CARDIOVASCULAR DRUGS Flashcards
(196 cards)
1
Q
give an example of a loop diuretic
A
furosemide
bumetanide
2
Q
which organ do loop diuretics act on?
A
kidneys
3
Q
which part of the kidneys do loop diuretics work on?
A
ascending limb of loop of henle
4
Q
how do loop diuretics act to inhibit reabsorption?
A
compete for chlorine binding sites by acting on sodium/potassium/chlorine co-transporters
5
Q
how do loop diuretics cause more urine to be produced?
A
inhibits reabsorption of electrolytes, less osmosis, more urine produced
6
Q
give 2 instances that loop diuretics are used
A
pulmonary oedema (LVF) heart failure
7
Q
what is the difference between IV and oral administration of loop diuretics?
A
IV fast acting
oral slow acting, lasts six hours, so twice daily
8
Q
name 2 circulatory instances that contraindicate use of loop diuretics
A
hypovolaemia
hypotension
9
Q
loop diuretics can cause hyperglycaemia. name 2 conditions that can be exacerbated by this
A
diabetes
gout
10
Q
what electrolyte imbalances can be caused by use of loop diuretics?
A
hypokalaemia/hyponatraemia
lead to hepatic encephalopathy/coma
11
Q
what is the risk of taking loop diuretics whilst pregnant?
A
maternal hypovolaemia
12
Q
name 2 serious GI side effects of loop diuretics
A
pancreatitis
hepatic encephalopathy
13
Q
name 3 other side effects of loop diuretics
A
hypersensitivity visual disturbances tinnitus deafness BM suppression Urinary retention Metabolic alkalosis
14
Q
how can loop & thiazide diuretics potentiate digoxin toxicity?
A
hypokalaemia
15
Q
how do NSAIDs interact with loop and thiazide diuretics?
A
reduce efficacy (COX inhibitors)
16
Q
why shouldn’t loop and thiazide diuretics be taken with corticosteroids?
A
enhance hypokalaemia
17
Q
give an example of a thiazide diuretic
A
bendroflumethiazide
metolazone
Chlortalidone
18
Q
where in the kidneys do thiazide diuretics act?
A
distal convoluted tubule
19
Q
how do thiazide diuretics inhibit reabsorption?
A
inhibiting Na reabsorption from DCT by inhibiting Na/Cl co-transporter
20
Q
how does reabsorption inhibition cause more urine to be produced in thiazide diuretics?
A
less osmotic force so less water reabsorbed
21
Q
name 2 conditions that thiazide diuretics are used in
A
Chronic heart failure
First line treatment or additional treatment for hypertension
22
Q
at what time in the day should thiazide diuretics be administered?
A
morning so don’t interfere w sleep
23
Q
name 2 conditions that can be exacerbated by thiazide diuretics
A
diabetes
gout= reduce uric acid secretion
SLE
24
Q
why are thiazide diuretics a risk in pregnancy?
A
neonatal thrombocytopenia, BM suppression, jaundice , hypoglycemia
25
what electrolyte imbalances can be caused by thiazide diuretics/
hypo-disorders
26
name 3 other side effects of thiazide diuretics
```
bone marrow depression
visual disturbances
tinnitus
deafness
hypersensitivity
Impotency in men
```
27
name 2 potassium sparing diuretics
spironolactone
| amiloride
28
how does spironolactone work?
aldosterone antagonist= binds to aldosterone receptor
| It blocks the effects of aldosterone which is promotes sodium and water retention and excretion of pottasium
29
how does amiloride work?
interferes with sodium and potassium exchange at the DCT. Promotes excretion of sodium and water and retnation of pottasium
Relatively week diuretic
30
name 4 conditions where potassium sparing diuretics are used
```
Chronic heart failure
Ascited and oedema in liver cirrhosis
Nephrotic syndrome
primary hyperaldosteronism
Hypokalaemia= amiloride
```
31
what is an electrolyte imbalance that contraindicates use of potassium sparing diuretics?
hyperkalaemia
32
what is a hormone imbalance syndrome that contraindicates use of potassium sparing diuretics?
addison's
33
why shouldn't potassium sparing diuretics be used in pregnancy?
feminisation of the male foetus
34
why shouldn't potassium sparing diuretics be used in conjunction with ACE inhibitors?
potentiate hyperkalaemia
35
why should NSAIDs be used in conjunction with potassium sparing diuretics?
