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Year 3 > Cardiology Drugs > Flashcards

Cardiology Drugs Flashcards

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1
Q

What is a key aspect of ACE inhibitor activation in the body?

A

ACE inhibitors are activated by phase 1 metabolism in the liver

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2
Q

What is an important side effect of ACE inhibitors?

A

hyperkalaemia
first-dose hypotension: more common in patients taking diuretics

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3
Q

Which heart pathology should ACE inhibitors be avoided?

A

Aortic stenosis

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4
Q

What drug interactions should ACE inhibitors be avoided with?

A

Diuretics due to risk of hypotension

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5
Q

What drug interactio should beta blockers be avoided with?

A

CCBs in heart failure due to risk of heat block

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6
Q

What is the

A
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7
Q

What does sudden decline in renal function with ACE inhibitors indicate?

A

Bilateral renal stenosis

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8
Q

What is amiodarone?

A

A class III antiarrhythmic agent used in the treatment of atrial, nodal, and ventricular tachycardias

Amiodarone blocks potassium channels, inhibiting repolarization and prolonging the action potential.

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9
Q

What is the main mechanism of action of amiodarone?

A

Blocking potassium channels, which inhibits repolarization and prolongs the action potential

Amiodarone also has class I effects by blocking sodium channels.

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10
Q

What are the limitations of using amiodarone?

A
  • Very long half-life (20-100 days)
  • Should ideally be given into central veins
  • Has proarrhythmic effects due to QT interval lengthening
  • Interacts with drugs (p450 inhibitor)
  • Numerous long-term adverse effects
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11
Q

What monitoring is required for patients taking amiodarone?

A

TFT, LFT, U&E, CXR prior to treatment and every 6 months

TFT = Thyroid Function Tests, LFT = Liver Function Tests, U&E = Urea and Electrolytes.

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12
Q

What are some adverse effects of amiodarone?

A
  • Thyroid dysfunction (hypothyroidism and hyperthyroidism)
  • Corneal deposits
  • Pulmonary fibrosis/pneumonitis
  • Liver fibrosis/hepatitis
  • Peripheral neuropathy, myopathy
  • Photosensitivity
  • ‘Slate-grey’ appearance
  • Thrombophlebitis and injection site reactions
  • Bradycardia
  • Lengthened QT interval
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13
Q

What is clopidogrel used for?

A

Management of cardiovascular disease

It is used when aspirin is not tolerated or in addition to aspirin for various conditions.

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14
Q

What class of drugs does clopidogrel belong to?

A

Thienopyridines

Other examples include prasugrel, ticagrelor, and ticlopidine.

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15
Q

What is the mechanism of action of clopidogrel?

A

Antagonist of the P2Y12 adenosine diphosphate (ADP) receptor, inhibiting platelet activation.

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16
Q

What interaction reduces the effectiveness of clopidogrel?

A

Concurrent use of proton pump inhibitors (PPIs).

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17
Q

What is dabigatran?

A

An oral anticoagulant that is a direct thrombin inhibitor.

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18
Q

What are the main indications for dabigatran?

A
  • Prophylaxis of venous thromboembolism following hip or knee replacement surgery
  • Prevention of stroke in patients with non-valvular atrial fibrillation with specific risk factors
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19
Q

What is the major adverse effect of dabigatran?

A

Haemorrhage.

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20
Q

In which condition should the dose of dabigatran be reduced?

A

Chronic kidney disease.

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21
Q

What is the mechanism of action of ivabradine?

A

Reduces heart rate by acting on the If (‘funny’) ion current in the sinoatrial node.

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22
Q

What are common adverse effects of ivabradine?

A
  • Visual effects (luminous phenomena)
  • Headache
  • Bradycardia
  • Heart block
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23
Q

What is nicorandil used to treat?

A

Angina.

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24
Q

What is the mechanism of action of nicorandil?

A

Potassium-channel activator that causes vasodilation through activation of guanylyl cyclase, increasing cGMP.

