Cardiac Drugs Flashcards
Post coronary artery stent, what medication would we want to prescribe?
Dual anti platelet therapy like aspirin and prasugrel or aspirin and clopidogrel
What is a side effect of amlodipine?
Peripheral oedema
what drugs might we use for medical treatment of AF?
Rate control= 1. beta blockers + digoxin OR 2. centrally acting Ca2+ blockers
Rhythm control= sotalol and amiodarone
Anticoagulation= warfarin or other oral anticoagulant
what is first line treatment for heart failure?
ACE inhibitor
what are some side effects of spironolactone
Side effects of spironolactone= causes gynaemastia/post menopausal bleeding bc it cross-reacts (inhibits) with sex steroid receptors. It also causes hyperkalemia and renal impairment. It can also drop blood pressure
what is indapamide? what is it used for?
thiazide diuretic, but works for blood pressure control not really used as a diuretic.
why won’t we use dihydropyridines in cardiac failure?
Blood pressure control, not contraindicated but NO role in heart failure. Also side effect= peripheral oedema
why won’t we use non-dihydropyridines in cardiac failure?
contraindicated in systolic heart failure
How does digoxin work? what is it primarily used for?
• Slows heart rate and reduces AV nodal conduction by an increase in vagal tone and a reduction in sympathetic activity.
• Increases the force of myocardial contraction by increasing the release and availability of stored intracellular calcium.
-Used for AF/flutter
what are the adjunct therapies we use in an AMI?
- O2
- IV morphine
- Aspirin
- IV heparin/clexane
- IV GTN
- Clopidogrel if stent is inserted
Beta blockers and ACEi if LV dysfunction
what are some serious side effects of digoxin?
atrial or ventricular extrasystoles, paroxysmal atrial tachycardia with AV block, ventricular tachycardia or fibrillation, heart block. also can cause vision to appear ‘yellow’. Gynaecomastia with long-term use
What are some side effects of amiodarone?
- hyper and hypothyroidism
- may exacerbate arrhythmia and cause new arrhythmia
- grey skin pigmentation
- neuro effects- tremor, parasthesia, weakness, ataxia, neuropathy
- sleep disturbances
- hypotension
- ocular effects=corneal micro deposits and blurry vision. Optic neuritis in worst case
- pulmonary toxicity
what medical therapy would we use for a patient with chronic angina?
- Beta blocker atenolol OR Calcium non dihydropyridine- NOT BOTH!!
- Dual anti platelet therapy (aspirin + clopidogrel) if high risk, or aspirin alone in low risk in ACS risk stratification.
- Long acting nitrates like isosorbide mononitrate if GTN short acting PRN is not working. Remember that nitrates are contraindicated in postural hypotension
if beta blocker OR calcium verapamil/diltiazem does not work for treating anginal symptoms, then what should you suggest?
add a dihydropyridine like amlodipine and nefidipine
contraindications of beta blockers
contraindicated in asthma and diabetes as there is a blunting of sympathetic drive to hypoglycaemia
