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308: Clinical Pharmacology and Therapeutics > Cardiology pharmacology > Flashcards

Cardiology pharmacology Flashcards

(44 cards)

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1
Q

Drug therapy for AF

A

Anticoagulation

Rate control strategy

Rhythm control strategy

‘Pill in the pocket’

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2
Q

Rate control strategy

A

Beta blocker

Rate lowering calcium antagonist (verapamil, diltiazem)

Digoxin

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3
Q

Rhythm control strategy

A

Structural heart disease: beta blocker or amiodarone

No structural heart disease: beta blocker, felcainide

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4
Q

‘Pill in the pocket’

A

Flecainide

Propafenone

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5
Q

Digoxin

A

Used to treat AF

Rhythm control- attempting to control sinus rhythm

Increases the force of contraction and reduces conductivity with the AV node

Only effective for controlling the ventricular rate at rest

Dose should be determined on ventricular rate at rest

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6
Q

Digoxin monitoring

A

Renally excreted

Regular monitoring of plasma digoxin concentration is not required

Toxic levels from 1.5-3mcg/l

Toxicity increased by AKI, hypokalaemia, hypercalcaemia, hypomagnesaemia

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7
Q

Signs of digoxin toxicity

A

Lethargy

Confusion

Vomiting

Loss of appetite

Diarrhoea

Visual changes

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8
Q

Digoxin dosing

A

Loading dose can be given on any ward

IM administration is not recommended

Adult loading: 750mcg-1mg in divided doses over 24 hours, reduce dose if elderly

Adult maintenance dose: 125-250mcg OD

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9
Q

Amiodarone dosing

A

Need 5-10g in total load

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10
Q

IV amiodarone dose

A

5mg/kg loading dose given over 20-120 minutes with ECG monitoring

Infusion 1.2g/24 hours preferred central administration

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11
Q

Oral amiodarone dose

A

200mg TDS for 1 week then

200mg BD for 1 week then

200mg OD as maintenance dose

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12
Q

Bloods to check on amiodarone

A

LFTs

TFTs

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13
Q

Cardiac amiodarone side effects

A

Worsen arrhythmia or new arrhythmia

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14
Q

Skin amiodarone side effects

A

Sensitive to the sun and/ or blue grey discolouration

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15
Q

Eyes amiodarone side effects

A

Corneal deposits in the eye; take care with night driving

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16
Q

Thyroid amiodarone side effects

A

Under active thyroid disease

Over active thyroid disease

Blood tests before and then every 6 months

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17
Q

Liver amiodarone side effects

A

Rarely causes abnormal liver tests

Need blood test before starting then every 6 months

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18
Q

Lung amiodarone side effects

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A

Rarely can cause inflammation of lining of alveoli in lungs

19
Q

Calcium channel antagonists

Study These Flashcards
A

Dihydropyridine

  • shorter acting
  • high affinity for blood vessels
  • antihypertensive effect

Non-dihydropyridine

  • long acting
  • high affinity for the heart
  • antiarrhythmic effect
20
Q

Dihydropyridine examples

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A

Amlodipine

Felodipine

Nicardipine

Nifedipine

Nimodipine

21
Q

Non-dihydropyridine examples

Study These Flashcards
A

Diltiazem

Verapamil

22
Q

MOAi

Study These Flashcards
A

Inhibit calcium ions from entering slow or voltage gated channels

In vascular smooth muscle
- relaxation of blood vessels

In myocardium

  • reduces cardiac contractility
  • depress SA node activity
  • slow AC node conduction
23
Q

Side effects of MOAi

Study These Flashcards
A

Constipation

Facial flushing

Headaches

Ankle swelling

Fatigue

Dizziness

24
Q

Heart failure definition

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A

Clinical syndrome characterised by typical symptoms that may be accompanied by signs caused by structural and/ or functional cardiac abnormality

Results in reduced cardiac output and/ or elevated intracardial pressure at rest or during stress

25
Heart failure with reduced ejection fraction
Left ventricle cannot contract adequately to eject blood into aorta Lack oxygen rich blood to meet body's need Fraction of blood ejected is <40% Predominantly caused by coronary artery disease
26
Heart failure with preserved ejection fraction
Heart muscle becomes stiff and does not relax properly resulting in impaired filling process Fraction of blood ejected is >50% Predominantly caused by hypertension
27
Causes of chronic heart failure
IHD ACS Hypertension Valve disease Arrhythmias Cardiomyopathy Myocarditis
28
Typical symptoms of heart failure
Breathlessness Orthopnoea Paroxysmal nocturnal dyspnoea Reduced exercise tolerance Fatigue, tiredness, increased time to recover after exercise Ankle swelling
29
Specific signs
Elevated JVP Hepatojugular reflux Third heart sound Laterally displaced apical impulse
30
Managing HF with reduced EF <40%
ACEi/ARB/ARNi Beta blocker AA Manage fluid status
31
Physiological response to heart failure
Increase cardiac output Increase catecholamine release Activation of renin angiotensin system Structural changes
32
Compensatory mechanisms of HF
Starling's Law Sympathetic nervous system RAAS Endothelin, NO and prostaglandin Vasopressin Stretch and pressure response
33
Drugs used in heart failure
Diuretics ACEi/ ARB Beta blockers Mineralocorticoid receptor antagonists Ivabradine Digoxin Nitrates Sacubitril/ valsartan
34
Diuretics and sites of action
Ascending LoH - loop diuretics Distal convoluted tubule - thiazide diuretics Later in distal convoluted tubule - mineralocorticoid receptor antagonists
35
Loop diuretics
e.g. furosemide, bumetanide Side effects - fatigue - dizziness - electrolyte imbalance 40mg PO furosemide 1mg PO bumetainde
36
Thiazide like diuretics
e.g. bendroflumethiazide, metolazone Side effects - may exacerbate gout
37
Potassium sparing diuretics
e.g. spironolactone, eplerenone Side effects - hyperkalaemia - gynaecomastia Eplerenone in MI patients with EF<40%
38
ACEi and ARB
First line treatment for ventricular HF Improve signs, symptoms and exercise tolerance Reduction in disease progression, hospitalisation and mortality Start at low dose, titrate upwards every 2 weeks Angiotensin 2 receptor antagonists in patients intolerance of ACEi
39
Beta blockers
Should not be initiated during acute HF due to short term deterioration in LV systole Start slowly and titrate upwards at maximum 2 weekly intervals Experience temporary decrease in QoL due to lethargy and fluid retention
40
Ivabradine
Licensed for chronic HF 5mg BD for 2 weeks then increase to 7.5mg BD 2.5mg BD if >75
41
Side effects of ivabradine
Slow heart rate Headache Dizziness Vision disturbance
42
Nitrates
10mg BD titrated upwards to total of 120mg daily divided doses Used ina cute LV HF causing pulmonary oedema
43
Sacubitril valsartan
Neprilysin inhibitor and angiotensin 2 receptor blocker
44
Lifestyle changes for heart failure
Monitor fluid intake Monitor breathlessness and oedema Smoking cessation Optimise BP Optimise diabetes management Diet and reduced salt intake Regular exercise providing condition is stable and doesn't preclude this Flu vaccination Pneumococcal vaccination Compliance with medication

308: Clinical Pharmacology and Therapeutics (14 decks)

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