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Year 3 - Drug Profiles > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

what type of drug is furosemide?

A

loop diuretic

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2
Q

how do loop diuretics work?

A

Inhibit reabsorption of Na+, K+ and Cl- (and therefore water) from the ascending limb of the loop on Henle in the renal tubule

also dilate capacitance veins - very useful in heart failure. reduces preload on heart and improves contractile function

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3
Q

what are the indications to take furosemide?

A

oedema, resistant hypertension, heart failure

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4
Q

what are the contraindications to taking furosemide?

A

dehydration
hypokalaemia/ hyponatraemia
gout - inhibit uric acid excretion

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5
Q

what are the side-effects of furosemide?

A

dehydration + hypovolaemia
any low electrolyte state
hearing loss/ tinnitus

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6
Q

what are the interactions with furosemide?

A

any drug excreted by the kidney e.g. lithium, digoxin

aminoglycosides - increase oto/nephrotoxicity

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7
Q

what type of drug is spironolactone?

A

potassium sparing diuretic

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8
Q

how do potassium sparing diuretics work?

A

act on distal convoluted tubules
inhibit Na uptake (and therefore water)
this causes potassium retention

often used in conjunction with other diuretics as weak on its own

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9
Q

what are the indications to take spironolactone?

A

oedema, hypokalaemia as a result of other diuretics

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10
Q

what are the contraindications to taking spironolactone?

A

Hyperkalaemia, anuria and Addison’s disease

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11
Q

what are the side effects of spironolactone?

A

GI upset, hypotension, dizziness, electrolyte disturbance

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12
Q

what are the interactions with spironolactone?

A

other potassium elevating drugs

digoxin, lithium (affects clearance of these)

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13
Q

what type of drug is bendroflumethiazide?

A

thiazide diuretic

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14
Q

how do thiazide diuretics work?

A

inhibit the sodium-chloride transporter in the distal tubule and therefore water. this lowers potassium as sodium is retained by the aldosterone pump

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15
Q

what are the indications to take thiazide diuretics?

A

Hypertension

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16
Q

what are the contraindications to taking thiazide diuretics?

A

hypokalaemia/ hyponatraemia

gout

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17
Q

what are the side effects of thiazide diuretics?

A

hyponatraemia/ hypokalaemia
this may then lead to cardiac arrhythmia
inc plasma glucose
impotence in men

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18
Q

what are the interactions with thiazide diuretics?

A

NSAIDs reduce effect
other potassium lowering drugs
other hypotensive drugs - greater effect

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19
Q

why are thiazides particularly useful in hypertension?

A

main adverse effects of thiazides is hypokalaemia,

main adverse effects of ACE inhibitors and ARBs is hyperkalaemia.

synergistic blood pressure lowering effect: thiazides activate the renin–angiotensin system, while ACE inhibitors/ARBs block it.

combination of a thiazide and an ACE inhibitor/ARB is very useful in practice to improve BP control and to maintain neutral potassium balance.

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20
Q

what type of drug is atenolol?

A

beta blocker

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21
Q

how do beta blockers work?

A

B1 - block receptor to reduce force and contraction speed of the heart. this reduces ischaemia by reducing cardiac workload

also lower BP by renin secretion inhibition

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22
Q

what are the indications to take beta blockers?

A 
IHD
CHF
AF
SVT
hypertension
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23
Q

what are the contrindications to taking beta blockers?

A

Asthma - can cause bronchospasm (act on B2 receptors)

COPD (only use B1 selective e.g. atenolol, bisoprolol rather than non selective e.g propanolol)

heart block
haemodynamic instability

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24
Q

what are the side effects of beta blockers?

A

fatigue, cold extremities, headache, GI upset, sleep disturbance, impotence in men

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25
Q

what are the interactions with beta blockers?

A

calcium channel blockers - can cause heart failure, bradycardia and asystole

theophylline decreases effect

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26
Q

how do calcium channel blockers work?

A

decrease Ca2+ entry into vascular and cardiac cell
relaxation and vasodilation in arterial smooth muscle

reduce myocardial contractility, suppress cardiac conduction
Reduced cardiac rate, contractility and afterload reduce myocardial oxygen demand, preventing angina

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27
Q

what are the two types of calcium channel blocker?

A

Dihydropyridines (amlodipine and nifedipine) - relatively selective for the vasculature
Non-dihydropyridines (verapamil, diltiazem) are more selective for the heart.

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28
Q

what are the indications to take calcium channel blockers?

A

Prophylaxis and treatment of STABLE angina, hypertension (amplodipine), supraventricular arrhythmia (diltazem)

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29
Q

what are the contraindications to taking calcium channel blockers?

A

poor left ventricular function - lead to HF
AV nodal conduction delay - may provoke complete heart block
unstable angina
severe aortic stenosis

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30
Q

what are the side effects of calcium channel blockers?

A

ankle swelling, flushing, headache, palpitations,

constipation, bradycardia, heart block and cardiac failure

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31
Q

what are the interactions with calcium channel blockers?

