Cardiac Pharmacology Flashcards
(20 cards)
What are the main side effects of ACEIs?
- Dry cough
- Hyperkalaemia
- 1st dose Hypotension
- Angioedema
- Renal failure
What are the effects of NSAIDs and Alcohol on ACEIs?
NSAIDs antagonise the anti-hypertensive effects
Alcohol can cause a compound hypotensive effect
What is the effect of ACEIs on the glomerular vessels?
Vasodilation of the efferent arteriole, lowering eGFR
What are the 3 main classes of CCBs?
Dihydropyridines - target the peripheral vessel Ca channels more selectively
Non-dihydropyridines - target the cardiac Ca channels more selectively
Mixed selectivity
Give examples of each of the 3 main classes of CCBs
Dihydro: Amlodipine and Nifedipine
Non-dihydro: Verapamil
Mixed: Diltiazem
What are the side effects of CCBs?
Dizziness
Peripheral oedema - Amlodipine especially can cause ankle swelling
CI in HF - use non-dihydro
How do Beta blockers reduce production of renin?
Blocking the beta 1 receptors in the JGA
What 2 main conditions are Beta blockers typically contraindicated in? Why?
Asthma
COPD
Blockage of the B2 receptors, preventing bronchodilation
What are the main side effects of Nitrates?
Headache
Dizziness
Palpitations
Tolerance (loss of efficacy)
What is the target INR in most individuals? What does an INR that is too low or too high mean?
2-3
Too high = too runny, risk of bleed and haemorrhage
Too low = too sludgy and risk of thrombosis
If anticoagulation is needed in pregnancy, what is the drug of choice?
LMWH
In what 3 main circumstances is Warfarin given over DOACs?
Metallic heart valve
Severe renal impairment
Anti-phospholipid syndrome
What coagulation factor does Apixaban, Rivaroxaban and Edixaban inhibit? What about Dabigatran?
Xa
IIa
What are some of the reasons DOACs are now first line over warfarin?
No monitoring required Quicker onset and shorter half life No need for initiation by heparin Fewer interactions 50% less chance of intracranial bleed Lower bleeding risk, especially of major bleeds
How do you reverse DOACs? What about Warfarin?
Prothrombin concentrate +/- tranexamic acid
Vitamin K supplement
What are the requirements for stopping DOACs for surgery?
24hrs before for minor bleed risk, 48 for major
Same time to wait after before you re-start it
LMWH can be used to bridge if at a particularly high risk of thrombosis
What is the mechanism of heparin? What about LMWH?
Activation of antithrombin III, which inhibits Thrombin/IIa and Xa
LMWH only inhibits Xa
Allows dissocation and subsequent repeat inhibition
Are anti-PLT drugs used for arterial or venous clots? What about anticoagulative drugs?
Anti-PLT: arterial
Anticoagulation: venous
How do fibrinolytic drugs work? Can you name two examples?
Promotes conversion of plasmin into plasminogen on fibrin strands, increasing fibrin and clot breakdown
Alteplase and Streptokinase
How do pro-haemostatic drugs work? Can you given an example?
Prevent conversion of plasmin into plasminogen (generally).
Tranexamic acid
