Cardiology Flashcards
(43 cards)
1
Q
Frusemide
20-40mg OD (in the morning) PO or IV
Bumetanide
1mg PO BD
A
- *Indications:** Pulmonary oedema 2ndary to LVF, Chronic heart failure, Oedema (cirrhosis/renal impairment/nephrotic syndrome), Resistant HTN
- *MOA:** LOOP DIURETICS - inhibit the Na/K/Cl triple transporter in the thick ascending limb of the loop of Henle - inhibuts NaCl reabsorption
- *S/E’s:** Low Na/K/Mg/Ca, High urate (gout), dehydration, postural hypotension, tinnitus/deafness, intrahepatic cholestasis, acute urine retention
- *CI’s:** Severe hypokalaemia/hyponatraemia, anuria (renal failure)
- *Interactions**: Increased toxicity with digoxin, NSAID’s, gentamicin, lithium, ACEi
- *Other info**: Increase doses in renal impairment, monitor U+E’s, can add K sparing diuretic to decrease K loss. Act within one hour orally or peak effect at 30mins IV.
2
Q
**Bendroflumethiazide **(use for CCF 5-10mg OD (am))
Metolazone
**Chlortalidone **(use in HTN)
**Indapamide **(use in HTN 2.5mg OD)
A
- *Indications:** HTN, Oedema from chronic CCF
- *MOA:** THIAZIDE diuretics –> block the NaCl symporter in the distal convoluted tubules increasing NaCl excretion.
- *S/E’s:** Low Na/K. High Ca/urate (gout)/glucose/lipids. Postural hypotension, impotence. GI disurbances.
- *CI’s:** Hypokalaemia, hyponatraemia, addison’s, gout, severe liver/renal failure (GFR<30)
- *Interactions:** Increased toxicity with digoxin, lithium
- *Other info:** Remember to lower dose in elderly pts. Take early in the day so diuresis does not interfere with sleep.
3
Q
**Spironolactone **(100-400mg daily)
Eplerenone
**Amiloride **(10mg daily)
A
Indications: Oedema/ascites 2ndary to cirrhosis, severe CCF, nephrotic syndrome, 1*hyperaldosteronism, refractory HTN
- *MOA:** K+ sparing diuretics –> aldosterone receptor antagonists –> Increased Na excretion, decreased K+ and H+ excretion
- *S/E’s:** Hyperkalaemia, GIT disturbance
- *CI’s:** Hyperkalaemia, hyponatraemia, anuria, addison’s, pregnancy
- *Interactions:** Increased toxicity with digoxin and lithium, increased risk of hyperkalaemia with ACEi/ARB
- *Other info:** Lower doses of spironolactone for HF compared to diuresis. Amiloride can be used as an adjunct with loop/thiazide diuretics to conserve K.
4
Q
Acetazolamide
A
- *Indications:** Open/closed angle glaucoma, weak diuretic (rarely used though)
- *MOA:** Carbonic anhydrase inhibitor –> Increased HCO3 excretion. Decreases aqueous production therefore decreases intra occular pressure.
- *S/E’s:** N/V/D, peripheral tingling, rash = EM +/- SJS!
- *CI’s:** Hypokalaemia, hyponatraemia, sulphonamide hypersensitivity, long term use
- *Interactions:** Amiodarone
- *Other info:** Monitor electrolytes
5
Q
Mannitol
IV infusion over 45mins, 0.25-2g/kg
A
Indications: Cerebral oedema (Increased ICP), Increased intra occular pressure
MOA: Osmotic diuretic –> cannot be reabsorbed by the kidney –> increased tubular fluid osmolarity - pulls in H20
S/E’s: Hypotension, fluid/electrolyte disturbance
CI’s: Severe cardiac failure, severe pulmonary oedema, intracranial bleeding, anuria, severe dehydration
Interactions:
Other info:200mg/kg test dose first. Extravasation causes thrombophelbitis. Monitor U+E’s
6
Q
Enalapril
Captopril
Ramipril
Lisinopril
Perindopril
A
- *Indications:** Heart failure (all grades), HTN, diabetic nephropathy, post MI, angina, prophylaxis of cardiovascular events
- *MOA:** ACEi -->inhibits ACE –> do not produce angiotensin2 therefore dont get vasoconstriction. Get vasodilation, decreased Na reabsorption (decreased circulating volume) therefore decreases BP.
