Cardiovascular Flashcards Preview

2a Pharmacology > Cardiovascular > Flashcards

Flashcards in Cardiovascular Deck (45):
1

Aldosterone Antagonists
Examples

- Spironolactone
- Eplerenone

2

Aldosterone Antagonists
MofA

Competitively bind to the aldosterone receptor, increasing sodium and water excretion, and potassium retention in distal convoluted tubules

3

Aldosterone Antagonists
Uses

- Ascites / oedema in liver cirrhosis --> 1st line = Spironolactone
- Congestive heart failure - in addition to Beta-blockers or ACE-I or ARB
- Primary hyperaldosteronism

4

Aldosterone Antagonists
Side effects

- Hyperkalaemia (leading to muscle weakness, arrhythmia)
- Spironolactone --> can cause gynaecomastia (enlargement of mans breast)

5

Aldosterone Antagonists
Contraindications

- Pregnancy or lactating women!!!
- Severe renal impairment
- Hyperkalaemia
- Addison's disease

6

Aldosterone Antagonists
Interactions

- ACE-I's and ARB's - both increase serum potassium
- Potassium supplements

7

Alpha-blockers
Examples

- Doxazosin
- Tamulosin

8

Alpha-blockers
MofA

Block alpha-1 adrenoreceptors in smooth muscle, inducing relaxation
Causes vasodilation and reduced resistance to bladder outflow

9

Alpha-blockers
Uses

- Benign prostatic hyperplasia
- Resistant hypertension (only doxazosin)

10

Alpha-blockers
Side effects

- Postural hypertension
- Dizziness

- Tamsulosin --> 3 D's (Dizziness, Drowsiness, Depression)

11

Alpha-blockers
Contraindications

- Existing postural hypertension

12

ACE-Inhibitors
Examples

End in PRIL

- Ramipril
- Lisinopril

- Enalapril
- Perindopril
- Trandolapril

13

ACE-Inhibitors
MofA

Block ACE, so prevent the conversion of angiotension 1 to angiotensin 2, lowering the peripheral vascular resistance - especially the efferent glomerular arteriole

Also block breakdown of bradykinin

14

ACE-Inhibitors
Uses

- 1st line for hypertension
- 1st line for chronic heart failure
- Ischaemic heart disease
- Diabetic nephropathy and CKD with proteinuria

15

ACE-Inhibitors
Side effects

- Hypotension
- Cough (due to increased bradykinin)
- Hyperkalaemia
- Angioedema
- Acute renal failure (if excess ACE-I given)

16

ACE-Inhibitors
Contraindications

- Renal artery stenosis
- AKI
- Pregnancy !!!

17

ACE-Inhibitors
Interactions

- Potassium supplements
- Potassium sparing diuretics
- Combining with NSAID's increases risk of renal failure

18

Angiotensin receptor blockers
Examples

End in SARTAN

- Candesartan

- Losartan
- Valsartan
- Irbesartan
- Telmisartan

19

Angiotensin receptor blockers
MofA

- Block action of angiotensin 2 on the AT1 receptor
- Reduces peripheral vascular resistance
- Reduces aldosterone levels --> promoting sodium and water excretion, helping reduce venous preload --> HF

20

Angiotensin receptor blockers
Uses

- 2nd line for hypertension
- 2nd line for chronic heart failure
- Ischaemic heart disease
- Diabetic nephropathy and CKD with proteinuria

21

Angiotensin receptor blockers
Side effects

- Hypotension
- Hyperkalaemia
- Renal failure - people most at risk have renal artery stenosis and rely on constriction of the efferent arterioles to maintain glomerular filtration
(NOTE - no angioedema and cough - so may be preferred to ACI-inhibitors)

22

Angiotensin receptor blockers
Contraindications

- Renal artery stenosis
- AKI
- Pregnancy !!!