COX inhibitors- reduce efficacy
36
give an example of a beta blocker
atenolol
37
how do beta blockers work?
block beta-adrenoreceptors in the heart, peripheral vasculature, bronchi, pancreas and liver
block action of sympathetic nervous system
slows the heart rate (can be vasodilatory)
38
give 4 when beta blockers used?
```
angina/MI
heart failure
hypertension
arrhythmia= AF and SVT
thyrotoxicosis
migraines
```
39
why are beta blockers contraindicated with asthma?
triggers exacerbation of attacks
40
why are beta blockers contraindicated in pregnancy?
can cause intrauterine growth
| can cause neonatal hypoglycaemia
41
why should beta blockers be used in caution with patients with diabetes?
can dull signs of a hypo
42
name 2 circulatory side effects of beta blockers
syncope
bradycardia
cold peripheries
43
why shouldn't beta blockers be used with anti-arrhythmias?
slow heart rate
44
why shouldn't beta blockers be used with anti-hypertensives?
lower blood pressure
45
why shouldn't antipsychotics be used with beta blockers?
can increase risk of arrhythmias
46
why shouldn't beta blockers or calcium antagonists be used with clonidine alpha blocker?
can cause rebound hypertension
47
give 2 examples of a calcium antagonist
amlodipine
verapamil
diltiazem
48
how do calcium antagonists work?
reduce calcium ion movement through cell membranes into vascular and cardiac cells
49
how do calcium antagonists affect myocardial contractility, oxygen demand and electrical impulse formation? what is the outcome of this?
In the hear reduce myocardial contractility.
They suppress cardiac conduction,= reduce ventricular rate
Reduced cardiac rate, contractility and afterload reduce myocardial oxygen demand, preventing angina
50
how do calcium antagonists affect coronary vascular tone?
Relaxation and vasodilation in arterial smooth muscle, lowering arterial pressure
51
when are calcium antagonists used?
Stable angina
hypertension
Diltiazem and verpamil are used in SVT, atiral flutter and AF
52
in which type of angina are calcium antagonists not effective against and can worsen the symptoms?
unstable
53
What are the side effects of verapamil?
```
Commonly= constipation
Rare= bradycardia, heart block and cardiac failure
```
54
name common side effects of amlodipine?
Ankle swelling
Palpitations
Flushing
Headache
55
What heart condition should verapmil and diltiazem be used with caution?
Patient with left ventricle hypertrophy as it can preciptate or worse the cardiac failure
56
Patient with what conduction problem should avoid diltiazem and verapmil?
With increase AV node conduction delay as it can lead to heart block
57
What condition predisposes the patient do collapse if taking amlodopine?
Severe aortic stenosis
58
give an example of ACE inihibitors
ramipril
| lisinopril
59
give 2 conditions where ACE inhibitors are used
Hypertension
chronic heart failure
IHD to prevent MI and stroke
Diabetic nephropathy and CKD with proteinuria
60
which organ insufficiency is contraindicated in administration of ACE inhibitors or AT1 blockers?
Renal artery stenosis or acute kidney injury
61
what heart abnormality is contraindicated in administration of ACE inhibitors?
aortic stenosis
62
name a circulatory insufficiency contraindicated in administration of ACE inhibitors
hypovolaemia
63
Should ACE inhibitors or AT1 blockers be used in pregnancy and breast feeding?
no
64
What are the common side effects of ACE inhibitor?
Hypotension espeially after first dose
Dry cough due elevated levels of bradykinin
Hyperkalaemia due to reduced levels of aldosterone so pottasium retention
65
how do ACE inhibitors results in vasodilation and reduce BP.
Inhibits the renin-angiotensin systemless
Inhibition of the angiotensin-converting enzyme, less angiotensin II.
Angiotensin 2 causes vasoconstriction and aldosterone production= reduced PV resistance and afterload.
Also promotes sodium and water excretion due to reduction in aldosterone and helps with HF
66
What is the severe interaction of NSAIDS and ACE inihibitors or AT1 blockers?
