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Cardioresp > Cardio pharma > Flashcards

Cardio pharma Flashcards

(50 cards)

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1
Q

Vaughn Williams 1a

A

Quinidine - delays

Ventricular dysrhythmias, AF

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2
Q

Vaughn Williams 1b

A

Lidocaine - aborts premature beats

VT and VF

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3
Q

Vaughn Williams 1c

A

Flecainide
(Not specific to damage cells;
suppresses re-entrant rhythms)
Paroxysmal AF; recurrent tachy’s (WPW)

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4
Q

Vaughn Williams 2

A

Beta blocker

Mi, Tachycardia

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5
Q

Vaughn Williams 3

A

K+ Channel Blockers
e.g. Amiodarone
(Prolong repolarisation)
SVT (WPW)

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6
Q

Vaughn Williams 4

A

Calcium Channel Blockers
e.g. Verapamil; Diltiazem
SVT; reduce rate in
AF (SA & AV node)

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7
Q

Beta blockers example

A

Bisoprolol; Atenolol; Propanolol.

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8
Q

Beta blockers mechanism

A

Negatively inotrophic & chronotrophic.

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9
Q

Beta blockers indication

A

hypertension; angina pectoris; following

MI; cardiac dysrhythmias (e.g. AF).

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10
Q

Beta blockers side effect

A

GI disturbances; bradycardia; fatigue;
cold peripheries; heart failure; hypotension; dizziness;
sexual dysfunction; peripheral vasoconstriction;
bronchospasm.

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11
Q

Beta blockers CI

A

asthma; marked bradycardia;
heart block; uncontrolled heart failure; PVD;
Prinzmetal’s angina; hypotension; cardiogenic shock.
Note: β - Blockers should not be used in conjunction with verapamil
and diltiazem (non-dihydropyridines) in HF because of their additive
effects (↓HR, contractility, CO).

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12
Q

Non-dihydropyridines

A 
Verapamil & Diltiazem
􀀹 Negatively inotrophic / chronotrophic but DO NOT
USE IN HEART FAILURE
• Indications:
o Verapamil: fast AF, SVT, hypertension.
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13
Q

Dihydropyridines

A

Amlodipine, Felodipine, Nifedipine
􀀹 Dilates peripheral arteries, ↓ after-load, dilates
coronary vessels, act on vessels > myocardium

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14
Q

CCB Indications:

A

o Verapamil: fast AF, SVT, hypertension.
o Dihydropyridines: hypertension; to prevent
angina.

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15
Q

CCB ADRs

A

• Side effects:
o Verapamil & Diltiazem: constipation; N&V;
flushing, headache, dizziness; fatigue.
o Dihydropyridines: abdominal pain; nausea;
palpitations, flushing, oedema; headache;
dizziness; sleep disturbances; fatigue.

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16
Q

CCB CIs

A

• Contraindications:
o Verapamil & Diltiazem: HF, 2nd or 3rd degree
heart block, cardiogenic shock.
o Dihydropyridines: Unstable angina, significant
AS.

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17
Q

Nitrates

A

Examples: Isosorbide Mononitrate (PO); GTN infusion
(IV); GTN spray (S/L).
• Indications: stable angina (prevention + treatment);
unstable angina (IV); acute heart failure (IV); chronic
HF.

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18
Q

Nitrate CIs

A

Contraindications: hypersensitivity to nitrates;
hypotensive conditions; hypovolaemia; hypertrophic
obstructive cardiomyopathy; AS; MS; cardiac
tamponade; constrictive pericarditis; marked anaemia.

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19
Q

Nitrate ADRs

A

Side effects: postural hypotension; tachycardia;
throbbing headache; dizziness.
o TOLERANCE

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20
Q

Ace inhibitors examples

A

ACE inhibitors

• Examples: Ramipril; Lisinopril; Enalapril.

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21
Q

ACE inhibitors mechansism

Study These Flashcards
A

Inhibits conversion of angiotensin 1 into
angiotensin 2, therefore inhibiting angiotensin 2 having
its effects:
o Increasing sympathetic activity.
o Fluid retention by kidney – via Increase in
aldosterone and direct action.
o Arteriolar vasoconstriction.
o Stimulating ADH secretion causing increased
fluid retention.
ACE inhibitors also cause:
o Reversal of left ventricular hypertrophy.
o Reversal of endothelial dysfunction.

22
Q

ACEi indications

Study These Flashcards
A

Indications: hypertension; HF; following MI
(especially ventricular dysfunction); IHD risk; diabetic
nephropathy; progressive renal insufficiency.

23
Q

ACEi ADRs

Study These Flashcards
A

Side effects: renal impairment; persistent dry cough;
angioedema; rash; hypotension; pancreatitis;
hyperkalaemia; GI effects.

24
Q

ACEi CIs

Study These Flashcards
A

Contraindications: hypersensitivity to ACEi
(angioedema); renal artery stenosis; pregnancy; aortic
stenosis; toxicity.

