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cardiac part 2 Flashcards

1
Q

what are some examples for angiotensin receptor blockers

A

losartna, candesartan, irbesartan - sartan

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2
Q

MOA for angiotensin receptor blockers

A

similar effects to ACEi but ARBs blocks the action of angiontensin II on the AT1 receptor

blocking angiotensin II will reduce the stimulation of aldersterone from the kidney - reducer peripheral resistance and hence lower BP (afterload) as well as vasodilation

reducing aldersterone - reduces venous return by reducing sodium and water retention (preload)

also dilates the efferent glomerular arteriole which reduces intra-glomerular pressure and slows the progression of CKD

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3
Q

indication of ARBs

A

generally used when ACEi are not tolerated due to cough

HTN - 1st or 2nd line treatment of HTN, to reduce the risk of stroke etc

chronic hear failure - 1st line treatment of all grade

ischaemic heart disease - reduce risk of subsequent cardiovascular events such as MI

Diabetic nephropathy and CKD

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4
Q

contra-indication for ARB

A

renal artery stenosis or AKI

pregnant women and breast feeding

lower dose should be used when CKD

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5
Q

side effect of ARB

A

hypotension (esp first dose)
hyperkalaemia
renal failure

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6
Q

interaction of ARB

A

other drugs which elevate potassium eg potassium sparing diuretics, aldersterone

combination of NSAIDs with ARB inc the risk of renal failure

with other diuretics, risk of profound first dose hypotension

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7
Q

what are some examples of nitrates?

A

isosorbide monoitrate, glyceryl trinitrate - nitirate

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8
Q

MOA for nitrates

A

nitrates are converted to nitric acid (NO)

NO inc cyclic guanosine monophosphate synthesis and reduces intracellular Ca2+ in vascular smooth muscles cells causing them to relax results in venous and atrial vasodilation

relaxation of venous capacitance vessels - reduce preload and left ventricular filling - reduce cardiac work and myocardial oxygen demand - relieving angina and cardiac failure

can also relieve coronary vasospasm and dilate collateral vessels - improving coronary perfusion

also relax the systemic arteries, reducing peripheral resistance and afterload

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9
Q

indication for nitrates

A

short-acting nitrate (glyceryl trinitrate) used in treatment of acute angina and chest pain associated with acute coronary syndrome

long-acting nitrate - prophylaxis of angina where a beta-blocker and/or a CCB are insufficient or not tolerated

IV nitrates are used in the treatment of pulmonary oedema usually in combination with furosemide and oxygen

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10
Q

contra-indication for nitrate

A

should not use in pt with severe aortic stenosis where cardiovascular collapse can happen - the heart is unable to inc cardiac output sufficiently through the narrow valve area to maintain pressure in the now dilated vasculature

should be avoid in those who are haemodynamically instable esp hypotension

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11
Q

side effect of nitrate

A

flushing, headaches, light-headedness and hypotension

tolerance with reduced symtpoms relief

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12
Q

interaction of nitrate

A

must not be used with phosphodiesterase inhibitors eg sildenafil - enhance and prolong the hypotensive effect of nitrates

caution with those taking antihypertensive medication

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13
Q

where is nitrate eliminated

A

liver, RBC and vessel walls

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14
Q

what is the drug class for digoxin

A

antidysrrhythmia

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15
Q

what is the MOA for digoxin

A

it is -ve chronotropic (reduced HR) and +ve iontropic (inc force of contraction)

it works indirectly in the situation of AF and flutter as it act through the vagal tone (parasympathetic) - reduced the conduction in AV node preventing some impulses from being transmitted to the ventricles - lowering ventricular rate

in HF - direct effect on myocytes by inhibiting the NA+/K- -ATPase pump - inc intra-cellular NA+ conc - inc contractile force

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16
Q

indication for digoxin

A

AF and atrial flutter - reduces the ventricular rate - beta-blocker or non-dihydropyridine CCB is more effective

severe HF - 3rd line treatment for patietns who are already taking ACEi, beta-blocker and either an aldosterone antagonist or AT1 blocker

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17
Q

contra-indication for digoxin

A

worsen conduction abnor - 2 degree heart block and intermittent complete heart block

no use in pt at risk of ventricular arrhythmia

should reduce in kidney failure

hypokalaemia, hypomagnesaemia and hypercalcamia can inc digoxin conc

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18
Q

side effect of digoxin

A

bradycardia
GI upset
rash
dizziness
visual disturbance (blur or yellow vision
needs to be aware of digoxin as it has a low therapeutic index

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19
Q

interaction of digoxin

A

loop and thiazide diuretics - hypokalaemia

amidorone, CCB, spironolactone and quinine - all inc plasma conc of digoxin and risk of toxicity

20
Q

what sort of drug is Amiodarone

A

Anti-dysarrhythmia

21
Q

MOA for Amiodarone

A

block - NA+, K- and Ca2+ channel in cardiomyocytes

antagonist for alpha and beta adrenergic receptors

main effect in the AV node - reduce spontaneous depolarisation ( automaticity), slow conduction velocity, inc resistance to depolarisation (refractoriness) - this reduces the ventricular rate in AF and flutter

will also inc the chance of conversion to and maintenance of sinus rhythm

may break the circuit of self-perpetuating that induces the AV node and restore the sinus rhythm in SVT

