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cardio Flashcards

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1
Q

What is the first line drug therapy for SVT?

A

Adenosine

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2
Q

What is the MOA for adenosine?

A

Activation of GPCR on cell surfaces -> reduces spontaneous depolarisation, increases resistance to depolarisation. Increases refractoriness of AV node.

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3
Q

Adverse effects of adenosine

A

Bradycardia
Asystole
Sinking feeling in chest
Breathlessness

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4
Q

Absolute contraindications to adenosine

A

Hypotension
Coronary ischaemia
Decompensated HF
Asthma

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5
Q

Relative contraindications to adenosine

A

COPD

Heart transplant - particularly sensitive to effects

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6
Q

Adenosine interactions

A

Dipyramidole - blocks cellular uptake of adenosine

Theophylline, aminophylline, caffeine - competitive antagonists of adenosine receptors, block effect

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7
Q

Administration of adenosine

A

Initial dose 6mg, then 12 if needed
LARGE BORE cannula - green or above
Administered as rapid IV injection then flushed immediately

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8
Q

Other info - adenosine

A

Continuous cardiac rhythm strip needed - constant monitoring

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9
Q

What drug is administered as a vital part of anaphylaxis and ALS management?

A

Adrenaline

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10
Q

What is the MOA of adrenaline?

A

Agonist of α1, α2, β1 and β2 adrenoceptors - vasoconstriction of vessels supplying abdominal organs, vasodilation of vessels supplying heart

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11
Q

Adverse effects of adrenaline

A 
Adrenaline induced hypertension 
Anxiety
Tremor
Palpitations
Angina 
MI 
Arrhythmias
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12
Q

Absolute contraindications to adrenaline

A

None in cardiac resus protocols

Injection into areas supplied by an end artery eg extremities

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13
Q

Relative contraindications to adrenaline

A

Heart disease - used with caution

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14
Q

Interactions with adrenaline

A

β-blockers - may induce widespread vasoconstriction

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15
Q

Administration of adrenaline

A

1mg IV given after 3rd shock then every 3-5 mins

ANAPHYLAXIS - 500mg IM from minijet

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16
Q

What drug is first line for ascites and oedema due to liver cirrhosis?

A

Spironolactone

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17
Q

What drug is first line (with a β-blocker and ACE inhibitor) for chronic HF?

A

Aldosterone antagonists - spironolactone, epleronone

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18
Q

What is the MOA of aldosterone antagonists?

A

Inhibit the effect of aldosterone by competitively binding to the aldosterone receptor. This increases sodium and water excretion and potassium retention.

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19
Q

Adverse effects of aldosterone antagonists

A

Hyperkalaemia!!!!
Gynaecomastia
Liver impairment - Stevens-Johnson syndrome

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20
Q

Absolute contraindications of aldosterone antagonists

A

Severe renal impairment
Hyperkalaemia
Addison’s

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21
Q

Relative contraindications of aldosterone antagonists

A

Pregnant lactating women - can cross placenta and appear in breast milk
Potassium supplementation - should only be done in specialist practice

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22
Q

Interactions of aldosterone antagonists

A

Any potassium sparing drug eg ACE inhibitor, ARB - increases risk of hyperkalaemia

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23
Q

Administration of aldosterone antagonists

A

Only available as oral tablet
100mg daily orally for ascites
25mg daily orally for HF

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24
Q

Any other info on aldosterone antagonists

A

Spironolactone is weak diuretic, takes several days to act, so initially prescribed with loop or thiazide diuretic until it takes effect - this counteracts K wasting and potentiates diuretic effect
Normally 5:1 eg spiro 200mg furosemide 40mg

