, heart failure, arrhythmias, HTN, long QT syndrome, thyrotoxicosis, anxiety, glaucoma
MOA: Beta blockers - cardioselective blocking Beta1Receptors in the heart therefore decreases CO by decreasing HR and contractility. Small decrease in BP therefore increased diastolic perfusion, decreased O2 demand and afterload.
S/E’s: Bronchospasm, hypotension, bradycardia, peripheral vasoconstrction –> cold peripheries/raynauds/PVD, lethargy, nightmares, increased risk of DM, impotence
CI’s: Asthma, marked bradycardia/hypotension, 2nd and 3rd degree heart block, severe heart failure, PVD, caution in DM as masks hypo’s
Interactions:
Other info: Lower dose in renal/hepatic impairment. Atenolol is H20 soluble therefore does not cross BBB.
Clonidine
- *Indications:** HTN, migraine, menopausal flushing
- *MOA:** Anti-hypertensive. Centrally acting alpha 2 agonist –> decreased CO + PVR
- *S/E’s:** Rebound HTN on withdrawal, postural hypotension, constipation, nausea, dry mouth
- *CI’s:** Severe bradyarrhythmias (2nd/3rd degree heart block), sick sinus syndrome
- *Interactions:** Increased risk of withdrawal HTN if given with Bblockers
- *Other info:**
Methyldopa
- *Indications:** HTN (in pregnancy/pre eclampsia)
- *MOA:** Anti-hypertensive. Centrally acting alpha 2 agonist. Is a pro drug converted to alpha-methylNA
- *S/E’s:** GI disturbances, hepatotoxic, drug induced lupus, postural hypotension, blood dyscrasias, drowsiness
- *CI’s:** Depression, phaeo, acute porphyria, liver disease
- *Interactions:** Avoid MAOI’s
- *Other info:**
Hydralazine
Indications: Mod-Severe HTN (adjunct), heart failure, hypertensive emergencies including in pregnancy
MOA: _Anti-hypertensive._Direct acting smooth muscle relaxant –> vasodilator arteries>veins
S/E’s: Tachycardia, hypotension, GI disturbance, headache, dizziness, drug induced lupus
CI’s: SLE, severe tachycardia, high output heart failure
Interactions:
Other info: Lower doses in renal/hepatic failure. Mainly used in pregnancy.
Sodium Nitroprusside
Indications: Hypertensive emergencies, controlled hypotension in anaesthesia, acute/chronic heart failure
MOA: Anti-hypertensive. Releases nitric oxide–> vasodilation –>arteries>veins
S/E’s: Associated with rapid drop in BP –> headache, dizziness, nausea, palpitations
CI’s:
Interactions:
Other info:
Minoxidil
Indications: Severe HTN (off label = alopecia)
MOA: Anti-hypertensive. Vasodilator
S/E’s: Hypertrichosis
CI’s: Pregnancy, phaeo.
Interactions:
Other info:
Nifedipine
Amlodipine
- *Indications:** Angina (prinzmetal), HTN, Raynauds + Premature labour (nifedipine)
- *MOA:** Dihydropyridine CCB’s - block L type Ca channels therefore inhibits Ca entry causing vasodilation including coronary arteries - only acts on arterial smooth muscle
- *S/E’s:** Flushing, headache, ankle oedema, dizziness, hypotension, constipation, gingival hypertrophy, reflex tachycardia!
- *CI’s:** Cardiogenic shock, severe aortic stenosis, within 1 month of MI, HOCM
- *Interactions:** Risk of severe hypotension with alpha/beta blockers, effects increased by grapefruit
- *Other info:** Nifedipine = no antiarrhythmic activity, short acting Amlodipine = long acting
Diltiazem
Verapamil
- *Indications:** Angina, HTN, SVT’s (verapamil)
- *MOA:** Non-dihydropyridines CCB’s - mainly cardiac activity. Negative ionotropes, verapamil slows conduction at SAN and AVN.
- *S/E’s:** Headache, flushing, AV block, Hypotension, ankle oedema, gynaecomastia
- *CI’s:** Severe bradycardia, hypotension, HF, 2/3rd degree heart block, AF assoc with WPW
- *Interactions:** Risk of AV block, HF and asystole witg B blockers. Verapamil effects increased by grapefruit juice and macrolides.
