Cardiology: The Drugs that make it possible

Question 1

What are the 3 types of diuretic and how does their MOA differ?

Answer 1

Loop: Blocks Na/2Cl/K co-transporter in ascending loop
Thiazide: Blocks Na/Cl symporter in DCT
Potassium sparing: Block Na channels in DCT

Question 2

Spironolactone, eplerenone and amiloride are all types of?

Answer 2

K+ sparing diuretics

Question 3

Furosemide and bumetanide are what drugs?

Answer 3

Loop diuretics

Question 4

What drug is metolozone? name another member of this class

Answer 4

Thiazide diuretic

indapamide

Question 5

Which of the following drugs will not cause hypokalaemia?

Amiloride

Metolazone

Indapamide

Eplernone

furosemide

Answer 5

Eplernone

K+ Sparing only block Na+ reabsorption

Question 6

Amenorrhea, gynaecomastia, decreased libido are features of which diuretic?

Answer 6

K+ sparing diuretics

Spares your potassium but not your sex life

Question 7

What are the side effects of thiazide diuretics?

Answer 7

Gout, Glucose tolerance impaired, Getting it up

(making you pee costs you the 3 Gs)

Question 8

Which diuretic causes your electrolytes to leave and not hear them go?

Answer 8

Loop diuretics

also remember hearing by induction LOOP

Question 9

Ramipril and lisinopril are what class of drugs?

Answer 9

ACE inhibitor

Blocks conversion of AT1–>2 which:

Prevents vasoDILATION

Secretes aldosterone .’. retain sodium (water)

BOTH OF WHICH RAISE BP

Question 10

Which of the following is NOT a contraindication to ramipril?

Pregnancy

Angioedema

Previous MI

Renal artery stenosis

Stroke

Answer 10

Previous MI

Stroke

SEs of ramipril: RAS, pregnancy, angioedema

Question 11

How does the effect of -sartans differ from ACEIs?

Answer 11

Blocks AT1 receptor rather than conversion to AT2

Does not deactivate bradykinin so no less vasodilation

Question 12

Compare the contraindications of losartan and lisinopril

Answer 12

Both RAS and pregnancy

Only losartan allowed in angioedema

Question 13

What is the action of GTN/Isorboside mononitrate and how do they differ?

Answer 13

Vasodilation

NO causes downstream reduction in Ca2+ influx

GTN shorter acting while ISMN longer acting

Question 14

What are the side effects of nitrate use?

Answer 14

Think of everything vasodilation would do

Hypotension

Tachycardia

Headaches

Flushing

Question 15

Amlodipine and verapamil are what kind of drug?

Answer 15

Calcium channel blockers

-dipines are dihydropyridines

verapamil and diltiazem are not

Question 16

Outline the action of nifedipine and verapamil

Answer 16

Both are CCBs so reduce contractile force

Verapamil, like diltiazem, is a ND-CCB so reduces AVN conduction to slow rate

Question 17

What drug should NEVER be given with verapamil or diltiazem?

Answer 17

B-blockers

Bradycardia

Question 18

How do the prolols work? why is propanolol special?

Answer 18

Block B receptors

Propanolol non selective

Question 19

What are the side effects of B-blockers?

Answer 19

Bronchospasm

Cold peripheries

Fatigue

Sleep disturbances

ED

Question 20

In which circumstances are B-blockers contraindicated?

Answer 20

Where bradycardia is BADycardia (HF, Sick sinus, + verapamil)

Asthma

Question 21

Aspirin, tirofiban, clopidogrel, ticagrelor are all what?

Answer 21

Antiplatelets

Question 22

Which of the following is not an antiplatelet?

Tirofiban

Ifetroban

Apixiban

Answer 22

Apixiban

Its an anticoagulant

Question 23

If a patient with PMHx of gastric ulcers is found to have aspirin, what should be changed?

Answer 23

Aspirin to clopidogrel

Question 24

If a patient has a thrombus, what blood altering medication should you give?

Answer 24

Depends if venous or arterial

Venous: Anticoagulant

Arterial: Antiplatelet

Question 25

Compare the MOA of warfarin vs LMWH/OACs

Answer 25

Both anticoagulants Warfarin is a vit K reductase inhibitor Others either inhibit thrombin or Factor Xa

Question 26

A patient has a major haemorrhage, what meds would help reverse: Warfarin LMWH OACs

Answer 26

Warfarin: Vitamin K Heparins: Protamine DOAC: idarucizamab (dabigitran), andexanet alfa

Question 27

Streptokinase, alteplase and duteplase are all what drugs?

Answer 27

Fibrinolytics Break down fibrin via plasminogen activation

Question 28

What are the main concerns with fibrinolytics?

Answer 28

Haemorrhage Streptokinase allergy --\> dont give following recent strep infection

Question 29

How do simvastatin and atorvostatin work?

Answer 29

Statins Reduce cholestrol formation through HMG-CoA reductase inhibition increased LDL receptor expression causing LDL clearance

Question 30

What are the side effects of atorvostatin, simvastatin

Answer 30

Myopathies Liver impairment so check 3 months the yearly

Question 31

What 3 patient groups should a statin be avoided in?

Answer 31

Pregnancy Macrolide users Previous IC bleed

Question 32

What do bezafibrate and gemfibrozil do?

Answer 32

Fibrates Reduce cholestrol By upregulating PPARa related genes

Question 33

Put the following drugs into their correct class Quinidine Lidocaine Procainamide Disopyramide Flecanide

Answer 33

All sodium channel blockers Flecainide: Slow acting Lidocaine: Fast acting Others: Medium acting

Question 34

What drugs are class II antiarrhythmics?

Answer 34

B-blockers

Question 35

What is amiodarone and what are its side effects?

Answer 35

Potassium channel blocker Side effects: Pulmonary fibrosis Photosensitivity Peripheral neuropathy Thyroid problems

Question 36

What is the effect of digoxin?

Answer 36

Reduces rate Increases force

Question 37

What are the side effects of digoxin and how do you look out for them?

Answer 37

Heart block, arrhythmias Not routinely monitored but measure 8-12 hours after last dose

Question 38

What does atropine do?

Answer 38

Speeds up the heart Blocks muscarnic inhibition of heart rate

Question 39

Ivabradine: How?

Answer 39

Reduces cardiac rate Through blocking 'funny' current in SA node

Question 40

Altered light vision, headache and bradys are caused by what cardiac drug?

Answer 40

Ivabradine

Question 41

How does the INR for warfarin differ between A-fib and VTE/

Answer 41

2. 5 for both 3. 5 if VTE recurrent

Question 42

Which of the following does not reduce warfarin's effect? Amiodarone NSAIDS Cranberry juice Ciprofloxacin Clindamycin Clopidogrel

Answer 42

Clopidogrel P450 inhibition: Amiodarone, cipro (ALSO LIVER DISEASE) NSAIDS: Inhibit platelet function and displace warfarin