- *S/E’s:** Postural hypotension, renal impairment, hyperkalemia, dry cough (2ndary to increased bradykinin), angioedema.
- *CI’s:** Suspected or confirmed bilateral renal artery stenosis, hypersensitivity to ACEi or pregnancy.
- *Interactions:** Increased risk of renal failure with NSAIDs, risk of v low BP with diuretics, TCA’s/Antipsychotics.
- *Other info:** Monitor U+E’s - if Cr increases by >30% do an MRA. Titrate the dose. Avoid in young woman that may become pregnant. Lower dose in renal failure.
7
Q
Losartan (short t1/2)
Irbesartan (long t1/2)
Candesartan (long t1/2)
A
- *Indications:** Heart failure (all grades), HTN, diabetic nephropathy, post MI, angina, prevention of cardiovascular events
- *MOA:** Angiotensin II receptor antagonists. Do not inhibit kinin breakdown therefore no cough!
- *S/E’s:** postural hypotension, renal impairment, hyperkalaemia, angioedema
- *CI’s:** Renal artey stenosis, pregnancy
- *Interactions:** Increased risk of renal failure with NSAID’s, risk of v low BP with diuretics, TCA’s/antipsychotics. Decreased lithium excretion.
- *Other info: **
8
Q
Bisoprolol
Atenolol
Metoprolol
Esmolol
Nebivolol
A
Indications: Angina, acute MI, heart failure, arrhythmias, HTN, long QT syndrome, thyrotoxicosis, anxiety, glaucoma
MOA: Beta blockers - cardioselective blocking Beta1Receptors in the heart therefore decreases CO by decreasing HR and contractility. Small decrease in BP therefore increased diastolic perfusion, decreased O2 demand and afterload.
S/E’s: Bronchospasm, hypotension, bradycardia, peripheral vasoconstrction –> cold peripheries/raynauds/PVD, lethargy, nightmares, increased risk of DM, impotence
CI’s: Asthma, marked bradycardia/hypotension, 2nd and 3rd degree heart block, severe heart failure, PVD, caution in DM as masks hypo’s
Interactions:
Other info:Lower dose in renal/hepatic impairment. Atenolol is H20 soluble therefore does not cross BBB.
9
Q
Clonidine
A
- *Indications:** HTN, migraine, menopausal flushing
- *MOA:** Anti-hypertensive.** **Centrally acting alpha 2 agonist –> decreased CO + PVR
- *S/E’s:** Rebound HTN on withdrawal, postural hypotension, constipation, nausea, dry mouth
- *CI’s:** Severe bradyarrhythmias (2nd/3rd degree heart block), sick sinus syndrome
- *Interactions:** Increased risk of withdrawal HTN if given with Bblockers
- *Other info: **
10
Q
Methyldopa
A
- *Indications:** HTN (in pregnancy/pre eclampsia)
- *MOA:** _Anti-hypertensive. _Centrally acting alpha 2 agonist. Is a pro drug converted to alpha-methylNA
- *S/E’s:** GI disturbances, hepatotoxic, drug induced lupus, postural hypotension, blood dyscrasias, drowsiness
- *CI’s:** Depression, phaeo, acute porphyria, liver disease
- *Interactions:** Avoid MAOI’s
- *Other info: **
11
Q
Hydralazine
A
Indications: Mod-Severe HTN (adjunct), heart failure, hypertensive emergencies including in pregnancy
MOA: _Anti-hypertensive._Direct acting smooth muscle relaxant –> vasodilator arteries>veins
S/E’s: Tachycardia, hypotension, GI disturbance, headache, dizziness, drug induced lupus
CI’s: SLE, severe tachycardia, high output heart failure
Interactions:
Other info:Lower doses in renal/hepatic failure. Mainly used in pregnancy.
