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Flashcards in Cardiovascular Deck (84):
1

Examples: loop diuretics

furosemide, bumetanide

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loop diuretics - how do they work?

inhibits Na, Cl, K reabsorption in ascending loop of henle

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indications: loop diuretics

pulmonary oedema due to LVF. Chronic heart failure. Kidney impairment. resistant hypertension

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Contra-indications: loop diuretics

electrolyte imbalance. renal dysfunction. Gestational hypertension

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Side effects: loop diuretics

dehydration, hypotension, any low electrolyte state, tinnitus

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Interactions: loop diuretics

NSAIDs (reduce diuretic efficiency), corticosteroids (enhance hypokalaemia), aminoglycosides (enhance ototoxicity/nephrotoxicity)

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Examples: thiazide diuretic

bendroflumethiazide

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bendroflumethiazide - how does it work?

inhibits NaCl transporter in distal tubule. Inhibit Na reabsorption and so also decrease H2O reabsorption

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Indications - bendroflumethiazide

hypertension. oedema secondary to heart failure. prophylaxis of Ca containing renal stones.

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Contra-indications - bendroflumethiazide

electrolyte imbalance. renal dysfunction. pregnancy. Addison's disease. Gout.

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Side effects: bendroflumethiazide

cardiac arrhythmias due to hypokalaemia and hyponatraemia. Male impotence. Thrombocytopenia.

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Interactions - bendroflumethiazide

NSAIDs (reduce diuretic efficacy). B-blockers (potentiate hyperglycaemia). Corticosteroids (enhance hypokalaemia) ACEi, lithium, digoxin, theophylline

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examples: potassium sparing diuretics

spironolactone, amiloride

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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

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Indications: potassium sparing diuretics

hypokalaemia. oedema from hepatic cirrhosis, congestive heart failure, Conn's syndrome

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Contra-indications: potassium sparing diuretics

severe renal impairment, hyperkalaemia, volume depletion, Addison's disease, pregnancy

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Side effects: potassium sparing diuretics

GI problems, dizziness, hypotension, urinary issues, skin rash

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Interactions: potassium-sparing diuretics

aldosterone antagonists, digoxin, lithium, cyclosporins, ACEi, NSAIDs

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Examples: Beta blockers (class II anti-arrhythmic)

atenolol, propanolol, bisoprolol

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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

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Indications - beta blockers

angina, ACS, chronic heart failure, AF, supraventricular tachycardia, hypertension (2nd line), panic disorder, anxiety

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Contra-indications: beta-blockers

asthma, caution in COPD, heart failure, heart block, unstable angina, sick sinus syndrome

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Side effects: beta-blockers

fatigue, headache, nausea, sleep disturbance, male impotence, liver damage, can mask hypoglycaemia

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Interactions: beta-blockers

Ca channel blockers (verapamil/diltiazem), bradycardia

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Examples: calcium antagonists

Diltiazem, amlodipine

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Calcium antagonists - how does it work?

reduced calcium relaxes smooth muscle --> lowers pressure. Lower cardiac conduction rate, contractility and afterload. Less oxygen demand.

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Indications - calcium antagonists

hypertension, stable angina, cardiac arrhythmias, cerebral vasospasm

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Contra-indications: calcium antagonists

poor LV function (heart failure), AV conduction delay (heart block), unstable angina, severe aortic stenosis

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Side effects: calcium antagonists

ankle oedema, headaches, flushing, palpitations, constipation

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Interactions: calcium antagonists

beta blockers, cyclosporins, digoxin, theophylline

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Examples: ACEi

ramipril, losartan

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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.

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Indications: ACEi

hypertension. Reduce stroke and MI risk. Chronic heart failure. Diabetic nephropathy

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Contra-indications: ACEi

renal artery stenosis, acute kidney injury, pregnancy

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Side effects: ACEi

persistent dry cough, hypotension, hyperkalaemia, angioedema

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Interactions: ACEi

NSAIDs, potassium elevating drugs

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Examples: nitrates

isosorbide mononitrate

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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.

