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Cardiovascular Flashcards

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1
Q

What is the mechanism of action of Furosemide?

A
  • it inhibits action of Na/K/2Cl pump in ascending loop of henle
  • it inhibits reabsorbtion of Na, K and water
  • this leads to an increase in salt and a loss of water and potassium
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2
Q

What are the indications for using Furosemide?

A

Acute pulmonary oedema secondary to LVF
Chronic Heart Failure
Oliguria secondary to renal failure

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3
Q

What are the contra-indications of furosemide?

A 
Hypovolaemia
Dehydration
Severe
Hypokalaemia/hyponatraemia
Comatose states
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4
Q

What are the possible side effects of Furosemide?

A

Mild GI disturbances
Hypotension
Hyperglycaemia
Electrolyte disturbances

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5
Q

What are the interactions of furosemide?

A
  • Antibacterials: ⬆️ risk of ototoxicity associated with aminoglycosides, colistin and vancomycin, ⬆️ renal toxicity with aminoglycosides
  • Digoxin: furosemide-induced hypokalaemia ⬆️ effects of digoxin and ⬆️ chance of dysthymias
  • Lithium: ⬇️ excretion = ⬆️ risk of toxicity
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6
Q

What class of drug is Bendroflumethiazide?

A

Thiazide diuretic

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7
Q

What is the mechanism of action of Bendroflumethiazide?

A
  • it inhibits Na/Cl reabsorption in the distal tubule

- ⬆️ Na/Cl/water excretion, stimulates K excretion further down the distal tubule

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8
Q

What are the indications for using Bendroflumethiazide?

A

Hypertension
Heart failure
Oedema (secondary to liver disease/nephrotic syndrome)
Prophylaxis of Ca-containing renal stones

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9
Q

What are the contra-indications for using Bendroflumethiazide?

A

Refractory hypokalaemia/hyponatraemia/hypercalcaemia
Addison’s disease

Cautions: gout, diabetes, SLE

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10
Q

What are the possible side effects of Bendroflumethiazide?

A

GI disturbances
Postural hypotension
Altered plasma lipid concentrations
Metabolic/electrolyte disturbances

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11
Q

What are the interactions of Bendroflumethiazide?

A
  • Digoxin: hypokalaemia ⬆️ risk of dysthymias

- Lithium: ⬆️ plasma concentration

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12
Q

What class of drug is spironolactone?

A

Potassium Sparing Diuretic

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13
Q

What is the mechanism of action of spironolactone?

A
  • Aldosterone antagonist
  • competes for receptors in distal tubule cells
  • inhibition of Na- retaining action
  • Concomitant ⬇️ in its potassium secreting effect
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14
Q

What are the indications for using spironolactone?

A 
Oedema/ascites in liver cirrhosis
Malignant ascites
Nephrotic syndrome
Congestive Heart Failure
Primary hyperaldosteronism
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15
Q

What are the contra-indications of Spironolactone?

A

Hyperkalaemia/hyponatraemia

Addison’s disease

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16
Q

What are the possible side effects of spironolactone?

A 
GI disturbance
Impotence
Gynaecomastia
Menstrual irregularities
Lethargy/headache/confusion
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17
Q

What class of drug is Atenolol

A

Beta Blocker

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18
Q

What is the mechanism of action of Atenolol?

A
  • Acts on Beta1 receptors in the heart
  • ⬇️ Heart rate and force of contraction thus ⬇️ workload on the heart
  • ⬇️ renin production by kidneys = anti-hypertension
  • conduction/AP initiation in the heart = anti arrhythmic effect
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19
Q

What are the indications for using Atenolol?

A 
Hypertension
Angina
Supraclavicular dysthymias
MI prophylaxis
Migraine prophylaxis
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20
Q

What are the contra-indications of Atenolol?

A 
Asthma
Heart failure
2nd/3rd degree heart block
Bradycardia
COPD
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21
Q

What are the possible side effects of Atenolol?

