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CARDIOVASCULAR Flashcards

(101 cards)

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1
Q

Furosemide

A

loop diuretic

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2
Q

mechinism of action of furosemide

A

loop diureticc - act on ascending loop of henle - inhbiit Na/K/Cl co trnsporter so prevents wter reabsorption

cause dilation of capacitance veins = reduces preload and improves contractility of overstretched heart

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3
Q

indications for furosemide

A

relief of breathlessness in acute pulmonary oedema in conjunction with oxygen and nitrates

symptomatic treatment of lfuid overload in chronic heart failure

symptomatic treatmnet of fluid overload in other oedematous states - renal diseaswe or liver failure

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4
Q

contraindications for furosemide

A

not in those w hypovolaemia or dehydration
with caution inhepatic encephalopathy severe hypokal/natraemia

can worsen gout when taken chronically

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5
Q

side effects of furosemide

A

dehydration and hypotension

hearing loss and tinnitis

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6
Q

interactions of furosemide

A

loop diuretics can affect drugs exrecreted by the kidneys

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7
Q

bendroflumethiazide

A

thiazide diuretic

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8
Q

bendroflumethiazide mechanism

A

inhibit Na/Cl co transporter in distal convoluted tubule of nephron
= prevent reabsorption of water

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9
Q

indications for bendroflumethiazide

A

alternative first line treatment for hypertension (instead of calcium channel blocker - cant due to oedema or heart failure)

add on treatment for hypertension in those not adequatel controlled by calcium channel blocker + ACEi/ARB

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10
Q

contraindications for bendroflumethiazide

A

avoided in patients with hypokal/natraemia

reduce uric acid secretion so may precipitate acute attakcs of gout

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11
Q

side effects of bendroflumethiazide

A 
hyponatraemia 
hypokalaemia
= cardiac arrhythmias
unmask type 2 diabetes
impotence in  men
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12
Q

interactions of bendroflumethiazide

A

effectiveness reduced by NSAIDs

combination of thiazides with other drugs that lower potassium conc should be avoided

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13
Q

spironolactone

A

potassium sparing diuretic /aldosterone antagonist

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14
Q

spironolactone mechanism of action

A

inhibits effwect of aldosterone by competitielvy binding to aldosterone receptor

this increases sodium and water excretion and potassium retention

their effect is greatest in primary hyper aldosteronism or when circulating aldosterone is released

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15
Q

indications of spironolactone

A

ascites and oedema due to liver cirrhosis - spironolactone is first line diuretic

chronic heart failure - in addition to beta blocker and ace inhibitor

primary hyperaldosteronism `

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16
Q

contraindication for spironolactone

A

severre renal impairemtn
hyperkalaemia
addisons disease (addiosns deficit)

avoid in pregnant and lactating

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17
Q

side effects of spironolactone

A

hyperkalaemia
gynaecomastia
liver impairment and jaundice

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18
Q

interactions of spironolactone

A

when combined with potasssium elevating drugs (ACEi, ARB), can case hyperkalaemia

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19
Q

atenolol

A

beta blocker

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20
Q

mechanism of action of beta blockers

A

block beta1receptors = reduce force of contraction and speed of conduction in the heart

slow ventricular rate in AF mainly by prolonging the refractory period of the AV node

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21
Q

indications for beta blockers

A

ischaemic heart disease - first line option
chronic heart failure
atrial fibrillation
supraventricular tachycardia

in hypertension when others are insufficient or innapropriate

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22
Q

contraindications of beta blockers

A

asthma - life threatening brnchospasms
heart fialure, should be titrating up s,oely
avoid in haemodynamic instability
contraindicated in heart block

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23
Q

side effects of beta blockers

A 
fatigue
cold extremities
headache
GI disturbance  (nausea)
sleep disturbances and nightmares
impotence
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24
Q