A

β-blockers - together may cause heart failure, bradycardia, and even asystole.

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32
Q

what type of drug are Ramipril, lisinopril and perindopril?

A

ACE inhibitor

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33
Q

how do ACEi work?

A

prevent the conversion of angiotensin I to angiotensin II
Angiotensin II is a vasoconstrictor and stimulates aldosterone secretion.
Blocking its action reduces peripheral vascular resistance (afterload), which lowers blood pressure

works particularly well on renal arteries so good for CKD

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34
Q

what are the indications to take ACEi?

A

hypertension
CHF
IHD
diabetic neuropathy and CKD

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35
Q

what are the contraindications to taking ACEi?

A

AKI, renal artery stenosis

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36
Q

what are the side effects of taking ACEi?

A

hypotension, persistent dry cough, renal failure, angioedema and anaphylaxis

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37
Q

what are the interactions with ACEi?

A

potassium-elevating drugs e.g. potassium sparing diuretics

NSAID - increase risk of renal failure

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38
Q

what type of drug is losartan?

A

Angiotensin receptor blockers (ARB)

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39
Q

how do Angiotensin receptor blockers work?

A

similar effect to ACEi - block action of angiotensin II on receptor

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40
Q

what are the indications to take Angiotensin receptor blockers?

A 
hypertension
CHF
IHD
diabetic neuropathy and CKD
(used when ACEi are not tolerated)
41
Q

what are the contraindications of taking Angiotensin receptor blockers?

A

pregnancy, breastfeeding

renal artery stenosis/ AKI

42
Q

what are the side effects of Angiotensin receptor blockers?

A

hypotension, hyperkalaemia, renal failure

less likely to cause a dry cough than ACEi

43
Q

what are the interactions with Angiotensin receptor blockers?

A

other potassium elevating drugs

NSAIDs - causes renal failure

44
Q

give 2 examples of nitrate drugs

A

isosorbide mononitrate, glyceryl trinitrate

45
Q

how do nitrates work?

A

Dilates blood vessels (is converted to NO which activates dilation)
reduce cardiac work and myocardial oxygen demand, relieving angina and cardiac failure

46
Q

what are the indications to take nitrates?

A

ACS/angina

47
Q

what are the contraindications to taking nitrates?

A

aortic stenosis, haemodynamic instability

48
Q

what are the side effects of taking nitrates?

A

Postural hypotension, tachycardia, throbbing headache, dizziness, tolerance

49
Q

what are the interactions with nitrates?

A 
phosphodiesterase inhibitors (sildenafil) - these enhance the effects of nitrates
antihypertensive medication - can cause hypotension
50
Q

what type of drug is digoxin?

A

cardiac glycoside

51
Q

how does digoxin work?

A

reduces HR ( increased vagal tone (reduces conduction at AV node)) , increases force of contraction

52
Q

what are the indications to take digoxin?

A

AF, heart failure

53
Q

what are the contraindications to take digoxin?

A

heart block, arrhythmia, renal failure (excreted by kidneys), electrolyte imbalance ( makes toxicity more likely)

54
Q

what are the side effects of digoxin?

A

bradycardia, gastrointestinal disturbance, rash, dizziness and visual disturbance

has low therapeutic index - toxicity likely. arrhythmias likely in toxicity

55
Q

what are the interactions with digoxin?

A

diuretics increase the chance of toxicity

Amiodorone, calcium channel blockers, spironolactone and quinine can all increase the plasma concentration of digoxin

56
Q

what type of drug is amiodarone?

A

anti-arrhythmic

57
Q

how does amiodarone work?

A

Increases duration of ventricular and atrial muscle action by inhibiting Na,K-activated myocardial adenosine triphosphatase – this results in decrease in heart rate and in vascular resistance

58
Q

what are the indications to take amiodarone?

A

any tachyarrhythmia (AF, SVT, VT, VF)

59
Q

what are the contraindications to taking amiodarone?

A

hypotension, heart block, thyroid disease

60
Q

what are the side effects of amiodarone?

A

hypotension, pneumonitis, heart block, hepatitis, photosensitivity, thyroid abnormalities

has a very long half life so symptoms may take a long time to settle after stopping the drug

61
Q

what are the interactions with amiodarone?

A

lots

increases plasma concentrations of digoxin, diltiazem and verapamil (increase the risk of bradycardia, AV block and heart failure.)

62
Q

what type of drug is aspirin?

A

anti-platelet

63
Q

how does aspirin work?

A

irreversibly inhibits cyclooxygenase (COX) to reduce production of the pro-aggregatory factor thromboxane from arachidonic acid, reducing platelet aggregation and the risk of arterial occlusion

64
Q

what are the indications to take aspirin?

A

ACS or acute ischaemic stroke
prevention of thrombotic arterial events
AF
(mild pain and fever)

65
Q

what are the contraindications to taking aspirin?

A

under 16s - can develop Reye’s syndrome
3rd trimester of pregnancy
peptic ulceration, gout

66
Q

what are the side effects of aspirin?

