Pharmacology - renal and cardiac Flashcards
Types of diuretics
Loop diuretics
Thiazide and thiazide-like diuretics
Potassium sparing diuretics
Osmotic.
Loop diuretics - examples
Furosemide, bumetanide.
Loop diuretics - mechanism
Inhibit the Na+/K+/2Cl- co-transporter. Excretion of 15-20% of filtered Na+.
Other effects of loop diuretics
venodilatory
Counterindications for loop diuretics
renal impairment,
cardiac glycosides, aminoglycosides.
Thiazide diuretic example
Bendroflumethiazide.
Mechanism of thiazide diuretics.
Inhibit Na+/Cl- co-transporter resulting in the excretion of 5-10% of the filtered Na+.
Indications for thiazide diuretics
Hypertension, with loop diuretic for profound oedema secondary to chronic heart failure.
Potassium sparing diuretics - types
Sodium channel blockers
Aldosterone antagonists.
Sodium channel blockers - examples. (Potassium sparing diuretics).
Amiloride, triampterene.
Aldosterone antagonists - example. (Potassium sparing diuretics).
Spironolactone
Contraindications for aldosterone antagonists
Being on ACEIs.
Treatment of urinary retention
a-blockers e.g. Doxazosin to relax smooth muscle at the urethra.
Parasympathomimetics to increase detrusor contraction.
Anti-androgens for benign prostatic hyperplasia.
Treatment of urinary incontinence
Antimuscarinics.
Aims of treatment of heart failure
Relieve symptoms, improve exercise tolerance, reduce exacerbations, reduce mortality.
Basic treatment for heart failure.
ACE inhibitor (or angiotensin II receptor antagonis if poorly tolerated). B-blocker e.g. bisoprolol, carvedilol.
Heart failure treatment after ACEI and B-blockers, if still symptomatic.
Aldosterone antagonist e.g. spironolactone
Digoxin improves symptoms and exercise tolerance but not mortality.
Heart failure treatment if after basic treatment, still has fluid overload
Thiazide diuretic if good renal function
Loop diuretic if renal impairment.
Treatments for high blood pressure
ACE Inhibitors
Ca++ channel blockers
Diuretics
Treatments for anyone over 55 with high blood pressure
Ca++ channel blocker - amlodipine
Diuretic - indapemide
Treatments for anyone under 55 or of African origin with high blood pressure.
An ACE inhibitor
IF ACD treatment for high blood pressure fails then use…
an alpha blocker e.g. doxazosin
How to treat brady-dysrhythmias.
Stop rate controlling drugs Check TSH and electolytes Atropine Temporary pacing Permanent pacing.
Management of supraventricula tachycardias.
Treat symptoms Carotid sinus massage Adenosine Verapamil DCC
Action of adenosine
Purine nucleotide slowing AV nodal conduction.
Action of verapamil
Calcium channel blocker prolonging conduction and refractoriness in AV node
Digoxin is used for which arrhythmia
atrial fibrillation or flutter.
Flecanide action
Blocks Na+ channels, slows conduction in cardiac channels.
Management of ventricular fibrillation and tachycardia
DCCV
Amiodarone
K+ and Mg++
Lidocaine.
Management of angina
ASA Lipid lowering agent Nitrates B-blockers Calcium channel blockers Potassium channel activators Funny current channel inhibitors.
Action of nitrates
Reduce preload by venodilation, dilates coronaries, reduces afterload by systemic vasodilatation.
What do nitrates interact with?
PDE5 inhibitors LETHALLY by causing profound hypotension.
Role of B-blockers in angina
Reduce HR and contractility leading to less cardiac demand for O2.
What diseases do B-blockers worsen?
Heart blocks
Acute cardiac failure
COPD and asthma
Peripheral vascular disease.
Calcium channel blockers used in angina
Di-hydropyridines and non-dihydropyridines.
Di-hydropyridines action and examples
Nifedipine, amlodipine.
Reduce afterload by arteriolar dilatation. Dilate coronaries.
Non-dihydropyridines
Diltiazem, verapamil.
Reduce afterload and have negative chronotropic effect due to affect on action on SA and AV nodes.
Potassium channel activators
Vasodilatory. Nicorandil.
Action of aspirin
COX inhibitor
Action and examples of thienopyridines
Thienopyriines include clopidogrel and ticlopidine. Irreversibly inhibit ADP binding in platelet activation.
Examples of glycoprotein 2b3a antagonists
abciximab, eptifibatide, tirofiban.
Action of glycoprotein 2b3a antagonists
Potent inhibitors of platelet aggregation.
Heart failure treatment
(Diuretics for symptomatic relief) ACEI B-blocker Spironolactone (isosorbide dinitrate with hydralazine, digoxin)
Treatment of unstable angina/NSTEMI: MONA BTC
Morphine
Oxygen
Nitrates
Aspirin
B-blockers
Thrombolysis
Clopidogrel
Thrombolytic drug used in ACS
glycoprotein IIb/IIIa inhibitors such as eptifibatide, tirofiban.
Treatment for STEMI: MOC thought nitrates assuages (the) burning.
Morphine Oxygen Clopidogrel Thrombolysis ACEI B-blockers.
What antibiotic should you absolutely not give with methotrexate?
Trimethoprim
Which antibiotic has 10% allergy crossover with paracetamol
Cephalosporins