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Pharmacology > Cardiovascular > Flashcards

Cardiovascular Flashcards

1
Q

ACE Inhibitors - Example, Mechanism and effects, Indications, Side Effects, Contraindications

A

Example - ‘pril’ e.g. Ramipril, captopril, lisinopril

Mechanism and effects - Stop conversion of angiotensin I to angiotensin II by ACE (angiotensin converting enzyme). Angiotensin II causes vasoconstriction so this is prevented. It also stimulates aldosterone production which causes salt (Na+) retention and increased BP so this is prevented.

Indications - All stages of heart failure

Side effects - Bradykinin cough, bronchospasm, hyperkalaemia, angio-oedema

Contraindications - Renal impairment, renal artery stenosis, pregnancy, hyperkalaemia, angio-oedema

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2
Q

Beta Blockers - Example, Mechanism and effects, Indications, Side Effects, Contraindications

A

Example - ‘olol’ e.g. Bisoprolol, Metoprolol, Carvidilol

Mechanism and effects - Beta adrenoceptor antagonists which reduce sympathetic stimulation. Result in slowed heart rate

Indications - All stages of heart failure

Side effects - Bradycardia, heart block, hypotension, fluid retention, sleep disturbances, impotence (erectile dysfunction)

Contraindications - Asthma, severe bradycardia or heart block

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3
Q

Spironolactone - Mechanism and effects, Indications, Side Effects, Contraindications

A

Mechanism and effects - An aldosterone (mineralocorticoid) receptor blocker, or ‘potassium sparing’ diuretic

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4
Q

What type of drug is nifedipine and what is it used for?

A

Calcium channel blocker - causes smooth muscle relaxation on vasculature so causes vasodilation. Uses: angina, heart failure, Raynaud’s phenomenon

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5
Q

What causes metabolism of nifedipine to be reduced and how?

A

Grapefruit Juice - It produces a molecule which inhibits cytochrome P450 enzymes and therefore decreases nifedipine metabolism

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6
Q

True / False: Nifedipine is a dihydropyridine calcium channel blocker

A

TRUE - Nifedipine is a dihydropyridine calcium channel blocker. Also included in this list is amlodipine.

Examples of NON-dihydropyridine calcium channel blockers include verapamil, diltiazem

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7
Q

Different calcium channels exert their effect on different tissues (smooth muscle). On which tissue does verapamil have an effect? On which tissue does nifedipine have an effect?

A 
Verapamil = heart
Nifedipine = vessels
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8
Q

Clopidogrel: Type of drug, mechanism of action

A

Anti-platelet drug

Prevents platelet aggregation by modifying the ADP receptors on the platelet surface

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9
Q

Loop diuretic: Example and mechanism of action

A

Example: Furosemide, bumetanide
Mechanism: Reduces Na+ and Cl- reabsorption in ascending limb of loop of Henle

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10
Q

Thiazide diuretic: Example and mechanism of action

A

Bendroflumethiazide

Mechanism: Reduces Na+ reabsorption in distal convoluted tubule

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11
Q

Give an example of a potassium sparing diuretic

A

Amiloride

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12
Q

What type of anti-arrhythmic drug is amiodarone?

A

Type III

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13
Q

What type(s) of AF might be amenable to cardioversion?

A

Only persistent

Not paroxysmal or permanent.

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14
Q

What is the treatment for permanent AF? 1st and 2nd line

A

1st line = beta blocker e.g. bisoprolol OR calcium channel blocker e.g. diltiazem, verapamil
2nd line = digoxin

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15
Q

When is digoxin indicated?

A

Rate control in AF with left ventricular failure

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16
Q

What is the mechanism of action of digoxin and what effect does this have?

A

Mechanism: Increases vagal tone
Effect: Slows AV node conduction

17
Q

Give 2 examples of non-dihydropyridine calcium channel blockers

A

Verapamil, diltiazem

18
Q

Which drug(s) can be used for acute cardioversion and maintaining sinus rhythm in a patient with a structurally normal heart?

A

Flecainide

Sotalol

19
Q

Which drug(s) can be used for acute cardioversion and maintaining sinus rhythm in a patient with a structurally abnormal heart?

A

Amiodarone

20
Q

What is adenosine and what is it used for?

A

A purine agonist, it causes a large AV blockade so is used to restore sinus rhythm in supra ventricular tachycardias.

21
Q

What are some key side effects of adenosine?

A

Bronchospasm, heaviness in the chest, flushing

22
Q

How is adenosine administered?

A

IV bolus in increasing amounts until AV block is achieved

23
Q

What is the termination for supra ventricular tachycardia (1st line and 2nd line)?

A

1st line: Vagal manoeuvres, carotid sinus massage, adenosine

2nd line: calcium channel blocker or beta blocker

24
Q

What is used for prevention of supra ventricular tachycardias?

A

Flecainide

Radiofrequency ablation

25
Q

List some side effects of furosemide

A 
Hypokalaemia
Hypomagnesia
Hyperglycaemia
Gout
Tinnitus
Hypocalaemia
26
Q

List 3 drugs which may cause tinnitus

A

Furosemide
Gentamicin
Vancomycin

27
Q

What effect does furosemide have on calcium levels? What effect does bendroflumethiazide have on calcium levels?

A

Furosemide = Hypocalcaemia

Thiazide diuretics = Hypercalcaemia

28
Q

What is the management process for acute pulmonary oedema?

A 
Oxygen
IV furosemide
IV GTN
CPAP
Diamorphine
Digoxin
29
Q

What is metolazone and when might it be used?

A

Acts like a thiazide diuretic, can be used in heart failure when patient on maximum dose of all other medications

30
Q

What dose of bumetanide corresponds to 120mg of furosemide?

A

120mg of bumetanide corresponds to about 3mg of furosemide

31
Q

What effect does metolazone have on potassium?

A

Causes hyPOkalaemia - thiazide diuretics are not potassium sparing

Thiazide diuretics also cause hyponatraemia

32
Q

Which vessels does hydralazine dilate?

A

Arterial vessels

33
Q

Which vessels does isosorbide mononitrate effect?

A

Causes vasodilation in venous system

34
Q

What are the indications for use of flecainide?

A

Medical cardioversion and maintaining sinus rhythm in atrial fibrillation and DVTs. Used in young patients with structurally normal hearts as can cause arrhythmias.

35
Q

Which agents could you use for rate control of chronic atrial fibrillation in a patient with a structurally normal heart

A

Beta blocker e.g. bisoprolol

Calcium channel blocker e.g. diltiazem, verapamil

36
Q

Which agent would you use for rate control of chronic atrial fibrillation in a patient with heart failure?

A

Digoxin

37
Q

What is used for an overdose of beta blockers?

A

Glucagon infusion

38
Q

What is used for an overdose of calcium channel blockers?

A

IV calcium, then insulin is 2nd line

Pharmacology (7 decks)

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