Cardioresp PPT Flashcards
(200 cards)
1
Q
name some thiazide diuretics
A
bendroflumethiazide, indapamide
2
Q
indications of thiazide diuretics
A
hypertension, sometimes chronic heart failure
3
Q
MOA of thiazide diuretics
A
inhibit the Na+/Cl- co-transporter on DCT, preventing reabsorption of Na+ and H2O
4
Q
side effects of thiazide diuretics
A
Hyponatraemia
Hypokalaemia
Cardiac arrhythmias
gout
5
Q
name some loop diuretics
A
furosemide (IV & oral), bumetanide (oral)
6
Q
indications of loop diuretics
A
acute pulmonary oedema, chronic heart failure, resistant hypertension
7
Q
MOA of loop diuretics
A
inhibit the Na+/K+/2Cl- pump in ascending loop which results in water retention. Also have a vasodilative effect
8
Q
side effects of loop diuretics
A
Dehydration
Hypotension
Almost any low electrolyte state
9
Q
name some potassium sparing diuretics and aldosterone antagonists
A
amiloride, spironolactone (AA), eplerenone (AA)
10
Q
indications of potassium sparing diuretics and aldosterone antagonists
A
prevention of hypokalaemia with use of other diuretics, primary hyperaldosteronism, severe heart failure
11
Q
MOA of potassium sparing diuretics
A
act at DCT to prevent reabsorbtion of Na+ and water, but spare K+
12
Q
MOA of aldosterone antagonists
A
competitive inhibitors of aldosterone at collecting duct and prevent it causing Na+ reabsorption and K+ excretion
13
Q
side effects of potassium sparing diuretics and aldosterone antagonists
A
GI upset
Hypotension
gynaecomastia (AA)
urinary symptoms
14
Q
name some beta blockers
A
propranolol, bisoprolol, atenolol, metoprolol and carvedilol
15
Q
indications of beta blockers
A
angina, MI, hypertension, arrhythmia, heart failure, anxiety
16
Q
MOA of beta blockers
A
block beta-1 receptors on the heart and reduce force of contraction and speed of conduction. Non-cardioselective ones inhibit release of renin from kidneys.
17
Q
side effects of beta blockers
A
Cold extremities
bronchospasm
fatigue
18
Q
warnings of beta blockers
A
cause bronchospasm in asthmatics
contraindicated in heart block
19
Q
name some calcium channel blockers
A
amlodipine, diltiazem, verapamil
20
Q
indications of calcium channel blockers
A
hypertension, angina, arrhythmias
21
Q
MOA of calcium channel blockers
A
decrease Ca2+ entry into vascular and cardiac cells. This causes relaxation and vasodilation in arterial smooth muscle. It suppresses cardiac conduction and slows heart rate
22
Q
side effects of calcium channel blockers
A
amlodipine - oedema, headaches, palpitations
verapamil - constipation, heart block, gum hypertrophy
diltiazem - any of the above
23
Q
warnings of calcium channel blockers
A
don’t use amlodipine in unstable angina
verapamil and diltiazem shouldn’t be used with beta blockers
24
Q
name some ACEi’s
A
ramipril, enalapril, captopril
25
indications of ACEi's
hypertension, chronic heart failure, ischaemic heart disease, diabetic nephropathy
26
MOA of ACEi's
blocks action of ACE, preventing conversion of angiotensin 1 to angiotensin 2. Angiotensin 2 is a vasoconstrictor and stimulates aldosterone production
27
side effects of ACEi's
hypotension
hyperkalaemia
persistnet dry cough
renal failure
28
warnings of ACEi's
avoid in renal artery stenosis, AKI
Don't use antacids at same time
Alcohol amplifies its effects
29
name some ARBs
lorsartan, candesartan, valsartan
30
indications of ARBs
hypertension, chronic heart failure, ischaemic heart disease, diabetic nephropathy
31
MOA of ARBs
block the action of angiotensin 2 on it's receptor. Prevents it causing vasocontriction and stimulating aldosterone release
32
side effects of ARBs
hypotension
hyperkalaemia
renal failure
33
warnings of ARBs
avoid in renal artery stenosis and AKI
34
name some alpha 1 receptor antagonists
doxazosin, tamulosin
35
indications of alpha 1 receptor antagonists
resistant hypertension
| benign prostatic hyperplasia
36
MOA of alpha 1 receptor antagonists
act on alpha-1 adrenoceptors which are present on smooth muscle of blood vessels and urinary tract. Blockage of these allows vasodilation and reduced resistance to bladder outflow
37
name some statins
simvastatin, atorvastatin
38
indication of statins
prevention of cardiovascular disease