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25
What drug is first line for BHP?
Alpha blockers
26
What drug is used in combination with ACE inhibitors, CCBs, and thiazide diuretics for resistant hypertension?
Alpha blockers eg doxazosin, tamsulosin, alfuzosin
27
What is the MOA of alpha blockers?
Block α1-adrenoceptor found in smooth muscle - causes vasodilatation and a fall in blood pressure, and reduced resistance to bladder outflow
28
Adverse effects of alpha blockers
Postural hypertension Dizziness Syncope all more prominent after first dose
29
Absolute contraindications of alpha blockers
Existing postural hypertensions
30
Interactions of alpha blockers
Due to BP lowering effects, may be worth omitting one dose of current regime as BP tends to drop severely - particularly applicable to β-blockers
31
Administration of alpha blockers
Only available as oral tablet Doxazosin 1mg orally daily then increased by 1mg weekly as needed (BPH and HTN) Tamsulosin 400mcg orally daily (BPH only)
32
Any other info on alpha blockers
Due to hypertension risk, may be best to take this at bedtime
33
What drug is given as rhythm control for tachyarrhythmias eg AF, flutter, SVT, VT, VF?
Amiodarone
34
What is the MOA of amiodarone?
Blockade of sodium, calcium and potassium channels, and antagonism of α- and β-adrenergic receptors -> reduction in spontaneous depolarisation, can break reentry circuit and restore sinus rhythm
35
Adverse effects of amiodarone
``` Hypotension - during IV infusion Pneumonitis Bradycardia AV block Hepatitis Photosensitivity Grey discolouration Thyroid abnormalities ```
36
Absolute contraindications to amiodarone
Severe hypotensions Heart block Active thyroid disease
37
Interactions of amiodarone
Diltiazem, digoxin, verapamil - increases plasma concentrations of these, doses should be HALVED when started on amio
38
Administration of amiodarone
VF/pulseless VT - 300mg IV after 3rd shock
39
Any other info on amiodarone
IV infusion should always be accompanied by continuous cardiac monitoring
40
What is the drug that is first line for HTN?
ACEi
41
What is the drug that is first line for heart failure?
ACEi
42
What is the drug that is first line for ICD?
ACEi
43
What is the drug that is first line for diabetic nephropathy?
ACEi
44
What is the MOA of ACEi?
Block the action of the ACE, to prevent the conversion of angiotensin I to angiotensin II -> reducing of aldosterone promotes sodium and water excretion
45
Adverse effects of ACEi?
``` Hypotension Persistent dry cough Hyperkalaemia Renal failure Angioedema Anaphylactoid reactions ```
46
Absolute contraindications of ACEi
Renal artery stenosis AKI Pregnancy Breastfeeding
47
Relative contraindications of ACEi
CKD
48
Interactions of ACEi
K elevating drugs - increased risk of hyperkalaemia
49
Administration of ACEi
Ramipril 1.25mg orally OD (HF) | Ramipril 2.5mg orally OD everything else
50
Any other info on ACEi
Best to take first dose before bed to counteract symptomatic hypertension
51
What drugs are used when ACEi aren't tolerated due to cough?
Angiotensin receptor blockers - losartan, candesartan, irbesartan
52
What drug is first line for chronic heart failure?
ARBs
53
What drug is used for ischaemic heart disease?
ARBs
54
What are the three most commonly used ARBs?
Losartan, candesartan, irbesartan
55
What is the MOA of ARBs
Block the action of angiotensin II on the AT1 receptor -> reduces afterload, lowers BP
56
Adverse effects of ARBs
Hypotension Renal failure Hyperkalaemia
57
Absolute contraindications of ARBs
Renal artery stenosis AKI Pregnancy Breastfeeding
58
Interactions of ARBs
K elevating drugs - increased risk of hyperkalaemia Diuretics - in combination are associated with profound first dose hypotension NSAIDs - in combination increases risk of renal failure
59
Administration of ARBs
Losartan 12.5mg orally OD for HF Losartan 50mg orally OD everything else Can then be titrated up
60
Any other info on ARBs
Need blood monitoring for kidney function | Avoid taking OTC NSAIDs eg ibuprofen - kidney damage
61
What drugs are first line in the management of bradycardia?
Antimuscarinics eg atropine
62
What drugs are first line in the treatment of IBD?
Antimuscarinics eg hyoscine butylbromide
63
What drugs are used for management of respiratory secretions?
Antimuscarinics eg glycopyrronium
64
What are the three most common antimuscarinics?
Atropine, hyoscine butylbromide, glycopyrronium
65
What is the MOA of antimuscarinics?
Bind to the muscarinic receptor -> competitive inhibitor of acetylcholine -> increase heart rate and conduction; reduce smooth muscle tone and peristaltic contraction, reduce secretions from respiratory glands
66
Adverse effects of antimuscarinics
``` Tachycardia Constipation Dry mouth Urinary retention Blurred vision Drowsiness and confusion in elderly ```
67
Contraindications of antimuscarinics
Those susceptible to angle closure glaucoma | Arrhythmias
68
Interactions of antimuscarinics
More pronounced effects when paired with other antimuscarinics eg tricyclic antidepressants
69
Administration of antimuscarinics
Atropine IV in incremental doses eg 300-600mg every 1-2mins | Hyoscine butylbromide - 10mg 8hrly
70
Any other info on antimuscarinics
If given for bradycardia, cardiac monitoring is needed
71
What drug is first line for antiplatelet therapy?