12
Q
Sodium Nitroprusside
A
Indications: Hypertensive emergencies, controlled hypotension in anaesthesia, acute/chronic heart failure
MOA: Anti-hypertensive**. **Releases nitric oxide–> vasodilation –>arteries>veins
S/E’s: Associated with rapid drop in BP –> headache, dizziness, nausea, palpitations
**CI’s:
Interactions:
Other info: **
13
Q
Minoxidil
A
Indications: Severe HTN (off label = alopecia)
MOA: _Anti-hypertensive. _Vasodilator
S/E’s: Hypertrichosis
CI’s: Pregnancy, phaeo.
**Interactions:
Other info: **
14
Q
Nifedipine
Amlodipine
A
- *Indications:** Angina (prinzmetal), HTN, Raynauds + Premature labour (nifedipine)
- *MOA:** _Dihydropyridine CCB’s _- block L type Ca channels therefore inhibits Ca entry causing vasodilation including coronary arteries - only acts on arterial smooth muscle
- *S/E’s:** Flushing, headache, ankle oedema, dizziness, hypotension, constipation, gingival hypertrophy, reflex tachycardia!
- *CI’s:** Cardiogenic shock, severe aortic stenosis, within 1 month of MI, HOCM
- *Interactions:** Risk of severe hypotension with alpha/beta blockers, effects increased by grapefruit
- *Other info:** Nifedipine = no antiarrhythmic activity, short acting Amlodipine = long acting
15
Q
Diltiazem
Verapamil
A
- *Indications:** Angina, HTN, SVT’s (verapamil)
- *MOA:** Non-dihydropyridines CCB’s - mainly cardiac activity. Negative ionotropes, verapamil slows conduction at SAN and AVN.
- *S/E’s:** Headache, flushing, AV block, Hypotension, ankle oedema, gynaecomastia
- *CI’s:** Severe bradycardia, hypotension, HF, 2/3rd degree heart block, AF assoc with WPW
- *Interactions:** Risk of AV block, HF and asystole witg B blockers. Verapamil effects increased by grapefruit juice and macrolides.
- *Other info: **
16
Q
GTN
A
- *Indications:** Sublingual = symptomatic relief of anginal pain, ACS. Topical = anal fissures
- *MOA:** Anti-Anginal.** **Nitric oxide donor –> increased cGMP –> SM relaxation –> venodilation –> decreased preload. Also small amount of coronary vasodilation. Rapid onset, short duration, high 1st pass metabolism.
- *S/E’s:** Postural hypotension! Tachycardia, throbbing headache, dizziness, syncope, flushing
- *CI’s:** Aortic stenosis and mitral stenosis, hypotension, constrictive pericarditis, tamponade, HOCM, anaemia, closed angle glaucoma, raised ICP, hypovolaemia
- *Interactions:** IV GTN infusion decreased the effect of heparin
- *Other info: **
17
Q
ISMN (Isosorbide mononitrate)
ISDN (Isosorbide dinitrate)
A
- *Indications:** Prophylaxis of angina, adjunct in CCF
- *MOA:** Anti-Anginal**. **Long acting nitrates. ISMN is active metabolite of ISDN. ISDN has unpredictable 1st pass metabolism. Tolerance develops quickly - need 8hr drug free period (at night!) so take in early day only.
- *S/E’s:** Postural hypotension, tachycardia, throbbing headache, dizziness, syncope, flushing
- *CI’s:** AS + MS, hypotension, constrictive pericarditis, tamponade, HOCM, anaemia, raised ICP, closed angle glaucoma, hypovolaemia
- *Interactions:** IV nitrate infusion decreases effect of heparin
- *Other info: **
18
Q
Nicorandil
A
- *Indications:** Prophylaxis and treatment of stable angina (uncontrolled)
- *MOA:** _Anti-Anginal - _K channel opener – Nitrate component (Increases cGMP–>SM relaxation) and K+ATP channel activator. Arterial and venous dilator.
