SBA summer Flashcards
Antibiotics, CV drugs
Bisoprolol, Atenolol, propranolol, metoprolol
what? indication?
Beta blockers
First line - AF and IHD (Angina and ACS), CHF (improves prognosis, SVT
MOA for beta-blockers
- AF
- HTN
propranolol, bisoprolol, atenolol, metroprolol
Beta1 receptor (mainly in heart) BB reduce contraction force and speed of conduction
AF- reduce ventricular rate in AF by prolonging AV node refractory period
HTN - reduce renin secretions from kidneys (B1 receptorrs)
Side effects of BB
Fatigue, headaches, nausea, sleep disturbance
Absolute contraindications for BB
which ones selective/non-selective
Asthma - Bronchospasms
Atenolol and bisoprolol - realatively B1 receptor selective
Propanolol - not
(kim put on propanolol for headaches)
2nd/3rd degree heart block, unstable HF
BB interaction
Non-dihydropyridine CCB
Verapamil and Diltazem
Vera and Dita don’t like Big Boys
Amlodipine, nifedipine, diltiazem and verapamil
what?
Indications?
CCB
Amlodipine - first line or 2nd line tx HTN (reduces risk of stroke, MI, and death from CVD)
Symptom control - stable angina
Diltiazem and Verapamil - controls cardiac rate in SVT, AF, Atrial flutter
CCB MOA
Amlodipine, Nifedipine, dilitiazem and verapamil
reduce CA2+ into vascular and cardiac cells. reducing intracellular Ca2+ conc
arteriol smooth muscles vasodilate
heart - reduces myocardial conraction, suppress cardiac conduction, reduce O2 demand
CCB selectivity
Verapamil - most cardio selective
(Vera wants love)
amlodipine, nifedipine - relatively selective for vasculature
Side effects CCB
ankle swelling, flushing, palpitations, constipation
Classes of CCB (3)
Dihydropyridines (Nifedipine, Amlodipine) potent Vasodilators
kNifes Are Violent
Phenylalkylamines (verapamil, gallopmil) potent myocardial depressants
Vera wants love
Benzothiazepines (Diltiazen) moderate both
Dita wants violent love
Side effects of CCB
Nifedipine, amlodipine (vasodilation) - headaches, ankle swelling, palpitations)
Verapamil (myocardial depression) bradyarrhythmias, AV block
Diltiazem - similar but milder
Contraindications for CCB
Pre-existing cardiac conduction disorders (AV block)
symptomatic hypotension
ACS
Verapamil and diltiazem - BB
Where are CCB metabolised
metabolised in liver, excreted by kidneys
Isosorbide mononitrate
glyceryl trinitrate
indication
GTN spray
acute angina and chest pain ass with ACS
Isosorbide mono (long acting)
prophylaxis for angina where BB or CCB not tol/insuff
Nitrates MOA
relax venous capacitance vessels reducing pre-load
thef. reduce cardiac work and O2 demand
Side effects - nitrates
vasodilator - flushing, headaches, hypotension,
sustained use can lead to tolerance
give am and lunch time
CI of nitrates
severe aortic senosis
hypotension
sildenafil
Nicorandil
MOA
Indication
vasodilation due to nitrate property
prevention/tx chest pain in stable angina
used if BB/CCB insuff or not tolerated
? cardiology referral if 2 antihypertensives not working
Nicorandil S/E
vasodilation
Mouth ulcers, flushing, dizzy, headaches, N+V
Ramipril, Lisinopril, Perindopril
what?
Indications?
ACE inhibitors
1st/2nd line tx of HTN (reduce risk of CVD complications and death)
CHF - 1st line all grades (improves symptoms and prognosis)
IHD - reduce risk following MI
Diabetic nephropathy - proteinuria (kidney protective)
ACE inhib MOA
Ramipril, Lisinopril, Perindopril
Blocks action of ACE
prevents conversion of angiotensin 1 to 2
Angiotensin 2 vasoconstrictor and stimulates aldosterone secretion
reduced Aldosterone promotes Na+ and H2O secretion this reduces preload (beneficial in HF)
Side effects of Ramipril, Lisinopril, Perindopril
ACE inhibitors
hypotension, cough, hyperkalemia, headaches
Contraindications for ACE I
Renal artery stenosis, AKI, pregnant/breast feeding
ACE I interactions
Potassium supplements
K+ sparing diuretics
NSAIDS (increased risk of renal failure)
monitor U+Es and renal func.