Potentiate the risk of renal failure
67
what serious allergic reaction can occur with ACE inhibitors?
angioedema due to bradykinin release
68
what electrolyte imbalance can be caused by ACE inhibitors?
hyperkalaemia
69
why shouldn't ACE inhibitors or AT1 blockers be used with potassium supplements or pottasium sparing diuretics?
can cause hyperkalaemia
70
give an example of an angiotensin-1 blocker and why is it used?
losartan and alternative to ACE inhibitor due to dry cough
71
how do AT1 blockers work?
competitive inhibition of angiotensin 2 and bocks the AT1 receptor
Slow renin angiotensin system
72
which of these processes is not mediated by AT1 blockers?
a) vasoconstriction
b) aldosterone release
c) thermoregulation
d) renal sodium reabsorbtion
e) vasopressin secretion
c) thermoregulation
73
give 3 conditions where AT1 blockers are used
Hypertension
chronic heart failure
IHD to prevent MI and stroke
Diabetic nephropathy and CKD with proteinuria:
74
which one of these is not a contraindication for AT1 blockers?
a) pregnancy
b) renal artery stenosis
c) hyperkalaemia
d) depression
d) depression
75
what serious muscle condition is a side effect of AT1 blockers?
rhabdomyolysis
76
What are the possible side effects of AT1 blocker?
Hyerkalamia
Renal failure
Hypotension = particularly after first dose
77
what effect do rifampicin & fluconazole have on AT1 blockers?r
reduce effect
78
Give example of a short and long acting nitrate?
a) short nitrate= glyceryl trinitrate
| b) long nirate = isosorbide mononitrate
79
how do nitrates work?
Nitrates converted to NO which prevents Ca from moving in vascular smooth muscles
Direct relaxant of smooth vascular muscle in mainly veins and arteries.
Causes reduction in venous return and left ventricle filling
80
What affect does nitrates have on preload?
Reduces caridac preload therefore reduce cardiac work and myocardial oxygen demand relieving the symptoms of angina and caridac failure
81
What 3 conditions are nitrates are used for
Short nirate for acute agina and ACS
Long nitrate for prophylaxis of angina
IV for pulmonary oedema with furosemide and oxygen
82
give 2 contraindications of nitrates
pregnancy
hypotension
Severe aortic stenosis = cause collapse
83
What are the common side effects of nitrates?
hypotension
Flushing
Headache
Light headedeness
84
why should nitrates not be used with alcohol or viagra?
also vasodilators - increase risk of serious hypotension
85
Interaction of nitrate with phospodiesterase inhibitor (sildenafil) will cause what?
It will increaes and prolong the hypotensive effects of nitrates
86
give an example of a cardiac glycoside
digoxin
87
how does digoxin cause intracellular calcium to rise and therefore treat heart failure?
Inhibits Na/K- ATPase pumps causing rise in intracellular Na, which inhibits Ca ion pump out of cell, so Ca retained which increases contractile forces
88
What affect does digoxin have on parasympathetic tone and therefore use for AF?
Increase in vagal (parasympathetic tone) which causes a reduction in conduction of AV node which means a reduction in ventricle rate
89
what does greater intracellular calcium mean in terms of myocytes in digoxin?
increased uptake - more powerful/automatic contraction
90
how does digoxin affect heart rate and force of heart contraction?
Decreases heart rate ( negative chronotropic)
| Increases force of contraction ( positive inotropic)
91
give 2 conditions where cardiac glycosides are used
arrhythmia= AF and atrial flutter ( reduce ventricle rate)
| congestive heart failure (severe)= 3rd line treatment
92
give a 3 heart conditions which contraindicates use of digoxin
2nd degreee Heart block
Intermittent heart block
Ventricle arrhythmias
93
What is the risk of giving digoxin when patient has electrolyte abnormalitiy? give examples
Can lead to digoxin toxicity
hypokalaemia = greatest risk as it competes with pottassium for binding to the pump
Hypomagnesaemia
Hypercalcaemia
94
what is digoxin a substrate of?
p-glycoprotein
95
a) Name two drugs that cause hypokalaemia and therefore digoxin toxicity?
b) Name 7 drugs that can increase the plasma concentration of digoxin and therefore risk of toxicity?
a) Loop diuretic and thiazide diuretic
| b) amiodarone, quinine, spirolactone, verapamil, CA channel blocker, gentimicin and Itraconazole
96
Give an example of class 1 sodium channel blocker anti-dysrhythmics
quinidine
| lidocaine
97
what are class 2 anti-dysrhythmics?
beta blockers
98
give an example of potassium channel blocker class 3 anti-dysrhythmics?
amiodarone
99
what are class 4 anti-dysrhythmics?
calcium channel blockers
100
give an example of class 5 anti-dysrthmics (unknown mechanism)
digoxin
| adenosine
101
give 3 examples of when amiodarone is used for?
