Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

FINALS > Prescribing - Cardiology > Flashcards

Prescribing - Cardiology Flashcards

1
Q

What drug class if Digoxin?

A

Cardiac glycosides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How does Digoxin Work?

A

Na+ K+ ATPase membrane pump inhibitor.

Increase in intracellular sodium. This leads to a subsequent rise in intracellular calcium through the Na+ Ca2+ exchanger

Causes positive inotropic effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When is Digoxin used?

A

Ventricular rate control in supraventricular arrhythmias

atrial fibrillation and atrial flutter

Heart Failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the presentation of Digoxin Toxicity?

A

Confusion
Loss of appetite
Nausea and vomiting
Diarrhoea

Evidence of cardiotoxicity ( palpitations, arrhythmias, conduction disturbances;)

eosinophilia
Rash,

Blurred or yellow vision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do you manage Digoxin Toxicity?

A

withdrawal of the drug and correction of electrolyte disturbances

If that doesn’t work then Digoxin Specific antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are contraindications to Digoxin?

A 
Caution in :
electrolyte disturbances (mainly Mg, Ca, K)

Thyroid disease

SRDS

Patients with recent MI

Avoid in:
Heart Block, WPW< Ventricular tachycardia or fibrillation
Myocarditis
Constrictive pericarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does Digoxin Interact with?

A

Amiodarone (increased plasma digoxin concentration – halve dose of digoxin)
Calcium channel blockers (increased plasma digoxin concentration)
Drugs which cause hypokalaemia, Diuretics or PPI (due to hypomagnesemia) as they increase risk of cardio toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How should Digoxin be monitored?

A

Monitor plasma digoxin concentration regularly if toxicity suspected, monitor renal function and adjust dose in renal impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What should be communicated to patients

A

Patients should be made aware of the symptoms of toxicity (nausea, vomiting, visual disturbance, confusion or dizziness)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are examples of Thiazide diuretics?

A

Cendroflumethiazide

Hydrochlorothiazide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are examples of Thiazide like diuretics?

A

Indapamide
Chlortalidone
Metolazone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do thiazide like diuretics work?

A

Inhibits NA+ Cl- symporter in distal convoluted tubule. Meaning their reabsorption is inhibited and water does also not get reabsorbed. Causing reduction in blood volume and pressure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are side effects of Thiazide and Thiazide like diuretics?

A

Altered plasma-lipid concentrations (elevated LDL cholesterol)
Gout
Electrolyte disturbances
Hyperglycaemia

Impotense!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When are thiazide like diuretics contraindicated?

A

Caution if malnourished and have renal impairment

Caution in patients with PMH of Gout or Diabetes

Do not use in:
Addisons disease
active gout
refractory electrolyte disturbances

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are interactions of Thiazide and Thiazide like diuretics?

A

Other antihypertensives (increased hypotensive effect)

Antidiabetic drugs (reduced hypoglycaemic effect)

Lithium (increased plasma lithium concentration, risk of toxicity)

NSAIDs (impaired diuresis AND increased risk of nephrotoxicity)

Other drugs causing hyponatraemia (diuretics, antidepressants, carbamazepine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What needs to be measured with Thiazide and Thiazide like diuretics?

A

U+E

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What drug class if Frusemide?

A

Loop diuretic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do loop diuretics work?

A

Inhibit Na+ K+ 2Cl- symporter in the thick ascending limb of the loop of Henlé.

Prevents the transport of sodium from the lumen of the loop of Henle into the basolateral interstitium.

Lumen becomes more hypertonic while the interstitium becomes less hypertonic.

Diminishes the osmotic gradient for water reabsorption throughout the nephron.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are side effects of Frusemide?

A

GI disturbance
Postural hypotension
Electrolyte distubances
Tinnitus

Important:

Hyperglycaemia, Hyperuricaemia (gout)
Ototoxicity
Nephrotoxicity
Hepatic encephalopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are contraindications for Frusemide?

A

Hypovolaemia
Hypotension
Prostatic hypertrophy
PMH of of diabetes or gout

Anuria
Severe hyponatraemia/hypokalaemia
liver cirrhosis
renal failure (nephrotoxic),

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are drug interactions of Frusemide?

A

Antihypertensives (increased hypotensive effect)

NSAIDs (impaired diuresis AND increased risk of nephrotoxicity)

Aminoglycoside antibiotics and vancomycin (increased risk of ototoxicity)

Lithium (increased plasma lithium concentration, risk of toxicity)

Thiazide diuretics (increased risk of electrolyte disturbance)

Pregnancy

Digoxin (risk of cardiotoxicity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What drug class is Spironolactone?

A

Aldosterone-dependent potassium sparing diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How does Spironolactone work?