Aspirin
72
What is the MOA of aspirin?
Irreversibly inhibits COX to reduce production of the pro-aggregatory factor thromboxane from arachidonic acid, reducing platelet aggregation -> lasts for lifespan of platelet
73
Adverse effects of aspirin
GI irritation GI haemorrhage Bronchospasm Long term therapy causes tinnitus
74
Contraindications of aspirin
``` SHOULD NOT BE GIVEN TO CHILDREN UNDER 16 -> RISK OF REYE'S SYNDROME Aspirin hypersensitivity 3rd trimester of pregnancy Peptic ulceration Gout ```
75
Interactions of aspirin
Acts synergistically with other antiplatelets - increased risk of bleeding Can be given with anticoagulants but needs monitoring
76
Administration of aspirin
ACS: loading dose 300mg, then 75mg orally OD ICS: 300mg orally OD 2 weeks, then 75mg OD AF/thrombosis prevention: 75mg orally OD CONSIDER GI PROTECTION (omeprazole 20mg OD)
77
Any other info on aspirin
To minimise GI irritation, take aspirin after food | Counsel patients to look out of bleeding/indigestion
78
What drug is first line in ischaemic heart disease?
Beta blockers
79
What drug is first line in SVT to restore sinus rhythm?
Beta blockers
80
What drug is first line in AF to reduce ventricular rate?
Beta blockers
81
What are the four most common beta blockers?
Bisoprolol, atenolol, propanolol, metoprolol
82
What is the MOA of beta blockers?
Block β1 receptor -> reduce force of contraction, speed of conduction in the heart -> relieves myocardial ischaemia by reducing cardiac work and oxygen demand, increasing myocardial perfusion
83
Adverse effects of beta blockers
``` Fatigue Cold extremities Headache GI disturbance Nightmares ```
84
Contraindications of beta blockers
Asthma Heart block Hepatic failure
85
Interactions of beta blockers
NOT TO BE USED with non-dihydropiridine calcium channel blockers - verapamil, diltiazem - risk of bradycardia, HF, asystole
86
Administration of beta blockers
Taken orally OD | IV metoprolol used only when rapid effect necessary
87
Any other info on beta blockers
Warn of side effects | Safety net for HF deterioration and breathing difficulty on background of existing obstructive airway disease
88
What is the drug that is given second line for HTN?
Calcium channel blockers
89
What drug is given to control symptoms in stable angina?
Calcium channel blockers
90
What drug is given to control cardiac rate in those with supraventricular arrhythmias?
Calcium channel blockers
91
What are the four most common calcium channel blockers?
Amlodipine, nifedipine, diltiazem, verapamil
92
What is the MOA of CCBs?
Decrease Ca2+ entry into vascular and cardiac cells -> reduction in intracellular calcium concentration -> relaxation and vasodilation in arterial smooth muscle, lowering arterial pressure
93
Adverse effects of CCBs
``` Ankle swelling Flushing Headache Palpitations Verapamil - constipation Bradycardia Heart block ```
94
Contraindications of CCBs
Unstable angina Severe aortic stenosis Poor LV function AV nodal conduction delay
95
Interactions of CCBs
Non dihydropyridine CCBs should be not be coprescribed with beta blockers - verapamil/diltiazem with bisoprolol, atenolol
96
Administration of CCBs
HTN: amlodipine 5-10mg orally OD Angina: diltiazem 90mg orally 12hrly SVT: verapamil 40-120mg orally 8hrly
97
Any other info on CCBs
Consider other measures to lower CV risk | Regular monitoring to judge efficacy on HTN/arrhythmias
98
What drug is used to manage torsades de pointes?
Mag sulph IV
99
What drug is co prescribed with aspirin for ACS?
Clopidogrel
100
What drug is first line anti thrombotic?
Clopidogrel
101
What is the MOA of clopidogrel?
Prevents platelet aggregation, reduces the risk of arterial occlusion -> binding irreversibly to ADP receptors (P2Y12 subtype) on platelet surface
102
What drug is for coronary artery occlusion prevention?
Clopidogrel
103
Adverse effects of clopidogrel
Bleeding - particularly GI GI upset Dyspepsia Thrombocytopenia
104
Contraindications to clopidogrel
Significant active bleeding | Renal and hepatic impairment
105
Interactions of clopidogrel
Cytochrome P450 inhibitors may make clopidogrel less effective - omeprazole, cipro, erythomycin Coprescription with antiplatelet drugs increases bleeding risk
106
Administration of clopidogrel
300mg loading dose orally | 75mg orally daily
107
Any other info on clopidogrel
Binds irreversibly to platelets so should be stopped 7 days before surgery Has synergistic action with aspirin
108
What is given to expand circulating volume in circulatory compromise?
Colloid fluids
109
What is the MOA of colloids?
Made up of 'large' molecules eg albumin, gelatin -> cannot diffuse out of cells -> osmotic pressure keeps fluid in plasma (70-80% remains in plasma, 20% of crystalloid remains in plasma)
110
Adverse effects of colloids
Overadministration may cause CO fall and cardiac failure -> over stretching on Starling curve Hypersensitivity reactions from gelatin Oedema from Na in solution
111
Contraindications of colloids
Fluid volume should be reduced in HF | Fluid balance needed in renal impairment
112
Administration of colloids
IV 250ml in 10mins fluid challenge Check for cannula patency
113
What drug can cause hypokalaemia and flatten the T wave?
Thiazides - indapamide, bendroflumethazide

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