A

GI irritation, ulceration, and haemorrhage
tinnitus
bronchospasm (allergy to NSAIDs)
bruising

67
Q

what are the interactions with aspirin?

A

other antiplatelets ( clopidogrel, dipyridamole) and anticoagulants (e.g. heparin, warfarin) - increase the effect

68
Q

what type of drug is clopidogrel?

A

antithrombotic

69
Q

how does clopidogrel work?

A

prevents platelet aggregation and therefore risk of arterial occlusion

70
Q

what are the indications to take clopidogrel?

A

treatment of ACS
prevent occlusion of stents
prevention of thrombotic arterial events eg in stroke, AF
post MI

71
Q

what are the contraindications to taking clopidogrel?

A

active bleeding
surgery
hepatic/renal impairment

72
Q

what are the side effects of clopidogrel?

A

bleeding
GI upset
thrombocytopaenia

73
Q

what are the interactions with clopidogrel?

A

effect reduced by P450 inhibitors e.g. omeprazole, ciprofloxacin,
other antiplatelet/anticoagulation drugs

74
Q

what type of drug is heparin?

A

Tissue plasminogen activator

75
Q

how does heparin work?

A

inhibit thrombin and factor X - help prevent clot formation

76
Q

what are the two types of heparin?

A

Unfractionated heparin (UFH) activates antithrombin that, in turn, inactivates clotting factor Xa and thrombin.

Low molecular weight heparins such as dalteparin and enoxaparin have a similar mechanism of action but preferentially inhibit factor Xa.

Low molecular weight heparins have a more predictable effect and, unlike UFH, do not usually require laboratory monitoring. Consequently, LMWHs are now preferred in most indications

77
Q

what is fondaparinux?

A

Fondaparinux is a synthetic compound that is similar to heparin. It inhibits factor Xa only. It appears to have similar efficacy to LMWH and has become the anticoagulant of choice in the treatment of ACS in many hospitals in the UK.

78
Q

what are the indications to take heparin?

A

VTE

ACS

79
Q

what are the contraindications to taking heparin?

A

clotting disorders, hypertension, surgery/trauma

renal impairment - can cause build up of drug

80
Q

what are the side effects of heparin?

A

bleeding (lower in LMWH/ fondaparinux)

thrombocytopaenia

81
Q

what are the interactions with heparin?

A

antithrombotics - risk of bleeding

82
Q

how does warfarin work?

A

inhibits vitamin K epoxide reductase, preventing reactivation of vitamin K and coagulation factor synthesis.

83
Q

what are the indications to take warfarin?

A

DVT/PE
prevent clots in AF + heart valve replacement

(not used in arterial thrombosis e.g. MI)

84
Q

what are the contraindications to taking warfarin?

A

bleeding risk
liver disease (reduced metabolism)
pregnancy

85
Q

what are the side effects of taking warfarin?

A

bleeding

86
Q

what are the interactions with warfarin?

A

P450 inhibitors (fluconazole, macrolides) increase bleeding risk

P450 inducers (phenytoin, carbamazapine) increase clotting risk

has a very low therapeutic index

antibiotics that kill gut flora that produce vitamin K - increases bleeding risk

87
Q

what class of drug is rivaroxaban?

A

Novel anti-coagulants

88
Q

how does rivaroxaban work?

A

Direct inhibitor of activated factor X

89
Q

what are the indications to take rivaroxaban?

A

Prophylaxis of venous thromboembolism (after hip/knee replacement surgery), treatment of DVT and PE, prophylaxis of DVT, PE, stroke, systemic embolism in AF; given in combination with clopidogrel/aspirin after acute coronary event

90
Q

what are the contraindications to taking rivaroxaban?

A

Active bleeding, significant risk of major bleed, (in acute coronary syndrome – previous stroke/TIA)

91
Q

what are the side-effects of rivaroxaban?

A

Nausea, vomiting, diarrhoea, constipation, dyspepsia, abdo pain, hypotension, dizziness, headache, renal impairment, haemorrhage, pain in extremeties, pruritus, rash

92
Q

what are the interactions with rivaroxaban?

A

Increased risk of haemorrhage with other anticoagulants

P450 inducers and inhibitors (same as warfarin)

93
Q

name two different statins

A

simvastatin, atorvastatin

94
Q

how do statins work?

A

reduce serum cholesterol by inhibiting HMG CoA reductase. This decreases cholesterol production by the lover and increases clearance from the blood.

95
Q

what are the indications to take a statin?

A

prevention of CVD if risk of cardiac event >20%

treatment of hyperlipidaemia

96
Q

what are the contraindications to taking a statin?

A

hepatic impairment, renal impairment, pregnant/breastfeeding

97
Q

what are the side effects of statins?

A

headache, GI upset, muscle aches, raise in liver enzymes

98
Q

what are the interactions with statins?

A

The metabolism of statins is reduced by cytochrome P450 inhibitors (amiodarone, diltiazem, itraconazole, macrolides) - increased risk of side-effects

amlodipine has similar effect

Year 3 - Drug Profiles (9 decks)

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