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Flashcards in Cardiac Deck (47):
1

Name the 5 main types of hypertensives

Angiotensin converting enzyme inhibitor (ACEi)
Angiotensin II Receptor Blocker (ARB)
Beta adrenoreceptor blockers (B Blocker)
Ca channel blocker (CCB)
Thiazides

2

What are the effects of ACEi

Vasodilation
Reduce afterload
Reduced BP
Reduces aldosterone (increased Na+, H20 secretion)

3

Side effects of ACEi

Persistent dry cough
Hypotension
Hyperkalaemia
NSAIDs used in conjunction with ACEi increase RF risk
Stop medication if patient is in renal failure, has an AKI or renal artery stenosis

4

Examples of ACEi

Ramipril. Max 10mg, initial 2.5mg OD

Lisinopril: Max 80mg, initial 2.5

Perindopril: Max 10mg. Initial 5mg

5

What is the mode of action of ACEi

Bind to angiotensin converting enzymes on the surface of pulmonary endothelium and renal endothelium preventing conversion of Angiotensin I to Angiotensin II. Thereby causing vasodilation, reduced BP and reduced aldosterone

6

Mechanism of action for B blockers

Blocks B1 adrenergic receptors:
In SAN has negative chronotrophic effect

In myocardium has negative ionotrophic effects (decreases force of contraction)

7

Side effects of B Blocker

Bronchospasm
Fatigue
Cold extremities
Headaches
GI disturbance
Sleep disturbance

Contraindication: Asthmatic

8

Examples of B Blockers

Atenolol: 25-50mg daily
Propanolol: 40mg OD to TD
Metoprolol: IVI max 15mg oral 50-200 mg (CS)
Bisoprolol: 10mg daily max. Long term (CS)

CS= Cardio selective

9

Mode of action for ARBs

Binds to angiotensin receptors preventing the binding of angiotensin II resulting in: reduced after load and inhibition of vasoconstriction

10

Cautions and side effects of ARB

1. Do not use in patient in AKI or renal artery stenosis
2. Do not use in patient with K+ sparring diuretics or IV K+ as on of the SE is hyperkalemia
3. Do not use in conjunction with NSAID = Increased risk of RF.
4. Avoid use with diuretics

Must monitor K+, BP and renal function

11

Examples of ARBs

Losartan max. 100mg daily. initial 50 mg
Candesartan max. 32 mg daily, initial 4.8 mg

Reduce dose in renal/hepatic patients

12

Three main classes of CCBs

Phenilalkylamines (e.g. Verapamil)
Benzothiazipines (e.g. diltiazem)
Dihydropyridines (e.g. Amlodipine)

13

Name 5 CCBs

Verapamil
Diltiazem
Amlodipine
Nifedipine
Nicardipine
Isradipine

14

Major side effects of CCBs

Ankle swelling/peripheral oedema
Headaches
Palpitations
Flushing

Avoid use if: Poor LV function, aortic stenosis, Heart block,unstable angina, grapefruit juice

15

Major side effects of verapamil and diltiazem

Constipation
Bradycardia
Cardiac Failure

16

What is the mode of action of aspirin

Aspirin is an anti-platelet. It is a non selective COX inhibitor.

Normally arachidonic acid is converted to thromboxane, prostaglandin and prostacyclin. Therefore inhibiting conversion prevents platelet aggregation, inflammation and pain relief. Its main effect is preventing platelet aggregation

17

What are the indications for aspirin

Prophylaxis for ACS, Angina, MI, Stroke, PVD, AF, analgesia, rheumatoid arthritis

18

What are the contra indications for aspirin

Asthma
High risk of bleeding
G6PD deficiency
<16 yrs old (reyes syndrome)

19

What are the doses for aspirin?

Loading dose 300 mg
Regular dose 75 mg
For pain: max 4g daily

20

Class and mode of action of digoxin

Cardiac Glycoside
Na-K pump inhibitor so decreases contraction force (negative ionotrophic)
Acts on AVN (decrease conduction, negative chronotrophic)

21

Side effects

Bradycardia leading to arrhythmia
Hypokalaemia
Rash
Dizziness
Visual disturbance

Caution when patient is in renal failure, electrolyte imbalance.
Diuretics further decrease K+
ACEi, NSAIDs, Amiodarone, CCBs all enhance digoxin effects

22

What is the contraindication for digoxin

2nd degree HB, complete HB, risk of ventricular arrhythmias

23

Loading + maintenance dose of digoxin

62.5 then 500 mg daily

24

What are the indications for amiodarone?

Treatment of arrhythmias, particularly when other drugs are ineffective or contra-indicated (including paroxysmal supraventricular, nodal and ventricular tachycardias, atrial fibrillation and flutter, ventricular fibrillation, and tachyarrhythmias associated with WPW

25

What is the mode of action of amiodarone?