- *S/E’s:** Headache, flushing, dizziness, GI ulcers (rare)
- *CI’s:** Cardiogenic shock, LVF, hypotension
- *Interactions:** Do not use with sildenafil because lowers BP drastically
- *Other info: **
19
Q
Aspirin
A
- *Indications:** Secondary prevention of thrombotic cerebrovascular or cardiovascular disease
- *MOA:** Antiplatelet –> Irreversible, non selective COX inhibitor –> decreased production of plt thromboxane A2 therefore decreased plt activation –> decreased plt adhesion and aggregation
- *S/E’s:** Gastric irritation (gastritis/ulcers), GI haemorrhage, bronchospasm, renal failure, gout, ototoxic in OD (tinnitus)
- *CI’s:** In children (risk of Reye syndrome) except in Kawasakis, active PUD, bleeding disorders, gout, pregnant
- *Interactions:** Increased bleeding risk with other anticoagulants/ antiplatelets, increased effect of sulphonylureas/methotrexate
- *Other info:** Caution in asthma and uncontrolled HTN. Stop 7d before any surgery if heavy bleeding expected. Relatively plt specific at low doses e.g 75-150mg. Max dose 4g/day.
20
Q
Clopidogrel
aka plavix
A
- *Indications:** Prevention of atherothrombotic events in peripheral arterial disease, MI, Ischaemic stroke, ACS (NSTEMI+STEMI), AF
- *MOA:** _Anti-platelet. _Prodrug - thienopyridine class of antiplatelets, activated by hepatic CYP enzymes, is an irreversible adenosine R antagonist –> stops ADP induced fibringoen binding to gPIIb/IIIa
- *S/E’s:** Dyspepsia, GI upset, bleeding (GI/Intracranial), TTP (rare)
- *CI’s:** Active bleeding, severe liver disease, breastfeeding
- *Interactions:** Warfarin!!, PPI’s/H2RA’s, cipro
- *Other info:** Used following baremetal or drug eluting stents for atleast 1 year. Stop 7days before surgery.
21
Q
Abciximab
Tirofiban
Eptifibatide
A
Indications: High risk pts with NSTEMI, PCI prevention of ischaemic cardiac complications
MOA: Anti-platelet.** **Inhibit GpIIb/IIIa receptors on platelets involved in plt activation, inhibition prevents aggregation and therefore thrombus formation.
S/E’s: Bleeding, N+V, hypotension, bradycardia, thrombocytopenia
CI’s: Active bleeding, major surgery
Interactions:
Other info:Only abciximab can be given PO, the rest = IV
22
Q
Dipyridamole
A
- *Indications:** Can be used with aspirin/warfarin in 2ndary prevention of stroke
- *MOA:** Anti-platelet.** **Inhibits phosphodiesterase enzymes (which normally breakdown cAMP) therefore increased cAMP levels –> prevent plt aggregation. Also inhibits thromboxane synthase.
- *S/E’s:** GI upset, headache, no increased risk of bleeding!!!
- *CI’s:** Myasthenia gravis, AS, recent MI, LVF, can exacerbate migraines
- *Interactions:** Enhances and extends effects of adenosine
- *Other info: **
23
Q
Aspirin OD
A
OD causes –> mixed metabolic acidosis and respiratory alkalosis
Presents as –> Vomiting, dehydration, tinnitus, hyperventilation
Ix –> Salicylate/paracetamol levels, FBC, U+E, LFT’s. Clotting, ABG, Glu
Rx –> If <1 hr since ingestion = gastric lavage Correct dehydration + acidosis (HCO3) Alkalinize urine: NaHCO3 + KCl If levels >700mg/L or heart/renal failure/seizures = Haemodialysis
24
Q
Atorvastatin
Simvastatin
Pravastatin
(STATINS in decreasing potency, nocte)
A
- *Indications:** Primary hypercholesterolaemia (total choles >5, LDL>3), Familial hypercholesterolaemia, any known CVD, DM if aged >40
- *MOA:** _Lipid lowering_ - _STATIN _HMG-CoA reductase inhibitors–> block rate limiting step in cholesterol synthesis –> decreased hepatocye cholesterol –> Increased hepatic LDL-R’s –> Decreased LDL cholesterol + Increase in HDL + Decrease in triglycerides (mildly)
- *S/E’s:** Myalgia, myopathy, myositis + rhabdo (–> ATN), deranged LFT’s, GI upset
- *CI’s:** Liver disease, ETOHics, pregnancy
- *Interactions**: Increased risk of myositis with fibrates, macrolides, azoles, grapefruit juice, protease inhibitors, ciclosporin
- *Other info:** Aim for total cholesterol <4. Monitor LFT’s and CK. Take nocte as increased cholesterol synthesis at night.