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25
What are the adverse effects of nicorandil?
* Headache * Flushing * Skin, mucosal, and eye ulceration * Gastrointestinal ulcers including anal ulceration
26
What is the mechanism of action of warfarin?
Inhibits epoxide reductase, preventing the reduction of vitamin K to its active form.
27
What are the indications for warfarin?
* Mechanical heart valves * Venous thromboembolism * Atrial fibrillation
28
What is the target INR for atrial fibrillation when using warfarin?
2.5.
29
What factors may potentiate the effects of warfarin?
* Liver disease * P450 enzyme inhibitors * Cranberry juice * NSAIDs
30
What are common side effects of warfarin?
* Haemorrhage * Teratogenic effects * Skin necrosis
31
What are the known P450 enzyme inducers that reduce warfarin effect?
* Carbamazepine * Rifampicin * Chronic alcohol * Phenytoin * Griseofulvin * Phenobarbitone * St John’s wort * Sulphonylurea * Smoking
32
What are the known P450 enzyme inhibitors that increase warfarin effect?
* Sodium valproate * Isoniazid * Cimetidine * Ketoconazole * Fluconazole * Acute alcohol and grapefruit juice * Chloramphenicol * Omeprazole * Metronidazole * Allopurinol * Quinupristin * Amiodarone
33
Which antibiotics inhibit beta cytochrome P450?
* Ciprofloxacin * Clarithromycin * Erythromycin
34
What is amiodarone?
A class III antiarrhythmic agent used in the treatment of atrial, nodal, and ventricular tachycardias ## Footnote Amiodarone blocks potassium channels, inhibiting repolarization and prolonging the action potential.
35
What is the main mechanism of action of amiodarone?
Blocking potassium channels, which inhibits repolarization and prolongs the action potential ## Footnote Amiodarone also has class I effects by blocking sodium channels.
36
What are the limitations of using amiodarone?
* Very long half-life (20-100 days) * Should ideally be given into central veins * Has proarrhythmic effects due to QT interval lengthening * Interacts with drugs (p450 inhibitor) * Numerous long-term adverse effects
37
What monitoring is required for patients taking amiodarone?
TFT, LFT, U&E, CXR prior to treatment and every 6 months ## Footnote TFT = Thyroid Function Tests, LFT = Liver Function Tests, U&E = Urea and Electrolytes.
38
What are some adverse effects of amiodarone?
* Thyroid dysfunction (hypothyroidism and hyperthyroidism) * Corneal deposits * Pulmonary fibrosis/pneumonitis * Liver fibrosis/hepatitis * Peripheral neuropathy, myopathy * Photosensitivity * 'Slate-grey' appearance * Thrombophlebitis and injection site reactions * Bradycardia * Lengthened QT interval
39
What is clopidogrel used for?
Management of cardiovascular disease ## Footnote It is used when aspirin is not tolerated or in addition to aspirin for various conditions.
40
What class of drugs does clopidogrel belong to?
Thienopyridines ## Footnote Other examples include prasugrel, ticagrelor, and ticlopidine.
41
What is the mechanism of action of clopidogrel?
Antagonist of the P2Y12 adenosine diphosphate (ADP) receptor, inhibiting platelet activation.
42
What interaction reduces the effectiveness of clopidogrel?
Concurrent use of proton pump inhibitors (PPIs).
43
What is dabigatran?
An oral anticoagulant that is a direct thrombin inhibitor.
44
What are the main indications for dabigatran?
* Prophylaxis of venous thromboembolism following hip or knee replacement surgery * Prevention of stroke in patients with non-valvular atrial fibrillation with specific risk factors
45
What is the major adverse effect of dabigatran?
Haemorrhage.
46
In which condition should the dose of dabigatran be reduced?
Chronic kidney disease.
47
What is the mechanism of action of ivabradine?
Reduces heart rate by acting on the If ('funny') ion current in the sinoatrial node.
48
What are common adverse effects of ivabradine?
* Visual effects (luminous phenomena) * Headache * Bradycardia * Heart block
49
What is nicorandil used to treat?
Angina.
50
What is the mechanism of action of nicorandil?
Potassium-channel activator that causes vasodilation through activation of guanylyl cyclase, increasing cGMP.
51
What are the adverse effects of nicorandil?
* Headache * Flushing * Skin, mucosal, and eye ulceration * Gastrointestinal ulcers including anal ulceration
52
What is the mechanism of action of warfarin?
Inhibits epoxide reductase, preventing the reduction of vitamin K to its active form.
53
What are the indications for warfarin?
* Mechanical heart valves * Venous thromboembolism * Atrial fibrillation
54
What is the target INR for atrial fibrillation when using warfarin?
2.5.
55
What factors may potentiate the effects of warfarin?
* Liver disease * P450 enzyme inhibitors * Cranberry juice * NSAIDs
56
What are common side effects of warfarin?
* Haemorrhage * Teratogenic effects * Skin necrosis
57
What are the known P450 enzyme inducers that reduce warfarin effect?
* Carbamazepine * Rifampicin * Chronic alcohol * Phenytoin * Griseofulvin * Phenobarbitone * St John’s wort * Sulphonylurea * Smoking
58
What are the known P450 enzyme inhibitors that increase warfarin effect?
* Sodium valproate * Isoniazid * Cimetidine * Ketoconazole * Fluconazole * Acute alcohol and grapefruit juice * Chloramphenicol * Omeprazole * Metronidazole * Allopurinol * Quinupristin * Amiodarone
59
Which antibiotics inhibit beta cytochrome P450?
* Ciprofloxacin * Clarithromycin * Erythromycin
60
Which group should aspirin be used with caution?
Young children due to the risk of Reye’s syndorme where swelling of the liver and brain occur
61
What is nicotinic acid commonly known as?
Niacin
62
What condition is nicotinic acid (niacin) used to treat?
Hyperlipidaemia
63
What are the primary effects of nicotinic acid in patients?
Lowers cholesterol and triglyceride concentrations, raises HDL levels
64
What is a common side effect of nicotinic acid?
Flushing
65
Flushing from nicotinic acid is mediated by _______.
Prostaglandins
66
List two other adverse effects of nicotinic acid.
* Impaired glucose tolerance * Myositis
67
True or False: Nicotinic acid has no side effects.
False
68
Which drug must e avoided in heart failure?
CCBs
69
What is the side effect of CCB?
Peripheral oedema

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