Flashcards in Cardiovascular Deck (84):
Examples: loop diuretics
loop diuretics - how do they work?
inhibits Na, Cl, K reabsorption in ascending loop of henle
indications: loop diuretics
pulmonary oedema due to LVF. Chronic heart failure. Kidney impairment. resistant hypertension
Contra-indications: loop diuretics
electrolyte imbalance. renal dysfunction. Gestational hypertension
Side effects: loop diuretics
dehydration, hypotension, any low electrolyte state, tinnitus
Interactions: loop diuretics
NSAIDs (reduce diuretic efficiency), corticosteroids (enhance hypokalaemia), aminoglycosides (enhance ototoxicity/nephrotoxicity)
Examples: thiazide diuretic
bendroflumethiazide - how does it work?
inhibits NaCl transporter in distal tubule. Inhibit Na reabsorption and so also decrease H2O reabsorption
Indications - bendroflumethiazide
hypertension. oedema secondary to heart failure. prophylaxis of Ca containing renal stones.
Contra-indications - bendroflumethiazide
electrolyte imbalance. renal dysfunction. pregnancy. Addison's disease. Gout.
Side effects: bendroflumethiazide
cardiac arrhythmias due to hypokalaemia and hyponatraemia. Male impotence. Thrombocytopenia.
Interactions - bendroflumethiazide
NSAIDs (reduce diuretic efficacy). B-blockers (potentiate hyperglycaemia). Corticosteroids (enhance hypokalaemia) ACEi, lithium, digoxin, theophylline
examples: potassium sparing diuretics
potassium sparing diuretics: how does it work?
competitive antagonists that either compete with aldosterone for intracellular cytoplasmic receptor sites or directly block Na channels. Prevents Na reabsorption and K/H ion secretion
Indications: potassium sparing diuretics
hypokalaemia. oedema from hepatic cirrhosis, congestive heart failure, Conn's syndrome
Contra-indications: potassium sparing diuretics
severe renal impairment, hyperkalaemia, volume depletion, Addison's disease, pregnancy
Side effects: potassium sparing diuretics
GI problems, dizziness, hypotension, urinary issues, skin rash
Interactions: potassium-sparing diuretics
aldosterone antagonists, digoxin, lithium, cyclosporins, ACEi, NSAIDs
Examples: Beta blockers (class II anti-arrhythmic)
atenolol, propanolol, bisoprolol
Beta blockers - how does it work?
block epinephrine/adrenaline from binding to B-receptors. Reducing heart contraction force, conduction speed, more perfusion. Reduce renin secretion caused decreased blood pressure
Indications - beta blockers
angina, ACS, chronic heart failure, AF, supraventricular tachycardia, hypertension (2nd line), panic disorder, anxiety
asthma, caution in COPD, heart failure, heart block, unstable angina, sick sinus syndrome
Side effects: beta-blockers
fatigue, headache, nausea, sleep disturbance, male impotence, liver damage, can mask hypoglycaemia
Ca channel blockers (verapamil/diltiazem), bradycardia
Examples: calcium antagonists
Calcium antagonists - how does it work?
reduced calcium relaxes smooth muscle --> lowers pressure. Lower cardiac conduction rate, contractility and afterload. Less oxygen demand.
Indications - calcium antagonists
hypertension, stable angina, cardiac arrhythmias, cerebral vasospasm
Contra-indications: calcium antagonists
poor LV function (heart failure), AV conduction delay (heart block), unstable angina, severe aortic stenosis
Side effects: calcium antagonists
ankle oedema, headaches, flushing, palpitations, constipation
Interactions: calcium antagonists
beta blockers, cyclosporins, digoxin, theophylline
ACEi - how does it work?
Reduce RAAS activity. block the conversion of angiotensin I --> angiotensin II, lowering arteriolar resistance and increasing venous capacity. Reduces aldosterone. Reduces preload.
hypertension. Reduce stroke and MI risk. Chronic heart failure. Diabetic nephropathy
renal artery stenosis, acute kidney injury, pregnancy
Side effects: ACEi
persistent dry cough, hypotension, hyperkalaemia, angioedema
NSAIDs, potassium elevating drugs
Nitrates - how do they work?
stimulates guanylate cyclase which decreases intracellular Ca. Relaxation of muscle cells and dilation of blood vessels. VASODILATION of vessels by donating NO.