39
MOA of statins
inhibit HMG coA reductase which is involved in making cholesterol. They decrease cholesterol production and increase LDL clearance
40
side effects of statins
myalgia
headaches
hepatitis
rhabdomyolysis
41
name some fibrates
fenofibrate, ciprofibrate
42
indications of fibrates
hypertriglyceridaemia
43
MOA of fibrates
activation of transcriptionfactors called PPARs which help regulate genes that control lipid metabolism. Increase HDL and reduce LDL
44
side effects of fibrates
GI upset
pruritis
headache
45
name a specific cholesterol absorption inhibitor
ezetimibe
46
indication of specific cholesterol absorption inhibitor
prevention of cardiovascular disease
47
MOA of specific cholesterol absorption inhibitors
Act on brush border of small intestine to reduce absorption of cholesterol
48
side effects of specific cholesterol absorbtion inhibitors
GI upset
| unpalatability of drug
49
warnings of specific cholesterol absorption inhibitors
interact with absorption of acidic drugs e.g. warfarin, digoxin
50
name some heparins
unfractionated heparin, deltaparin (LMWH), fondaparinux (not a heparin but similar)
51
indications of heparins
thromboembolism, acute coronary syndrome (ACS)
52
MOA of heparins
activates antithrombin which inactivates thrombin and factor Xa, which are key in the common coagulation pathway.
unfractionated heparin inhibits both equally
LMWH inhibits factor Xa preferentially
Fondaparinux inhibits factor Xa only
53
side effects of heparins
bleeding
thrombocytopenia
reaction around injection site
54
name some DOACs
apixaban, rivaroxaban
55
indications of DOACs
thromboembolism treatment and prophylaxis
56
MOA of warfarin
Inhibits an enzyme that reactivates vitamin K. This prevents synthesis of vitamin K dependent coagulation factors
57
MOA of non-vitamin K dependent DOACs
they reversibly bind to factor Xa and inhibit it's action. This causes quick onset anticoagulation
58
side effects of warfarin
haemorrhage
teratogenic effects on foetus
alopecia
59
warnings of warfarin
broad spectrum antibiotics can increase its anticoagulant effect. CYP450 inhibitors increase risk of bleeding e.g. NSAIDs, amiodarone, SSRIs
60
side effects of non-vitamin K dependent DOACs
haemorrhage
| nausea
61
name some fibrinolytic drugs
alteplase, tenecteplase, streptokinase
62
indications of fibrinolytic drugs
acute stroke (alteplase can be given upto 4.5hrs after), STEMI, thrombolysis of thromboembolism
63
MOA of fibrinolytic drugs
catalyses conversion of plasminogen to plasmin which dissolves clots and re-canalises occluded vessels.
64
side effects of fibrinolytic drugs
bleeding
hypotension
cardiac arrest
N&V
65
name vitamin K as a drug
phytomenadione
66
indications of phytomeandione (vit K)
reverse the anticoagulant effect of warfarin,
| used in newborns
67
MOA of phytomenadione (vit K)
supplies vitamin K for the synthesis of vitamin K dependent clotting factors
68
side effects of phytomenadione(vit K)
occasionally anaphylaxis
69
name a prothrombin complex concentrate
beriplex
70
indications of prothrombin complex concentrate
reverse the anticoagulant effect of warfarin and vit K antagonists
71
what drug causes reversal of anticoagulation from DOACs
idarucizamab
72
name some nitrates
isosorbide mononitrate, glyceryl trinitrate
73
indications of nitrates
acute angina, ACS (both use glyceryl trinitrate), prophylaxis of angina (isosorbide), pulmonary oedema
74
MOA of nitrates
converted to NO which helps reduce intracellular Ca2+ in vascular smooth muscle, helping them relax. This reduces cardiac work and myocardial oxygen demand
75
side effects of nitrates
frequent headaches
postural hypotension
dizziness
tolerance
76
name a potassium channel opener
nicorandil
77
indications of potassium channel openers
angina
78
MOA of potassium channel openers
they open ATP-inhibited potassium channels, allowing outflow of K+ and hyperpolarisation (-ve potential). Also activates guanylyl cyclase which increases cGMP to further decrease Ca2+. This results in vasodilation which helps reduce myocardial oxygen demand
79
side effects of potassium channel openers
skin, eye and GI ulcers
flushing
headaches
80
side effects of sinus node inhibitors