- *Other info:**
GTN
- *Indications:** Sublingual = symptomatic relief of anginal pain, ACS. Topical = anal fissures
- *MOA:** Anti-Anginal. Nitric oxide donor –> increased cGMP –> SM relaxation –> venodilation –> decreased preload. Also small amount of coronary vasodilation. Rapid onset, short duration, high 1st pass metabolism.
- *S/E’s:** Postural hypotension! Tachycardia, throbbing headache, dizziness, syncope, flushing
- *CI’s:** Aortic stenosis and mitral stenosis, hypotension, constrictive pericarditis, tamponade, HOCM, anaemia, closed angle glaucoma, raised ICP, hypovolaemia
- *Interactions:** IV GTN infusion decreased the effect of heparin
- *Other info:**
ISMN (Isosorbide mononitrate)
ISDN (Isosorbide dinitrate)
- *Indications:** Prophylaxis of angina, adjunct in CCF
- *MOA:** Anti-Anginal. Long acting nitrates. ISMN is active metabolite of ISDN. ISDN has unpredictable 1st pass metabolism. Tolerance develops quickly - need 8hr drug free period (at night!) so take in early day only.
- *S/E’s:** Postural hypotension, tachycardia, throbbing headache, dizziness, syncope, flushing
- *CI’s:** AS + MS, hypotension, constrictive pericarditis, tamponade, HOCM, anaemia, raised ICP, closed angle glaucoma, hypovolaemia
- *Interactions:** IV nitrate infusion decreases effect of heparin
- *Other info:**
Nicorandil
- *Indications:** Prophylaxis and treatment of stable angina (uncontrolled)
- *MOA:** Anti-Anginal - K channel opener – Nitrate component (Increases cGMP–>SM relaxation) and K+ATP channel activator. Arterial and venous dilator.
- *S/E’s:** Headache, flushing, dizziness, GI ulcers (rare)
- *CI’s:** Cardiogenic shock, LVF, hypotension
- *Interactions:** Do not use with sildenafil because lowers BP drastically
- *Other info:**
Aspirin
- *Indications:** Secondary prevention of thrombotic cerebrovascular or cardiovascular disease
- *MOA:** Antiplatelet –> Irreversible, non selective COX inhibitor –> decreased production of plt thromboxane A2 therefore decreased plt activation –> decreased plt adhesion and aggregation
- *S/E’s:** Gastric irritation (gastritis/ulcers), GI haemorrhage, bronchospasm, renal failure, gout, ototoxic in OD (tinnitus)
- *CI’s:** In children (risk of Reye syndrome) except in Kawasakis, active PUD, bleeding disorders, gout, pregnant
- *Interactions:** Increased bleeding risk with other anticoagulants/ antiplatelets, increased effect of sulphonylureas/methotrexate
- *Other info:** Caution in asthma and uncontrolled HTN. Stop 7d before any surgery if heavy bleeding expected. Relatively plt specific at low doses e.g 75-150mg. Max dose 4g/day.
Clopidogrel
aka plavix
- *Indications:** Prevention of atherothrombotic events in peripheral arterial disease, MI, Ischaemic stroke, ACS (NSTEMI+STEMI), AF
- *MOA:** Anti-platelet. Prodrug - thienopyridine class of antiplatelets, activated by hepatic CYP enzymes, is an irreversible adenosine R antagonist –> stops ADP induced fibringoen binding to gPIIb/IIIa
- *S/E’s:** Dyspepsia, GI upset, bleeding (GI/Intracranial), TTP (rare)
- *CI’s:** Active bleeding, severe liver disease, breastfeeding
- *Interactions:** Warfarin!!, PPI’s/H2RA’s, cipro
- *Other info:** Used following baremetal or drug eluting stents for atleast 1 year. Stop 7days before surgery.
Abciximab
Tirofiban
Eptifibatide
Indications: High risk pts with NSTEMI, PCI prevention of ischaemic cardiac complications
MOA: Anti-platelet. Inhibit GpIIb/IIIa receptors on platelets involved in plt activation, inhibition prevents aggregation and therefore thrombus formation.
S/E’s: Bleeding, N+V, hypotension, bradycardia, thrombocytopenia
CI’s: Active bleeding, major surgery
Interactions:
Other info: Only abciximab can be given PO, the rest = IV
Dipyridamole
- *Indications:** Can be used with aspirin/warfarin in 2ndary prevention of stroke
- *MOA:** Anti-platelet. Inhibits phosphodiesterase enzymes (which normally breakdown cAMP) therefore increased cAMP levels –> prevent plt aggregation. Also inhibits thromboxane synthase.