interactions of beta blockera

A

not use with non-dihydropyridine calcium channel blockers

can cause heart failure, bradycardia and even astystole

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25
amlodipine
calcium channel blocker
26
mode of action of amlodipine
decrease Ca entry into vascular and cardiac cells, reducing intracellular conc. = relaxation and vasodilation in arteries = lower pressure in heart, reduce myocardial contractility suppress cardiac conduction, slowing ventricular rate reduced cardiac rate, contractility and afterload reduce myocardial oxygen demand preventing angina
27
indications for amlodipine
amlodipine as first or secodn line for hypertension, reduce risk of stroke, MI and death from caridovascular disease cpntrol sumptoms in patients with stable angina - beta blockers are main alternative control rate in those w supraventricular arrhythmias inc supraventricular tachy, AF and Afl
28
contraindications for amlopidine
unstable angina (due to vasodilation leading to contractility and tachy) aortic stenosis - can provoke collapse
29
side effects of amlodipine
``` ankle swelling flushing headache palpitations - caused by vasodilation and compensatory tachycardia ```
30
what kind of calcium channel blocker should not be used with beta blockers
non-dihudropyridin e
31
ramipril
ace inhibitor
32
mechanism of action of ramipril
blocking action of aldosterone = reduce peripheral vascular resistance and lowers blood pressure slows progression of CKS by dilating effect arteriole
33
inidcations for ramipril
hypertension - first or second line treatment - reduce risk of stroke, MI and death chronic heart failure - first line treamtnet ischaemic heart disease - reduce risk of subsequent MI and stroke etc diabetic nephropathy and CKD with proteinuria - reduce proteinuria and progression of nephropathy
34
contraindications for ramipril
renal artery stenosis AKI women pregnant or breastfeeding
35
side effects of ramipril/acei
hypotension after first dose peristent dry cough hyperkalaemia can cause or worsen renal failure
36
possible interactions of ACEi
avoid perscribing with other ptassium elevating durgs in combination with other diuretics, hypotension NSAID + ACEi = increased risk of renal failure
37
losartan
ARB | angiotension II receptor antagonist
38
mode of action of losartan/ARB
similar to ACEi reduces peripheral vascular resistance and lowers blood pressure dilates efferent arteriole, reducing interglomerular pressure and slows progression of CKD
39
indications for Losartan/ARB
hypertension chronic heart failure ischaemic heart disease diabetic nephropathy and CKD with proteinuria
40
contraindications of losartan/ARBs
avoid in patient siwth renal artery stneosis or AKI | women pregnant or breastfeeding
41
side effects of losartan/ARBs
hypotension on first dose hyperkalaemia renal fialure n
42
interactions of ARBs
other potassium elevating drugs in combo with other diuretics - profound first dose hypotension + NSAIDs = risk of kidney damage
43
isosorbide mononitrate
nitrates
44
mode of action of isosorbide mononitrate
relax vessels smooth muscle | = reduce cardiac work and myocardial oxygen demand
45
indications of isosrobide mononitrate
long acting for prophylaxis of angina where bblocker and/or calcium channel blocker are insufficient or not tolerated IV used to treat pulmonary oedema with furosemide nad oxygen short acting for treatment of acute angina and chest pain associated with ACS - GTN spray
46
contraindications for isosorbide mononitrate
severe aortic stenosis - may cause cardiovascular collapse haemodynamic instability (in particular hypotension)
47
side effects of isosorbide mononitrtate
flushing, headaches, lightheadedness and hypotension sustained use can lead to tolerance + reduced symptom releif despite conintued use
48
interactions of nitrates
phosphodiesterase inhibitors - enhance and prolong hypotensive effect of nitrates. antihypertensive medication - precipitate hypotension
49
digoxin
cardiac glycoside
50
digoxin mode of action
cardiac glycoside - increase the output force of the heart and increase its rate of contractions by acting on the cellular sodium-potassium ATPase pump.
51
indications for digozin
AF or atrial flutter - to reuce ventricular rate (bblocker or calcium channel blocker more effective tho) severe heart failure - third line treatment ( ACEi, bblocker, aldosterone antagonist)
52
contraindications of digoxin
second degree heart block and intermittent complete heart block ventricular arrhymias electrolyte abnromalities
53
side effects of digoxin
``` bradycardia, GI disturbance rash dizziness visual disturbance (blurred or yellow vision) arrhythmias in digoxin toxicity ```
54
interactions of digoxin
loop and thiazide diuretics can increase risk fo digoxin toxicity = hypokalaemia amiodarone, Ca channel blockers, spironolactone and quinine - icnrease palsma conc
55
amiodarone
anti-dysrhythmic