A

Antagonist to aldosterone receptors in the renal tubules.

Inhibits Na+/K+ exchange in the distal tubule and collecting ducts, promoting potassium retention and sodium and water loss.

Causing weak diuresis, potassium retention and hypotensive effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the side effects of Spironolactone?

A

GI upset
Hyperkalaemia

Important:

Gynaecomastia/hypogonadism, impotence in males, menstrual irregularities in females

Acute renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are contraindications to Spironolactone?

A

Avoid in hyperkalaemia, hyponatraemia, anuria and Addison’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the drug interactions of Spironolactone?

A

Drug affecting RAAS (increased risk of hyperkalaemia)

ACE inhibitors

ARBs

direct renin inhibitors

Other potassium sparing diuretics e.g. amiloride, triamterene (increased risk of hyperkalaemia)

Potassium supplements

Antihypertensives (increased hypotensive effect)

NSAIDs (increased risk of nephrotoxicity)

Lithium – excretion is inhibited by spironolactone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What should be communicated to the patient when prescribing Spironolactone?

A

take this medication with or after food.

Avoid salt substitutes as they have high potassium

Do not take NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What drug class is Amiodarone

A

Anti-arrythmic (class III)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How does Amiodarone work?

A

Prolongs the cardiac action potential seen as an increase in the QT interval on the ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are side effects of Amiodarone?

A 
Bradycardia
Hyper/hypothyroidism
Jaundice
Trrmour
D + V

Peripheral neuropathy and myopathy!!
Optic neuritis!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

When is Amiodarone contraindicated?

A

caution in heart failure
avoid in thyroid disorders
SAN heard block or bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Amiodarone interacts with which medicines?

A

Antiarrythmics- increased risk of myocardial depression

Antihypertensives - bradicardia and AV block risk

Digoxin - increases digoxin concentration, must half digoxin dose

Warfarin- increased anticoagulatory effect

TCA - increases risk of ventricular arrhythmia
statins - increases myopathy risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What needs to be checked on Amiodarone?

A

Ongoing monitoring:

LFT

TFT

ECG

before starting:

CXR

K+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What should be communicated to patients?

A

Avoid exposure to direct sunlight and sun lamps during treatment and for several months after

wear high factor sunscreen

Advise patients that this medication can produce changes in their eyes which may cause them to be dazzled by car headlights when driving at night.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What drug class is Bisoprolol?

A

B Blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what are cardioselective BBlockers ?

A

Atenolol, Metoprolol, Nebivolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are non cardioselective BBlockers

A

Carvedilol, Propranolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How do BBlockers work?

A

is an antagonist to B adrenoreceptors meaning there is a reduction in contractility (negative intropy), reduce heart rate (negative chronotropy), reduce blood pressure, reduce cardiac work

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what are side effects of BBlockers

A

common:

Dizziness, fatigue, cold hands, impotence, headache

Important:

Hypotension
raynauds and intermittent claudication
bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are contraindications to BBlockers

A

Asthma
Heart block
Hypotension
Har failure (needs monitoring as can exacerbate)

Diabetes - may mask symptoms of a hypo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are the interactions of BBlockers?

A

Alcohol (increased hypotensive effect)

Other antihypertensives (increased hypotensive effect)

Anti-arrhythmics (bradycardia, myocardial depression, ventricular arrhythmias)

Clonidine (increased risk of rebound hypertension when stopping beta blockers)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

what is important to communicate to patients ?

A

Explain to patients that they should not stop taking this medication unless told to do so by their doctor.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What drug class if Doxazosin

A

Alpha 1 blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

how do Alpha 1 blockers work

A

alpha adrenoreceptor antagonist causing Vascular smooth muscle relaxation, vasodilatation and reduction in arterial blood pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

When are alpha 1 lockers used?

A

Hypertension

Benign prostatic hyperplasia (α1 specific)

Raynaud’s syndrome (prazosin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

what are side effects of alpha 1 blockers

A 
Anxiety
back pain
influenza-like symptoms; paraesthesia
 sleep disturbance
vertigo

Postural hypotension!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

When are alpha 1 blockers contraindicated?

A

Parkinsons
if about to have cataract surgery (floppy iris)

first dose may cause hypotension and collapse best taken at bedtime

48
Q

What drug interactions do alpha 1 blockers have?

A

Other antihypertensives (increased hypotensive effect)

MAOIs (enhanced hypotensive effect)

49
Q

What is important to communicate to patients

A

fist dose at nighttime before bed - first dose hypotension

may cause in ability to perform skilled tasks

50
Q

What drug class is rampril?

A

ACEi

51
Q

How does ramipril work?