- *S/E’s:** GI upset, headache, no increased risk of bleeding!!!
- *CI’s:** Myasthenia gravis, AS, recent MI, LVF, can exacerbate migraines
- *Interactions:** Enhances and extends effects of adenosine
- *Other info:**
Aspirin OD
OD causes –> mixed metabolic acidosis and respiratory alkalosis
Presents as –> Vomiting, dehydration, tinnitus, hyperventilation
Ix –> Salicylate/paracetamol levels, FBC, U+E, LFT’s. Clotting, ABG, Glu
Rx –> If <1 hr since ingestion = gastric lavage Correct dehydration + acidosis (HCO3) Alkalinize urine: NaHCO3 + KCl If levels >700mg/L or heart/renal failure/seizures = Haemodialysis
Atorvastatin
Simvastatin
Pravastatin
(STATINS in decreasing potency, nocte)
- *Indications:** Primary hypercholesterolaemia (total choles >5, LDL>3), Familial hypercholesterolaemia, any known CVD, DM if aged >40
- *MOA:** Lipid lowering - STATIN HMG-CoA reductase inhibitors–> block rate limiting step in cholesterol synthesis –> decreased hepatocye cholesterol –> Increased hepatic LDL-R’s –> Decreased LDL cholesterol + Increase in HDL + Decrease in triglycerides (mildly)
- *S/E’s:** Myalgia, myopathy, myositis + rhabdo (–> ATN), deranged LFT’s, GI upset
- *CI’s:** Liver disease, ETOHics, pregnancy
- *Interactions**: Increased risk of myositis with fibrates, macrolides, azoles, grapefruit juice, protease inhibitors, ciclosporin
- *Other info:** Aim for total cholesterol <4. Monitor LFT’s and CK. Take nocte as increased cholesterol synthesis at night.
Gemfibrozil
Benzafibrate
- *Indications:** Hypertriglycerideaemia, adjunct to diet in hyperlipidaemia if statin not tolerated/CI.
- *MOA:** Lipid lowering - Fibrates –> Increase sysnthesis of lipoprotein lipase so increases the clearance of triglycerides (v small decrease in LDL and increase in HDL)
- *S/E’s:** Gallstones, GI upset, decreased appetitie, myositis
- *CI’s:** Gallbladder/biliary tract disease, PBC, low albumin, hepatic/renal impairment, pregnancy
- *Interactions:** Increased risk of myositis with statins, increased effect of anti-diabetics
- *Other info:**
Cholestyramine
Choletipol
- *Indications:** Hypercholesterolaemia, pruritis assoc with partial biliary obstruction/PBC
- *MOA:** Lipid lowering. A bile acid sequestrant –> a strong ion exchange resin (binds bile acids in the GIT to prevent reabsorption)–> prevents enterohepatic recycling therefore liver must make more bile acids (increases LDL-R’s)
- *S/E’s:** Constipation, N+V, bloating, impaired ADEK absorption
- *CI’s:** Complete biliary obstruction
- *Interactions:** Decreases absorption of digoxin
- *Other info**: Don’t take within 3 hours of other drugs!
Nicotinic Acid
- *Indications:** Adjunct to statins in dyslipidaemia or alone if statin CI/not tolerated
- *MOA:** Lipid lowering. Inhibits cholesterol and TG synthesis (increases HDL)
- *S/E’s:** N+V+D, abdo pain, dyspepsia, flushing (bad), myopathy
- *CI’s:** Arterial bleeding, active PUD, pregnancy
- *Interactions:** Increased risk of myopathy with statins
- *Other info:**
Ezetimibe
- *Indications:** Adjunct to diet + statins in primary hypercholesterolaemia and familial hypercholesterolaemia
- *MOA:** Lipid lowering. Inhibits absorption of cholesterol from the intestine.
- *S/E’s:** GI disturbances, headache, fatigure, myalgia
- *CI’s:** Pregnancy
- *Interactions:** Ciclosporin. Increased risk of myositis with statins.
- *Other info:**
Omega-3-FA
Indications: Adjunct to diet + statins in hypertriglyceridaemia
MOA: Lowers TG’s
S/E’s: Dyspepsia, nausea
CI’s: Pregnancy
Interactions:
Other info:
Orlistat
- *Indications:** Adjunct to diet/exercise in obesity
- *MOA:** Inhibits gastric and pancreatic lipases –> impaired absorption of dietary fat. Lipid lowering.