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Indications - nitrates

angina. ACS. pulmonary oedema. left ventricular heart failure

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contra-indications: nitrates

severe aortic stenosis, hypotension, electrolyte imbalance, Wolf-Parkinson-White syndrome

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Side effects: nitrates

flushing, headaches, light-headedness

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interactions: nitrates

phosphodiesterase inhibitors, viagra, tri-cyclic antidepressant

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Examples: cardiac glycosides

digoxin

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Cardiac glycosides - how does it work?

inhibits Na/K ATPase pumps, increased myocyte contraction, increased parasympathetic tone. decreased heart rate, increased contraction force

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Indications: cardiac glycosides

congestive heart failure, AF, flutter

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Contra-indications

electrolyte imbalance, 2nd degree heart block, ventricular arrhythmias, renal failure

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Side effects: cardiac glycosides

bradycardia, GI effects, blurred vision

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Interactions: cardiac glycosides

loop/thiazide diuretics, amiodarone, calcium channel blockers, NSAIDs

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Examples: anti arrhythmic drugs (class III)

amiodarone

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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.

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Indications - anti-arrhythmic agents

dysrhythmias

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Contra-indications- anti-arrhythmias

heart block, thyroid dysfunction

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Side effects: anti-arrhythmic agents

hepatitis, photosensitivity, colour loss, thyroid problems

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Interactions: anti-arrhythmias

digoxin, diltiazem, verapamil

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What drug class is aspirin?

NSAID

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aspirin: how does it work?

irreversibly inhibits COX. Stops formation of arachidonic acid --> thromboxane. Decreased platelet aggregation

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Indications: aspirin

ACS, acute ischaemic stroke, AF, fever

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Contra-indications: aspirin

children under 16 (Reye's syndrome), pregnancy, peptic ulcer disease, gout

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Side effects: aspirin

bronchospasm, tinnitus, GI haemorrhage

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Interactions: aspirin

anticoagulants

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Examples: antiplatelet agent

clopidogrel, ticagrelor

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antiplatelet - how does it work?

adenosine diphosphate receptor antagonist. Decreased platelet aggregation

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Indications: anti-platelet

ACS, preventing coronary artery stent occlusion, CVD, AF

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Contra-indications: anti-platelet

active bleeding, renal/hepatic impairment, haemophilia

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Side effects: anti-platelet

bleeding, GI upset, thrombocytopenia

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interactions: anti-platelet

cytochrome p450 inhibitors, aspirin, heparin, warfarin, NSAIDs

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Examples: tissue plasminogen activator

heparins (enoxaparin)

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Tissue plasminogen activator - how does it work?

inhibits thrombin and factor Xa. UFH activates anti-thrombin, inactivate Xa. LMWH directly inhibit

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Indications: tissue plasminogen activator

VTE, DVT, PE, ACS

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Contra-indications: tissue plasminogen activator

clotting disorders, severe hypertension, trauma/invasive surgery, renal impairment

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Side effects: tissue plasminogen activator

bleeding, injection site reactions, heparin induced thrombocytopenia

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Interactions: tissue plasminogen activator

antiplatelets, anticoagulants, nicotine, antihistamines

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Examples: anticoagulants

warfarin, rivaroxaban

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Anticoagulants - how does it work?

rivaroxaban = factor Xa inhibitor. inhibits vitamin K reductase so theres no vitamin K reactivation. Coagulation factor synthesis

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Indications - anticoagulants

DVT, PE, preventing embolic complications in AF

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Contra-indications - anticoagulants

pregnancy, haemorrhagic risk, liver disease

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Side effects - anticoagulants

bleeding, alopecia

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interactions - anticoagulants

alcohol. cytochrome p450 inhibitors (omeprazole, ciprofloxacin, erythromycin). cytochrome p450 inducers (phenytoin, carbamazepine, rifampicin)

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Examples: statins

simvastatin

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statins - how does it work?

inhibit HMG-CoA reductase. Clears LDLs and reduced triglyceride levels, increases HDL levels

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Indications - statins

primary/secondary cardiovascular disease prevention, primary hyperlipidaemia

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Contra-indications - statins

pregnancy, liver disease, renal disease

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Side effects - statins

headache, GI issues, myopathy, rhabdomyolosis, high liver enzyme levels, hyperglycaemia

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Interactions - statins

cytochrome p450 inhibitors (amiodipine)