Indications - nitrates
angina. ACS. pulmonary oedema. left ventricular heart failure
severe aortic stenosis, hypotension, electrolyte imbalance, Wolf-Parkinson-White syndrome
Side effects: nitrates
flushing, headaches, light-headedness
phosphodiesterase inhibitors, viagra, tri-cyclic antidepressant
Examples: cardiac glycosides
Cardiac glycosides - how does it work?
inhibits Na/K ATPase pumps, increased myocyte contraction, increased parasympathetic tone. decreased heart rate, increased contraction force
Indications: cardiac glycosides
congestive heart failure, AF, flutter
electrolyte imbalance, 2nd degree heart block, ventricular arrhythmias, renal failure
Side effects: cardiac glycosides
bradycardia, GI effects, blurred vision
Interactions: cardiac glycosides
loop/thiazide diuretics, amiodarone, calcium channel blockers, NSAIDs
Examples: anti arrhythmic drugs (class III)
anti-arrhythmic drugs - how does it work?
bind to and block potassium channel channels that are responsible for phase 3 repolarization. prolongs action potential and refractory period.
Indications - anti-arrhythmic agents
heart block, thyroid dysfunction
Side effects: anti-arrhythmic agents
hepatitis, photosensitivity, colour loss, thyroid problems
digoxin, diltiazem, verapamil
What drug class is aspirin?
aspirin: how does it work?
irreversibly inhibits COX. Stops formation of arachidonic acid --> thromboxane. Decreased platelet aggregation
ACS, acute ischaemic stroke, AF, fever
children under 16 (Reye's syndrome), pregnancy, peptic ulcer disease, gout
Side effects: aspirin
bronchospasm, tinnitus, GI haemorrhage
Examples: antiplatelet agent
antiplatelet - how does it work?
adenosine diphosphate receptor antagonist. Decreased platelet aggregation
ACS, preventing coronary artery stent occlusion, CVD, AF
active bleeding, renal/hepatic impairment, haemophilia
Side effects: anti-platelet
bleeding, GI upset, thrombocytopenia
cytochrome p450 inhibitors, aspirin, heparin, warfarin, NSAIDs
Examples: tissue plasminogen activator
Tissue plasminogen activator - how does it work?
inhibits thrombin and factor Xa. UFH activates anti-thrombin, inactivate Xa. LMWH directly inhibit
Indications: tissue plasminogen activator
VTE, DVT, PE, ACS
Contra-indications: tissue plasminogen activator
clotting disorders, severe hypertension, trauma/invasive surgery, renal impairment
Side effects: tissue plasminogen activator
bleeding, injection site reactions, heparin induced thrombocytopenia
Interactions: tissue plasminogen activator
antiplatelets, anticoagulants, nicotine, antihistamines
Anticoagulants - how does it work?
rivaroxaban = factor Xa inhibitor. inhibits vitamin K reductase so theres no vitamin K reactivation. Coagulation factor synthesis
Indications - anticoagulants
DVT, PE, preventing embolic complications in AF
Contra-indications - anticoagulants
pregnancy, haemorrhagic risk, liver disease
Side effects - anticoagulants
interactions - anticoagulants
alcohol. cytochrome p450 inhibitors (omeprazole, ciprofloxacin, erythromycin). cytochrome p450 inducers (phenytoin, carbamazepine, rifampicin)
statins - how does it work?
inhibit HMG-CoA reductase. Clears LDLs and reduced triglyceride levels, increases HDL levels
Indications - statins
primary/secondary cardiovascular disease prevention, primary hyperlipidaemia
Contra-indications - statins
pregnancy, liver disease, renal disease
Side effects - statins
headache, GI issues, myopathy, rhabdomyolosis, high liver enzyme levels, hyperglycaemia