```
Ventricular arrhythmias
AF
Atrial flutter
SVT
ventricular tachycardia
Wolfs-parkinson-white syndrome
```
102
what is wolfs-parkinson-white syndrome?
abnormal electrical conduction pathway between atria and ventricles causing ventricles to contract prematurely
103
why are pregnancy and breastfeeding contraindicated in amiodarone?
similar structure to thyroxine can cause foetal thyroid issues
104
What are the potential side effects of chronic use of amiodarone?
```
Lung= pneumonitis
Heart= AV block and bradycardia
Skin= Photosensitivtiy and great colourisation
Liver= Hepatitis and jaundice
```
105
Amiodarone has similar strucutre to thyroid hormone what effect does this have on the patient potentially?
Lead to hypo or hyperthyroidism
106
why shouldn't amiodarone be used with benzyl-alcohol formulations in neonates?
cause gasping syndrome
107
Which patients should use of amiodarone be avoided in?
Severe hypotension
Heart block
Active thyroid disease
108
Interaction of amiodarone with what drugs can cause bradycardia, heart failure and Av block. Therefore have there dose halved?
Verapamil
Diltiazem
Digoxin
109
What is the interaction of amiodarone and cytochrome p450?
Metabolised and inhibits cytochrome p450
110
how does amiodarone affect serum digoxin?
increases
111
give 2 examples of anti-platelet agents
aspirin
| clopidogrel
112
how do anti-platelets inhibit thrombus formation?
inhibit platelet aggregation
113
in which circulation system are anti-platelets most effective?
arterial
114
how does aspirin block thromboxane formation? Leading to reduction in platelet aggregation and arterial occlusion
COX inhibitor= blocks cox 1 formation
115
how does clopidogrel work as an anti-platelet?
competitive inhibition of ADP receptors on surface of platelet cell membrane= prevent platalet aggregation
116
What are the most common adverse effect of aspirin and clopidogrel?
GI irritation leading to ulceration and bleeding.
117
Give the use of anti-platelet agents
ACS
Thromoblytic therapy for, Pe, cerebral infarctiona nd MI
Af to prevent stroke
Mild to moderate pain and fever = aspirin
Prevent occlusion of coronary artery stents= clopidogrel
118
why are anti-platelets contraindicated in haemophilia and dengue fever, peptic ulcers and hypertension?
high risk of bleeding
119
which anti platelet is contraindicated in the case of salicylate allergy? Causing potential bronchospasm
aspirin
120
why is aspirin contraindicated in hyperuricaemia and gout?
inhibits kidney excretion of uric acid
121
what is Reye's syndrome and which anti-platelet is it associated with?
Liver encephalopathy after acute viral illness (influenza, varicella) in under 16 and associated with aspirin
122
Large doses of apsirin can cause what and why?
Tinnitus due to large doses of salicylate
123
how does alcohol interact with aspirin?
enhances activity
124
how is clopidogrel metabolised?
It is a pro drug and is metabolised by cytochrome p450 to its active form
125
which GI drug reduces the effect of clopidogrel?
omeprazole therefore use other PPI for GI protection
126
how might SSRIs and anti-platelets interact?
increase risk of bleeding
127
how might NSAIDs and warfarin interact with anti-platelets?
increase risk of bleeding
128
what is streptokinase (alteplase) and tissue plasminogen activator an example of?
thrombolytics
129
how is streptokinase produced?
Produced by strep bacilli
130
how do thrombolytics work?
Catalyse the conversion of plasminogen to plasmin which breaks down clots=
131
give 3 examples when thrombolytics are used
MI with ST elevation = in the first 12 hours with antiplatelet and anticoagulants.
