Flashcards in Cardiology Medications Deck (30):
Name some typical ACE-Is
Why do these medications cause a dry cough in 10% of people? How is this remedied?
They prevent breakdown of bradykinin, which accumulates to give these symptoms
Replace with Angiotensin Receptor Block, Candesartan or Losartan.
In which people are ACE-I and ARBs inefficacious?
Drug interactions of ACE-I?
Lithium (sodium and potassium deviations (particularly Na).
NSAIDs (renal impairement- could accidentally cause an AKI).
Other side effects of an ACE-I? Do ARBs have these?
Dizziness, postural hypotension and taste
(metallic) and electrolyte disturbances.
take before bed
How do ACE-I affect potassium? how might this manifest??
Are ACE-I prone to hypersensitivity reactions?
In some people they can manifest as a rash
Who should you avoid giving ACE-I to?
NB: ACE I's are nephrotoxic (because that is where they are metabolised, and if AKI already present there...), but also they're nephroprotective at the same time due to cardiac remodelling that reduces renal HT.
How do Calcium Channel Blockers act?
They bind to L type calcium channels on vascular smooth muscle and cardiac myocytes
These regulate contractions
The channels also regulate pacemaker cells and can decrease contraction through the AV node
Two types of CCBs?
Dyhydropyridines: reduce smooth muscle contraction, decreasing afterload and LV force. Does not bind heart
Non-Dyhydropyridine: These slow down AV-conduction, thus having anti-arrythmic effects. Binds to the heart
overall they slow down contractility and conductivity
What other conditions can CCBs be used for?
Examples of DHPs?
examples of Non-DHPs?
Which CCB should you prescribe by brand?
dilitiazem; due to issues with bioavailability
Side effects of CCBs?
(reduced oxygen demand)
could precipitate AV block
Drug interactions of CCBs?
avoid with beta blocker: asystole risk
Examples of beta blockers??
Atenolol (beta 1 )
Propanolol (non-selective, therefore both 1 & 2)
How do beta blockers act?
They target beta 1: a major cardiac component, blocking norepinephrine released by sympathetic adrenergic nerves
Define the following:
Components of sympathetic system, describing what hey stimulate
What other conditions can beta blockers be used for?
arrthymia and UA
Common side effects of beta blockers?
bronchospasms, fatigue, bradycardia, hypoglycaemia, acute heart failure aggravation
Sutolol associated with nightmares or vivid dreams!
Common contraindications of beta blockers?
interaction with verapamil causing asystole
What are cardiac glycosides?
Digoxin. alters K and Na exchange and inhibits ATP-action, resulting in decreased heart contractility. Positive ionotrope, negative chronotrope. Also inhibits vagal impulse to reduce sympathetic tone
When would you prescribe digoxin? Be cautious of what?
Counselling points for digoxin?
Congestive heart failure. Also supraventricular dysrhythmias,particularly atrial fibrillation
V good in v. young and sedentary people (elevations in HR problematic if active).
Narrow TW: caution in elderly and with thyroid disorders
Be very cautious with dosaging. Anorexia, nausea and
vomiting in babies you might see sinus bradycardia
CNS disturbances and dizziness, Visual disturbances
– blurred vision
• Nausea and vomiting
• Skin rashes- usually present together with
What are K channel agonists/activators?
Act by: Dilation of the arterial and venous return in some cases, smooth muscle in the hyperpolarised state relaxes.
• Nicorandil has no direct effect on myocardial contractility.
• Minoxidil is indicated for the treatment of severe hypertension.
Prescribing Nicorandil or Minoxidil: what should you warn patient about?
Do not prescribe with...
Flushing and headaches and Dizziness
Salt and water retention
Feeling weak and Mouth ulcers- Nicorandil
• Sildenafil (synergy)
What causes hypertension?
Primary : 90-95% of cases, unknown genetic factor likely
Secondary HT: renal disease, endocrine (cushing's), vascular (renal artery stenosis)
What is bendroflumethiazide?
thiazide diuretic, it's in the name you goon
Bendroflumethiazide is a thiazide diuretic which works by inhibiting sodium reabsorption at the beginning of the distal convoluted tubule (DCT). Water is lost as a result of more sodium reaching the collecting ducts. Bendroflumethiazide has a role in the treatment of mild heart failure although loop diuretics are better for reducing overload. The main use of bendroflumethiazide currently is in hypertension (part of the effect is due to vasodilation).
Side effects of diuretics? When prescribing be mindful of what?
low K, hypoantremia, hypomagnesia, hypocalcaemia, headache, thirst, dizziness. Gynecomastia for spironolactone
Be aware that it can lead to inappropriate diuresis. Gynecomastia w spirinolactone. Postural hypotension. Increased AKI risk. Hypokalaemia w digoxin