25
**Gemfibrozil**
**Benzafibrate**
* *Indications:** Hypertriglycerideaemia, adjunct to diet in hyperlipidaemia if statin not tolerated/CI.
* *MOA:** _Lipid lowering - Fibrates_ --\> Increase sysnthesis of lipoprotein lipase so increases the clearance of triglycerides (v small decrease in LDL and increase in HDL)
* *S/E's:** Gallstones, GI upset, decreased appetitie, myositis
* *CI's:** Gallbladder/biliary tract disease, PBC, low albumin, hepatic/renal impairment, pregnancy
* *Interactions:** Increased risk of myositis with statins, increased effect of anti-diabetics
* *Other info: **
26
**Cholestyramine**
**Choletipol**
* *Indications:** Hypercholesterolaemia, pruritis assoc with partial biliary obstruction/PBC
* *MOA:** _Lipid lowering_. A bile acid sequestrant --\> a strong ion exchange resin (binds bile acids in the GIT to prevent reabsorption)--\> prevents enterohepatic recycling therefore liver must make more bile acids (increases LDL-R's)
* *S/E's:** Constipation, N+V, bloating, impaired ADEK absorption
* *CI's:** Complete biliary obstruction
* *Interactions:** Decreases absorption of digoxin
* *Other info**: Don't take within 3 hours of other drugs!
27
**Nicotinic Acid**
* *Indications:** Adjunct to statins in dyslipidaemia or alone if statin CI/not tolerated
* *MOA:** _Lipid lowering_. Inhibits cholesterol and TG synthesis (increases HDL)
* *S/E's:** N+V+D, abdo pain, dyspepsia, flushing (bad), myopathy
* *CI's:** Arterial bleeding, active PUD, pregnancy
* *Interactions:** Increased risk of myopathy with statins
* *Other info: **
28
**Ezetimibe**
* *Indications:** Adjunct to diet + statins in primary hypercholesterolaemia and familial hypercholesterolaemia
* *MOA:** _Lipid lowering._ Inhibits absorption of cholesterol from the intestine.
* *S/E's:** GI disturbances, headache, fatigure, myalgia
* *CI's:** Pregnancy
* *Interactions:** Ciclosporin. Increased risk of myositis with statins.
* *Other info: **
29
**Omega-3-FA**
**Indications:** Adjunct to diet + statins in hypertriglyceridaemia
**MOA:** Lowers TG's
**S/E's:** Dyspepsia, nausea
**CI's**: Pregnancy
**Interactions:
Other info: **
30
**Orlistat**
* *Indications:** Adjunct to diet/exercise in obesity
* *MOA:** Inhibits gastric and pancreatic lipases --\> impaired absorption of dietary fat. Lipid lowering.
* *S/E's:** GI upset/oily PR leakage, flatulence, urgency, steatorrheoa, impaired fat soluble ADEK vitamin absorption
* *CI's:** Chronic malabsorption syndrome, cholestasis
* *Interactions:** Warfarin (unable to control INR)
* *Other info: **
31
**Disopyramide**
* *Indications:** Prevention and treatment of ventricular and SVT arrhythmias --\> esp post MI, maintenance of sinus rhythm post cardioversion.
* *MOA:** _Anti-Arrhythmic CLASS Ia. _Sodium channel blocker. Inhibits conduction --\> prolongs PR interval by lengthening QRS and P wave duration. Also negative inotropic effect.
* *S/E's:** VT, VF, torsades de pointes, hypotension, AV blovk, anti-muscarinic effects e.g. dry mouth/blurred vision etc
* *CI's:** Heart block (2nd/3rd degree/bifasic/trifasicular block)
* *Interactions:** Amiodarone, TCA's
* *Other info: **
32
**Lignocaine**
**(Lidocaine)**
* *Indications:** Ventricular arrhythmias esp post MI. Terminates VT and decreases risk of VF.