Acute ischaemic stroke
Large PE
arterial occlusion
132
what type of stroke are thrombolytics contraindicated in?
haemorrhagic= CT scan before administration for acute stroke
133
What are the main contradications to use of thromblytics?
Factors that increase risk of bleeding such as
| Recent trauma and surgery, severe hypertension, peptic ulcers and recent haemorrhage and bleeding disorders
134
what aortic abnormality contraindicates use of thrombolytics?
aortic dissection
135
What is the time framce for alteplase after a acute ischaemic stroke?
Be given within 4.5 hours of the stroke to have maximal effect
136
What is the risk of reperfusion of infarcted brain or heart tissue?
Causes cerebral oedema or arrhythmia respectively
137
what is common side effect of thrombolytics?
Nausea, vomiting and brusing around the Iv sight
| With hypotension
138
give an example of a heparin
enoxaparin
139
where are heparins producedf?
basophils
| mast cells
140
```
What is the mechanism of
a)UF
b)LMWH?
c)Fondaparinux
to prevent clot formation?
```
a) bind to and activate antithrombin III which inactivates thrombin and factor Xa
b) Direct inhibition of thrombin and factor Xa
c) inhibits factor Xa
141
What is the main adverse affects of heparin?
Bleeding and injection sight reaction
142
give 4 examples of when heparin is used
ACS
AF
DVT/PE
indwelling venous cannulas
143
why are IM injections of heparins avoided?
high risk of haematoma= disabling bruisingof the arm
144
What is a rare but serious side effect of heparin?
Heparin induced thrombocytopenia= leading to low levels of platetlet and thrombosis (blood clot formation)
Complications are DVT and PE formation
145
what 2 products in heparin formulations are allergens?
pork
| benzyl alcohol
146
What contra indications are there for heparin?
Heparin should be used with caution for patients with increased risk of bleeding:
Severe uncontrolled hypertension, clotting disorders, recent trauma and surgery
147
What is the risk of giving heparin to a patient that has renal impairment?
Reduced excertion and causes accumulation of LMWH and fondaparinux= reduce the dose or use UF
148
give 2 examples of oral anticoagulants
warfarin
| rivaroxaban
149
how does warfarin work? which clotting factors and proteins does it inhibit production of
Inhibits vitamin K epoxide reductase which inhibits vitamin K activation which stimulates synthesis of clotting factors 2, 7, 9, 10 and proteins C, S, Z
150
how dies rivaroxaban work?
| which pathways does it interrupt
inhibits factor 10a
| intrinsic and extrinsic pathways
151
What is the use of oral anticoagulant?
Treatment of PE and DVT
Prophylaxis of VTE ( recurrent DVT and PE)
Prevent stroke (embolic event) from AF
Short term use for prevention of embolic event from tissue valve replacement
Long term use for prevention of embolic event from metal valve replacement
152
give 2 conditions which would contraindicate use of oral anticoagulants
Risk of bleeding:
thrombocytopenia
ulcerative disease
active haemorrhage
153
what is the major side effect of anti-coagulants?
haemorrhage
154
what is purple toe syndrome?
| what can it be a side effect of?
emboli and bruises in feet due to cholesterol deposits
| side effect of oral anticoagulants
155
what is warfarin necrosis?
sudden drop in protein C causing rebound coagulation &massive thrombosis. Causing skin and limb necrosis (gangrene)
156
Why is it contradictive to giving oral anticoagulant to patient with liver impairment?
Reduced metabolism and therefore greater chance of bleeding
157
Why should you not give warfarin
a) 1st trimester of pregnancy
b) just before delivery?
a) neonatal malformations such as cardiac and cranial malformatuons
b) Materal haemorrhage during delivering
158
how are warfarin and rivaroxaban metabolised?
cytochrome p450
159
give an example of a statin
sinvastatin
| atorvostatin
160
how do statins work?
HMG-CoA reductase inhibitors so interrupts cholesterol production chain.