A

Lethargy
Bradycardia
AV block

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22
Q

What are the interactions of Atenolol?

A
  • Diltiazem: ⬆️ risk of bradycardia/AV block
  • Insulin: mask symptoms of hypoglycaemia
  • Verapamil: ⬆️ risk of Heart Failure/bradycardia/AV block
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23
Q

How is Atenolol eliminated?

A

50% urine

50% faeces

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24
Q

What class of drug is Diltiazem?

A

Calcium Channel Blocker (Calcium antagonist)

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25
What are the types of some Calcium channel blockers?
Verapamil Diltiazem Dihydropyridine Calcium channel blockers - amlodipine
26
What is the mechanism of action of Diltiazem?
- inhibits Ca influx into vascular smooth muscle cells and myocardium by binding to L- type Ca channels - relaxation of vascular smooth muscle - ⬇️ myocardial contractility - ⬇️ conduction at AV node, ⬆️ refractory period - ⬇️ afterload and heart rate = ⬇️ oxygen consumption
27
What are the indications for Diltiazem?
Angina treatment/prophylaxis Hypertension Dysthymias
28
What are the contra-indications for Diltiazem?
Severe bradycardia Heart Failure 2nd/3rd degree heart block Pregnancy/breastfeeding
29
What are the possible side effects of Diltiazem?
Headache, dizziness Nausea Hypotension, bradycardia Ankle swelling Rare: lethargy, rash
30
What are the interactions of Diltiazem?
- anti-arrhythmias: ⬆️ myocardial depression - beta blockers: ⬆️ risk of AV block/bradycardia - cyclosporin: ⬆️ plasma concentration - digoxin: ⬆️ plasma concentration - theophylline: ⬆️ effects
31
What class of drug is Ramipril?
ACE inhibitor
32
What is the mechanism of action of Ramipril?
- inhibits angiotensin converting enzyme = ⬇️ angiotensin II synthesis and ⬆️ bradykinin accumulation - ⬇️ angiotensin II = ⬇️ peripheral resistance/fluid overload - ⬆️ bradykinin = peripheral vasodilation
33
What are the indications of Ramipril?
Hypertension Heart Failure Post- MI Diabetic nephropathy
34
What are the contra-indications for using Ramipril?
- renal vascular disease (renal artery stenosis) - aortic stenosis - pregnancy - porphyria
35
What are the possible side effects of Ramipril?
Postural Hypotension Dry cough Rash Rare: hyperkalaemia, ⬇️ renal function
36
What are the interactions of Ramipril?
- Diuretics: pronounced hypotension - Lithium: ⬆️ plasma concentration - NSAIDs: ⬆️ risk renal impairment - Potassium sparing diuretics: ⬆️ risk hyperkalaemia
37
What are the special instructions with the first dose of Ramipril?
Patients take first dose before bed to avoid first dose hypotension
38
What class of drug is Losartan?
Angiotensin II receptor blocker
39
What is the mechanism of action of Losartan?
- inhibits angiotensin II binding to AT1 - inhibits AT1 mediated vasoconstriction and aldosterone secreting effects - results in decreased vascular resistance and blood pressure
40
What are ye indications for using Losartan?
Hypertension | Diabetic nephropathy in type 2 diabetes
41
What are the contra-indications of using Losartan?
Pregnancy Breastfeeding Cautions: hepatic/renal impairment
42
What are the possible side effects of Losartan?
Hypotension Diarrhoea Cough
43
What class of drug is Isosorbide Mononitrate?
Nitrate
44
What is the mechanism of action of Isosorbide Mononitrate?
- GTN metabolised to NO in smooth muscle cells - Guanylyl cyclise activation = vascular smooth muscle relaxation - Coronary artery/systemic vein vasodilation = ⬇️ preload and ⬆️ oxygen supply to myocardium
45