* *MOA:** _Anti-Arrhythmic CLASS Ib_ - Na channel blocker --\> slows conduction and shortens repolarisation.
* *S/E's:** Dizziness, paraesthesia, drowsiness, hypotension, bradycardia (can lead to cardiac arrest)
* *CI's:** AV block!!
* *Interactions:** Cimetidine, propanolol
* *Other info:** IV use only.
33
**Flecainide**
* *Indications:** Pre-excited AF (WPW), chemical cardioversion in AF, suppression of ventricular ectopics
* *MOA:** _Anti-Arrhythmic CLASS Ic_ - Na channel blocker --\> slows conduction, no effect on repolarisation. Strongly negatively ionotropic.
* *S/E's:** Oedema, SOB, dizziness, fatigue
* *CI's:** Heart failure, post MI, valvular/*structural heart disease*, longstanding AF, 2/3rd degree heart block
* *Interactions:** Amiodarone, TCA's, Bblockers
* *Other info: **
34
**Amiodarone**
* *Indications:** SVT, AF/flutter, pre excited AF, ventricular arrythmias incl VF
* *MOA:** _Anti-Arrhythmic CLASS III_ - K+ channel effects --\> slows conduction through the heart, MOA not fully understood.
* *S/E's:** Eye- cornal microdeposits, thyroid - hyper/hypo, lung - pulm fibrosis, GI - deranged LFT's, N+V, skin - photosensitivity (stay out of sun!) and blue-grey discolouration and phelbitis, neuro - periph neuropathy
* *CI's:** Sinus bradycardia, thyroid disease, iodine allergy, long QTc --\> TdP
* *Interactions:** Bblockers/CCb's = increased risk of heart block and bradycardia, digoxin, warfarin, phenytoin, TCA's, other antiarrhythmics
* *Other info:** Give centrally to avoid periph phelbitis. Accumulates in body - very long half life (10-100days) - need a loading dose!
Monitor TFT's, LFT's, K, CZR, skin
35
**Digoxin**
* *Indications:** SVT --\> AF/flutter, Heart failure
* *MOA:** _Anti-Arrhythmic_ - Cardiac gylcoside, MOA not fully understood. Increases tone of contraction and decreases AVN conduction.
* *S/E's:** Toxicity = any arrhythmia, nausea, xanthopsia, confusion, hyperkalaemia, Chronic = gynaecomastia. Get reverse tick ECG finding.
* *CI's:** 3rd degree heart block, VF/VT, HOCM, SVT's with acces pathways (WPW)
* *Interactions:** Toxicity increased by CCB's, amiodarone, diuretics. Antacids decrease digoxin absorption from GIT.
* *Other info:** Renally excreted - therefore caution in impairment and elderly. Monitor U+E, drug levels 6hrs post dose. Narrow therapeutic index 1-2.5nmol/L. Loading dose then maintenance dose needed.
36
**Adenosine**
* *Indications:** SVT (diagnosis and Rx)
* *MOA:** _Anti-Arrhythmic_ - Binds adenosine receptors in cardiac conduction system, opening Ach sensitive K+ channels --\> prolongs refractory period in AVN = decreases conduction
* *S/E's:** Nausea, flushing, chest pain, SOB, bronchospasm \*\*\* WARN pt before!! Will make them feel awful for few seconds.
* *CI's:** Asthma/COPD, 2/3rd degree heart block, sick sinus syndrome, severe hypotension
* *Interactions:** Effects prolonged by dipyridamole and decreased by theophylline
* *Other info:** Half life = 8-10secs, v short lived
37
**Warfarin**
* *Indications:** Treatment of VTE. Prophylaxis of VTE, AF, mechanical heart valve, large anterior MI (3/12), dilated cardiomyopathy/LV aneurysm, PE
* *MOA:** Inhibits Vit K epoxide reductase --\> prevents recycling of vit K --\> functional vit K deficiency. Inhibits synthesis of F2, 7, 9, 10, C + S (Cyp metabolism).
* *S/E's:** Haemorrhage, bruising, skin necrosis (protein s deficiency), purple toe syndrome (cholesterol embolism), OP, hepatic dysfunction
* *CI's:** Pregnancy (teratogenic 1st trimester/fetal haemorrhage 3rd tri), PUD, severe HTN, avoid in severe renal/hepatic impairment, alcholics
* *Interactions:** Enzyme inhibitors, ETOH, simvastatin, NSAIDs, amiodarone, Abx, cranberry juice, OCP, phenytoin, St John's wart
* *Other info: Initally pro-coagulant as protein s is depleted first therefore need to cover pt with LMWH. Aim INR = 2-3 in all conditions except metal heart valves + APS = INR 3-4.**
**_DOSE - TAIT MODEL_** Day 1-4 = 5mg warfarin OD at 6pm Day 5 = check INR and adjust accordingly Day 8 = " \>Day 8 = check INR every 4 days and adjust accordingly
38
**Apixaban**
**Dabigatran**
**Rivaroxaban**
* *Indications:** VTE prophylaxis, non valvular AF
* *MOA**: _ANTI COAGULANTS_
Apixaban = direct inhibitor of FXa - PO Dabigatran = direct thrombin inhibitor - PO Rivaxaban = direct inhibitor of FXa - PO
* *S/E's:** Nausea, dyspepsia, diarrhoea, abdo pain, haemorrhage, bruising
* *CI's:** Active bleeding, sig risk of major bleeding, avoid in renal/hepatic failure and pregnancy
* *Interactions:** Many --\> other anticoagulants
* *Other info: **
39
**Heparin**
* *Indications:** Rx and prophylaxis of VTE, ACS, acute arterial obstruction
* *MOA:** _ANTI COAGULANT_ - Cofactor for ATIII - inhibits F2, 10, 11, 12
* *S/E's:** Thrombocytopaenia (lowers plts), OP (long term use), hyperkalaemia (heparin inhibits aldosterone)
* *CI's:** Bleeding disorders, plts\<60, previous HIT, PUD, cerebral haemorrhage, severe HTN, neurosurgery
* *Interactions:** Increased risk of bleeding with other anticoagulants
* *Other info:** LMWH - longer half life, response is predictable therefore no monitoring required, less risk of HIT + OP too.
Unfractionated heparin - rapid onsent, short half life
**Reversal agent = protamine sulphate (IV)**
40
**Streptokinase**
**Alteplase (Rh-TPA)**
**Indications:** Acute MI (STEMI), DVT, PE, acute ischaemic stroke
**MOA:** Fibrinolytic drugs --\> activate plasminogen, forming plasmin --\> degrades fibrin --\> breaking up thrombus
**S/E's:** Bleeding, hypotension, reperfusion dysrhythmias, allergy!
**CI's:** Haemorrhagic stroke\*, CNS trauma/neoplasm\* (absolute CI's), recent haemorrhage, trauma, surgery, coagulation defects
**Interactions: -
Other info:** Streptokinase --\> derived from streptococci --\> develop Ab's - therefore use once only or can get allergic reactions!
41
**Phenylephrine**
**Timolol**
**Indications:** Mydriasis, chronic open angle glaucoma
**MOA:** Alpha agnonists --\> decrease aqueous humour production
**S/E's:** Blurred vision, photophobia, palpitations, tacchycardia, HTN
**CI's:** CVD, HTN, thyrotoxicosis
**Interactions:
Other info: **
42
**Vaughan - Williams Classification **
**(Anti-Arrhythmics)**
**Class I -** Na+ channel blockers --\> all slow conduction - subclasses have different effects on action potential. 1a) Procainamide 1b) Lignocaine 1c) Flecainide
**ClassII -** Bblockers - act on atria/SAN/AVN/ventricles and decrease Ca entry to cells. Increase refractory period of AVN (slow the conduction)
**Class III -** K+ channel blockers - act on atria/SAN/AVN/ventricles, increases refractory period and QTc.
**Class IV -** Ca2+ channel blockers - acts on AVN to slow conduction
**Class V - Unclassified --\> Digoxin (cardiac glycoside), Adenosine**
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