blurred vision & ocular symptoms
ventricular ectopics
heart block
81
name a sinus node inhibitor
ivabradine
82
indications of sinus node inhibitors
angina, chronic heart failure
83
MOA of sinus node inhibitors
Inhibit current from pacemaker cells so slows rate of firing of sinus node
84
name a late sodium current inhibitor
ranolazine
85
indications of late sodium current inhibitors
angina
86
MOA of late sodium current inhibitors
they weaken the late Na+ current in ischaemic myocardial cells which goes on to reduce Ca2+ in the cell. This reduces compression of vessels and increases perfusion
87
side effects of late sodium current inhibitors
dyspepsia
constipation
elongation of QT interval
88
name a COX inhibitor used in cardiovascular disease
Aspirin
89
indications of Aspirin
ACS and stroke, secondary prevention of cardiovascular disease, prevention of stent occlusion, treat pain
90
MOA of aspirin
irreversibly binds to COX to help prevent formation of thromboxane, reducing platelet aggregation. cox 1 &2 inhibitor
91
side effects of aspirin
GI upset
GI ulcers
tinnitus
92
warnings of aspirin
Don't prescribe in under 16s due to risk of Reyes syndrome
| acts synergistically with other anti-platelets
93
name a phosphodiesterase (PDE) inhibitor involved in treating CV events
dipyridamole
94
CV indications of PDE inhibitor
secondary prevention of cardiovascular events, prevention of stent occlusion
95
MOA of PDE inhibitors
inhibits reuptake of adenosine, the increased plasma conc of adenosine inhibits platelet aggregation. Also inhibits PDE which leads to reduced platelet activation
96
side effects of PDE inhibitors
GI upset
myalgia
angina
97
name some adenosine diphosphate receptor antagonists
clopidogrel, ticagrelor
98
indications of ADP receptor antagonists
ACS, secondary prevention of CV event, prevention of stent occlusion, prevent thromboembolism
99
MOA of ADP receptor antagonists
irreversibly binds to ADP receptor (P2Y12) on surface of platelet, this inhibits platelet aggregation.
100
side effects of ADP receptor antagonsists
SOB (ticagrelor)
bleeding
thrombocytopenia
101
warnings of clopidogrel
generally prescribed with aspirin because clopidogrel doesn't affect COX pathway so they act synergistically.
CYP450 inhibitors can reduce efficacy e.g. omeprazole, ciprofloxacin, erythromycin, some SSRIs
102
name a glycoprotein IIb/IIIa antagonists
tirofiban
103
indications of glycoprotein IIb/IIIa antagonists
secondary prevention of CV event, prevention of occlusion of a stent
104
MOA of glycogen IIb/IIIa antagonists
tirofiban reversibly binds to GP IIb/IIIa receptors, preventing binding of fibrinogen which reduces platelet aggregation
105
side effects of glycogen IIb/IIIa antagonists
bleeding
| thrombocytopenia
106
indications of adrenaline
cardiac arrest, iontropic support in ICU, anaphylaxis, local vasocontriction
107
MOA of adrenaline
potent agonist of alpha 1&2 and beta 1&2 adrenoceptors resulting in a multitude of effects. specific ones include vasodilation of vessels supplying heart, increased HR and strength of contractions
108
side effects of adrenaline
hypertension
MI
angina
arrhythmia
109
name an antimuscarinic agent with CV use
atropine
110
indications of antimuscaranic agents (CV)
treat symptomatic bradycardia
111
MOA of antimuscarinic agents
bind to muscarinic receptors where they are competitive antagonists of Ach. Ach should cause parasympathetic effects, but as it's blocked the opposite occurs and heart rate and conduction increases
112
side effects of antimuscarinic agents
tachycardia
dry mouth & blurred vision
urinary retention
hypohydrosis
113
name a class III antiarrhythmic drug
amiodarone, sotalol
114
indication of amiodarone
any tachyarrhythmia
115
MOA of amiodarone
blockade of sodium, potassium and calcium channels as well as antagonism of alpha and beta receptors. This helps slow conduction through the heart and increase resistance to depolarisation
116
side effects of amiodarone
```
hypotension
pneumonitis/pulmonary fibrosis
AV block
grey skin discolouration
hepatitis
thyroid dysfunction
corneal deposits
peripheral neuropathy
ventricular arrhythmias (with erythromycin)
rhabdomyolysis (with statins)