25
Loop diuretics
Loop diuretics • Examples: Furosemide, Bumetanide. • Action: Blocks Na+/K+/Cl- co-transporter in the apical membrane of the thick ascending limb of loop of Henle.
26
Loop indications
• Indications: hypertension; water overload: pulmonary oedema in LVF, chronic HF, nephrotic syndrome, renal failure.
27
Loop ADRs
Side effects: hypokalaemia; metabolic alkalosis; sodium & magnesium depletion; hypovolaemia & hypotension; deafness; nausea; allergies.
28
Thiazides
Examples: Bendroflumethiazide. • Action: Inhibits Na+ reabsorption at the beginning of the distal convoluted tubule. Blocks Na+/Cl- symporter that is associated with the luminal membrane. • Side effects: postural hypotension; hypokalaemia; hypomagnesaemia; hyponatraemia; hypercalcaemia; metabolic alkalosis; hyperuricaemia; impotence; hyperglycaemia.
29
Thiazide indications
• Indications: hypertension; severe resistant oedema; | HF.
30
Thiazide side effects
• Side effects: postural hypotension; hypokalaemia; hypomagnesaemia; hyponatraemia; hypercalcaemia; metabolic alkalosis; hyperuricaemia; impotence; hyperglycaemia.
31
Thiazide CIs
• Contraindications: refractory hypokalaemia; hyponatraemia; hypercalcaemia; symptomatic hyperuricaemia; Addison's disease.
32
Potassium sparing
K+ Sparing Diuretics • Examples: Spironolactone; Amiloride. • Action: Act on collecting tubules. Spironolactone is an aldosterone antagonist. Other potassium sparing diuretics act by directly inhibiting sodium channels e.g. Amiloride. • Indications: co-use with K+ losing diuretics; CCF; cirrhosis; oedema.
33
Potassium sparing ADRs
• Side effects: GI disturbances; impotence; gynaecomastia; menstrual irregularities; lethargy; headache; confusion; hyperkalaemia; hyponatraemia; hepatotoxicity.
34
Lipid lowering drugs
``` Main indications: o Secondary prevention of MI and stroke. o Primary prevention arterial disease (raised serum Cholesterol). o Dyslipidaemias. • Main drug classes: o Statins o Fibrates o Ezetimibe ```
35
Statins
• Examples: Atorvastatin; Simvastatin. • Action: Lowers cholesterol levels in blood by: o Blocking liver enzyme hydroxy-methylglutarylcoenzyme A reductase (HMG-CoA reductase), thereby inhibiting liver synthesis of cholesterol. o This leads to upregulation of expression of LDL receptors on liver cells causing ↑ absorption of LDL from the circulation.
36
Statin CIs and ADRS
Side effects: myositis; rhabdomyolysis; headache; altered LFTs; paraesthesia; GI effects. • Contraindications: active liver disease; pregnancy; breast-feeding.
37
Other lipid lowering drugs
Fibrates • Lower triglycerides more than LDL. Ezetimibe • ↓ Cholesterol absorption in the intestine. Note: Risks of rhabdomyolysis increases with combination lipid lowering treatment. NEVER co-prescribe GEMFIBROZIL (a fibrate) and a STATIN.
38
Antiplatelet indications
Main indications relate to arterial thrombosis: acute MI; CABG; unstable angina; coronary artery angioplasty / stenting; cerebrovascular disease; AF.
39
Aspirin
• Suppresses production of prostaglandins and thromboxane by irreversibly inactivating the cyclooxygenase (COX) enzyme. • Irreversibly blocks the formation of thromboxane A2 in platelets, inhibiting platelet aggregation.
40
Clopidogrel
Inhibits ADP-induced aggregation through an active metabolite. • STEMI / NSTEMI given with aspirin.
41
Dipyrimadole
• Phosphodiesterase inhibitor. May be given in addition to aspirin in those with a history of recurrent cerebrovascular disease.
42
Glycoprotein IIA/ IIIB receptor antagonists
• Example: Abciximab.
43
Heparin mechanisms
• UHF: o Binds to Antithrombin III (ATIII). o ATIII is an endogenous inhibitor of coagulation. o Increases ATIII ability to inhibit factors IXa, Xa, XIa, XIIa (serine proteases) and thrombin (unfractionated). o UHF fully reversible with Protamine. • LMWH: o Inhibits factor Xa but not thrombin. o LMWH not fully reversible with Protamine.
44
Heparin indications
``` • Main indications: acutely for short-term anticoagulation: DVT; PE; AF; prosthetic heart valves; cardiac events (unstable). ```
45
Heparin side effects and CIs
• Side effects: haemorrhage. • Contraindications: uncontrolled bleeding / risk of bleeding e.g. peptic ulcer, recent cerebral haemorrhage; endocarditis.
46
Warfarin
• A coumarin • Action: Inhibits vitamin K dependent clotting factors (II, VII, IX, X, protein C & S). Does this through inhibiting the reductase enzyme responsible for the regeneration of the active form of vitamin K.
47
Warfarin indications
• Indications: long-term anticoagulation: DVT; PE; AF; | prosthetic heart valves; cardiac events (unstable).
48
Warfarin ADRs and CIs
• Side effects: haemorrhage. • Contraindications: peptic ulcer; severe hypertension; bacterial endocarditis; pregnancy.
49
Warfarin OD
``` • Overdose: INR <6: Decrease / omit Warfarin INR 6-8: Stop Warfarin. Restart when INR<5 INR >8: If no bleeding stop Warfarin & give 0.5- 2.5mg vitamin K if risk of bleeding. ```
50
Managing a major bleed on warfarin
• Major bleed: Stop Warfarin. Give prothrombin complex concentrate (Beriplex) contains factors II, VII, IX, X or FFP. Give 5mg vitamin K. Get HELP!

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