Cardiovascular Flashcards
ACE inhibitors
Antihypertensive
I- hypertension, heart failure (HEFrEF), renal failure, post MI, protienuria, diabetic nephropathy
Captopril- 12.5-150mg daily in 2-3 doses
Enalapril 2.5-40mg daily in 1 or 2 doses
Fosinopril 5-40mg daily
Lisinopril 2.5-40mg od
Perindopril arginine 2.5-10mg (erbumide 2-8mg) once daily
Quinapril 5-40mg daily in 1-2 doses
Ramipril- 2.5-10mg daily in 1 or 2 doses
Trandalopril 1-4mg once daily
Initiate with lower doses in HF and titrate up to highest tolerable dose
M- electrolytes (particularly potassium), renal function, blood pressure, cough, angioedema
AE- dry cough (20%), headache, dizziness, fatigue, nausea, angioedema, hypotension
C-can take 2-4weeks to work, don’t take potassium, may make you feel dizzy (esp when starting) be careful when standing up
CAL- 11, 21, (12, 16 when initiating)
Amiodarone
Antiarrhythmic- mostly class III (K channel blocker but also has Na, B-blocker and Ca-blocker activity)
I- tachyarrythmias refractory to other treatments (ventricular tachycardia, AF and SVT)
D- maintenance oral 100-200mg daily (max 400mg) (week 1 200mg tds, week 2 200mg bd). IV load 5mg/kg over 20min-2h. Maintenance 15-20mg/kg/24h (max 1.2g in 24h)
M- thyroid function, LFT, electrolyte , chest X-ray, ECG, LFT, QT interval, pulmonary toxicity, vision (photophobia, haloes, optic neuropathy or neuritis), TDM 1-2.5mg/L (1.6-4micromol/L) (rarely used in practice- max effect not seen 1-3 months after treatment due to long half life).
AE- NV, constipation, taste disturbance, headache, pulmonary toxicity, thyroid dysfunction, ocular effects
C- doctor will monitor you regularly, if vision problem breathing difficulty dry cough weight loss muscle weekness see doctor, sun exposure, grapefruit interaction, regular ECG, bllod tests, chest xrays,
CAL- 5, 8, 18
Beta-blockers
Cardioselective (beta1)- atenolol, bisprolol, metoprolol, nebivolol
Nonselective (beta1 and 2)- oxpenolol, pindolol, propranolol
Nonselective (beta1 and 2 and alpha1)- carvedilol, labetalol
I- hypertension, angina, tachyarrhythmias, MI, systolic heart failure, migraine prophylaxis
Atenolol 25-100mg od (max 200mg)
Bisoprolol- 1.25-10mg daily
Carvedilol- 25-50mg daily in 1 or 2 doses (max 100mg daily in 2 doses)
Labetalol- 200-400mg bd (max 2.4g daily in 3-4 doses)
Metoprolol- 50-300mg/d in one two or three doses (max 400mg/d). XR 47.5-190mg once daily
Nebivolol- 1.25-10mg once daily
Oxprenolol- 80-160mg in 2 or 3 doses (max 320mg daily)
Pindolol- 7.5-30mg daily in 2 or 3 doses
Propranolol- 30-320mg/d in two three or four doses (also used for portal hypertension to prevent oesophageal variceal bleeding and infantile haemangiomas)
M- BP, heart rate, migraine resolution, renal function (atenolol esp is renally cleared), LFTs (all except atenolol have some hepatic clearance), diabetes- may mask signs of hypoglycaemia, respiratory- CI in severe uncontrolled airway disease consider beta1 selective (eg metoprolol) cautiously
C- can cause dizziness or tiredness when starting treatment- gets better with time do not operate machinery if effected, dizziness when standing up, CAL 9- don’t stop abruptly, AE- NVD, abdo pain, cold hands/feet, dizziness, insomnia, nightmares, carvedilol- take with food
CALs- Atenolol- 9, 12, 16 Bisoprolol- 9, 12, 16, A Carvedilol- 9, 12, 13, 16, B Labetalol- 9, 12, 16 Metoprolol- 9, 12, 16, A (for XR) Nebivolol- 9, 16 Oxprenolol- 9, 16, A Pindolol- 9, 12, 16 Propranolol- 9, 12, 16
Calcium channel blockers
Dihydropyridines (mainly peripherally acting)- amlodipine, clevidipine, felodipine, lercadapine, nifedipine, nimodipine
Non-dihydropyridines (mainly cardiac acting)- diltiazem, verapamil
I- hypertension, angina, nifedipine- preterm labour, nimodipine- aneurysnal subarachnoid haemorrhage, diltiazem- AF, verapamil- SVT, AF, atrial flutter, prevention of cluster headache
Amlodipine- 2.5-10mg od
Clevidipine IV infusion 4-16mg/h (32mg/h has been used) doses >500mg/24h are not recommended
Felodipine- 2.5-20mg od
Lercanidipine 10-20mg od take 30min before food