23

Angiotensin receptor blockers
Interactions

- Potassium supplements
- Potassium sparing diuretics
- Combining with NSAID's increases risk of renal failure

24

Beta Blockers
Examples

A lot end in OLOL

B1 = Heart:
- Bisoprolol
- Metoprolol

Middle:
- Atenolol

B1/B2 = Lungs (non-selective):
- Propanolol
- Nadolol
- Carvedillol

25

Beta Blockers
MofA

- Block the B1 adrenergic receptor located mainly in the heart - reduce force of contraction and speed of conduction
- Relieves cardiac ischaemia, by reducing work and oxygen demand, and increasing perfusion
- Prolongs refractory period of AV node
- Reduces renin secretion by kidney - B1 receptors

26

Beta Blockers
Uses

- 1st line for IHD - improves symptoms and prognosis with angina and ACS
- 1st line for chronic heart failure
- 1st line for SVT - for patients without circulatory compromise to restore sinus rhythm
- Hypertension when not CCB's or ACE-I's

27

Beta Blockers
Side effects

- Fatigue
- Cold extremities
- Headache
- Nausea
- Sleep disturbances and nightmares

28

Beta Blockers
Contraindications

- Asthma (life-threatening bronchospasm when B2 airway receptors are blocked)
- COPD (choose cardio selective beta blocker)
- HF - start at low dose and up-titrate as they may initially impair cardiac function
- Heart block
- Reduce dose in hepatic failure

29

Beta Blockers
Interactions

- Non-dihydropyridine CCB's (diltiazem, verapamil) can cause heart failure and bradycardia

30

Calcium channel blockers
Types and examples

1. Dihydropyridines - vascular selective
End in PINE
- Amlodipine
- Nifedipine
- Felodipine
- Lacidopine

2. Non-dihydropyridines - cardiac selective
- Diltiazem
- Verapamil

31

Dihydropyridine CCB's
MofA

Decrease calcium entry into vascular and cardiac cells, causing vasodilation, lowering BP

32

Dihydropyridine CCB's
Uses

- Hypertension - 2nd line
- Stable angina - 2nd line to BB

33

Dihydropyridine CCB's
Side effects

- Flushing
- Ankle oedema
- Headache
- Palpitations

34

Dihydropyridine CCB's
Contraindications

- Unstable angina - vasodilation causes a reflex increase in contractability and tachycardia, which increases myocardial oxygen demand
- Severe aortic stenosis

35

Dihydropyridine CCB's
Interactions

- Beta-blockers (negatively inotropic and chronotropic)

36

Non-dihydropyridine CCB's
MofA

In the heart.
They suppress cardiac conduction by blocking Ca channels, particularly across the AV node, reducing cardiac rate and oxygen demand

37

Non-dihydropyridine CCB's
Uses

- Supraventricular arrhythmia's (incl. AF and flutter)
- Stable angina - 2nd line to BB

38

Non-dihydropyridine CCB's
Side effects

- Constipation
- Bradycardia
- Heart block
- Heart failure
- POSTURAL HYPERTENSION

39

Non-dihydropyridine CCB's
Contraindications

- Poor left ventricular function
- AV nodal conduction delay

40

Non-dihydropyridine CCB's
Interactions

- Beta-blockers (negatively inotropic and chronotropic)

41

Adenosine
MofA

Agonist of adenosine receptors on cell surfaces
Activation in the heart reduces automatically, slowing sinus rate

42

Adenosine
Uses

- 1st line for SVT (Supraventricular tachycardia)
(Increases refractoriness in the AV node which breaks the re-entry circuit)

43

Adenosine
Side effects

- Bradycardia
- Feels like a sinking feeling in chest/sense of impending doom - short lived as plasma half-life = 10 seconds

44

Adenosine
Contraindications

- Patients who will not tolerate transient bradycardiac effects - hypotension, IHD, HF
- Asthma and COPD - bronchospasm

45

Adenosine
Interactions

- Half dose if on dipyridamole (blocks cellular uptake so prolongs effect)
- Theophylline and caffeine reduce effect