- *S/E’s:** GI upset/oily PR leakage, flatulence, urgency, steatorrheoa, impaired fat soluble ADEK vitamin absorption
- *CI’s:** Chronic malabsorption syndrome, cholestasis
- *Interactions:** Warfarin (unable to control INR)
- *Other info:**
Disopyramide
- *Indications:** Prevention and treatment of ventricular and SVT arrhythmias –> esp post MI, maintenance of sinus rhythm post cardioversion.
- *MOA:** Anti-Arrhythmic CLASS Ia. Sodium channel blocker. Inhibits conduction –> prolongs PR interval by lengthening QRS and P wave duration. Also negative inotropic effect.
- *S/E’s:** VT, VF, torsades de pointes, hypotension, AV blovk, anti-muscarinic effects e.g. dry mouth/blurred vision etc
- *CI’s:** Heart block (2nd/3rd degree/bifasic/trifasicular block)
- *Interactions:** Amiodarone, TCA’s
- *Other info:**
Lignocaine
(Lidocaine)
- *Indications:** Ventricular arrhythmias esp post MI. Terminates VT and decreases risk of VF.
- *MOA:** Anti-Arrhythmic CLASS Ib - Na channel blocker –> slows conduction and shortens repolarisation.
- *S/E’s:** Dizziness, paraesthesia, drowsiness, hypotension, bradycardia (can lead to cardiac arrest)
- *CI’s:** AV block!!
- *Interactions:** Cimetidine, propanolol
- *Other info:** IV use only.
Flecainide
- *Indications:** Pre-excited AF (WPW), chemical cardioversion in AF, suppression of ventricular ectopics
- *MOA:** Anti-Arrhythmic CLASS Ic - Na channel blocker –> slows conduction, no effect on repolarisation. Strongly negatively ionotropic.
- *S/E’s:** Oedema, SOB, dizziness, fatigue
- CI’s:** Heart failure, post MI, valvular/structural heart disease*, longstanding AF, 2/3rd degree heart block
- *Interactions:** Amiodarone, TCA’s, Bblockers
- *Other info:**
Amiodarone
- *Indications:** SVT, AF/flutter, pre excited AF, ventricular arrythmias incl VF
- *MOA:** Anti-Arrhythmic CLASS III - K+ channel effects –> slows conduction through the heart, MOA not fully understood.
- *S/E’s:** Eye- cornal microdeposits, thyroid - hyper/hypo, lung - pulm fibrosis, GI - deranged LFT’s, N+V, skin - photosensitivity (stay out of sun!) and blue-grey discolouration and phelbitis, neuro - periph neuropathy
- *CI’s:** Sinus bradycardia, thyroid disease, iodine allergy, long QTc –> TdP
- *Interactions:** Bblockers/CCb’s = increased risk of heart block and bradycardia, digoxin, warfarin, phenytoin, TCA’s, other antiarrhythmics
- *Other info:** Give centrally to avoid periph phelbitis. Accumulates in body - very long half life (10-100days) - need a loading dose!
Monitor TFT’s, LFT’s, K, CZR, skin
Digoxin
- *Indications:** SVT –> AF/flutter, Heart failure
- *MOA:** Anti-Arrhythmic - Cardiac gylcoside, MOA not fully understood. Increases tone of contraction and decreases AVN conduction.
- *S/E’s:** Toxicity = any arrhythmia, nausea, xanthopsia, confusion, hyperkalaemia, Chronic = gynaecomastia. Get reverse tick ECG finding.
- *CI’s:** 3rd degree heart block, VF/VT, HOCM, SVT’s with acces pathways (WPW)
- *Interactions:** Toxicity increased by CCB’s, amiodarone, diuretics. Antacids decrease digoxin absorption from GIT.
- *Other info:** Renally excreted - therefore caution in impairment and elderly. Monitor U+E, drug levels 6hrs post dose. Narrow therapeutic index 1-2.5nmol/L. Loading dose then maintenance dose needed.
Adenosine
- *Indications:** SVT (diagnosis and Rx)
- *MOA:** Anti-Arrhythmic - Binds adenosine receptors in cardiac conduction system, opening Ach sensitive K+ channels –> prolongs refractory period in AVN = decreases conduction
- *S/E’s:** Nausea, flushing, chest pain, SOB, bronchospasm *** WARN pt before!! Will make them feel awful for few seconds.
