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Final Year MBBS > Pharmacology - Cardiology > Flashcards

Pharmacology - Cardiology Flashcards

1
Q

Frusemide

20-40mg OD (in the morning) PO or IV

Bumetanide

1mg PO BD

A
  • *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.
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2
Q

Bendroflumethiazide (use for CCF 5-10mg OD (am))

Metolazone

Chlortalidone (use in HTN)

Indapamide (use in HTN 2.5mg OD)

A
  • *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.
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3
Q

Spironolactone (100-400mg daily)

Eplerenone

Amiloride (10mg daily)

A

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.
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4
Q

Acetazolamide

A
  • *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
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5
Q

Mannitol

IV infusion over 45mins, 0.25-2g/kg

A

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

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6
Q

Enalapril

Captopril

Ramipril

Lisinopril

Perindopril

A
  • *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.
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7
Q

Losartan (short t1/2)

Irbesartan (long t1/2)

Candesartan (long t1/2)

A
  • *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:**
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8
Q

Bisoprolol

Atenolol

Metoprolol

Esmolol

Nebivolol

A

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.

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9
Q

Clonidine

A
  • *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:**
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10
Q

Methyldopa

A
  • *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:**
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11
Q

Hydralazine

A

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.

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12
Q

Sodium Nitroprusside

A

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:

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13
Q

Minoxidil

A

Indications: Severe HTN (off label = alopecia)
MOA: Anti-hypertensive. Vasodilator
S/E’s: Hypertrichosis
CI’s: Pregnancy, phaeo.
Interactions:
Other info:

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14
Q

Nifedipine

Amlodipine

A
  • *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
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15
Q

Diltiazem

Verapamil

A
  • *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:**
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16
Q

GTN

A
  • *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:**
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17
Q

ISMN (Isosorbide mononitrate)

ISDN (Isosorbide dinitrate)

A
  • *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:**
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18
Q

Nicorandil

A
  • *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:**
19
Q

Aspirin

A
  • *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.
20
Q

Clopidogrel

aka plavix

A
  • *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.
21
Q

Abciximab

Tirofiban

Eptifibatide

A

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

22
Q

Dipyridamole

A
  • *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:**
23
Q

Aspirin OD

A

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

24
Q

Atorvastatin

Simvastatin

Pravastatin

(STATINS in decreasing potency, nocte)

A
  • *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.
25
Q

Gemfibrozil

Benzafibrate

A
  • *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:**
26
Q

Cholestyramine

Choletipol

A
  • *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!
27
Q

Nicotinic Acid

A
  • *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:**
28
Q

Ezetimibe

A
  • *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:**
29
Q

Omega-3-FA

A

Indications: Adjunct to diet + statins in hypertriglyceridaemia
MOA: Lowers TG’s
S/E’s: Dyspepsia, nausea
CI’s: Pregnancy
Interactions:
Other info:

30
Q

Orlistat

A
  • *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:**
31
Q

Disopyramide

A
  • *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:**
32
Q

Lignocaine

(Lidocaine)

A
  • *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.
33
Q

Flecainide

A
  • *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:**
34
Q

Amiodarone

A
  • *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

35
Q

Digoxin

A
  • *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.
36
Q

Adenosine

A
  • *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
37
Q

Warfarin

A
  • *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

38
Q

Apixaban

Dabigatran

Rivaroxaban

A
  • *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:**
39
Q

Heparin

A
  • *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)

40
Q

Streptokinase

Alteplase (Rh-TPA)

A

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!

41
Q

Phenylephrine

Timolol

A

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:

42
Q

Vaughan - Williams Classification

(Anti-Arrhythmics)

A

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

43
Q
A

Final Year MBBS (39 decks)

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