What are the indications for using Isosorbide Mononitrate?
Angina | Heart Failure
46
What are the contra-indications for using Isosorbide Mononitrate?
``` Hypotension Aortic/mitral stenosis Constrictive pericarditis/cardiac tamponade Hypertrophic obstructive cardiomyopathy Head trauma/cerebral haemorrhage ```
47
What are the possible side effects of Isosorbide Mononitrate?
Headache, dizziness, postural hypotension Flushing Tachycardia
48
What are the interactions of Isosorbide Mononitrate?
Sildenafil: ⬆️ hypotensive effects
49
What class of drug is Digoxin?
Cardiac Glycoside
50
What is the mechanism of action of Digoxin?
- it inhibits Na/K pump = ⬆️ intracellular Na concentration which inhibits Na/Ca pump - ⬇️ Ca pumped out of cell = ⬆️ force of concentration - ⬆️ vagel activity ⬇️ heart rate/AV node conduction
51
What are the indications for Digoxin?
Heart failure | Supra ventricular arrhythmias (AF)
52
What are the contra-indications of Digoxin?
Complete heart block Hypertrophic cardiomyopathy Wolff-Parkinson-White syndrome
53
What are the possible side effects of Digoxin?
Nausea, vomiting, diarrhoea Anorexia Visual disturbances Rare: confusion, hallucinations
54
What are the interactions of Digoxin?
- Amiodarone/propafenone/quinidine: anti arrhythmias ⬆️ risk of digoxin toxicity - Ca channel blockers: ⬆️ risk of digoxin toxicity - Diuretics: hypokalaemia can ⬆️ risk of toxicity
55
What class of drug is Amiodarone?
Anti-dysrhythmic
56
What is the mechanism of action of Amiodarone?
- prolongs refractory period in all parts of conduction system - ⬇️ speed of conduction through the heart
57
What are the indications for Amiodarone?
Supraventricular/ventricular arrhythmias
58
What are the contra-indications of Amiodarone?
``` Sinus Bradycardia SA block Sinus node disease Thyroid dysfunction Iodine sensitivity (contains iodine) Pregnancy/breastfeeding ```
59
What are the possible side effects of Amiodarone?
``` Nausea, vomiting Jaundice Bradycardia Hypo/hyperthyroidism Sleep disturbances ```
60
What are the interactions of Amiodarone?
- Beta blockers: ⬆️ risk of bradycardia/AV block/myocardial depression - Digoxin: ⬆️ risk toxicity - Diltiazem/verapamil: ⬆️ risk of bradycardia/AV block/myocardial depression - Phenytoin: inhibits phenytoin metabolism - Warfarin: ⬆️ effects by inhibiting warfarin metabolism = ⬆️ risk of bleeding
61
What class of drug is aspirin?
Anti-platelet agent
62
What is the mechanism of action of aspirin?
- Inactivates COX by acetylating a serine residue in its active site - ⬇️ TXA2 synthesis (substance the promotes platelet aggregation)
63
What are the indications of aspirin?
Stroke/MI prophylaxis
64
What are the contra-indications of aspirin?
Active bleeding Peptic ulcer Haemophilia Breastfeeding
65
What are the possible side effects of aspirin?
``` Bronchospasm GI haemorrhage (other haemorrhage) ```
66
What class of drug is Clopidogrel?
Anti-platelet agent
67
What is the mechanism of action of clopidogrel?
- inhibits platelet aggregation by preventing ADP (adenosine diphosphate) release preventing activation of glycoprotein gp11b/11a complexes
68
What are the indications of Clopidogrel?
- prevention of atherosclerotic events in ACS/peripheral arterial disease - post MI/ischaemic stroke
69
What are the contra-indications of clopidogrel?
Active bleeding | Breastfeeding
70
What are the possible side effects Clopidogrel?
Dyspepsia Abdominal pain Diarrhoea Bleeding disorders (GI/intracranial)
71
What are the interactions of Clopidogrel?
NSAIDs: increased risk of haemorrhage
72
How is Clopidogrel eliminated?
50% urine | 40% faeces
73
What class of drug is Streptokinase?