56
amiodarone mode of action
reduces ventricular rate in AF and Atrial flutter
57
indications for amiodarone
management of wide range of tachyarrhythmias - AF, atrial flutter, SVT, VT, VF,
58
contraindications for amiodarone
only used when risk benefit balance is justified as is potentially dangerous drug avoid in severe hypotension, heart block and thyroid disease
59
side effects of amiodarone
many when taken chronically - pnuemonitis, bradycardia, AV block, hepatitis, photosensitivity thyroid problems
60
aspirin
antiplatelet
61
aspirin mode of action
irreversibly inhibits cyclooxygenase (COX) = reduce production of pro aggregatory factor thormboxane = reduce platelet aggregation
62
indications for aspirin
acute coronary syndrome and acute ischaemic stroke prevention of thrombotic arterial events in those w cardiovascula r, cerebrovacular and PAD reduce risk of intracardiac thrombus and embolic stroke in AF where warfarin and others are contraindicated control pain and fever
63
contraindications of aspirin
<16 yo allergy to NSAIDs third trimester of preg peptic ulceration and gout
64
side effects of aspirin
``` GI irritation GI ulceration and haemoorhage hypersensitivity reactions inc bronchospasm tinitus life threatening in overdose ```
65
interactions of aspirin
caution with other antiplatelet and anticoagulants
66
clopidogrel
antiplatelet
67
clopidogrel mode of action
prevetns plaelet aggregation and reduces risk of arterial occlusion
68
indications of clopidogrel
ACS prevent occlusion of coronary artery stents prevention of thrombotic events reduce risk of intracardiac thormbus and embolic stroke in AF
69
contraindications of clopidogrel
significant active bleeding stopped 7 days before elective surgery caution in renal and hepatic impairment
70
side effects of clopidogrel
bleeding, in particular, GI
71
tissue type plasminogen activator
thrombolytic - alteplase
72
mode of action of tissue plasminogen activator
catalyses conversion of plasminogen to plasmin - major enzyme repsonsible for clot breakdown
73
indications for thrombolytics
6-12 hrs of symptom onset of STEMI, PE, acute sichaemic stroke occluded central venous access devices
74
contraindications for thrombolytics
``` recent haemorrhage trauma surgery coagulation defects aortic dissection aneurysm coma heavy vaginal bleeding severe hypertension ```
75
side effects of thrombolytics
nausea and vomiting and bleeding in MI, repurfuion arrhythmias, recurrent ischaemia and angina may occur cerebral and pulmonary oedema
76
enoxaparin
low molecular weight heparin = anticoagulant
77
low molecular weight heparin
anticoagulant
78
mode of action of heparin
inhibiting thrombin and factor Xa = prevent formation and propogation of blood clots
79
mode of action of LMWH
inhibit factor Xa | = prevent blood clots
80
indications for LMWH
venous thromboembolism VTE acute coronary syndrome (ACS)
81
contraindications of LMWH
increased risk of bleedng clotting disorders hypertension (severe) invasive procedures
82
side effects of LMWH
bleeding | injection site reactions
83
warfarin
oral anticoagulant
84
mode of action of warfarin
inhibits production of vit K dependent coagulation factors = prevents clotting
85
indications for warfarin
prevent VTE prevent embolic complications in AF (stroke) prevent embolic complications after valve replacements
86
why not use warfarin in arterial thrombosis (MI, thrombotic stroke)?
driven by platelet aggregation = prevented by antiplateletsw not by anticoagulants
87
contraindications for warfarin
risk of haemorrhage liver disease pregnancy
88
side effects of warfarin
bleeding increased risk of abnormalities - peptic ulcers epistaxis r retroperitoneal haemorrhage
89
contraindications of warfarin
cytochrome P450 inhibitors cytochrome P450 inducers some antibitoics
90
rivaroxaban
novel anticoagulant
91
mode of action of rivaoxaban
inhibits factor Xa in prothrombinase complex = interrupts blood coagulantion cascade = inhibit thrombin formation
92
inidcations for rivaoxaban
prevent VTE | prevent embolic complications in AF and after heart valve replcaments
93
contraindications of rivaoxaban
immediate risk of haemorrhage - truam, childbirth and requiring surgery
94
side effects of rivaoxaban
bleeding
95
antidote for warfarin
vitamin K
96
intercactions for rivaroxaban
cytochrome P450 inhibitors and inducers as hepatic impaiemnt
97
simvastatin
statin
98
mode of action of statins
decrease cholesterol production by liver and increase clearance of LDL cholesterol from the blood reduce triglcerises and increase HDL cholesterol levels
99
indications for statins
primary and secondary prevention of CVS disease | primary hyperlipidaemia
100
contraindications for statins
hepatic impairment renal imparemnt pregnant women and breastfeeding
101
interactions of statins
cytochrome P450 inhibitors and amlodipine = stop/reduce dose whilst on these

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