A

Inhibits ACE thus nhibits synthesis of potent vasoconstrictor peptide angiotensin II leading to vascular smooth muscle relaxation and vasodilatation reducing BP

52
Q

What are side effects of Ramipril

A

Persistent dry cough
hyperkalaemia and increase in serum creatinine

(First dose) hypotension

Important!!

Acute renal failure, cholestatic jaundice/hepatitis
Angioedema

53
Q

What are contraindications for Ramipril?

A

caution with diuretics

Pregnancy!!!

54
Q

What are interactions for Ramipril?

A

Diuretics - hypotension and hyperkalaemia if pot. sparing

potassium salts

immunosuppressnts

lithium

55
Q

What needs to be measured when prescribing Ramipril?

A

U+E

56
Q

What needs to be communicated to patients about Ramipril?

A

Explain need for blood U+E.

If a dry cough occurs to go to GP

Take first dose at night before bed.

57
Q

What drug is class is Irbesartan?

A

angiotensin receptor blocker

58
Q

How do ARBs work?

A

Antagonist at angiotensin receptor meaning theres Selective inhibition of potent vasoconstrictor peptide angiotensin II leading to vascular smooth muscle relaxation and vasodilatation

59
Q

What are side effects of ARBs?

A

First dose hypotension

acute renal failure!
angioedema!

60
Q

what are contraindications to ARBs?

A

pregnancy and breast feeding

61
Q

what do ARBs interact with?

A

other antihypertensives and potassium sparing diuretics

lithium

62
Q

what needs to be monitored

A

U+E

63
Q

what class is Glyceryl Trinitrate

A

Nitrates

64
Q

How does GTN work

A

Nitrate binding to its receptor causes an intracellular reaction which causes a reduction in intracellular calcium causing smooth muscle relaxation and vasodilation.

65
Q

What are side effects of GTN?

A 
headache
Postural hypotension
Tachycardia
Flushing
Tolerance
66
Q

What are contraindications to using GTN?

A

Hypothyroidism
recent MI
heart failure
hypotension

67
Q

What can GTN interact with?

A

antihypertensives

68
Q

what should be communicated to patients?

A

Explain to patients how they should take their GTN – spray 1-2 times under the tongue and then close mouth. This medication is for use when the patient notices their angina symptoms – it is for relief of an acute attack.

69
Q

Amilodipine drug class?

A

CCB

70
Q

How does amilodipine work?

A

Inhibit influx of calcium ions into vascular smooth muscle cells through L-type calcium channels decreasing arterial smooth muscle contratility leading to vasodilatation

71
Q

What are common side effects of Amilodipine?

A 
Abdominal pain
oedema
dizziness
fatigue
flushing
headache
palpitation
sleep disturbances
72
Q

What are important side effects of Amilodipine?

A

Heart failure in patients with poor left ventricular function

73
Q

What are contraindications for Amilodipine

A

elderly
heart failure
MI in last month

74
Q

What drugs does amilodipine interact with?

A

Antihypertensives
Simvastatin (inc. myopathy)
Digoxin (inc. plasma concentration)
Theophylline (inc. theophylline concentration)

75
Q

Diltazem and Verapamil drug class?

A

Rate limiting CCB

76
Q

How do rate limiting CCB’s work?

A

Antagonist to L type calcium channels. Inhibiting calcium influx causing negative inotropic effect

77
Q

what are common side effects?

A 
Asthenia
Constipation
Oedema
Dizziness
Headaches
Hypotension and bradicardia
78
Q

what are important Side effects?

A

sino atrial and AV block in those taking digoxin or B Blockers

79
Q

what are contraindications for ditazem/verapamil?

A

B Blockers!!! can cause systole, severe hypotension and heart failure

antiarrythmics and antihypertensives

verapamil shouldnt be used in VT

80
Q

what is the name of a low molecular weight heparin?

A

Deltaparin

81
Q

How do LMWH work?

A

The activate anti-thrombin
this inhibits clotting factor Xa meaning that prothrombin does not get converted to thrombin
does inhibiting coagulation

82
Q

What are important side-effects of LMWH?

A

Haemorrhage

heparin induced thrombocytopenia – this is immune-mediated and doesn’t develop until 5 to 10 days afterwards

hyperkalaemia

83
Q

What are contraindications for low molecular weight heparin?

A

Elderly and those at risk of falls

renal or hepatic impairment

haemophilia and other haemorrhagic disorders

recent haemorrhage

peptic ulcer disease

those with a particularly low body weight

84
Q

What drugs does LMHW interact with?

A

NSAIDS

anti platelet

ACE inhibitors and ARBs – increased risk of hyperkalaemia

85
Q

What is the monitoring of low molecular weight heparin?

A

Platelet count and potassium should be checked at the start of treatment

regular monitoring if treatment is over four days

86
Q

What drug class is warfarin?