Liver produces less cholesterol and more LDL clearance from the blood
Increase in HDL levels
161
give an example of primary statin therapy
prevent cardiovascular disease in those with high cholesterol and risk of cardiovascular event
162
give an example of secondary statin therapy
decrease mortality and further events in those who have evidence cardiovascular disease
163
give a hereditary condition where statins are used
familial hypercholesterolaemia (primary hyperlipidaemia)
164
are statins contraindicated in pregnancy and breast feeding?
| Explain
yes as cholesterol is essential for the growth of neonate
165
Caution should be used with statin when the patient has impairment of what organs?
Liver (metabolism)
| Renal (excretion)
166
What is are the rare MSK side effectes of statin?
Can cause muscle ache to myopathy and even rhabdomylsis
167
how are statins metabolised?
cytochrome p450
168
How does Thiazide increase renal blood flow?
By increasing the renal synthesis of prostagladins
169
What is the fatal outcome of using thiazide diuretic with a patient with severe liver disease?
Hypokalamia can lead to coma
170
What circulatory side effects are there of Thiazide Diuretics?
Postural HT
| Cardiac Arrhythmias
171
What is the interaction between B blockers and Thiazide Diruetcs?
Potentiate hyperglycemia/ lipidaemia
172
What is the process of elimination of all 3 types of diuretics?
Renal with small contribution from liver
173
Should you give potassium sparing diuretics to someone with renal dysfunction?
no
174
What are the blood S/E of spirolactone?
Leucopenia, agranulocytosis and thrombocytopenia
175
Which of the diuretics have a possible side effect of gynaecomastia, impotence and sexual dysfunction and Steven Johnson syndrome?
PSD
176
Where are B1- adrenoreceptors and B2 adrenoreceptors found?
B1 found in the heart
| B2 found mainly in the smooth muscles of blood vessels and airways
177
Which adrenoreceptors does beta blockers affect and what affect does that have?
β1-receptor,--> reduce force of contraction and speed of conduction in the heart.
178
How does beta blockers relieve MI symptoms?
Reduce cardiac work and oxygen demand and increase myocardial perfusion
179
How do beta blockers help to improve prognosis of heart failure?
By protecting the heart from chronic sympathetic stimulation
180
What affect does beta blockers have on the kidney to low BP?
Act on the kidney and cause a reduction in renin secretion
181
How does beta blockers treat Af?
By increasing the refractory period of AV node so reduction in venctricle contraction
182
Which two calcium channel blockers are used to treat supraventricular arrhythmias ?
Diltiazem and verapamil control cardiac rate
183
Give examples of supraventricular arrhythmias ?
Supraventricular tachycardia, Af and atrial flutter
184
Why is LMWH prefered over UF?
Low molecular weight heparins have a more
predictable effect and, unlike UFH, do not usually require laboratory
monitoring.
185
What is the interaction of B blocker and Verapamil/ diltiazem?
Can cause severe reduction in the force of contraction (inotrophic) and rate of the heart (chronotropic)
Causing potential bradycardia, heart block and even asystole
186
What affect does nitrates have on afterload and coronary perfusion?
Reduce afterload
| Improve coronary perfusion by reducing coronary vasospasm and dilation of collateral vessels
187
What are the side effects of digoxin?
```
bradycardia
GI disturbances
Rash
Dizziness
Visual disturbances
```
188
What is the dose changes requirement for clopidogrel and aspirin before surgery?
Aspirin can be carried on taken throughout surgery
| Have to stop clopidogrel 7 days before hand
189
What is the possible risk of giving thromboylsis with anticoagulants and antiplatelets for treatment of stroke?
Increase risk of haemorrahage
190
Is the risk of heparin induced thrombocytopenia greater with LMWH?
No reduced risk
| Greater risk with Uf
191
For bleeding assoicated with heparin what is the antidote?
protamine = reverses the anticoagulation
192
What is the limitation of protamine?
Effective for UF
Reduced effectiveness to stop bleeding for LMWH
Not effective against fondaparinux
193
What is the interacation of aspirin and heparin?
Increase anticoagulation effects of heparin
194
What is a antidote for bleeding due to warfarin use?
Iv vitamin K= direct antidote
Or
Prothrombin complex concentrate
195
What is the pro and con of rivaroxaban?
```
Pro= no need to measure INR
Con= no antidote for bleeding
```
196
Why is warfarin not used for arterial thrombosis (MI)?
This is due to platelet formation which is affected by antiplatetels agents such as aspirin and clopidogrel
