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Flashcards in Cardiac Pharmacology Deck (6)
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1
Q

ACE-I

A
  • Mechanism of action
    • Reduced aldosterone secretion - involved in volume regulation via Na and K excretion
    • Reduced ADH secretion - ADH acts on kidneys to increase reabsorption (independent of Na)
    • Reduced arterial vasoconstriction
    • Reduced sympathetic activity
  • Contraindications
    • Hypotensive
    • Pregnancy (teratogenic)
    • Hx of angiooedema (hereditary idiopathic or ACE-I induced)
    • Renal artery stenosis
  • Interactions
    • NSAIDs (renal impairment)
    • Diuretics (renal impairment)
  • Side effects
    • Cough
    • Headache
    • Hypotension
    • Hyperkalaemia
    • Angiooedema
  • Moniroting
    • BP (post)
    • U&Es (pre and post)
2
Q

CCBs

A
  • Mechanism of action
    • Inhibiting L-type calcium channels
    • Reduce intracellular Ca
      • Vascular smooth muscle relaxation → vasodilation → ↓PVR →↓BP
      • ↓ Cardiac muscle contractility (negative inotropic action) → ↓CO → ↓BP
      • ↓ SAN rate (negative chronotropic action) → ↓HR → ↓CO→ ↓BP
      • ↓ AVN conduction (negative dromotropic action) → termination of supraventricular arrhythmias
  • Contraindications
    • Hypotension/cardiogenic shock
    • AS (severe)
    • Cautious use in HF
    • Pregnancy risks unknown (avoid)
  • Interactions
    • CYP3A4
  • Side effects
    • Headache
    • Peripheral oedema
    • Constipation
    • Flushing
    • Dizziness
    • Gingival hyperplasia
  • Monitoring
    • Nil
3
Q

Thiazide-like diuretics

A
  • Mechanism of action
    • DCT of the nephron inhibiting the Na/Cl co-transported
    • Preventing Na and Cl entering the tubule cells and, therefore, water
    • Antihypertensive effects are due to vasodilation of peripheral vasculature
  • Contraindications
    • Severe renal failure
    • Severe impairment of liver function (risk of hepatic encephalopathy)
    • Pregnancy
  • Interactions
    • ACE-I or NASIDs (risk of renal failure)
    • Lithium (increases lithium concentration)
  • Side effects
    • Maculopapular rash
    • Erectily dysfunction
    • Gout
    • Urinary frequency
  • Monitoring
    • U&Es (Ca, Na, K)
4
Q

BBs

A
  • Mechanism of action
    • Highly beta-1-selective-adrenoreceptor antagonist
    • Low affinity to the beta-2-receptor of the smooth muscles of bronchi and vessels
    • Reduced CO through nefative inotropic and negatice chronotropic effects
    • Reduced renin release through blockage of the sympathetic triggered release
    • Vasodilation due to blockade of beta-2-receptors in vascular smooth muscle
  • Contraindications
    • Asthma
    • COPD (caution)
    • Cardiogenic shock (negatively inotropic)
    • Decompensated HF (negativly inotropic)
    • Bradycardia/2nd or 3rd degree HB
  • Interactions
    • Rate-limiting CCBs
    • Amiodaone (risk of potentiated AV conduction time)
  • Side effects
    • Bradycardia
    • Cold peripheries
    • Headache
    • Dizziness
    • Fatigue
    • Erectile dysfunciton
    • Hypoglycaemia (non-selective BBs)
  • Monitoring
    • Careful monitoring in HF
5
Q

Loop diuretics

A
  • Mechanism of action
    • Acts on Na/K/Cl symporter in the Loop of Henle
    • Prompt diuretic effect
    • Decreases ventricular filling pressures
    • Encourages hypocolaemia and lowers BP
  • Contraindications
    • Hypovolaemia
    • Hyponatraemia/hypokalaemia
    • Hypotension
  • Side effects
    • Acute gout
    • Electrolyte abnormalities (as above)
    • Urinary incontinence in elderly
    • Renal failure
  • Monitoring
    • If on IV daily weights and U&Es
    • If on PO similar but less frequent
6
Q

Potassium sparing diuretics

A
  • Mechanism of action
    • Inhibits action of mineralocorticoids - increased water excretion, lowers BP and prevents excretion of K
    • Potentiates action of ACE-I in HF - inhibits RAA system
    • Binds to androgen receptors of testosterone and reduces activity
  • Contraindications
    • Addison’t disease
    • Hyperkalaemia
  • Side effects
    • Hyperkalaemia
    • Renal dysfunction
    • Gynaecomastia
    • Hyperchloraemia, leg cramps
  • Monitoring
    • Regular U&Es if titrating (pay close attention to K)