Inhibits voltage gated Ca, K+ thereby prolonging the refractory period, hence slowing the heart rate.
Also acts on B1 adrenergic receptors as an antagonist reducing the heart rate.
It is primarily a class III arrhythmic drug

26

What are the different classes of arrhythmic drugs?

Class I agents interfere with the sodium (Na+) channel.
Class II agents are anti-sympathetic nervous system agents. Most agents in this class are beta blockers.
Class III agents affect potassium (K+) efflux.
Class IV agents affect calcium channels and the AV node.
Class V agents work by other or unknown mechanisms.

27

Name the side effects of amiodarone?

Hypotension (IV)
Pneumonitis
Bradycardia
AV block
Hypo/Hyperthyroidism
Photo sensitivity (most common complaint)
Grey discolouration to the skin

28

Name the contraindications for amiodarone?

Active thyroid disease
Severe conduction disturbances (heart block, bradycardia)
Severe hypotension
Heart failure
Drugs that prolong the QT interval (digoxin, diltiazem, Verapamil)

29

Which drugs prolong the QT interval

Antipsychotics (e.g. haloperidol)
Type 1a antiarrythmics (e.g. Quinidine)
Type IC antiarrhythmics (e.g. Flecainide)
Class III antiarrhythmics (e.g. Sotalol, amiodarone)
Tricyclic antidepressants (e.g. Amitriptyline)
Antihistamines (e.g. Diphenhydramine)

30

Dosages for amiodarone

Tachycardic arrhythmias

Oral: 200 mg TDS (1st week), 200mg OD (week 2) then ween down to 200mg OD.

IV: initially 5 mg/kg, to be given over 20–120 minutes with ECG monitoring, subsequent infusions given if necessary according to response; maximum 1.2 g per day.

V fib: Initially 300 mg, dose to be considered after administration of adrenaline, dose should be given from a pre-filled syringe or diluted in 20 mL Glucose 5%, then (by intravenous injection) 150 mg if required, followed by (by intravenous infusion) 900 mg/24 hours.

31

Indications for ivabradine

Treatment of angina in patients with normal sinus rhythm
Mild to severe chronic heart failure

Usually used when patient is on their maximum dosage of B blocker

32

Mechanism of action

Ivabradine lowers heart rate by selectively inhibiting If channels ("funny channels") in the heart in a concentration-dependent manner without affecting any other cardiac ionic channels (including calcium or potassium).
The If currents are located in the sinoatrial node and are the home of all cardiac pacemaker activity. Ivabradine therefore lowers the pacemaker firing rate, consequently lowering heart rate and reducing myocardial oxygen demand.

33

Side effects of ivabradine (5)

Atrial fibrillation;
blurred vision;
bradycardia; dizziness;
first-degree heart block;
headache;
phosphenes;
ventricular extrasystoles;
visual disturbances

34

What are the 5 main classes of diuretics

Loop diuretics
Potassium sparing diuretic
Thiazides
Osmotic diuretics
Carbonic anhydrase

35

Name some loop diuretics and the general site of action

Furosemide (40mg morning. max 80mg daily)
Bumetanide
Torasemide

36

What is the mode of action for loop diuretics

Acts at the thick ascending limb of henle inhibiting Nak-K pump so no reabsorption of Na and therefore fluid excretion

37

Side effects of loop diuretics

Dehydration
Hypotension
Hyponatraemia, Hypokalaemia
Hyperglycaemia, gout
Hearing loss, tinnitus

38

Contraindication for loop diuretics

Severe hypokalemia or hyponatraemia
Renal failure due to nephrotoxic or hepatotoxic drugs
Hypovolaemic patient
H(x) gout

39

Management of moderate to severe PAD

pentoxifylline, cilostazol, or naftidrofuryl

40

Mode of action of pentoxifylline

Pentoxifylline inhibits erythrocyte phosphodiesterase, resulting in an increase in erythrocyte cAMP activity. Subsequently, the erythrocyte membrane becomes more resistant to deformity. Along with erythrocyte activity, pentoxifylline also decreases blood viscosity by reducing plasma fibrinogen concentrations and increasing fibrinolytic activity

41

Side effects of pentoxifylline

Rare: Angina, hypotension, bleeding

42

Contraindication of pentoxifylline

MIs, Arrythmias, Haemorrhages

43

Mode of action of cilostazol

yclic AMP (cAMP) phosphodiesterase III inhibitors (PDE III inhibitors), inhibiting phosphodiesterase activity and suppressing cAMP degradation with a resultant increase in cAMP in platelets and blood vessels, leading to inhibition of platelet aggregation and vasodilation

44

Side effect of cilostazol

Abdo pain, angina, diarrhoea, dizziness, headache, fatigue

45

Contraindication of cilostazol

Concurrent use with two ore more anticoagulants or antiplatelets

46

Mode of action of naftidrofuryl

Vasodilator

47

Side effect of naftidrofuryl

Epigastric pain
Hepatic failure
Hepatitis
Nausea
Rash