22
Q

indication for Amiodarone

A

tachyarrhythmia - AF, atrial flutter, SVT, ventricular tachycardia and refractory ventricular fibrillation

generally used when other treatments are not available

23
Q

contra-indication for amiodarone

A

should be avoided with

  • severe hypotension
  • heart block
  • active thyroid disease
24
Q

where is digoxin eliminated

25
side-effect of amiodarone
can cause hypotension during IV infusion when taken chronically - pneumonitis, bradycardia, AV block, hepatitis, photosensitivity and grey discolouration (skin) can stimulate thyroid - contain iodine (amiodarone) - ca n cause hypo-hyperthyroidism long half-life and take months to take out of system
26
interaction of amiodarone
many inc plasma conc of digoxin, diltiaem and verpamil - inc risk of bradycardia, AV block and HF (dose should be 1/2 is used with amiodarone)
27
what sort of drug is aspirin
anti-platelet
28
MOA for aspirin
aspirine irreversibility inhibit cyclooxygenase (COX) to reduce production of pro-aggregatory factor thromboxane from arachidonic acid - reducing platelet aggregation aspirin binds to platelet for the lifetime of platelets and will only disappear with platelet dies
29
indication for aspirin
treatment for ACS and acute ischaemic stroke long term secondary prevention of thrombotic arterial events in pt with cardiovascular, cerebrovascular adn peripheral arterial disease reduce the risk of thrombus and embolic stroke in AF when warfarin are contra-indicative mild-to-moderate pain and fever (other drugs preferred)
30
contra-indication for aspirin
should not be give to children under 16 - risk of Reye's syndrome (rare but life threatening affect the liver and brain) hsould be avoided in 3rd trimester of pregnancy when prostaglandin inhibition caution with peptic ulcers and gout as it will trigger any effect
31
side-effect of aspirin
``` GI irritation GI ulceration and haemorrhage hypersensitivity reaction incl bronchospasm high dose causes - tinnitus overdose is life threatening ```
32
interaction of aspirin
inc risk of bleeding if used with other antiplatelet
33
What sort of drug is Clopidogrel
clopidogrel prevents platelet aggregation and reduces the risk of arterial occlusions by binding irreversibly to adenosine diphosphate (ADP) receptor on the surface of platelets
34
indication for clopidogrel
generally prescribed with aspirin although clopidogrel maybe used alone 1) treatment of ACS 2) prevent occlusion of coronary artery stents 3) for long-term secondary prevention of thrombus arterial events in pt with cardiovascular, cerebrovascular and peripheral arterial disease 4) reduce risk of intracardiac thrombus and and embolic stroke in AF where warfarin is contraindicated
35
contra-indication for clopidogrel
should not be prescribed to pt with active bleeding needs to stop 7 days before elective surgery should be used in caution with pt with renal and hepatic impairment
36
where is clopidogrel elminated in the body
liver and kidney
37
side effect of clopidogrel
bleeding esp GI bleed, intracranial GI pset - dyspepsia, abdo pain and diarrhoea might cause thrombocytopenia
38
interaction of clopidogrel
pro-durg and needs metabolisation of P450 cytochrome to activate it maybe reduced by cytochrome P450 inhibitors eg omeprazole, ciprofloxacin, erythromycin, ssri inc risk of bleeding with aspirin, anticoagulants - heparin or NSAIDs
39
what are some examples of heparins and fondaparinux
Enoxaparin, dalteparin, fondaparinux, unfractionated heparin
40
which one of the heparins and fondaparinux are low molecular weight?
enoxaparin and delteparin
41
MOA for heparin and fondaparinux
mainly inhibiting thrombin and factor Xa which are finally step to fibrin clot unfractureated heparin - activates antithrombin - inactivates clotting factor Xa and thrrombin LMWH - dalteparin & enoxaparin - also activate the antithrombin and inactivates clotting factor Xa Fondaparinux - synthetic compound similar to heparin and inhibit factor Xa only
42
indication for heparin and fondaparinux
venous thromboembolism - LMWH fist choice and 1st chocie for DVT and PE ACS - LMWH or fondaparinux part of 1st line treatment
43
contra-indication for heparin and fondaparinux
used with caution in pt at inc risk of bleeding incl clotting disorder, severe unctonroled hypertension or recent surgery or trauma heparin hsould be avoid in times of invasice procedures eg LP and spinal anaesthesia lower dose for pt with renal impairment as they can accumulate
44
where are heparin and fondaparinux eleminated
kidney
45
side-effect of heparin and fondaparinux
bleeding | injection site infection heparin-induced thrombocytopenia
46
interaction of heparin and fondaparinux
antithrombotic drugs combination should be avoided - inc risk of bleeding

Year 3 Drug (12 decks)

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