```
117
name a class 1b antiarrhythmic drug
lidocaine
118
indication of any classified antiarrhythmic drug
treat atrial and ventral arrhythmia
119
MOA of class 1b antiarrhythmics
provide a weak Na+ channel blockade in abnormal heart tissue, causing slowed impulse conduction
120
side effects of class 1b antiarrhythmics
CNS toxicity - seizures, respiratory depression
| bradycardia
121
name a class 1c antiarrhythmic
flecainide
122
MOA of class 1c antiarrhythmics
marked blockade of Na+ channels and slight blockade on both Ca2+ and K+ channels. This slows the rate of impulse conduction
123
side effects of class 1c antiarrhythmics
CNS toxicity - dizziness, visual problems
oedema
dyspnoea
124
name a class 4 antiarrhythmic
verapamil
125
MOA of class 4 antiarrhythmics
selectively block specific calcium channels in heart which leads to slowed impulse conduction in AV node
126
name some unclassified antiarrhythmics
adenosine, digoxin
127
indications of unclassified antiarrhythmics
atrial tachyarrhytmias
128
MOA of adenosine
agonist of adenosine receptors which helps slow sinus rate and conduction, and increase AV refractoriness by breaking the re-entry circuit
129
side effects of adenosine
bradycardia
| asystole - chest symptoms and breathlessness
130
MOA of digoxin
it's negatively chronotropic and positively ionotropic. It inhibits Na+/K+ pump which increases intracellular Na+, this means Ca2+ can't be secreted out so there's increased intracellular Ca2+ which increases force of contractions
131
side effects of digoxin
bradycardia
GI upset
digoxin toxicity - cause of arrhythmias
132
name some drugs used in ALS algorithm that treat electrolyte and metabolic abnormalities
sodium bicarbonate
calcium gluconate
magnesium sulfate
133
name some penecillins
amoxicillin, flucloxacillin, co-amoxiclav, benzylpenecillin
134
indications of penecillins
streptococcal infection - tonsillitis, pneumonia, endocarditis, skin infection
clostridial infection - tetanus
meningococcal infection - meningitis, septicaemia
135
MOA of penecillins
inhibit the enzymes that cross link peptidoglycans in cell walls. This weakens the cell wall, causing swelling, lysis and death
136
side effects of penecillins
resistance of bacteria to beta lactam ring
allergy
anaphylaxis
CNS toxicity
137
name some cephalosporins
cefalaxin, cefotaxime, cefuroxime
138
indications of cephalosporins
community acquired pneumonia, serious antibiotic resistant infection
139
MOA of cephalosporins
broad spectrum. Inhibit enzymes responsible for crosslinking peptidoglycans in cell walls. This weakens cell wall causing swelling, lysis and death
140
side effects of cephalosporins
resistance - contains a beta lactam ring (less resitance than to penecillins)
GI upset
colitis
CNS toxicity - seizures
141
name some macrolides
erythromycin, clarithromycin, azithromycin
142
indications of macrolides
community acquired pneumonia, atypical pneumonia, respiratory and skin infection, H.pylori
143
MOA of mcrolides
bacteriostatic and broad spectrum. Inhibit protein syntesis by binding to ribosomes and preventing translocation
144
side effects of macrolides
```
GI upset
thrombophelbitis (when IV)
cholestatic jaundice
prolonged QT
ototoxicity
```
145
name some aminoglycosides
gentamycin, streptomycin, amikacin
146
indications of aminoglycosides
endocarditis, pyelonephritis, sepsis,
147
MOA of aminoglycosides
act on gram -ve, are bacteriostatic. bind irreversibly to ribosomes to inhibit protein synthesis
148
side effects of aminoglycosides
nephrotoxicity
| ototoxicity
149
name some tetracyclines
doxycycline, lymecycline, minocycline
150
indications of tetracyclines
community acquired pneumonia, atypical pneumonia, chlamydia, acne
151
MOA of tetracyclines
broad spectrum and bacteriostatic. Bind to ribosomes to inhibit protein synthesis
152
side effects of tetracyclines
oesophogeal irritation
photosensitivity
intracranial hypertension
GI upset
153
name some quinolones
ciprofloxacin, moxifloxacin
154
indications of quinolones
UTI, LRTI, GI infection, community acquired and atypical pneumonia
155
MOA of quinolones
mainly bacteriocidal against gram +ve and gram -ve. They inhibit DNA synthesis.