A

Vitamin K antagonist

87
Q

How does warfarin work?

A

It is a competitive inhibitor to vitamin K reductase

it depletes the active clotting factors 2, 7, 9 and 10

causes anticoagulation

takes several days to work

88
Q

What are common adverse effects of warfarin?

A

Haemorrhage and bruising

89
Q

what are important side effects of warfarin?

A

Skin necrosis

high-sensitivity (pyrexia)

liver disfunction causing jaundice

90
Q

What contraindications to warfarin?

A

Pregnancy

peptic ulcers disease and anyone at risk of bleeding

renal impairment

91
Q

What is the monitoring of warfarin?

A

IN our should be checked regularly at the beginning of treatment done every day then progressively longer intervals until up to 12 weeks once the steady INR is achieved

92
Q

What should be communicated to patients when taking warfarin?

A

Do not take any over-the-counter medicines especially aspirin without checking with the pharmacist

make sure you inform anyone he wants to start you taking medication you are on warfarin

do not get pregnant

avoid drinking cranberry juice or eating lots of leafy green vegetables do not binge drink

take warfarin at the same time everyday

93
Q

What drugs interact with warfarin?

A

increase anticoagulant effect

Alcohol
NSAIDS and aspirin

94
Q

What type of drug is Riveroxiban?

A

A factor XA inhibitor

prothrombin is in converted thrombin

meaning fibrongen isn’t converted to fibrin

95
Q

what are common side effects of riveroxiban

A 
Abdominal pain
constipation or diarrhoea
dizziness
dyspepsia
pain in the extremities
headaches
96
Q

What are serious side-effects of riveroxiban

A

Haemorrhage
hepatobiliary disorder
renal impairment

97
Q

What does rivaroxiban interact with

A

NSAIDS
amiodarone
verapamil
triazole antifungals

98
Q

What drug class is aspirin?

A

Antiplatelet

99
Q

How does aspirin work?

A

Is an irreversibleinhibitor of cyclooxygenase enzymes

reduces platelet aggregation

100
Q

What is a typical dose of aspirin?

A

75 mg once daily

101
Q

What are important side effects of aspirin?

A

Bronchospasm

GI irritation – ulceration and bleeding

102
Q

what are contraindications to Aspirin?

A

Asthma
uncontrolled hypertension
previous peptic ulcer

avoid in active peptic ulcer disease, haemophilia and other breathing disorders

103
Q

What drugs does aspirin interact with?

A

NSAID
Anticoagulants
SSRI

104
Q

What should be communicated to patients about aspirin?

A

Advise patients to take tablet whole.
Do not take indigestion remedies.
To be taken with food.

Not to be given to children under 12 increases risk of Reyes syndrome.

105
Q

What replaces clopidogrel?

A

An anti platelet

106
Q

How does clopidogrel work?

A

Is an inhibited ADP receptor

inhibits platelet aggregation

107
Q

What are common side effects of clopidogrel?

A

GI disturbances and bleeding disorders (including intracranial)

108
Q

What drugs does clopidogrel interact with?

A

Other antiplatelet or anticoagulant
fibrinolytic
PPIs or H2 agonists
NSAIDs

109
Q

what drug class is simvastatin?

A

It’s a statin

110
Q

How do statins work?

A

Target the HMG CoA reductase as a competitive inhibitor. Meaning that hepatic cholesterol is synthesised less and up regulates LDL receptors and increased removal of hepatic LDL

overall reducing LDL cholesterol reducing triglycerides and increasing HDL cholesterol

111
Q

When are statins used?

A

Treatment of hypercholesterolaemia

prevention of cardiovascular events in high-risk patients with atherosclerosis or diabetes mellitus

112
Q

What are common side effects of statins?

A

Abnormal liver function tests (elevated transaminases) - stop If this occurs

GI disturbance e.g. constipation and flatulence

myalgia

113
Q

What are important side effects of statins?

A

myositis
hypothyroidism
low body mass index
Rhabdomolysis

114
Q

When are statins contraindicated?

A

In active liver diseaseor history of liver disease

in pregnancy

115
Q

What drug interactions are there with statins?

A 
Myopathy risk increases with:
amiodarone
CCB
antifungals
colchicine

warfarin – may increase anticoagulant effect

116
Q

What monitoring is required with statins?

A

LFTs - checked every three months
if suspecting rhabdomyolysis check CKs

TFT, CK, HBA1C, U+E at start

117
Q

What is important to communicate to patients when taking statins?

A

Report properly any unexplained muscle pain, tenderness or weakness

report any shortness of breath coffee or weight loss

do not get pregnant on statins or one month after taking statins

FINALS (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions