Cardiology Flashcards
What drug class is Furosemide?
Loop diuretics
How do loop diuretics work?
Inhibits Na/K/Cl co transporter in ascending limb of loop of henle
Can improve contractile function of overstretched heart muscle
What are loop diuretics indicated for?
Pulmonary oedema (alongside O2 and nitrates) Fluid overload - oedmatous conditions
What are the side effects of loop diuretics?
Dehydration/ hypotension
Hearing loss, tinnitus - inner ear co transporter affected
What are the contraindications of loop diuretics?
Hepatic encephalopathy Hypokalaemia Hyponatraemia Hypovolaemia Gout - reduced uric acid excretion
Important drug interactions of loop diuretics?
Lithium toxicity
Digoxin toxicity - due to diuretic associated hypokalaemia
What is the best time do give diuretics and why?
Morning due to nocturia problems
What drug class is Bendroflumethiazide?
Thiazide diuretics
What are Thiazides indicated for?
Alternative 1st line hypertension treatment where a calcium channel would have been used
How do Thiazide diuretics work?
Inhibits Na/K/Cl co transporter in distal convolated tubule
What are the side effects of Thiazide diuretics?
Cardiac arrhythmias (due to low sodium and potassium) Male impotence Can increase plasma glucose - diabetes type 2
What are the contraindications of Thiazide diuretics?
Hyponatraemia
Hypokalaemia
Gout
Important drug interactions of Thiazide diuretics?
Effectiveness reduced by NSAIDs (not aspirin)
Loop diuretics
What drug class is Spironolactone?
Aldosterone antagonist - potassium sparing
What are Aldosterone antagonists indicated for?
Liver cirrhosis (ascites/oedema) because of loop/thiazide diuretics Chronic heart failure
How do Aldosterone antagonists work?
Competitively bind to aldosterone receptor, increasing sodium and water excretion; potassium retention
What are the side effects of Aldosterone antagonists?
Hyperkalaemia
Gynaecomastia
Steven Johnson syndrome
Liver impairment
What are the contraindications of Aldosterone antagonists?
Severe renal impairment
Hyperkalaemia
Addison’s disease (aldosterone deficient)
Pregnant or lactating women
Important drug interactions of Aldosterone antagonists?
Other potassium elevating drugs - ACEi and ARBs
Give an example of a potassium sparing diuretic that isn’t spironalactone?
Amiloride
What drug class is Atenolol?
Beta Blocker
What are Beta Blockers indicated for?
Ischaemic Heart Disease
Chronic Heart failure
AF, SVT
Hypertension
How do Beta Blockers work?
Beta blockers via B1 receptor reduce heart contraction and conduction speed
Prolong refractory period of AV node - slow ventricular rate in AF
Reduce renin from kidneys
What are the side effects of Beta Blockers?
Fatigue
Cold extremities
Headache
GI disturbance
What are the contraindications of Beta Blockers?
Asthma - life threatening brochospasm Slowly increase dose in heart failure Haemodynamic instability Heart block Hepatic failure
Important drug interactions of Beta Blockers?
Calcium channel blockers- can cause heart failure, bradycardia
What drug class is Diltiazem?
Calcium channel blocker
What are Calcium channel blockers indicated for?
Hypertension
Stable angina symptom control
Supraventricular arryhthmias
How do Calcium channel Blockers work?
Decrease calcium entry into vascular and cardiac cells
Relaxation and vasodilation in arterial smooth muscle
Suppress cardiac conduction
What Calcium channel blockers are used cardiac purposes?
Diltiazem, Verapamil
What Calcium channel blockers are used vascular purposes?
Amlodipine, nifedipine, Diltiazem (has both functions)
What are the side effects of cardiac Calcium channel Blockers?
Bradycardia
Cardiac failure
Heart block
What are the side effects of vascular Calcium channel Blockers?
Ankle swelling
Flushing
Headache
Palpitations
What are the contraindications of Calcium channel Blockers?
Cardiac -Poor left ventricular function -AV nodal conduction delay Vascular -Unstable angina - drug can make it worse -Severe aortic stenosis
Important drug interactions of Calcium channel Blockers?
Not with B blockers
What drug class is Ramipril?
ACEi
What are ACEi indicated for?
Hypertension Chronic Heart failure Ischaemic Heart disease Diabetic nephropathy CKD
How do ACEi work?
Prevent conversion of angiotensin 1 to 2 Vasoconstrictor Stimulates aldosterone secretion Reduces proteinuria Reduces progression of nephropathy
What are the side effects of ACEi?
Hypotension (problem after 1st dose) Persistent dry cough Hyperkalaemia Renal failure Angioedema Anaphylaxis
What are the contraindications of ACEi?
Renal Artery stenosis AKI Pregnant Breastfeeding CKD
Important drug interactions of ACEi?
Potassium elevating drugs
NSAID + ACEi = increased risk of renal failure
If dry cough is a problem what is an alternative drug?
Losartan - ARBs