Thrombolytic
74
What is the mechanism of action of streptokinase?
- binds to circulating plasminogen, forming activator complex - converts plasminogen to plasmin - plasmin lyses fibrin within thrombus
75
What are the indications for streptokinase?
Acute MI | Thromboembolic events: DVT/PE/arterial thrombosis
76
What are the contra-indications for using streptokinase?
Recent haemorrhage/trauma/surgery Coagulation defects Aortic dissection Acute pancreatitis
77
What are the possible side effects of streptokinase?
``` Nausea/vomiting Bleeding Hypotension Allergy (rash, flushing) Reperfusion arrhythmias/cerebral oedema ```
78
What are the interactions of Streptokinase?
Warfarin: ⬆️ risk of bleeding
79
What are the special cautions of streptokinase?
Body generates antibodies to streptokinase so cannot be used twice in the same year
80
What class of drug is Enoxaparin?
Low Molecular Weight Heparin
81
What is the mechanism of action of Enoxaparin?
Causes higher anti-factor Xa to antithrombin activities (anti-factor IIa) ratio than heparin, which may prevent thrombosis
82
What are the indications for Enoxaparin?
DVT, PE, MI | Unstable angina
83
What are the contra-indications for using Enoxaparin?
``` Haemophilia/haemorrhagic disorders Thrombocytopenia Recent cerebral bleed Severe liver disease Peptic ulcer disease ```
84
What are the possible side effects of Enoxaparin?
Haemorrhage | Thrombocytopenia
85
What are the interactions of Enoxaparin?
Aspirin: ⬆️ risk of bleeding
86
What class of drug is Warfarin?
Oral anticoagulant
87
What is the mechanism of action of Warfarin?
- Inactivates vitamin K in hepatic microsomes - interferes with formation of vitamin K dependent clotting factors including prothrombin, VII, IX and X - delayed onset due to long prothrombin half life (48-72hrs)
88
What are the indications for using Warfarin?
Prophylaxis of embolism in AF, prosthetic heart valves, rheumatic heart disease Prhylaxis of DVT/PE TIAs
89
What are the contra-indications of Warfarin?
``` Peptic Ulcer Endocarditis Haemorrhagic stroke Severe hypertension Pregnancy ```
90
What are the possible side effects of Warfarin?
``` Haemorrhage Hypersensitivity Rash Hepatic dysfunction Nausea and vomiting ```
91
What are the interactions of Warfarin?
Amiodarone: ⬆️ effects of warfarin by inhibiting metabolism | Cranberry juice: ⬆️ anticoagulant effects
92
What is the elimination of warfarin?
After rapid absorption warfarin is bound to plasma albumin with a 37.5 hr half life It's en metabolised in hepatic to give inactive metabolites excreted in urine and faeces
93
What class of drug is simvastatin?
A statin
94
What is the mechanism of action of simvastatin?
- It reversibly inhibits HMG CoA reductase, the rate limiting enzyme in cholesterol synthesis by the liver - Liver responds by ⬆️ LDL receptor expression, taking in ⬆️ LDL to ⬇️ plasma cholesterol - small ⬇️ in plasma triglyceride concentration
95
What are the indications for simvastatin?
Hypercholesterolaemia
96
What are the contra-indications for giving simvastatin?
Active liver disease/persistently deranged LFTs | Pregnancy/breastfeeding
97
What are the possible side effects of simvastatin?
Myosotis (may lead to rhabdomyolysis) GI disturbances Rare: pancreatitis, hepatitis, jaundice
98
What are the interactions of simvastatin?
- cyclosporin: ⬆️ risk of myositis - fibrate: ⬆️ risk of myositis - warfarin: ⬆️ effects of warfarin
99
How is simvastatin eliminated?
ABC transporter mediated biliary excretion
100
What class of drug is Furosemide?
A loop diuretic

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