Nifedipine IR 10-40mg bd, CR 20-120mg od
Nimodipine oral 60mg q4h, IV 0.5-2mg/h
Diltiazem IR 90-360mg/d in 3-4 doses, CR 180-360mg/d
Verapamil IR 160mg bd-tds, CR 180-240mg od- bd
M- BP, peripheral oedema
AE- peripheral oedema, dizziness, headache, flushing
C- can take up to 2 weeks to reduce BP, initially caused dizziness headache flushing- reduce with use, causes dizziness when standing- get up slowly from sitting or lying, if swollen ankles- see doctor ASAP, CAL 18- grapefruit, CAL 9- don’t stop abruptly, verapamil- take with food, lercanidipine- empty stomach
CALs Amlodipine- 9, 16, 18 Felodipine- 9, 16, 18, A Lercanidipine- 9, 16, 18, C Nifedipine- 9, 12, 13, 16, 18, A (for CR) Nimodipine- 12, 16, 18
Diltiazem- 5, 9, 16, 18, A (for CR)
Verapamil- 5, 9, 12, 13, 16, 18, for CR- A and B
Digoxin
Antiarrhythmic (cardiac glycoside)
I- AF, heart failure, atrial flutter
D- 62.5-250mcg once daily (max 125mcg in elderly). Larger loading doses can be used
M- arrthymias- ECG, plasma digoxin concentration (0.5-2microg/L), heart rate, serum potassium, QT, pulse rate, renal function (70% renally cleared), thyroid function (hypo or hyper thyroid may change digoxin concentration), electrolytes (Hypokalaemia, hypomagnesaemia, hypercalcaemia, acidosis, hypoxia- may increase sensitivity to digoxin)
AE- NVD, visual disturbance, dizziness, loss of appetite, drowsiness, bradycardia, arrythmia. Symptoms of toxicity-
C- tell HCP before using other meds, see doctor if AE become intolerable or severe, dr will monitor ECG
CAL- 5
Ezetimibe
Cholesterol intestinal absorption inhibitor
I- hypercholesterolaemia, homozygous sitosterolaemia
D- 10mg od
M-blood lipids, LDL, HDL, triglycerides, cholesterol, LFT
C- see dr if muscle pain tenderness or weakness, reduce CV risk factors with lifestyle, continue to take even if you feel no different, AE- abdo pain, headache, diarrhoea, fatigue
CALs- nil
Loop Diuretics
I- oedema associated with HF, hepatic cirrhosis, renal impairment and nephrotic syndrome
Bumetanide 0.5-4mg od or bd (1mg bumetadine= 40mg oral frusemide)
Etacrynic acid 50-200mg od or bd (50mg etacrynic acid = 40mg oral frusemide)
Frusemide oral 20-40mg od or bd, maintenance 20-400mg daily (max 1g daily) (20mg IV frusemide = 40mg oral frusemide)
M- serum electrolytes, body weight (volume load), gout, fluid balance, prostatic obstruction (precipitate acute urinary retention), ototoxicity (highest risk with fast IV infusion and etacrynic acid), renal function (CI in anuria, nephrotoxicity),
AE- frequent urination, electrolyte disturbance (hypo Na, K, Mg, Cl, Ca), dehydration, gout, dizziness
C- usually taken mane (and lunch for 2nd dose), dizziness when standing
CALs
Bumetadine-13,16
Etacrynic acid- 16, B
Frusemide- 16
Nitrates
I-Prevention and treatment of angina, chronic HF (isosorbide dinitrate with hydralazine), acute HF associated with MI and unstable angina (GTN infusion)
Glyceryl trinitrate
-acute SL tab 300-600mcg, spray 400-800mcg (1-2 sprays)
-maintenance- patch 5-15mg/d, remove at night
Isosorbide mononitrate 30-120mg once daily
Isosorbide dinitrate- 10-40mg tds-qid. acute attack SL 5-10mg
M- angina relief, frequency of use, blood troponin for acute to rule out MI, fluid status (CI in hypovolaemia), other drugs (CI with PDE5 inhibitors and riociguat), FBC (CI if severe anaemia), CI in raised intracranial pressure
AE- headache, flushing, NV, palpitations
C- sit before using acutely, dose every 5min, if not relieved in 10min call 000, spit SL tablet out after relief to avoid AE, spray under tongue, patch apply to chest or inner upper arm, dizziness be careful when standing, isosorb tabs should not be used in acute attack takes time to work. get up slowly from sitting or standing, SL tablets expire 3 months after opening, spray expires 2 years after opening Prime spray with 1 spray if not use for 7 days and 5 sprays if not used for 4 or more months, ISMN swallow whole and take at time of day when angina is worse but not BD because no nitrate free period.
