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Clinical pharmacology and therapeutics > Cardiovascular drugs 1 > Flashcards

Cardiovascular drugs 1 Flashcards

1
Q

Describe the pathophysiology of atrial fibrillation

A

Chaotic atrial electrical activity

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2
Q

What is fibrosis and loss of atrial wall muscle mass related to?

A

Age
Chamber dilation
Inflammation
Genetic

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3
Q

List the risk factors of atrial fibrillation

A 
Hypertension
Valvular heart disease
Coronary artery disease
Cardiomyopathy 
Congenital heart disease
Previous cardiac surgery 
Pericarditis 
Lung disease - PE, pneumonia, COPD
Hyperthyroidism 
Alcohol
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4
Q

Describe the classification of atrial fibrillation

A

Lone AF
Paroxysmal <7 days
Persistent >7 days
Permanent >7 days and cardioversion

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5
Q

List the clinical features of atrial fibrillation

A 
Asymptomatic
Palpatiations 
SOB 
Chest pain 
Syncope
Pre-syncope
Heart failure
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6
Q

Describe the aims of treatment of AF

A

Anticoagulation
Rate control
Rhythm control

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7
Q

How is compromised AF treated?

A

DC shock

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8
Q

How is uncompromised AF treated?

A

Pharmacotherapy

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9
Q

How is AF <48hrs treated?

A

Attempt rhythm control

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10
Q

How is AF>48hrs treated?

A

Rate control

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11
Q

When is rhythm control preferred in the treatment of AF?

A

Symptom improvement
Younger patient
Heart failure related to AF
Adequacy of rate control

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12
Q

Describe rate control of acute AF without heart failure

A

Beta blocker or CCB

Add digoxin

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13
Q

Describe rate control of acute AF with heart failure

A

Digoxin

Amiodarone

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14
Q

Describe rate control of permanent or paroxysmal AF

A

Beta blocker or CCB

Digoxin

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15
Q

Describe rhythm control of AF with acute cardioversion in a normal heart

A

Flecainide, sotalol

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16
Q

Describe rhythm control of AF with acute cardioversion in an abnormal heart

A

Amiodarone

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17
Q

Describe rhythm control of AF when maintaining sinus rhythm in a normal heart

A

Flecainide, sotalol

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18
Q

Describe rhythm control of AF when maintaining sinus rhythm in an abnormal heart

A

Amiodarone

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19
Q

Name some non-cardioselective beta blockers

A

Propanolol
Carvedilol
Sotalol

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20
Q

Name some cardioselective beta blockers

A 
Atenolol 
Bisoprolol 
Esmolol 
Metoprolol 
Nebivolol
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21
Q

Name some vasodilatory beta blockers

A

Labetalol

Carvedilol

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22
Q

Name some rate limiting calcium channel blockers

A

Verapamil

Diltiazem

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23
Q

Name some dihydropyridine calcium channel blockers

A 
Amlodipine 
Nifedipine 
Felodipine
Lercanidipine 
Nimodipine
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24
Q

What score is used to calculate the need for anticoagulation?

A

CHA2DS2VASC

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25
Q

Describe the CHA2DS2VASC score

A 
C - congestive heart failure - 1
H- hypertension - 1
A2 - Age >75 - 2
D- diabetes - 1
S2 - previous stroke, TIA or thromboembolism - 2
Vascular disease - 1
Age - 65-74 - 1
Sc - Sex category (female gender) - 1
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26
Q

What CHA2DS2VASC score indicates warfarin or direct oral anticoagulant?

A

> 2

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27
Q

What must be considered when deciding on anticoagulation in AF?

A

The risk benefit ratio

28
Q

What scoring system is used to determine bleeding risk?

A

HASBLED

29
Q

Describe the HASBLED scoring system

A 
H- hypertension - 1
A- abnormal renal/liver function - 1 point each 
S- stroke in the past - 1
B - bleeding history - 1
L- Labile INR - 1 
E- elderly - 1
D - drugs/alcohol - 1 point each
30
Q

What HASBLED score indicates a significant risk of bleeding?

A

Greater than 3

31
Q

List some non pharmacological treatments of AF

A

Radiofrequency catheter
Cyro-ablation
Left atrial appendage occlusion (LAAO)

32
Q

Describe the classification of stroke

A

Ischaemic

Haemorrhagic

33
Q

What are the aims of stroke treatment?

A

Lipid modification

Treat hypertension

34
Q

List some secondary causes of increased lipids

A 
Excess alcohol
Uncontrolled diabetes 
Hypothyroidism
Liver disease
Nephrotic syndrome
35
Q

When do you refer to a lipid specialist?

A

Total cholesterol > 7,5mmol/L and family history of premature coronary artery disease
Total serum cholesterol >9mmol/L

36
Q

Describe lipid modification in primary prevention

A

Offer atorvastatin to

  • People who have greater than a 10% chance of developing CVD in 10 years
  • Adults with type 1 diabetes
  • People with chronic kidney disease
37
Q

Describe lipid modification in secondary prevention

A

Offer atorvastatin in secondary prevention of CVD in any patient who has had a stroke or MI

38
Q

Describe Ezetimibe

A

Monotherapy for treating primary (heterozygous familial or non familial) hypercholesterolemia in adults in whom initial statin therapy is contraindicated or not tolerated
May be appropriate to co administer with initial statin therapy

39
Q

Name some proprotein convertase subtilisin/kexin type 9 inhibitors (PCSKi)

A

Alirocumab

Evolocumab

40
Q

Describe the pathophysiology of heart failure

A

Activation of sympathetic system - Vasoconstriction

Renin angiotensin aldosterone system - Sodium and fluid retention

41
Q

What are the treatment aims of heart failure

A

Relieve symptoms

Relieve mortality

42
Q

List the types of treatment for heart failure

A

Lifestyle measures - exercise, decrease alcohol, stop smoking
Drugs
Devices
Surgery

43
Q

List some classes of drugs used to treat heart failure

A 
Diuretics 
ACE inhibitors
Beta blockers
Aldosterone antagonists 
ARBs
Hydralazine/Nitrates
Digoxin
44
Q

List the different types of diuretic

A

Loop
Thiazide
K+ sparing

45
Q

Give examples of loop diuretics

A

Furosemide

46
Q

Give examples of thiazide diuretics

A

Bendroflumethiazide

Metolazone (thiazide like)

47
Q

Give examples of K+sparing diuretics

A

Spironolactone

Amiloride

48
Q

Where do loop diuretics act?

A

Na/K/Cl symporter

49
Q

Where do thiazide diuretics act?

A

Na/Cl symporter

50
Q

Where do the K sparing diuretics act?

A

Epithelial Na channel

51
Q

Describe diuretics

A

Provide symptom control
Reduces cardiac preload
Side effects

52
Q

Describe ACE inhibitors

A

Increases life expectancy
Effect more marked in patients with more severe LV dysfunction
Benefit for all NYHA classes
Reduces risk of hospitalisation

53
Q

List some examples of ACE inhibitors

A 
Ramipril
Lisinopril
Enalapril
Perindopril 
Captopril
54
Q

List some examples of ARBs

A

Losartan
Candersartan
Valsartan

55
Q

Describe the ARBs

A

Reduces mortality
Symptom of control - increases QOL
Used in patients who cannot tolerate ACE inhibitors

56
Q

Describe beta blockers

A

Increase life expectancy
All NYHA classes
Reduces hospitalisation
Low dose, titrate up, monitor BP, HR and clinical progression

57
Q

List some examples of beta blockers

A

Bisoprolol
Carvedilol
Metoprolol

58
Q

Describe spironolactone

A 
Patients with severe heart failure 
Increases life expectancy 
Reduces hospital admission 
Low dose (12.5-25mg)
Prevent aldosterone secretion
59
Q

List the treatment for chronic heart failure

A

Diuretics
ACE inhibitors (ARBs)
Beta blockers
Spironolactone

60
Q

Describe ivabradine

A

Used with or in place of beta blcokers if heart rate is too high > 75bpm

61
Q

Describe the use of hydralazine and nitrate

A

Used if ARBs and ACEi not tolerated or contraindicated or in people of african origin

62
Q

Describe SGLT2 inhibitors

A

Inhibitors of sodium glucose cotransporter 2
Dapagliflozin
S1 segment proximal tubule where 90% glucose reabsorption occurs

63
Q

Describe the basic measures of treating acute heart failure

A

Sit patient upright

High dose oxygen

64
Q

Describe the initial drug treatment of acute heart failure

A

Intravenous loop diuretics - Causes venodilation and diuresis
Intravenous opiates and opioids (morphine/diamorphine)) - Reduces anxiety and preload
Intravenous/buccal/sublingual nitrates - Reduce preload and afterload, ischaemia and pulmonary pressures

Continue beta blockers but do not initiate

65
Q

List some non pharmacological treatments of heart failure

A

Coronary revascularisation
Cardiac resynchronisation therapy
Cardiac transplantation

Clinical pharmacology and therapeutics (27 decks)

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