Cardiology Medications Flashcards
(30 cards)
Name some typical ACE-Is
Ramipril
Enalapril
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?
Afro-carribean
Drug interactions of ACE-I?
Lithium (sodium and potassium deviations (particularly Na).
mTOR inhibitors
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
Yes
How do ACE-I affect potassium? how might this manifest??
hyperkalaemia
tachycardia
Are ACE-I prone to hypersensitivity reactions?
In some people they can manifest as a rash
Who should you avoid giving ACE-I to?
Afro-Car
Pregnant
Renal stenosis
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?
arrthymia
angina
Examples of DHPs?
Amlodipine
nifedipine
examples of Non-DHPs?
Verapamil
diltiazem
Which CCB should you prescribe by brand?
dilitiazem; due to issues with bioavailability
Side effects of CCBs?
(reduced oxygen demand)
lowered BP bradycardia could precipitate AV block abdo pain headache peripheral oedema
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: Chronotropy: Ionotropy Dromotropy Lusitropy
Components of sympathetic system, describing what hey stimulate HR contractility electrical conduction Relaxation
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 asthma HF/ block uncontrolled diabetes occluded extremities
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
eosinophilia