resistance is rapidly developed
156
side effects of quinolones
GI upset
ruptured muscle tendons
neurological effects e.g. low seizure threshold
157
name some rifamycins
rifampicin, rifabutin
158
indications of rifamycins
TB, endocarditis
159
MOA of rifamycins
broad spectrum bactericidal action. Inhibit RNA synthesis through binding to DNA dependant RNA polymerase
160
side effects of rifamycins
resistance buils quickly
GI upset
leucopenia, thrombocytopenia and anaemia
orange discolouration of sweat and urine
161
indication of isoniazid
TB
162
MOA of isoniazid
narrow spectrum, bactericidal with dividing bacteria but bacteriostatic with resting bacteria. It's a cell wall synthesis inhibitor
163
side effects of isoniazid
GI upset
peripheral neuropathy
systemic lupus erythematosus
164
indication of pyrazinamide
TB
165
MOA of pyrazinamide
selectively bactericidal. unclear, but may inactivate a key enzyme in fatty acid synthesis
166
side effects of pyrazinamide
hepatotoxicity
arthralgia
sideroblastic anaemia
167
indication of ethambutol
TB
168
MOA of ethambutol
bacteriostatic. Cell wall synthesis inhibitor
169
side effects of ethambutol
peripheral neuritis
gout
visual disturbances
170
name some beta 2 agonists
salbutamol, salmeterol, formoterol
171
indications of beta 2 agonists
asthma, COPD
172
MOA of beta 2 agonists
Beta 2 receptors are located in smooth muscle of bronchi and other locations. When they are stimulated they cause smooth muscle relaxation resulting in bronchodilation
173
side effects of beta 2 agonists
tachycardia
anxiety
muscle cramps
174
name some antimuscarinic bronchodilators
tiotropium, ipratropium, glucopyrronium
175
indications of antimuscarinic bronchodilators
asthma, COPD
176
MOA of antimuscarinic bronchodilators
Ach acts at muscarinic receptors causing rest and digest. These drugs are competitive inhibitors of Ach and so cause opposing effects resulting in reduced smooth muscle tone and reduced secretions from glands
177
side effects of antimuscarinic bronchodilators
dry mouth
178
name some theophyllines
theophylline, aminophylline
179
indications of theophyllines
asthma, COPD
180
MOA of theophyllines
inhibit phosphodiesterase which leads to vasodilation, bronchodilation and anti-inflammatory effects
181
side effects of theophyllines
GI upset
CNS stimulation - insomnia, irritability, seizures
hypokalaemia
182
name some inhaled corticosteroids (glucocorticoid )
beclometasone, budesonide, fluticasone
183
indications of ICS
asthma, COPD
184
MOA of ICS
Corticosteroids pass through plasma membrane and activate receptors in the cytoplasm. These receptors then travel to the nucleus to alter transcription of some genes, downregulating inflammatory cytokines and upregulating inflammatory proteins. This results in reduced mucosal inflammation, bronchodilation and reduced secretions
185
side effects of ICS
oral candidiasis
pneumonia
adrenal suppression (rare)
186
name some oral/parenteral corticosteroids
prednisolone, hydrocortisone
187
indications of oral/parenteral corticosteroids
asthma, COPD, autoimmune disease, cancers, adrenal insufficiency, hypopituitarism
188
MOA of oral/parenteral corticosteroids
same as for ICS, but effects are systemic.
189
side effects of oral/parenteral corticosteroids
immunosuppression
diabetes
mood changes
hypertension
190
name a cromone
sodium cromoglicate
191
indications of cromones
prophylaxis in mild to moderate asthma
192
MOA of cromones
cause mast cell stabilisation, protection against eosinophil accumulation and decreased bronchoconstriction
193
side effects of cromones
GI upset
headache
cough after inhalation
194
name some leukotriene receptor antagonists (LTRA)
montelukast, zafirlucast
195
indications of LTRAs
asthma
196
MOA of LRTAs
inhibit bronchoconstriction by blocking receptors on bronchial smooth muscle
197
side effects of LTRAs
GI upset
| headaches
198
side effects of alpha 1 receptor antagonists
postural hypotension
headache
dizziness
199
important side effect of niacin
increases insulin resistance
200
what drug class is dabigitran
direct thrombin inhibitor