- *CI’s:** Asthma/COPD, 2/3rd degree heart block, sick sinus syndrome, severe hypotension
- *Interactions:** Effects prolonged by dipyridamole and decreased by theophylline
- *Other info:** Half life = 8-10secs, v short lived
Warfarin
- *Indications:** Treatment of VTE. Prophylaxis of VTE, AF, mechanical heart valve, large anterior MI (3/12), dilated cardiomyopathy/LV aneurysm, PE
- *MOA:** Inhibits Vit K epoxide reductase –> prevents recycling of vit K –> functional vit K deficiency. Inhibits synthesis of F2, 7, 9, 10, C + S (Cyp metabolism).
- *S/E’s:** Haemorrhage, bruising, skin necrosis (protein s deficiency), purple toe syndrome (cholesterol embolism), OP, hepatic dysfunction
- *CI’s:** Pregnancy (teratogenic 1st trimester/fetal haemorrhage 3rd tri), PUD, severe HTN, avoid in severe renal/hepatic impairment, alcholics
- *Interactions:** Enzyme inhibitors, ETOH, simvastatin, NSAIDs, amiodarone, Abx, cranberry juice, OCP, phenytoin, St John’s wart
- *Other info: Initally pro-coagulant as protein s is depleted first therefore need to cover pt with LMWH. Aim INR = 2-3 in all conditions except metal heart valves + APS = INR 3-4.**
DOSE - TAIT MODEL Day 1-4 = 5mg warfarin OD at 6pm Day 5 = check INR and adjust accordingly Day 8 = “ >Day 8 = check INR every 4 days and adjust accordingly
Apixaban
Dabigatran
Rivaroxaban
- *Indications:** VTE prophylaxis, non valvular AF
- *MOA**: ANTI COAGULANTS
Apixaban = direct inhibitor of FXa - PO Dabigatran = direct thrombin inhibitor - PO Rivaxaban = direct inhibitor of FXa - PO
- *S/E’s:** Nausea, dyspepsia, diarrhoea, abdo pain, haemorrhage, bruising
- *CI’s:** Active bleeding, sig risk of major bleeding, avoid in renal/hepatic failure and pregnancy
- *Interactions:** Many –> other anticoagulants
- *Other info:**
Heparin
- *Indications:** Rx and prophylaxis of VTE, ACS, acute arterial obstruction
- *MOA:** ANTI COAGULANT - Cofactor for ATIII - inhibits F2, 10, 11, 12
- *S/E’s:** Thrombocytopaenia (lowers plts), OP (long term use), hyperkalaemia (heparin inhibits aldosterone)
- *CI’s:** Bleeding disorders, plts<60, previous HIT, PUD, cerebral haemorrhage, severe HTN, neurosurgery
- *Interactions:** Increased risk of bleeding with other anticoagulants
- *Other info:** LMWH - longer half life, response is predictable therefore no monitoring required, less risk of HIT + OP too.
Unfractionated heparin - rapid onsent, short half life
Reversal agent = protamine sulphate (IV)
Streptokinase
Alteplase (Rh-TPA)
Indications: Acute MI (STEMI), DVT, PE, acute ischaemic stroke
MOA: Fibrinolytic drugs –> activate plasminogen, forming plasmin –> degrades fibrin –> breaking up thrombus
S/E’s: Bleeding, hypotension, reperfusion dysrhythmias, allergy!
CI’s: Haemorrhagic stroke*, CNS trauma/neoplasm* (absolute CI’s), recent haemorrhage, trauma, surgery, coagulation defects
Interactions: -
Other info: Streptokinase –> derived from streptococci –> develop Ab’s - therefore use once only or can get allergic reactions!
Phenylephrine
Timolol
Indications: Mydriasis, chronic open angle glaucoma
MOA: Alpha agnonists –> decrease aqueous humour production
S/E’s: Blurred vision, photophobia, palpitations, tacchycardia, HTN
CI’s: CVD, HTN, thyrotoxicosis
Interactions:
Other info:
Vaughan - Williams Classification
(Anti-Arrhythmics)
Class I - Na+ channel blockers –> all slow conduction - subclasses have different effects on action potential. 1a) Procainamide 1b) Lignocaine 1c) Flecainide
ClassII - Bblockers - act on atria/SAN/AVN/ventricles and decrease Ca entry to cells. Increase refractory period of AVN (slow the conduction)
Class III - K+ channel blockers - act on atria/SAN/AVN/ventricles, increases refractory period and QTc.
Class IV - Ca2+ channel blockers - acts on AVN to slow conduction
Class V - Unclassified –> Digoxin (cardiac glycoside), Adenosine