CAL 16, 7B (GTN SL tabs only), A (ISMN SR)
Sartans
ARBs- angiotensin receptor blockers
I- hypertension, heart failure, proteinurea, post MI
Candesartan 8-32mg od Eprosartan 400-600mg od Irbesartan 75-300mg od Lorsartan 25-100mg od Olmesartan 20-40mg od Telmisartan 40-80mg od Valsartan 40-320mg in 1 or 2 doses
M- BP, serum electrolytes, renal function, hyperkalaemia, angioedema (cross reactivity with ACEI), drugs that cause hyperkalaemia, Sprue-like enteropathy (severe chronic watery diarrhoea)
AE- dizziness, headache, hyperkalaemia
C- takes 4-6w to work, dizziness when standing up- disappears with continued use, don’t drive if dizziness is problematic, don’t take potassium, monitor BP at home or in pharmacy, continue to take if you dont feel any different
CAL- 11, 12 + 16 (initiation), 21, A
Aldosterone Antagonists
I- HEFrEF (both). Spironolactone only- primary hyperaldosteronism, oedema associated with secondary hyperaldosteronism (eg cirrhosis), resistance HTN (adjunct), hirsutism
Eplerenone (more prone to CYP3A4 inhibitor interactions)- 25-50mg once daily
Spironolactone 12.5-200mg daily in 1 or 2 doses (max 400mg may be required in ascites)
M- serum electrolytes (risk of hyperkalaemia), renal function, BP, interactions with other drugs that cause hyperkalaemia, spironolactone- antiandrogen effects (gynaecomastia, menstural abnormalities, sexual dysfunction)
AE- NVD, headaches, dizziness, renal impairment, hyponatraemia
C- don’t take potassium, take with or soon after food, can cause dizziness when standing
Eplerenone CAL 11,12, 18
Spironolactone CAL- 11, 16, 21 (12 initiation), B
Statins
HMG-CoA reductase inhibitor
I- hypercholesterolaemia, high risk of coronary artery disease, post MI
Atorvastatin 10-80mg od
Fluvastatin- 80mg CR od
Pravastatin- 10-80mg nocte
Rosuvastatin 5-20mg (max 40mg) od
Simvastatin 10-40mg nocte (max 80mg)
M- LFT, blood lipids, compliance
AE- dizziness, constipation, N, abdo pain, headache- usually disappear with use
C- simvastatin and pravastatin take at night, atorvastatin and simvastatin CAL 18 avoid grapefruit, won’t feel different but important to keep taking, se dr ASAP if dark urine, muscle pain/weakness, CV lifestyle advice
Ivabradine
Anti-anginal drug- decreases heart rate
I- stable angina with normal SR >70bpm
Stable HF SR >77bpm as adjunct to standard treatment (inc beta-blocker)
D- 2.5-7.5mg bd titrate to resting HR 50-60bpm
M- HR, ECG, anginal symptoms, luminous effects (enhanced brightness), bradycardia
C- take with food, avoid grapefruit, tell all HCP you’re taking ivabradine, may blur vision and see bright areas- likely in first 2 months- do not drive if effected, tell dr if HR is slow (SOB, tired, dizzy)
CAL- 5, 12, 13, 18, 21, A, B
Milrinone
Phosphodiesterase 3- inhibitor. Ionotrope- increases myocardial contraction
I-Severe refractory HF short term use <48h, low cardiac output eg after cardiac surgery
D- IV 0.375-0.75microg/kg/min (max 1.13mg/kg/day)
M-QT interval, arrhythmias, blood pressure, LFT, FBC
C-reduce infusion rate in renal impairment, avoid with other PDE-3 inhibitors Cilostazol or anagrelide, injection only- hospital settings
Sacubitril with Valsartan (Entresto)
Neprilysin inhibitor and sartan
I- HEFrEF
D- 24/26mg- 97/103mg bd
M- electrolytes (correct hyperkalaemia, volume or sodium depletion) before initiating treatment), angioedema, renal function, blood pressure,
I- dizziness when starting, get up slowly from sitting, do not take potassium, allow 36h betwwen stopping ACEI and starting entresto, caution with other drugs that increase potassium concentration. AE- dizziness, headache, cough, anaemia, diarrhoea
CAL- 5, 11, 12, 13, 16, 21, A
Nicorandil
Anti-anginal medication
I-prevention and treatment of stable angina
D- 5-20mg bd
M-ulcers and fistulae (caution in diverticular disease), treatment with PDE5 inhibitors or riociguat (CI), BP
C- may cause dizziness- do not drive if affected, tell dr of any ulcers wounds or skin problems, AE- headaches, dizziness, nausea, palpitations, flushing, myalgia
CAL- 9, 12, 13
