Cardiac Drugs

Question 1

Name some examples of beta blockers

Answer 1

• Atenolol

- Propranolol

Question 2

What are the side effects f beta blockers

Answer 2

• bronchospasm
• cold peripheries
• fatigue
• sleep disturbances
• erectile dysfunciton

Question 3

What are the contraindications of beta blockers

Answer 3

• Uncontrolled heart failure
• asthma
• sick sinus syndrome
• concurrent verapamil use

Question 4

What happens when beta blockers and verapamil are used together

Answer 4

• Can cause complete heart block

Question 5

What happens if you have a beta blocker overdose

Answer 5

• bradycardia
• hypotension
• heart failure
• syncope

Question 6

What is the management of beta blocker overdose

Answer 6

• atropine

- in resistant cases glucagon may be used

Question 7

What does a negative inotrope do

Answer 7

these slow the hearts contraction and slows the heart rate down

Question 8

name examples of negative inotropes

Answer 8

• beta blockers

- calcium channel blockers

Question 9

What are the two types of calcium channel blockers

Answer 9

• non dihydropyridines

- Dihydropyridines

Question 10

Name some examples of non dihydropyridine calcium channel blockers

Answer 10

• Dilitizem

- Verapamil

Question 11

Name some examples of dihydropyridine calcium channel blockers

Answer 11

• Nifedipine

- Amlodipine

Question 12

What are the side effects of verapamil

Answer 12

• heart failure
• constipation
• hypotension
• bradycardia
• flushing

Question 13

What are the side effects of diltiazem

Answer 13

• hypotension
• bradycardia
• heart failure
• ankle swelling

Question 14

What are the side effects of nifedipine, amlodipine, felodipine

Answer 14

• flushing
• headache
• ankle swelling

Question 15

What are the side effects of ACE inhibitors

Answer 15

• cough
• angioedema
• hyperkalamia
• first dose hypotension

Question 16

what are the contraindications for ACE inhibitors

Answer 16

• pregnancy and breastfeeding
• renovascular disease
• aortic stenosis

Question 17

Name an example of an aldosterone inhibitor

Answer 17

Spironolactone

Eplerenone

Question 18

What are the adverse effects of spironolactone

Answer 18

• hyperkalaemia

- gynaecomastia less common with eplerenone

Question 19

What are the side effects of thiazide diuretics

Answer 19

• dehydration
• postural hypotension
• hyponatraemia
• hypokalaemia
• hypercalcaemia
• gout
• impaired glucose tolerance
• impotence

Question 20

How do thiazide diuretics work

Answer 20

• Work by inhibiting sodium reabsorption at the beginning of the distal convoluted tubule by blocking the thiazide sensitive Na+Cl- symporter

Question 21

Name some thiazide like diuretics

Answer 21

• Indapamide

- chloratalidone

Question 22

Name a thiazide diuretic

Answer 22

bendroflumethiazide

Question 23

What are the two types of potassium-sparing diuretics

Answer 23

• aldosterone antagonists e.g. spironolactone

- Amiloride - blocks the epithelial sodium channel in the distal convoluted tubule

Question 24

what does amiloride do

Answer 24

• blocks epithelial sodium channel in the distal convoluted tubule

Question 25

Name some loop diuretics

Answer 25

- furosemide and bumetanide

Question 26

what are the adverse effects of loop diuretics

Answer 26

- hypotension - hyponatraemia - hypokalamiea - hypomagensaemia - - ototoxicity - hypocalcaemia - hypercholraemic alkossi - renal impairment

Question 27

What are the classes of anitarrhytmics

Answer 27

Class I - sodium channel blockers e.g. flecainide, procainamide, quinidine Class II - Beta blockers e.g. propranolol and metoprolol Class III - Potassium channel inhibitors e.g. Amiodarone, Sotalol Class IV - Calcium channel blockers e.g. verapamil, dilimiazem

Question 28

How does amiodarone work

Answer 28

- Works by blocking potassium channels which inhibits depolarisation and therefore prolongs the action potential

Question 29

What are the adverse effects of amiodarone

Answer 29

- thyroid dysfunction = both hypothyroidism and hyperthyroidism - corneal deposits - pulmonary fibrosis - liver fibrosis/hepatits - peripheral neuropathy - photosensitivity - slate-gray apperance - bradycardia - lengths QT interval

Question 30

What drug interactions does amiodarone have

Answer 30

- decreases the metabolism of warfarin therefore results in an increase in INR - increases digoxin levels

Question 31

What is adenosine used for

Answer 31

- It is used to terminate supra ventricular tachycardias

Question 32

How does adenosine work

Answer 32

- causes transient heart block in the AV node - agonists of the A1 receptor in the atrioventricular node which inhibits adenylyl cyclase thus reducing cAMP and causing hyperpolarization by increasing outward potassium flux

Question 33

what is the half life of adenosine

Answer 33

half life of about 8-10 seconds

Question 34

What are the adverse effects of adenosine

Answer 34

- chest pain - bronchospasm - avoided in asthmatics - transient flushing

Question 35

What is digoxin used in

Answer 35

- used in rate control in the management of atrial fibrillation

Question 36

Name a positive inotrope

Answer 36

digoxin

Question 37

How does digoxin work

Answer 37

- decreases conduction through the atrioventricular node which slows the ventricular rate in atrial fibrillation and flutter - increases the force of cardiac muscle contraction due to inhibition of the sodium/potassium ATPase pump

Question 38

What are the symptoms of digoxin toxicity

Answer 38

- generally unwell - lethargy - nausea and vomiting - anorexia - confusion - yellow-green vision - Arrhythmias - gynaecomastia

Question 39

What is the precipitating factors of digoxin toxicity

Answer 39

- hypokalaemia - increasing age - renal failure - MI - hypomagensaemia - hypoalbuminaemia - hypothermia - hypothyroidism

Question 40

How does atropine work

Answer 40

- anticholinergic medicine that increases firing of the SA node

Question 41

What are the ECG features of digoxin toxicity

Answer 41

- down-sloping ST depression - flattended/inverted T waves - short QT interval - Arrhythmias